My Approach to Endometriosis as a Naturopathic Doctor
Characterized by the presence of endometrial-like tissue outside the uterus, endometriosis can lead to debilitating symptoms and significantly impact quality of life. Despite its prevalence affecting approximately 1 in 10 women, the condition is often underdiagnosed or misdiagnosed, leading to delays in treatment and unnecessary suffering. Endometriosis can occur in women of all ages, races, and socioeconomic backgrounds, highlighting the importance of awareness and advocacy for improved diagnosis and management.
Diagnosing Endometriosis:
Diagnosing endometriosis can be challenging due to its varied and nonspecific symptoms, which may include pelvic pain, painful periods, infertility, and gastrointestinal issues.
However, several testing options are available to aid in diagnosis:
1. Medical History and Physical Examination: A thorough medical history and pelvic examination can provide valuable insights into a patient’s symptoms and help guide further diagnostic testing. Although the most common symptom is chronic pelvic pain, endometriosis can present in a variety of ways, sometimes presenting as only pain with defecation or passing a bowel movement, or pelvic pain only with intercourse. Ensuring you are working with a doctor who provides a thorough intake is important, as these symptoms you are dealing with should not be dismissed.
2. Imaging Studies: Imaging modalities such as ultrasound or magnetic resonance imaging (MRI) are then used to visualize pelvic structures and detect endometrial lesions or cysts. In many cases, we are not able to see endometriosis through imaging alone, and patients are referred for laparoscopy which would be the next step in diagnosis.
3. Laparoscopy: Considered the gold standard for diagnosing endometriosis, laparoscopy involves inserting a thin, lighted tube through a small incision in the abdomen to view the pelvic organs directly. During laparoscopy, tissue samples (biopsies) may be taken for further evaluation, and sometimes lesions will be removed. Naturopathic Doctors in Ontario are not able to run diagnostic imaging or laparoscopy, so getting on a waitlist through your medical doctor to see an OB GYN for diagnosis is very important. But while we wait on this, working with a naturopathic doctor alongside your medical doctor can be very helpful for managing symptoms and starting your healing journey right away.
4. Biomarker Testing: Research is ongoing into the development of biomarker tests for endometriosis, which could potentially provide a less invasive means of diagnosis in the future. Naturopathic Doctors are able to run many of these blood tests and can be useful while we wait for imaging, which I will elaborate on below.
Unfortunately due to the healthcare overwhelm in Ontario, we are seeing a high wait list to receive imaging or treatment, with a limited number of specialists experienced in this condition. Naturopathic medicine can be a helpful adjunct to conventional treatments for endometriosis while patient’s wait to see specialists, and can help uncover new perspectives to address pain, inflammation, immune dysregulation and hormonal changes seen in endometriosis.
Naturopathic Investigations and Treatments for Endometriosis:
Before I dive into the specific tests and treatments, I want to talk briefly about the pathophysiology behind endometriosis. Despite what many people think is a hormonal only issue, this condition actually occurs when there is immune and inflammatory dysregulation in the body, then hormones add fuel to the fire. This makes sense, as normally our body should not be making endometrial tissue in the wrong parts of our body, and if it does, our immune system should be recognizing this quickly and putting a stop to it.
But instead what happens is these endometrial lesions continue to grow with hormone surges each month during our cycle, and our immune system becomes more and more dysregulated. At the same time, the endometrial lesions are growing more nerves, which become continuously over-stimulated by inflammation, creating a vicious pain cycle. When we are in pain, we become more stressed, which surges our stress molecules cortisol and adrenaline, causing more inflammation and altering the immune system further. I also often see people’s endometriosis flare up after viral infections, high stress or immune changes, in which addressing these systems can help achieve a root cause approach. The approach I like to take through naturopathic medicine is to calm down these systems after doing specific testing to identify the areas that need most support.
So while we wait for imaging through your medical doctor, here are the following tests I like to run to get a better picture of someone’s specific endometriosis case from an immune and inflammation perspective:
- CA125
- CBC (including neutrophil: lymphocyte ratio)
- Autoimmune workup may be indicated in some cases including: RF, ANA, anti-TPO, anti-TG
- Vitamin D
- ESR, CRP
- Complement C3 and C4
- Iron studies
- Liver panel
Hormonal testing is actually not always very helpful with endometriosis. Usually we know that estrogen is helping drive the growth of endometrial tissue, but sometimes this is only happening locally in the tissue and will not show up as abnormal in the blood. Usually we can assume that estrogen is part of the problem even if it shows up as normal on testing, but if a patient really wants to look at their hormones as well, I am always open to talking further about additional testing.
Conventional Treatment Options:
Once we get the labs back, we can start on a naturopathic plan that can be complementary to your conventional treatments. Usually conventional treatments involve any of the following:
1. Pharmacological Pain Management: Over-the-counter or prescription medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal therapies may be used to alleviate pelvic pain and discomfort associated with endometriosis.
2. Hormonal Therapies: Hormonal treatments, including birth control pills, progestins, or gonadotropin-releasing hormone (GnRH) agonists, can help regulate the menstrual cycle, inhibit ovulation and reduce the growth of endometrial tissue. These options vary based on the patient’s age, fertility goals and severity of endometriosis.
3. Surgery: In cases of severe or refractory endometriosis, surgical intervention may be necessary. Laparoscopic surgery can be performed to remove endometrial lesions, cysts, or scar tissue, potentially improving symptoms and fertility outcomes.
4. Fertility Treatments: For women struggling with infertility due to endometriosis, assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intrauterine insemination (IUI) may be recommended to achieve pregnancy.
Naturopathic Treatment Options:
Nutrition: A diet rich in antioxidants that is anti-inflammatory, blood sugar balancing and gut healing can do a lot of good for endometriosis. I always say that you cannot out-supplement or out-medicate a poor diet, as nutrition is a foundational part of optimal healing. Food intolerances can also flare up immune health and inflammation, in which digging deeper to figure out a diet that supports full body healing is extremely important.
Natural Anti-Inflammatory Treatments: There are a variety of herbs that can help lower inflammatory cascades in the body, and can also reduce pain. Antioxidants through the diet and supplementation can also help to lower inflammation.
Immune Support: Supplements to break up immune complexes and reduce pain are important in managing endometriosis both in the short term, as well as long term. If someone is dealing with chronic infections making their immune health worse, low Vitamin D, or autoimmunity, these need to be addressed to improve endometriosis symptoms and prevent further progression.
Reshaping the Microbiome: A variety of “bad bugs” in the gut, vaginal canal and peritoneum can cause inflammation. Naturopathic Medicine takes a whole body approach as all organ systems are connected. Therefore gut health can be a very important piece in managing someone’s endometriosis.
Stress Management: In addition to lifestyle changes and therapy to work on the mental and emotional side of stress, naturopathic medicine can be helpful at lowering stress molecules like cortisol and adrenaline on a physiological level. Certain herbs and supplements are well researched to help lower these molecules if they are high, which can help put the body in less of a stressed state on a cellular level. Reducing cellular stress has profound effects in healing the immune system, hormones and inflammation, and is very important to consider if someone is dealing with a high stress picture.
Acupuncture: This modality can help reduce pain, inflammation and reduce overstimulation of nerves in the pelvic region that can propagate pain. Acupuncture can be a helpful adjunct therapy to all of the above.
Lifestyle Modifications: Adopting a healthy lifestyle, including regular exercise, stress management techniques, and a balanced diet, may help alleviate symptoms and improve overall well-being in individuals with endometriosis.
Conclusion:
In conclusion, endometriosis is a common yet often misunderstood condition that can significantly impact people’s lives. Early recognition, accurate diagnosis, and individually tailored treatments are essential for effectively managing symptoms and improving outcomes for folks with endometriosis. While there is currently no cure for endometriosis, various treatment options both natural, pharmacological and surgical are available to manage symptoms and improve quality of life. By raising awareness, advocating for improved access to care, and supporting ongoing research efforts, we can work towards better understanding and management of this complex condition.
