“My periods are so painful, I typically call off work one to three days per month.” Does this sound like you? If so, you could be dealing with endometriosis, a condition that is estimated to impact between 3 and 10 percent of reproductive-aged women—but that typically takes almost 10 years to receive a diagnosis for. If you’ve wondered about if you have endo, or you’ve just been diagnosed, keep reading for a few tips on how to treat it and what your next steps should be.
What is endometriosis?
Endometriosis occurs when endometrial tissue, the tissue that thickens on the internal layer of your uterus, is found in a location other than the uterus. Typically it’s found in the abdomen, on the ovaries, or outside of the uterus. The misplacement of this tissue can cause pelvic pain, which is often associated with menstrual periods. But those with endometriosis typically describe menstrual pain that’s far worse than usual, hence needing to call in sick to work, or being unable to go about your normal routine.
You might also experience lower back and abdominal pain, pain with intercourse, pain with bowel movements or urination, excessive bleeding and infertility.
Understanding Endometriosis: Diagnosis
At MIMC, we typically start with hormone testing for endometriosis patients. DUTCH testing is a comprehensive lab that can show the metabolites associated with estrogen metabolism and detoxification, including making sure that the estrogen is going down the correct pathway. With this test, we learn about how your body is breaking down estrogen, and how that can impact your DNA, and make your periods worse.
Phase 1 of estrogen metabolism happens in your liver. This is where estrone (one type of estrogen in your body) breaks down into three metabolites. Of those three, one metabolite is a healthy metabolite, one is negative, and one is a weaker form of estrogen. Many women with endometriosis will have a majority of their estrogen being metabolized into the negative metabolite of estrone, which can cause DNA damage, and affect the quality of your periods (ie. make them heavier, and more painful). With DUTCH, we can discover if this is happening to you.
After phase 1, your estrogen needs to go through phase 2 of metabolism, which is affected by both genetics and your ability to methylate that metabolite and get it out of your body. Here’s an analogy to understand the process: If you think of phase 1 as filling up your bathtub full of metabolites, phase 2 pulling the plug, and letting all those metabolites head down the drain.
If your body has a hard time with phase 2 of the process (in addition to phase 1), your endometriosis symptoms can again be much worse. DUTCH testing will help us understand exactly what’s going on in your body, and then guide us to treatment options like supplements and food changes that support your body’s estrogen metabolism.
The other hormonal piece to endometriosis is the possibility of lack of progesterone to balance out your estrogen. Patients with endometriosis are usually found to have lower progesterone numbers, as well as abnormal progesterone signaling by the endometrial layer. Additionally, there are emerging scientific theories surrounding chronic inflammation, typically found in endometriosis patients causing progesterone-resistance, or the decreased sensitivity of the cells to the signal of progesterone.
By testing your progesterone levels and understanding how your body is processing your hormones, we can come up with a treatment plan specific to your symptoms, your needs, and your wellness.
Typically, a doctor will first prescribe hormonal birth control as a treatment, which can help reduce the pain associated with endometriosis. But some women want a different approach, especially given that hormonal birth control can come with its own issues. That’s why we test and treat based on the hormone levels we talked about earlier—in addition to a couple other symptom management options.
A large part of treatment in endometriosis patients is also managing and decreasing inflammation. During the inflammatory process, prostaglandins are made, which can cause increased smooth muscle contraction. Since your uterus is a smooth muscle, this can contribute to cramping, pain, and other symptoms. There are several ways we can work with your body to naturally decrease prostaglandins and help to alleviate the pain.
Food can play a big part of inflammation in your body. Examining your diet, and other sources of inflammation are going to be another key in unlocking your endometriosis management. Stress reduction, as well as ensuring you get enough sleep, can also be key parts to keeping endometriosis symptoms at bay.
While endometriosis does not currently have a cure, it’s possible to live with endo without extreme symptoms every month. Each endo case is different, which is why we design treatment plans based on your needs. If this sounds like the support you need, schedule a complimentary 15-minute call with us to learn more.