The role of diet in endometriosis treatment is a bit more complicated than in addressing other conditions. This is because endometriosis is more a problem of location rather than a pathogen or ailment.
To that end, properly understanding endometriosis causes and treatments and the role a healthy diet can have, a bit of explanation about the condition itself is warranted.
What Is Endometriosis?
Endometriosis is when tissue from the lining of the uterus (the endometrium) begins to grow elsewhere in the body. Usually, this endometrial implant occurs somewhere on the ovaries, bowel, or the pelvis, but in rare cases it can be found even further.
Most of the time, this wayward endometrial tissue just sits there doing nothing. However, the tissue still acts like it’s within the uterus, meaning that it will thicken, break down, and bleed during the menstrual cycle. This is a problem since, although the tissue is doing what it’s supposed to, it is doing so in the wrong location. Without a way for the blood and shed tissue to be removed, it sticks around and starts irritating the surrounding area. This results in inflammation and scarring.
What Causes Endometriosis?
There is no definitive cause of endometriosis and the search is ongoing for an exact culprit. However, there are a few possible theories as to how the condition develops.
- Endometrial transport: Blood vessels and the lymphatic system serve as transportation networks to various areas of the body. One possibility is that endometrial cells somehow slip into either area and get carried off elsewhere, where the cells then implant and grow.
- Surgical implantation: During certain procedures such as a hysterectomy, C-section, or other operation that affects the uterus, endometrial cells may be inadvertently spread to the site of the surgical incision and grow.
- Embryonic cell growth: The cells which line the abdominal and pelvic cavities have their origins in embryonic cells. The idea behind this theory is that small patches of these cells inadvertently develop into endometrial tissue.
- Retrograde menstruation: The most likely cause of endometriosis is something called “retrograde menstruation.” This is a phenomenon where menstrual blood (which contains endometrial cells) somehow backflows through the fallopian tubes and enters the pelvic cavity rather than exiting the body. These displaced cells then stick to the pelvic wall or the surface of nearby organs, growing and bleeding with each cycle.
Symptoms of Endometriosis
Endometriosis symptoms tend to wax and wane in association with the menstrual cycle. Some may only appear during menstruation while others could become more severe.
- Painful periods (dysmenorrhea)
- Pelvic pain or cramps
- Lower back or abdominal pain
- Pain in response to intercourse (during or after)
- Heavy periods (menorrhagia) or vaginal bleeding between periods (menometrorrhagia)
- Discomfort or pain during bowel movements
- Endometriomas (cysts of endometrial tissue on the ovaries)
Endometriosis pain is not always a reliable indicator of the severity of the problem. Women with severe cases may report minimal pain and cramping while those with minor cases could find themselves crippled by it. The pain from endometriosis can begin a few days before signs of menstruation appear and does not necessarily have to persist during the entire cycle.
Since irritable bowel syndrome can cause many of the same symptoms as endometriosis, the two are easily confused. Not helping matters is the fact that the two can occur simultaneously and make a diagnosis more difficult. Similar issues arise with endometriosis and ovarian cysts or pelvic inflammatory disease.
Who Is Affected by Endometriosis?
For what are hopefully obvious reasons, endometriosis only affects women. More specifically, anyone who has reached reproductive age can potentially develop endometriosis though most cases arise in women between ages 25 and 35. Women who have never given birth, have a pelvic infection in their medical history, have uterine abnormalities, any condition that affects menstrual flow, or a first degree relative (mother, aunt, sister) with endometriosis are known to have a higher likelihood of getting it themselves. There is some statistical evidence that tall, thin women are more prone to endometriosis but this is not as concrete as other known risk factors. It is rare, but not unheard of, for a postmenopausal woman to develop endometriosis.
Endometriosis Diagnosis and Testing
As mentioned, endometriosis has several overlapping symptoms with other conditions. This makes getting an accurate diagnosis extremely important since if you end up trying to treat the wrong thing you aren’t going to see any benefit. The diagnostic process for endometriosis has several components:
A detailed medical history lets your doctor understand what risk factors you may have, any symptoms you have experienced, and if there is a family history of endometriosis. A history can also reveal signs that indicate other underlying conditions or help rule out other possibilities.
A physical exam allows the doctor to feel your abdomen for any cysts or scars that may have formed behind the uterus. A negative pelvic exam does not rule out endometriosis, but a positive one can avoid further testing.
An abdominal or transvaginal ultrasound can be used to get images of the reproductive organs or surrounding systems. They are useful tools for finding signs of cysts and possible scarring that can be caused by endometriosis.
Sometimes a direct visual is needed and a laparoscopy will be performed. This is a minor surgical procedure where a small camera is inserted through an incision in the abdomen to get a proper look at the pelvic and abdominal organs. If necessary, a laparoscope can also take a biopsy sample.
What Is the Conventional Treatment for Endometriosis?
There are several different treatment options available for endometriosis that either aim to treat the primary symptoms or try and prevent their occurrence:
Over-the-counter drugs such as ibuprofen may be effective treatment for endometriosis pain but you may find them ineffective for more aggressive presentations. Your doctor may prescribe something stronger if OTC pain medicine proves ineffective.
Birth control pills are commonly employed to help make menstrual flows shorter or lighter and these effects can also work to limit the symptoms of endometriosis. Birth control pills, patches, or vaginal rings can control estrogen levels when used in a regular cycle and can reduce or even eliminate the pain caused by mild to moderate cases.
Gonadotropin-Release Hormone (GnRH) Agonists and Antagonists
This particular mouthful of a drug is used to block estrogen production and effectively induces an artificial menopause. It is a more aggressive form of treatment when compared to normal birth control and shouldn’t be used without trying less intense methods first.
Another drug—this one injectable—and is used to stop menstruation. Although Depo-Provera is very effective at halting the growth of wayward endometrial tissue, it can also cause weight gain, depression, and decreased bone production.
Surgical solutions involve attempting to remove the endometrial tissue and possible scar tissue, cysts, or endometriomas that have formed around it. Surgery for endometriosis ranges from conservative, which aims to remove the endometrial growth without damaging other organs, to radical, a full hysterectomy where the uterus and cervix are removed.
Warm baths, heating pads, and similar approaches can be used at home to soothe the pelvic muscles and reduce the cramping and pain caused by endometriosis.
Is There a Special Endometriosis Diet for Women?
Technically, the answer is no. Endometriosis is the result of wayward endometrial tissue growing and shedding in an inappropriate location and there is little that diet can do to influence this. I say “technically” because although diet cannot influence the endometrial implant itself, certain nutrients can help you deal with the symptoms better. While a well-balanced and a healthy diet is always advisable, keep an eye out for the following nutrients in particular for a more effective, endometriosis-targeting diet:
- Iron: Endometriosis causes you to bleed more than normal during menstruation. If flows are particularly severe or persistent, your iron levels may be affected. Chicken and lean red meats can provide excellent sources of iron. For more vegetarian-friendly options, consider fortified cereals, lentils, leafy vegetables, or beans.
- Calcium: As mentioned above, certain endometriosis treatments can cause decreased bone production as a side effect. Upping your calcium intake if you are on such a treatment can be one way to help minimize this possibility. Dairy products are traditionally good sources of calcium and almonds, sesame seeds, soy beans, broccoli, and kale can be eaten as well.
- Fiber: Endometriosis can result in constipation or diarrhea due to the inflammation and irritation the implanted tissue can cause to your bowels. Although both forms of fiber are important, you will want to focus more on insoluble fibers since it’s the type that has the strongest impact on your bowel movements. Insoluble fiber is best found in foods like whole grains or legumes.
- Vitamin E: Since endometriosis symptoms tend to become most pronounced during the menstrual cycle, some nutrients that can help lessen menstrual symptoms may help endometriosis. Vitamin E is known to ease pelvic cramps and can be found in foods such as peanut butter, tomatoes, spinach, broccoli, sunflower seeds, and hazelnuts.
The Role of Supplements in an Endometriosis Diet
Supplements have their uses but may not be necessary or recommended in every case of endometriosis. Vitamin supplements are useful if you have a known deficiency and can be used to compensate if you are unable to get the right nutrition through diet alone. However, it is always better to get your nutrients from food directly rather than a supplement.
This is because supplements only contain the listed nutrient while food offers the vitamin or mineral in question along with other sorts of healthful goodies that your body enjoys. It is best to try and get proper nutrition from your diet first and to only use vitamin supplements at the advice of your doctor. When taking vitamin supplements it is important not to exceed the dosage instructions in order to avoid possible side effects.
Hormonal Supplements for Endometriosis
Hormonal supplements are a different story. Endometriosis and the menstrual cycle in general are influenced by the way that the body’s hormones rise and fall and taking action to balance this out is one possible treatment method. Birth control pills, for instance, are essentially a form of estrogen and progesterone supplement. Although you can usually take a birth control pill without needing to speak to your doctor (obtaining the pills may be a different story), you should not take more powerful hormonal supplements without medical approval.
Hormones are a tricky area of the body since they often have multiple duties and increasing or decreasing them can have unexpected effects. If you plan on taking hormone supplements as part of treating your endometriosis, it is best to do so only on the advice of your doctor and to stick to the dosage instructions.
Foods to Avoid in an Endometriosis Diet
The good (or bad, depending on your view) news is that there don’t appear to be many foods you should outright avoid when you have endometriosis. Although there is mixed evidence that some foods may raise or lower a woman’s chance of developing endometriosis, more investigation is needed to say anything definitive. What is known for certain is that once endometriosis actually occurs the main governing factor is estrogen, and there are no effective ways to influence estrogen levels through diet or nutrition (unless you count deficiencies, which aren’t recommended).
Having said that, it might be a good idea to avoid:
- Salty foods; and
- Heavy meals.
These are known to aggravate the bloating and/or fluid retention that can accompany menstruation. While it won’t address endometriosis specifically, limiting your salt intake and sticking to lighter but more frequent meals can be a way to keep your normal menstruation symptoms from making things worse.
Lifestyle Changes for Endometriosis
Endometriosis can be a very stressful and emotionally draining time, especially in cases of severe symptoms. Taking certain steps to try and ease the stress in your life can go a long way to making you feel better and more able to handle your condition:
- Maintaining a proper sleep schedule
- Employing yoga, massage, deep breathing, meditation, or other relaxing techniques
- Exercising at least 30 minutes per day four to five times per week.
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