Endometriosis - My Approach
- 3 days ago
- 3 min read
What Is This Issue?
Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and other pelvic organs. This misplaced tissue responds to hormonal changes throughout the menstrual cycle, leading to inflammation, scar tissue formation, and often debilitating pain. It affects approximately 10% of women of reproductive age and can significantly impact fertility, quality of life, and overall wellbeing.
What Is Underlying This Issue?
When I work with women with endometriosis, I see it as more than just a gynaecological problem. There are several interconnected factors at play:
Oestrogen Dominance: Excess oestrogen fuels the growth of endometrial tissue
Poor Oestrogen Metabolism: The body's inability to properly detoxify and eliminate excess oestrogen
Chronic Inflammation: A key driver of pain and tissue growth
Immune Dysfunction: An impaired immune system that fails to recognise and eliminate ectopic endometrial tissue
Gut Dysbiosis: An imbalanced microbiome that can recirculate oestrogens and promote inflammation
Small Intestinal Bacterial Overgrowth (SIBO): Research has shown a significant link between endometriosis and SIBO, with many women experiencing both conditions simultaneously
Nutrient Deficiencies: Often stemming from compromised gut absorption rather than inadequate intake
My Functional Nutrition Perspective
In my practice, I've found that endometriosis is really about deeper metabolic and hormonal imbalances. The gut-hormone connection is crucial—when the gut isn't functioning optimally, excess hormones that should be eliminated get reabsorbed into circulation, creating a vicious cycle of hormonal imbalance.
What I often see is that the conventional approach of prescribing the contraceptive pill only masks symptoms without addressing the root causes. While hormonal treatments may provide temporary relief, they don't resolve the underlying factors driving the condition.
The nervous system also plays a critical role in endometriosis, as stress impacts both digestion and hormone regulation. The gut-brain axis is particularly relevant, with stress often exacerbating digestive dysfunction and hormonal imbalances that fuel endometriosis symptoms.
What I Will Look At
When working with endometriosis, I focus on several key areas to understand your unique situation:
Hormonal Balance
I'll assess your oestrogen metabolism pathways to identify how your body processes and eliminates oestrogen
I'll examine the relationship between oestrogen and progesterone to understand any imbalances
I'll evaluate how your stress hormones (cortisol) might be affecting your reproductive hormones
Gut Health
I'll investigate potential SIBO, which is commonly associated with endometriosis
I'll assess your microbiome balance to identify any dysbiosis that might be contributing to inflammation
I'll evaluate your digestive function and nutrient absorption capabilities
Immune Function
I'll look at markers of inflammation that might be driving pain and tissue growth
I'll examine how your immune response might be affected by hormonal and digestive issues
Nervous System Impact
I'll evaluate your stress response and how it might be affecting your digestive and hormonal health
I'll consider the role of the vagus nerve in regulating inflammation and pain
I'll assess how your nervous system might be contributing to symptom severity
Recommended Lab Testing
For comprehensive assessment of endometriosis, I recommend both the DUTCH Plus test and the GI Map test:
The DUTCH Plus test provides:
Complete hormone panel including oestrogen, progesterone, testosterone, and DHEA metabolites
Cortisol awakening response and daily rhythm to assess stress impact on the nervous system
Organic acid markers that reveal methylation capacity (crucial for hormone detoxification)
Melatonin production to assess sleep quality and hormonal recovery
The GI Map test offers:
Detailed analysis of gut microbiome balance
Identification of potential pathogens contributing to inflammation
Assessment of digestive function and nutrient absorption
Markers for intestinal permeability and inflammation
Hormone Considerations
Many women with endometriosis have a progesterone deficiency, which is worth investigating as progesterone helps control oestrogen and can therefore help with pain in endometriosis. Research has shown that progesterone can alleviate endometriosis by inhibiting uterine cell proliferation, inflammation and angiogenesis in mouse models. In endometriosis, there is a disruption in how progesterone and oestrogen function, which may contribute to the development and progression of the condition.
Citation
Progesterone Alleviates Endometriosis via Inhibition of Uterine Cell Proliferation, Inflammation and Angiogenesis in an Immunocompetent Mouse Model - PubMed
Disturbed progesterone signalling in an advanced preclinical model of endometriosis - ScienceDirect
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