A change is coming for endometriosis treatment. Until now, the clinical approach has been surgery followed by hormonal suppression with the Pill or other drugs. Going forward, the approach will shift to anti-inflammatory and immune-modulating treatments. There is growing evidence that endometriosis is not primarily a hormonal condition. it is autoimmune.
The autoimmune connection is explored in detail in the 2012 paper: “Is there an association between autoimmunity and endometriosis?” After an extensive literature review, the authors conclude that endometriosis fulfils most of the classification criteria for autoimmune disease including blood markers of inflammatory cytokines and tissue specific autoantibodies. They make the point that endometriosis frequently co-occurs with other autoimmune conditions such as autoimmune thyroid disease and inflammatory bowel disease.
Pharmaceutical immune treatment for endometriosis may still be a few years away. Fortunately, natural immune-modulation is already at hand. I have used it with my endometriosis patients for many years.
What is Endometriosis?
Endometriosis is a painful gynecological condition in which bits of the endometrial (uterine) lining grow outside of the uterus. The most common site is the ovaries (resulting in a type of ovarian cyst called endometrioma or chocolate cyst). Endometriosis lesions also occur on the fallopian tubes, pelvic ligaments, and on the outside of the uterus, bowel and bladder. Active endometriosis lesions are hormone-sensitive, so they swell and then bleed with every menstrual cycle. This causes pain, scar tissue and heavy clotted periods. It causes infertility.
Why does it happen?
Endometrial tissue probably enters the pelvis through retrograde flow of menstrual fluid back out through the fallopian tubes. However, that is not the whole story because retrograde flow is believed to occur in most women. In a normal situation, the immune system simply mops up the endometrial tissue. In the case of endometriosis, something different happens. The immune system does not mop up the tissue, but instead makes inflammatory cytokines and auto-antibodies that promote its growth. There are undoubtedly multiple reasons for this aberrant immune response. Known reasons include exposure to environmental toxins such as dioxins and bacterial endotoxins (lipopolysaccharides). I look forward to future research about the endometriosis-autoimmune connection.
Natural Immune-modulating Treatments
Here are the natural treatments that I have found work best for my endometriosis patients.
- Avoid A1 casein. As I discuss in a previous post, Holstein cow’s milk contains a powerfully inflammatory protein called A1 casein that causes immune problems in some people. My clinical experience is that most endometriosis patients improve when they stop having standard dairy products.
- Consider avoiding gluten. Like A1 casein, gluten is immune-disruptive for some people. There are reports that endometriosis symptoms improve after 12 months on a gluten-free diet. Gluten free can also improve intestinal permeability (see below). It is certainly worth trying, especially if you test positive for gluten antibodies on a blood test.
- Repair intestinal permeability. Intestinal permeability or leaky gut is a known driver for autoimmune conditions such as thyroid and inflammatory bowel disease [1], so it makes sense that it is a driver for endometriosis. Treatments for intestinal permeability include gluten-elimination and supplementation with zinc and the herbal medicine berberine.
- Turmeric is a powerful anti-inflammatory and immune-modulating herbal medicine. A 2012 animal study demonstrated that turmeric can cause endometriosis lesions to regress. The authors went on to propose turmeric (curcurmin) as a novel and potent anti-endometriotic medicine. I prescribe turmeric tablets for almost all of my endometriosis patients. It is a very safe, and can be used long term.
- Selenium and zinc are important immune-modulating nutrients, and may be deficient in women with endometriosis [2]. Please speak to your clinician about the dose that is appropriate for you.
Other treatments
- Surgery. Surgical removal of the endometriosis lesions is helpful, especially for women who are trying for pregnancy. The other treatments can then be used to prevent recurrence.
- Natural Progesterone. Progesterone inhibits the growth of endometrial cells, and is a useful additional treatment for endometriosis. In my experience, progesterone rarely works as a single treatment, but it works well together with the immune-modulating treatments discussed above. Endometriosis lesions are typically resistant to progesterone, so you have to use fairly high doses.
- Hormonal contraception is standard treatment for endometriosis. It suppresses ovulation, and therefore prevents hormonal stimulation of any existing endometriosis lesions. As I mentioned in my last Pill-post, severe endometriosis is one of the few medical conditions that I think can sometimes justify Pill use. However, many of my patients find that they can manage the condition just as well – or better – with natural treatments.
Yours in Health, Lara Briden
About the Author:
Lara Briden, ND, before qualifying as a Naturopathic Doctor, studied evolutionary biology at University of Calgary. She then went on to graduate from the Canadian College of Naturopathic Medicine (CCNM) in 1997. Her love of science and the natural world has informed the way she practices medicine. Seeing the body as a pragmatic, regenerative system. The body wants to be healthy. So often, the best thing that we can do for health is to remove the obstacles that get in its way. In her 18 years as a Naturopathic Doctor, thousands of patients have entrusted her with their hormone stories. Every story was unique. Here is what she has learned: Some things really work for hormone balance. The rest are just theories. With this blog, she strives to assemble some health truths, and to dispel some health myths. Some Truths: Coffee has merits; the Pill is chemical castration; and antibiotics are bad for hormones. Another Truth: Wheat, sugar and vegetable oil are not suitable food for humans (or for any creature). That is not new information, but it is a truth that has recently been made sexy by the Paleo hipsters. Follow her on her blog and on Facebook.
