Endometriosis is simply the presence of endometrial glands outside of their normal location. It is found in approximately 3-10% of reproductive age women, but is much more common in women dealing with infertility. Endometrial tissue can travel to close by areas such as the pelvic lining or the ovaries, or it can be found in very unusual and distant places such as the lungs, brain or scar tissue throughout the body.
It is important to note that endometrial tissue responds to and makes its own estrogen just like fibroids, so everything in Part 1 is equally important for endometriosis as it is for fibroids. In normal endometrial tissue there is no aromatase, but in endometriosis the tissue is unhealthy and expresses the aromatase enzyme which promotes even more estrogen in an already saturated estrogen environment.
Endometriosis and the Immune System
Endometriosis has been associated with many chronic immune system disorders and autoimmune conditions. Some of the conditions it has been found to be associated with include everything from headaches to hypothyroidism. Specifically it has been found correlated or together with many immune related conditions such as chronic fatigue syndrome, rheumatoid arthritis, Sjorgren syndrome and even multiple sclerosis. Some studies show that even allergies and asthma are more common in women with endometriosis.
Just as endometriosis is developed over time, I often see women and men that develop allergies over time. What I tell patients is that if you weren’t having allergic symptoms from something before, it is rare that you should experience them now. Actually most people with allergies should see them diminish as they age. We often refer to this as growing out of asthma or allergies.
It is difficult to tell which is the chicken or the egg, but we know that in general, once endometriosis is established, an improperly functioning immune system contributes to more endometriosis by not clearing endometrial tissue from the areas where it should not be.
Estrogen Inflammation Circle
Looking closer at endometrial tissue itself, we see 2 factors that promote fibroids and endometriosis and those are are inflammation and estrogen.
A common medical intervention for endometriosis is to use an aromatase inhibitor, thus decreasing the estrogen load and hopefully helping to reduce endometriosis. While this works sometimes, it it only a one system approach. A multi-system approach has to be used if you want to really eliminate estrogen properly. Anti-aromatase drugs or natural herbs only decrease the production of estrogen. They do not aid in detoxification or help us understand why you have too much aromatase in the first place.
The estrogen inflammation circle occurs because inflammatory chemicals like PGE2 stimulates aromatase and then aromatase stimulates the conversion of other hormones into estrogen. The circle then continues as estrogen then stimulates the production of even more inflammatory chemicals and promotes more unhealthy endometrial tissue.
The best way to stop the estrogen-inflammation cycle is first via diet to decrease insulin and the excess inflammation. Once insulin and diet are not a factor, then you can help the liver by providing the necessary nutrients to aid the liver in estrogen detoxification.
Your Liver Is Clogged
Without fail, I find that anyone with an estrogen problem also suffer from a liver problem. In todays world the toxic burden put on the liver is just too much. Pesticides for example have to be detoxified by the liver and if they are not, they have been shown to increase aromatase by over 200%. And as you know, aromatase converts other hormones into estrogen. If simply have high estrogen, this will require your liver to work overtime to get eliminate it. I find it almost never can keep up and most people require support to get over the hump. Its like a giant stack of dishes that keeps pilling up, it takes a lot of effort if you get behind, but if you stay ahead and don’t let them build up, then its not so bad. The best way to avoid overburdening the liver is to avoid all the toxic products in the world as best you can. With everything around these days it is hard, but avoiding hair dye’s, hair products, pesticides, cleaning chemicals, make-up, all forms of plastics, GMO foods and even standard tap water, you can help your liver have a lesser load so that it can keep up with your detoxification needs.
The Fibroid & Endometriosis Connection
Lets take a look at how these two conditions are so similar and often intertwined.
-Both cause more inflammation
-Inflammation causes more estrogen (estrogen promotes both)
-Inflammation causes more insulin (inflammation –> insulin)
-Insulin causes more estrogen (inflammation –> insulin –> aromatase –> estrogen)
-Excess body fat cause more estrogen
-Excess body fat promotes inflammation (inflammation –> insulin –> aromatase –> estrogen)
These connections show why you can’t just try and decrease inflammation or insulin alone. It also shows how the elimination of estrogen will be of little benefit if you don’t address the issue that come before estrogen like inflammation, insulin and aromatase.
I have written this over and over again that the first place to fix estrogen at its root level is the gut. The improper gut flora take estrogen that is ready to leave the body and recycle it back into the body, meaning you can never really eliminate your estrogen no matter how good your liver or other detox mechanisms are working.
What I find most days of the week is that the gut most has to be treated before we get to worry about the liver, uterus or ovaries. Probiotics don’t seem to be strong enough to make fast clinical changes in most cases and herbal antimicrobials or essential oil antimicrobials often are necessary. In addition, I don’t find most brands of antimicrobials to be adequate. I only use Supreme Nutrition in my office for restoring balance to the gut flora.
Methylation is a process that occurs in the liver and one of its major roles is to help eliminate estrogen by binding to it and preparing it to be excreted via feces. Providing the right nutrients to support the liver and methylation is critical to allow the liver to do its job.
Another not very commonly known factor is that estrogen build up in pregnancy is something that many women experience. You may not know it, but as estrogen makes bile builds up in the gall bladder, women become constipated. This is best assessed and treated prior to pregnancy as some natural supplements and herbs can’t be taken during pregnancy.
Another important pathway in the liver is glucuronidation. Glucuronidation is a big word but it plays an important part in the detoxification of many commonly prescribed drugs, fake vanilla, aspirin and estrogen. This is also important to know because this is the pathway that an unhealthy gut or dysbiosis can affect. The unhealthy gut reverses all the work that this pathway does, so even if you help the liver without eliminating the “gad guys” in the gut, it won’t serve much purpose.
Decrease Estrogen Production
To decrease estrogen production you must first decrease aromatase production. The strongest stimulator of aromatase in fibroids is inflammation. Probably second most important for decreasing aromatase is insulin. The insulin connection to endometriosis, fertility and fibroids is so important that you will often see women get prescribed metformin (a diabetic medication) in order to help keep insulin levels low and thus control inflammation via medication. Obviously fixing your diet is a better way to control your insulin levels rather than taking a medication. All medications have side effects and alter normal biochemistry.
For more causes of inflammation even if you are thin and/or have your diet in check, click here.
Decrease Estrogen Exposure
All plastic containers are estrogenic. If it came in a bag or in a bottle, its estrogenic. This is why the problem is so out of control in today’s society. Buy organic food and avoid estrogen promoting chemicals including makeup, hair products and processed foods. There are close to 20,000 known estrogenic chemicals and products, so the key is to avoid the ones that you can knowingly avoid.
A Holistic Multi-System Approach
To often we are just looking at one system. We think we only have high estrogen for example. But, the truth is the high estrogen developed from something else. Each treatment in my office involves 2-6 systems. By taking a holistic approach, looking and looking at how the individual systems interact, it gives us a better picture to look at and understand what is driving your condition whether it is endometriosis, fibroids or infertility.
As always, the real purpose of healthcare shouldn’t be just to eliminate pain or decrease a symptom but rather optimize optimize your overall health and thus promote things like fertility, energy and happiness.