Endometriosis
Conventional vs. Functional Medicine's views on Endometriosis
Endometriosis is a common and often painful condition that affects many women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, often on the ovaries, fallopian tubes, or other organs in the pelvic region. This tissue can become irritated and inflamed, causing pain, scarring, and other complications.
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💊 Conventional Medicine
Views on Endometriosis
Conventional medicine views endometriosis as a chronic condition that has no cure. This means that while the symptoms of endometriosis can be managed and treated, the underlying condition itself cannot be completely eliminated. The exact causes of endometriosis are unknown and the focus on treatment is further prevention of tissue growth and pain control. Regular check-ups and follow-up care are important for monitoring the condition and preventing further complications.
Conventional medicine believes that endometriosis is caused by retrograde menstruation, which occurs when menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. The displaced endometrial tissue then attaches to organs and tissues outside the uterus and continues to grow and thicken in response to hormones.
Conventional perspective on other possible causes of endometrial tissue growth:
Transformation of peritoneal cells (“induction theory”) - Suggests that hormones or immune factors promote the transformation of peritoneal cells into endometrial-like cells
Embryonic cell transformation - Proposes that hormones such as estrogen may transform embryonic cells into endometrial-like cell implants during puberty
Surgical scar implantation - Endometrial cells may attach to a surgical incision after a surgery, such as a hysterectomy or C-section
Endometrial cell transport - Occurs when the blood vessels or lymphatic system transports endometrial cells to other parts of the body
Immune system disorder - May prevent the body from recognizing and destroying endometrial-like tissue that's growing outside the uterus
Overview of Goals
Goal 1 - Slow endometrial tissue growth and prevent new implants of endometrial tissue
Goal 2 - Comfort & improved or maintained quality of life through pain control & symptom management
Goal 3 - Fertility treatment (in cases of infertility)
Diagnosis & Lab Testing
In conventional medicine, the diagnosis of endometriosis is typically made through a combination of physical exams, medical history, and imaging tests such as ultrasounds or MRIs. A definitive diagnosis is usually made through laparoscopic surgery, which involves inserting a small camera through a small incision in the abdomen to visualize the pelvic region and any abnormal tissue growth.
Pelvic exam - Palpates areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus
Ultrasound - Captures the images of your reproductive organs to identify cysts (endometriomas), however, won't definitively tell your doctor whether you have endometriosis
Magnetic resonance imaging (MRI) - Captures detailed images of the organs and tissues within your body and helps determine location and size of endometrial implants and cysts
Laparoscopy - A surgeon makes a tiny incision near your naval to view inside your abdomen. This provides information about the location, extent, and size of the endometrial implants and offers opportunity for a biopsy of tissue for further testing; Often the surgeon can remove some of the endometrial tissue during the laparoscopy
Treatment Approach
Once a diagnosis of endometriosis is confirmed, treatment options typically depend on the severity of the condition and the individual patient's symptoms and goals. For mild to moderate cases, pain relief and hormonal therapies are often used to manage symptoms and prevent further growth of endometrial tissue. For more severe cases, surgical intervention may be necessary.
Medication
Pain Control - Pain relief medication, such as non-steroidal anti-inflammatory drugs (NSAIDs), may be prescribed to alleviate pain and inflammation associated with endometriosis.
Hormone Therapy - Hormonal therapy, such as birth control pills or gonadotropin-releasing hormone (GnRH) agonists, may also be used to suppress ovulation and reduce the growth of endometrial tissue.
Hormonal contraceptives - Birth control pills, patches, vaginal rings
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists - Block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation
Progestin therapy - Prevent menstrual periods and the growth of endometrial implants; examples are levonorgestrel (Mirena, Skyla), contraceptive implant (Nexplanon), contraceptive injection (Depo-Provera) or progestin pill (Camila)
Aromatase inhibitors - Reduce the amount of estrogen in your body
Surgical
Surgical interventions, such as laparoscopy or hysterectomy, may also be recommended to remove the endometrial tissue and alleviate symptoms.
There are different types of surgeries that may be performed for endometriosis, depending on the severity of the condition and the symptoms experienced by the patient.
Laparoscopic surgery is the most common surgical procedure used to diagnose and treat endometriosis. It involves making small incisions in the abdomen and inserting a laparoscope, which is a thin, lighted instrument that allows the surgeon to view the pelvic organs. The surgeon can then remove the endometrial tissue or cysts using specialized instruments.
Laparotomy is a more invasive surgery that may be required in severe cases of endometriosis. It involves making a larger incision in the abdomen to allow the surgeon to access the pelvic organs more easily. This type of surgery is typically used for cases in which there are large cysts or extensive endometrial growths.
Hysterectomy may also be considered as a last resort for severe cases of endometriosis. This surgery involves the removal of the uterus and may also involve the removal of the ovaries and fallopian tubes. It is typically recommended for women who have completed their childbearing years or for those who have not responded to other treatments.
It is important to note that surgery for endometriosis is not a cure, and endometrial tissue may still grow back after surgery.
Fertility treatment
Endometriosis can have a significant impact on fertility, and women with endometriosis may experience difficulty getting pregnant. However, there are fertility treatments available that can help increase the chances of conception, including IVF, laparoscopic surgery, and hormonal therapy. The most appropriate treatment will depend on the individual's specific circumstances and fertility goals, and should be discussed with a healthcare provider or fertility specialist.
🌳 Functional Medicine
Functional Views on Endometriosis
Functional medicine views endometriosis as a multifactorial disease that can be influenced by a variety of factors such as hormonal imbalances, inflammation, immune system dysfunction, genetic predisposition, and environmental toxins. Instead of just treating the symptoms of endometriosis, these approaches aim to identify and address the underlying causes of the condition.
Although there is currently no official cure for endometriosis, functional medicine believes that endometriosis can be improved or even resolved when the root causes are identified and addressed with the right combination of therapies.
While conventional medicine believes the cause of endometriosis is often retrograde menstruation, functional medicine believes there’s likely more at play.
Functional views of possible factors impacting endometriosis:
Issues with gut health (i.e. dysbiosis, intestinal permeability, bacterial contamination, imbalance of the estrobolome), hormonal imbalances, estrogen metabolism, immune dysregulation, autoimmunity, endocrine-disrupting chemicals, environmental chemicals and pollutants, toxin overload, inflammatory diet, nutrient deficiencies, systemic inflammation, stress, and more.
Overview of Goals
Goal 1 - Reduce inflammation
Goal 2 - Reboot, rebalance, and rejuvenate gut health to improve immune system function
Goal 3 - Detoxify and support healthy estrogen metabolism to decrease excess estrogen in the body
Goal 4 - Address nutrient deficiencies in the diet
Goal 5 - Improve overall health and wellness through dietary and lifestyle choices
Goal 6 - Balance hormones
Goal 7 - Minimize exposure to environmental toxins
Lab Testing
Functional medicine practitioners may use a variety of diagnostic tools, including specialized blood and urine tests, to identify imbalances in hormones, gut health, and the immune system that may contribute to the development of endometriosis.
Gut Health - A comprehensive stool analysis to evaluate gut health, the microbiome, intestinal permeability, beta-glucuronidase, infections, inflammation and much more.
Examples: GI Effects by Genova Diagnostics; GI Map by Diagnostic Solutions; GI360 by Doctor’s Data; Gut Zoomer by Vibrant America
Organic Acids - Organic acids testing to evaluate micronutrient status of essential vitamins, minerals, amino acids, fatty acids and plant-based antioxidants, as well as cellular functions like mitochondria, and accumulation of toxic environmental pollutants and heavy metals.
Examples: Organix, NutrEval, or Metabolomix by Genova; The Organic Acids Test by Great Plains
Blood Chemistry & Hormones - A comprehensive functional blood chemistry panel with complete blood count (CBC), basic or comprehensive metabolic panel (BMP or CMP), inflammatory markers (i.e. CRP-hs, interleukin-6 (IL-6)), liver function, kidney function, lipid panel, iron panel, thyroid panel, hormone panel, homocysteine, HA1C, CA125, and more.
Labs: Patients can run most or all of these blood markers at any facility with a lab such as Quest, LabCorp, specialty labs, hospitals, local lab concierge services, etc.
Hormone testing: Dutch Complete or Dutch Plus by Precision Analytical
Toxic Burden - Environmental toxin, such as heavy metals or endocrine disruptors, and chemical exposure testing to evaluate toxic burden in the body.
Examples: MycoTox or GPL-TOX by Great Plains, Urine Toxic Metals or Hair Elements by Doctor’s Data; Mycotoxins, Environmental Toxins, Heavy Metals, or Total Tox-Burden (combines the Environmental Toxins, Mycotoxins, and Heavy Metals tests) by Vibrant America
Genetic Testing & Hormones - Genetic testing to evaluate methylation status (MTHFR, COMT), as well as inflammation and oxidative stress (TNF-alpha).
Examples: MTHFR blood marker by Vibrant America or Cell Science Systems; DNA Methylation by Doctor’s Data; MTHFR Genotyping by SpectraCell
Treatment Approach
Treatment for endometriosis may involve a combination of dietary and lifestyle changes, detoxification, supplementation, and other targeted therapies to address underlying imbalances. Each patient’s case is unique and treatment plans are tailored to address their individual needs.
Supplementation
Detox/Liver Support - Endometriosis is often linked to compromised liver function and detoxification pathways. This can hinder the removal of synthetic estrogens and hormone disruptors, including aluminum, detergents, plastics, and PCBs. To assist the body's natural detoxification processes, practitioners may suggest targeted therapies, such as liver-supportive nutrients or detoxification protocols. Additionally, they may suggest adopting a clean diet to reduce the burden of toxins.
Supplements & herbs: burdock, calcium-D-glucarate, dandelion root, alpha-lipoic acid, methyl B12, methyl folate, N-acetylcysteine, diindolylmethane (DIM), milk thistle, selenium, sulforaphane
Gut Health, Immune System & Inflammation - There is growing evidence linking gut health to endometriosis, so practitioners may recommend strategies to improve the gut flora and decrease inflammation.
Supplements & herbs: berberine, magnesium, probiotics, prebiotics, turmeric, vitamin A, D, K, vitamin C, vitamin E, zinc
Hormone Balance - Practitioners may use natural therapies to help balance hormones, such as herbal remedies, bio-identical hormones (BHRT), or nutrient supplements.
Supplements & herbs: evening primrose, b vitamins, vitamin B6
BHRT: uses bio-identical rather than synthetic hormones to treat hormonal conditions and imbalances
Interested in my supplement protocol for endometriosis? Receive access to my protocol for free and receive 10% off on all future supplement orders!
Lifestyle Modification
Diet & Nutrition - A functional medicine approach to diet for endometriosis typically involves three key components: 1) reducing inflammation, 2) supporting detoxification, and 3) optimizing gut health.
Balance blood sugar levels and avoid pro-inflammatory foods such as caffeine, refined sugar and carbohydrates, gluten, dairy, trans-fats, concentrated soy, and processed foods
Choose organic as much as possible and reduce intake of animal products, especially non-organic meat and dairy
Eat an anti-inflammatory diet rich in fresh vegetables, leafy greens, fruits, herbs and spices, omega-3 fats, and phytonutrients.
Promote healthy estrogen metabolism and clearance by increasing intake of liver-loving foods and herbs, such as cruciferous vegetables, beets, lemon, turmeric, and onions
Stay hydrated and support healthy bowel movements with dietary fiber and probiotic-rich foods
Exercise - Low-impact exercises that promote circulation and lymphatic drainage can be beneficial for managing symptoms.
Examples: yoga, Pilates, walking, low-impact strength training, swimming, cycling
Stress Management - Chronic stress can contribute to inflammation and hormonal imbalances. A functional medicine approach may involve recommending stress-reducing practices to help promote relaxation and improve overall well-being.
Examples: self-care techniques, mindfulness, meditation, yoga, deep breathing, massage
Other Modalities & Recommendations
Acupuncture, contrast hydrotherapy, massage, dry brushing, home detox
Download my Diet & Lifestyle Guide for Endometriosis
In summary, endometriosis can be a challenging condition to manage and understanding the variety of treatment options will be an important part of the journey. While conventional medicine and functional medicine both aim to treat endometriosis, they differ in their approach. Conventional medicine focuses on managing symptoms with medication and surgery, while functional medicine aims to reverse the disease by addressing the root causes of the condition through supplementation, diet, and lifestyle modification. As with any medical condition, it's important to work closely with a healthcare provider to develop a personalized treatment plan that addresses your unique needs and goals.
Other Articles & Podcasts on Endometriosis from a Functional Medicine Perspective
Functional Medicine Approach to Endometriosis — Steve Grant Health
Endometriosis: Root Causes and Lifestyle Interventions — IMF
A Functional Medicine Approach to Endometriosis — Flo Living
A Functional Medicine Approach To The Root Causes Of Endometriosis — Dr. Hyman
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