One of the main goals of nutritional intervention is to block and or decrease excess estrogenic stimulation. By doing so, the aim is to help manage pelvic pain and augment other treatments tackling associated infertility.
What is endometriosis?
Endometriosis is the presence of endometrial tissue outside of the endometrium, where it is not supposed to be. Places that it can be found include the ovaries, the outer uterus, anus and the pelvic/abdominal cavities. Even though this endometrial tissue is found outside of the uterus, it is still functional tissue and as such, responds to estrogenic stimuli just as the uterine lining does. This is what causes the hallmark symptoms of endometriosis: painful menses, infertility, pelvic and abdominal pain, as well as pain during intercourse. Some women also present with nonspecific symptoms such as: chronic lower back pain or abdominal pain, adnexal masses, dyschezia (difficulty with defecation), dysmenorrhea, dyspareunia, and dysuria. These nonspecific symptoms contribute to the difficulty in arriving at the diagnosis of endometriosis. According to Hadfield et al, it takes an average of 11.7 years for endometriosis to be diagnosed in a woman experiencing symptoms.1
Who does it affect?
American Family Physician states that Endometriosis affects up to 10% of reproductive-aged women. It is more commonly seen in women with pelvic pain (70 to 90%) or infertility (21 to 40%). It predominantly affects reproductive-aged women with the highest incidence between women 25 to 29 years of age.2
The risk of endometriosis is six times higher in first-degree relatives of women with severe endometriosis. Risk factors include:
-First-degree relative with endometriosis
-Low body mass index
-Prolonged menstruation (> five days)
-Shorter menstrual cycles (< 28 days)
Diagnosis ultimately must be done through imaging and biopsy. The gold standard of diagnosis is laparoscopy where extrauterine endometrial cells are confirmed.
What are we trying to help with?
Ectopic endometrial tissue is hormonally active, making it highly responsive to estrogenic stimuli. One of the main goals of nutritional intervention is to block and or decrease excess estrogenic stimulation. By doing so, the aim is to help manage the pelvic pain, and possibly augment or support other treatments aimed at tackling the associated infertility.
Currently, there is not much evidence to support nutritional interventions having the capability to completely reverse or stop the processes that underlie endometriosis once they have started. However, there is evidence to suggest that there is a correlation between a woman’s diet, environmental exposures and her potential to get this disease. One large study (n=70,709) found a relatively strong association between endometriosis and trans-fatty acid consumption, and a lower risk of endometriosis with increased consumption of long-chain omega-3 fatty acids.3
The aim of the following interventions is to reduce the impact of the symptoms and slow disease progression and severity.4 The hope is that this in turn will reduce the need for surgery. Often women with endometriosis undergo multiple surgeries depending on the severity and particulars of a given case.
-Acupuncture for pain management
-Nutrition and meal planning
-Increased intake of Omega 3 fats vs. Omega 6.5 Omega 6 has been found to be pro-inflammatory, endocrine disrupter, associated with higher circulating steroids and estradiol
-Increased intake of fiber, which has been related to lowering plasma estrogen by increasing excretion
-Increased intake of organic fruits and vegetables. These have anti-oxidant, and anti-inflammatory activity.
-Increased intake of high ORAC value, antioxidant superfoods.6 Examples include: matcha, cinnamon, sumac, cocoa, soaked black chia seeds and pecans.
-Regular consumption of prebiotic and foods
-Reduced intake of refined sugars, caffeine and alcohol
-Environmental exposure assessment
-Identify and limit exposure to endocrine disrupting chemicals
-Support of the body’s detoxification pathways
-Adverse childhood event and trauma assessment
- B-Complex: Help with hepatic clearance of estrogens Dosing suggestion: 50-100mg; 1-2 tablets daily. Do not take on an empty stomach
- Indole-3-carbinol or DIM: Reduces effects of estrogenic metabolites on endometrial tissues Dosing suggestion: 200-400mg daily, but especially during follicular phase
- Vitamin D: Anti- inflammatory, immune modulating (7) Dosing suggestion: 2000-5000IU daily, with a fatty meal. It is possible to overdose on any fat soluble vitamin, including Vitamin D. Always discuss appropriate dosage for yourself with your doctor.
- Niacin: Vasodilation, pain-relief Dosing suggestion: 100mg every hour as needed to reduce menstrual pain / cramping. **Caution: Niacin flush, liver disease
- Probiotics: Limit the amount of estrogen re-absorbed from the large intestine. Dosing suggestion: 6 billion CFU of Lactobacillus acidophilus or other appropriate strains
- NAC: Antioxidant, detoxification Dosing suggestion: 600mg three times a day, for three days per week only, for three months.(8)
- Hadfield R1, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod. 1996 Apr;11(4):878-80.
- Schrager S, Falleroni J, Edgoose J. Evaluation and Treatment of Endometriosis. University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Available on the American Family Physician Website (http://www.aafp.org/afp/2013/0115/p107.pdf)
- Hansen SO1, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):162-71. doi: 10.1016/j.ejogrb.2013.03.028. Epub 2013 May 2.
- Halpern G., Schor E., Kopelman A. Nutritional aspects related to endometriosis. Rev Assoc Med Bras 2015; 61(6):519-523. Available online: http://www.scielo.br/pdf/ramb/v61n6/0104-4230-ramb-61-06-0519.pdf
- Khanaki, K., Nouri, M., Ardekani, A. M., Ghassemzadeh, A., Shahnazi, V., Sadeghi, M. R., … & Imani, A. R. (2012). Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids. Iranian Biomedical Journal, 16(1), 1.
- Anne Marie Darling, Jorge E. Chavarro, Susan Malspeis, Holly R. Harris, and Stacey A. Missmer. A prospective cohort study of Vitamins B, C, E, and multivitamin intake and endometriosis. J Endometr. 2013 Jan 1;5(1):17-26. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916184/
- Harris, H. R., Chavarro, J. E., Malspeis, S., Willett, W. C., & Missmer, S. A. (2013). Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. American journal of epidemiology. 2013 Mar 1;177(5):420-30. doi: 10.1093/aje/kws247. Epub 2013 Feb 3
- Maria Grazia Porpora et. al. A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evid Based Complement Alternat Med. 2013; 2013: 240702. Published online 2013 May 7. doi: 10.1155/2013/240702. PMCID: PMC3662115. PMID: 23737821