Lena Dunham has recently been sharing her struggles with endometriosis and it appears that more celebrities also suffer with the condition; even Marilyn Monroe is rumoured to have had it. Whilst this helps to raise awareness of a painful, not uncommon condition, many people still don’t know, or have even heard of it, making everyday life a further struggle for those with the condition.  

Whether you suspect you have symptoms, have been newly diagnosed or have been living with endometriosis for some time, this article hopes to shed some light on why endometriosis develops and the steps you can take to support your condition through diet, supplementation and lifestyle.  

Endometriosis is believed to affect 1 in 10 women of reproductive age, and yet it takes on average 7 years for a diagnosis to be made, mainly due to a lot of the symptoms overlapping with those seen in other conditions, making misdiagnoses a common problem. The condition itself is characterizes by tissue, which would normally be found lining the uterus, being located in areas it wouldn’t usually be. This includes the ovaries, the fallopian tubes, the bladder, digestive system and in some cases it has been found in further locations such as the lungs, neck, nose and brain. The most common symptom of endometriosis is pelvic pain, which can be debilitating and arise at any point in the menstruation cycle – such as before, during or after a period and ovulation. Other symptoms include long, heavy and irregular periods, pain on urination and passing stools, pain during sex, pain in the lower back and bowels, constipation, diarrhoea, nausea and vomiting. The only way to identify and diagnose endometriosis is via a laparoscopy which will reveal the endometrial lesions.

The actual cause of endometriosis is unknown, although there are a lot of theories as to why endometriosis might occur. Originally, it was believed that the endometrial tissue, usually lost during menstruation, flowed back and planted itself outside the uterus. We now know, however, that many women actually experience this ‘retrograde menstruation’ and yet do not have endometriosis. The role of genetics has also been considered, as it is common for more than one person in a family to have the condition; thus far, however there is no clear evidence to confirm that there is a genetic cause.  

What we know so far is that there are many factors at play in endometriosis, including a dysregulation of hormones and inflammatory processes. Our bodies produce androgenic sex hormones which are then converted to oestrogen via an enzyme called aromatase, both of which are found in high levels in women with endometriosis. Oestrogen is important throughout the menstruation cycle, with a decrease in oestrogen leading to the endometrium being shed and a period to occur. Endometrial tissue in other areas, as seen in endometriosis, is believed to react to fluctuating levels of oestrogen in the same way, however it does not have the same route of escape from the body, leading to inflammation.

The inflammation that occurs in endometriosis is similar to what happens when we get a cut to the skin, i.e. the immune system is triggered by the misplaced endometrial tissue to come to the site of injury. This results in a mixture of classic inflammatory symptoms, including swelling, heat, pain, bleeding, clotting and scarring. With endometriosis, these scars can form bands with other affected areas within a close proximity. Inflammation has been found to also encourage aromatase activity, so it appears that the combination of hormone imbalance and high levels of inflammation is a self-perpetuating cycle. 

There are 4 stages of endometriosis starting with stage I, classified as having smaller lesions and inflammation around the pelvic area, to stage IV, where the lesions infiltrate tissue of the pelvic organs which may lead to distortion of the structure. 

As the cause is unknown, treatment is not always effective as it is focused on either removing the lesions via a laparoscopy, reducing oestrogen levels with hormone therapy, or reducing inflammation with use of non-steroidal anti-inflammatory drugs (NSAID), or a mix of all three. However, these methods do not always lead to a reduction in pain or stop further lesions from occurring.  

Whilst there is huge variation in the outcome of treatment for endometriosis, there are many things you can do to support your body through nutrition and lifestyle interventions that will help you at various stages of your condition to manage and help prevent further progression.

As inflammation is already occurring in the body, eating foods that are pro-inflammatory will exacerbate the problem. Grains such as wheat, barley, rye and other gluten-containing foods can trigger inflammatory processes, as can meats where the animals are fed on a diet of grains. Instead, look at purchasing grass fed meat and try non gluten-containing grains such as buckwheat, quinoa, amaranth, wild rice and millet. Focus on consuming oily fish 2 to 3 times per week – such as salmon, mackerel, anchovies and herring, which contain healthy fats that are anti-inflammatory in the body. Try snacking on a handful of nuts or seeds each day – try brazil nuts, almonds, cashews and pumpkin seeds which also contain healthy fats. You can even try making your own nut milk as a cost efficient and simple alternative to cow’s milk.Dairy can be a source of inflammation for some people. If you suffer with digestive issues or get skin rashes, eczema or spots, or you feel an excess of mucus building up, making you itchy or ‘bunged up’ after eating dairy, then reducing your intake or switching to an alternative such as almond, oat or rice milk may be worthwhile. If you don’t feel you react to dairy, make sure you are buying organic milk and dairy products from pasture reared, naturally (grass) fed cows. 2. Antioxidant rich

Bright colourful fruits and berries all contain high amounts of antioxidants, as do dark green leafy vegetables such as spinach, kale and collards, which protect your cells from the effects of inflammation. Furthermore, antioxidants present in grapes, turmeric and green tea have been shown to inhibit the enzyme that converts androgenic hormones to oestrogen. Therefore, adding a side salad to your meals, a fruit salad as a mid-day snack, and switching your standard cup of tea or coffee to a green tea or a turmeric latte with almond milk, can be a useful strategy to further manage inflammation and the resulting oxidative stress.  

Not only are your dark green leafy vegetables providing you with lots of protection for your cells, vegetables such as broccoli, cauliflower and cabbage are also high in a substance called Indole-3-Carbinol (I3C), which inhibits aromatase activity and thus the conversion of the androgenic sex hormones to oestrogen – a perfect excuse for that kale smoothie! If you’re feeling adventurous, you could try sprouting broccoli seeds and adding them to your salads or smoothies for some additional support. I3C and the active component Diindolymethane (DIM) can also be supplemented for more intensive support in more severe cases or if you struggle to consume lots of vegetables.

Endocrine-disrupting chemicals are chemicals such as BPA and phthalates found in plastics; pesticides sprayed on fruit and vegetables; and arsenic found in tap water. These chemicals have the ability to disrupt hormones within the body and are particularly known to increase oestrogen levels. It is highly recommended to become familiar with endocrine disruptors and how best to avoid them; purchasing organic foods where possible, reducing use of plastics, non-stick pans and even some household cleaning goods, which are all sources of these nasty chemicals, are useful ways to reduce your chemical overload. This link is a useful place to start and includes a downloadable PDF. 

Regular exercise is a great way to increase anti-inflammatory and anti-oxidant activity in the body but, as this can cause pain, ensure you listen to your body and don’t push yourself too hard. A 30-minute walk each day, or swimming a few days a week is enough to help reduce the severity of symptoms as well as gain the benefits of exercise, and you can increase intensity or duration as it becomes easier. Weight-bearing exercise is a great way to keep bones healthy, which can be an issue in conditions associated with oestrogen imbalance. If you have any concerns, or you are experiencing a lot of pain, speak to an experienced personal trainer who listens to you and your needs and can support you with an exercise programme that is right for you.

Our bodies naturally produce a hormone called melatonin which is responsible for making us feel tired. It peaks in the evening and stays elevated throughout the night, allowing us to stay asleep. Melatonin production is affected by exposure to light during the day (allowing us to wake up and stay awake during the day), and exposure to artificial light in the evening can alter its natural rhythm. Melatonin has been shown to reduce pain and painful periods associated with endometriosis, so be sure to implement a healthy lifestyle plan to support your melatonin levels naturally. You can do this by gaining maximum exposure to daylight in the early half of the day such as by taking an early morning walk, then making sure the room is dimly lit in the evening and that your room is as dark as possible when you sleep. Reducing exposure to bright artificial lights or intense blue light from mobile phones and the TV for an hour or so before bed, and trying to go to sleep and wake up at the same time each day can help ensure healthy melatonin production and release at the right times of day. Foods rich in melatonin, including cherries, orange bell peppers, walnuts, flaxseeds, tomatoes, goji berries, almonds and raspberries, may be a useful addition to your diet to further promote melatonin release. Read more about supporting healthy sleep here.

Endometriosis is still poorly understood by the mainstream medical profession, making it, unfortunately, unsurprising that you may become frustrated and feel alienated when faced with the lack of support available. Finding a local support group on the endometriosis UK website is a helpful way to meet other people who understand the daily frustrations and agonising pain you are experiencing, and to receive ongoing support with your condition. The Igennus website also has a list of practitioners able to support you in managing your condition, by helping to identify potential drivers and putting strategies in place to support the optimal function of the pathways involved in the onset and progression of your condition.