Endometriosis & Fertility by Alison Hall

Painful periods, heavy periods, pelvic pain, ovulation pain, bloating, pain in the lower back and abdomen, vomiting and diarrhoea, painful sex, pain passing urine or with bowel movements, dizziness, extreme fatigue and low energy, depression, subfertility …

Sound familiar?  It’s quite a list and one that’s way too familiar to so many of the 176 million women worldwide who suffer with endometriosis.  In the UK, that’s a huge 1 in 10 women of reproductive age. And up to 50% will have fertility problems.  

What’s astonishing, is that considering endometriosis is the second most common gynaecological condition (after fibroids) in the UK, it is widely misdiagnosed.  Complaints from teenage girls are often taken with a pinch of salt:

“it’s all part of becoming a woman, you’ll get used to it” (while passing the painkillers).

We’re led to believe that we just have to put up with it. It’s not what we deserve and it’s really not okay.

Recent studies suggest it can take, on average, a staggering7.5 years for a woman to receive diagnosis.  One of the conventional approaches is to put women on the pill, which merely masks the symptoms, rather than digging deeper to find out what’s really going on.  Many sufferers are (wrongly)told they have IBS or chronic fatigue – and there are many overlaps with these conditions.  And often, diagnosis only happens when fertility becomes an issue.  

But what is Endometriosis?

Endometriosis is a condition where endometrial tissue – or the cells that line the uterus/womb – migrate to other areas of the pelvic cavity.  This tissue is hormonally active, and like the lining in our uterus, it responds to the chemical messengers – or hormones – of our menstrual cycle.  It thickens and sheds each month.  But, unlike the cells in our uterus, it has no way to escape so becomes trapped, causing inflammation, swelling, scarring and the formation of adhesions or lesions.The ovaries, fallopian tubes, bladder and / or bowels are all commonly affected.  

Our fertility can take a big hit. Blood filled ‘chocolate cysts’ (so called because of their dark brown appearance) may form on the ovaries, affecting ovarian reserve and ovulation.  If adhesions develop in the fallopian tubes it can block the journey of the egg.  Sometimes the uterus becomesmisaligned.  And for most (but not all) women, comes debilitating pain.  

You suspect endometriosis.  What next?

Diagnosis is via laparoscopy, where a camera is inserted into the pelvic area via a tiny incision near the navel, allowing the surgeon to look for any signs of the disease.

There is no cure for endometriosis and Western medicine is limited in terms of what it can do.  The first port of call for conventional treatment - particularly for young girls with cripplingly painful periods - is painkillers and the contraceptive pill; but these can cause side-effects and long-term use of painkillers can set you up for further digestive issues from damage to the gut lining.  Key-hole surgery to remove the lesions can provide relief, but because it doesn’t address the root cause, symptoms often return within a couple of years.

Is there another way?

Taking an integrative approach which blends conventional medicine with complementary care like nutrition and lifestyle, has helped thousands of women.  While everyone is different and everyone has their own endo story, we are beginning to understand quite a lot about the condition and with that understanding comes ways to ease the pain and make living with endo more bearable.

What do we know?

• There is a genetic component – so if your mother or sister suffers, that may be a flag to get your symptoms checked, to reduce the time to diagnosis

• Inflammation is a big factor and causes a lot of the associated pain

• Immune dysfunction suggests an autoimmune component at play (think of it as the immune system misfiring)

• We also know that hormonal changes throughout the menstrual cycle are a trigger, so balancing female hormones and supporting detoxification pathways can make a big difference.

Anti-inflammatory approach

The term ‘anti-inflammatory’ diet is bandied around a lot, but what the heck is it?  In essence, it’s using specific foods to support the immune system.  Many of these same foods are really helpful for hormonal balance as well:

• Eating a colourful rainbow of fruit and vegetables provides a rich variety of phytochemicals (plant nutrients) which have anti-inflammatory properties, are plentiful in antioxidants and fibre.  

o Cruciferous vegetables (broccoli, cauliflower, rocket, watercress, brussel sprouts, cabbage) are great to include daily for hormone balancing properties.

o Top tip:   try to eat all the colours of the rainbow every day:  green, red, yellow, orange, purple and white / brown.

• Anti-inflammatory fats from oily fish, nuts, seeds, avocados and olive oil should regularly.  Consumption of omega 3 oils (oily fish, flaxseeds, walnuts) have been shown to reduce painful periods in adolescent girls and women and lower endo risk.

• Plant-based protein in the form of beans and pulses, with some eggs, white fish and (organic) poultry and limiting red meat can help.  A little organic tofu – fermented tempeh is best – can also be included and the phytoestrogens in the soy may even be protective against some of the more harmful types of oestrogen.

Just as some foods can be anti-inflammatory, there are others that are best minimised:

• Sugar

• Refined carbohydrates (think the white, fluffy variety and processed biscuits, cakes etc)

• Alcohol (yup, sorry…)

• Caffeine

• Red meat

• Dairy foods

• Many women find cutting out gluten helps as well.

Working with a nutritionist to navigate these changes and ensure you still get all the vital nutrients that you need can really help.

Ditching Toxins

It’s not just what we eat that affects our hormones.  Theenvironment we live in plays a big part too; particularly when it comes to hormone balance and fertility.  And of course, hormone balance is a key driver for endo.

Endocrine disrupting chemicals (EDCs) are everywhere and some of them – xenoestrogens – mimic oestrogen’s action which can upset the whole apple cart and worsen symptoms.  Plastic is a big offender:  plastic food containers, bottles, takeaway coffee cup lids.  Then there are cans lined with BPA, even shop till receipts, which have a BPA thermal coating. We also need to think about what we pour onto our bodies:  shampoos, conditioners, body lotions and washesoften contain nasties like parabens; and many cleaning products add further to our toxic load. Don’t forget sanitary wear:  they are often rife with dioxins from the bleaching process.  I favour unbleached sanitary products and menstrual cups, instead.

Top tip:  swap kitchen plastics for glass, ceramic and stainless steel; avoid handling till receipts where possible and overhaul your cosmetic and menstrual products.

Lifestyle and zzzzzzz….

Finally think about the way you live your life.  Poor sleep, stress and lack of exercise all make inflammation a whole heap worse:

• Prioritise sleep, aiming for at least 7-8 hours a night.  When our sleep gets disrupted it affects production of melatonin, our sleepy hormone, which is also a powerful antioxidant that our ovaries LOVE.  Giving yourself a screen curfew of say, 8pm each night can be really helpful to minimise evening exposure to blue light.

• Gentle exercise, particularly outdoors, acts as a natural de-stressor, helps eliminate excess oestrogen and boosts mood through the release of endorphins.  These endorphins also have pain relieving benefits.  Even 10-20 minutes in nature each day can work wonders, as anyone with a dog knows.

• A relaxing Epsom salt bath, a good old-fashioned hot water bottle across your pelvic area or warm castor oil packs can also soothe the cramping pain.

When it comes to fertility, we know it takes three months to mature an egg.  Using that time to also combat inflammation and hormone balance may not only reduce the pain and make you feel better, but also improve the quality of your eggs to get you in the best shape possible for a successful pregnancy.

What have you got to lose?

Alison Hall is a registered nutritional therapist with a special interest in fertility and miscarriage.  She helps couples who want to get their bodies in the best shape possible to improve their chances of a successful pregnancy.  Alison sees clients online and from her North London clinic.  

Find her on Instagram:  alisonhall_fertility or email her at alison@alisonhallnutrition.co.uk .




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