With 176 million women across the world believed to have endometriosis, it’s a condition affecting a huge number of lives, and yet for many of us it remains a bit of a mystery… Here, nutritional therapist Sonal Shah, explores the symptoms to be aware of, possible causes, along with how diet could be key to managing the condition

The second most common gynaecological condition in the UK, endometriosis is the abnormal growth of cells that form in the lining of the uterus. Some of these cells may, instead of being expelled from the body during the menstrual process, actually end up continuing their cycle elsewhere. They then have no way of leaving the body, so the material builds up and may attach itself to other organs in the lower abdomen, such as the ovaries, fallopian tubes, or bowel.

While endometriosis can affect women of any age, it is most often found in those in their 30s and 40s. While it’s difficult to pinpoint the exact number of women who develop endometriosis, it’s estimated that one in 10 women of reproductive age in the UK have it, and it costs the UK economy around £8.2 billion each year due to treatment, loss of work, and associated healthcare costs. So, understanding how to manage and reduce the impact of endometriosis on the lives of sufferers is essential, and the likelihood is you already know someone who is all-too-familiar with the pain and discomfort this condition can bring...

Symptoms and complications

When it comes to endometriosis, it really can be quite a unique experience for people. One thing to note is that the severity of endometriosis does not always correspond to the level of pain and discomfort experienced. Additionally, symptoms can vary from one woman to another, and some women may not experience any symptoms at all.

woman in white knitted jumper and blue denim jeans sitting on the floor with legs crossed

For those who do, the classic symptoms to be aware of include pelvic pain, heavy periods, intermittent pain throughout the menstrual cycle, painful intercourse, painful bowel movements, fatigue, nausea, vomiting and constipation during menses, and infertility.

One of the primary concerns with endometriosis is that it can cause fertility problems. While the reasoning for this is not fully understood, it is thought to be because of damage caused to the fallopian tubes or ovaries.

Other issues which can arise include some women developing adhesions – ‘sticky’ areas of endometriosis tissue that can join organs together. Ovarian cysts may also develop, which are fluid-filled cysts in the ovaries that can sometimes become very large and painful, and can be treated with surgery.

For some women, the impact that endometriosis can have on their life can lead to depression, so it’s important to recognise symptoms, and look for support with managing the condition as soon as possible.

If you suspect you may have endometriosis, it’s important that you speak with your GP. As symptoms can vary, it’s a good idea to keep track of them in a diary so that you can accurately describe them during your appointment with the doctor.

Potential causes

Unfortunately, the exact cause of endometriosis is unknown, and there is no definite cure. However, some possible reasons are outlined here, and the likelihood is it could be a result of a combination of factors:

It's estimated that one in 10 women of reproductive age in the UK have endometriosis

• One theory is that hormonal imbalances, such as oestrogen dominance, may play a role. Interestingly, the symptoms of oestrogen dominance are similar to that of endometriosis.

Endometrial tissue produces an enzyme called aromatase which, in turn, leads to oestrogen production. Furthermore, oestrogen and progesterone both regulate phases of the menstrual cycle, and if a woman has gut and liver imbalances, the old hormones might not get cleared out soon enough. This can provide the opportunity for the unwanted recycling of oestrogen, and high levels of oestrogen compared to progesterone.

• Endometriosis and irritable bowel syndrome (IBS) seem to go hand-in-hand, with many women who have endometriosis reporting this. A recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that IBS is five times higher in women with endometriosis, compared to women without endometriosis, prompting thoughts of a possible link.

A bacterial imbalance in the gut can also impact the microbes and bacteria in the large intestine, small intestine and pelvic area. This could potentially cause inflammation that damages the cells and activates the immune cells in the body leading to a dysfunctional immune system, which is also a potential trigger.

• In the 1920s, Dr John Sampson believed ‘retrograde menstruation’ could be one explanation behind the condition. He believed that endometriosis could be caused by menstrual tissue flowing in reverse through the fallopian tubes, and landing on the pelvic organs where it may stay and grow.

• Another possible cause could be simply down to our genetic disposition – an individual might find their risk of developing endometriosis increases if it runs in the family. Additionally, hormonal developments like early puberty might be influenced by genetics.

How nutrition can help

Given the importance of gut health, including the detoxification of hormones through the liver, it makes sense to investigate how improving our gut health could help to manage the symptoms of endometriosis.

woman with red hair wearing a blue crop top with white stripes, sitting outside with a happy expression

Because those with endometriosis are likely to have inflammation in the gut and pelvic area, the emphasis is therefore on an anti-inflammatory diet to help with this.

This would mean eating oily fish for their omega-3 content, or seeds, nuts and avocados, olive oil, colourful foods like dark berries, carrots, sweet potatoes, and leafy vegetables, which provide vitamins and minerals that help lower inflammation and strengthen our immune system.

Green tea, cinnamon, ginger, and turmeric are also good at helping the body to fight inflammation. Cruciferous vegetables like broccoli, kale, and Swiss chard contain magnesium, along with a compound called indole-3-carbinol that assists the body in healthy oestrogen metabolism. Furthermore many of these foods (also beans and pulses) are rich in fibre, which can all help to restore hormonal imbalance.

Things to try today

1. Sources of omega 3 oil, which can reduce levels of an inflammatory chemical and slow the growth of endometrial tissue. If you’re on a plant-based diet, I’d recommend flaxseed oil daily.

2. Try supplementing iron, as low iron is common with heavy menses. You can get your blood iron levels tested, and then supplement accordingly.

3. Increase your omega 6 intake – Gamma-Linolenic Acid (GLA). Starflower oil contains more GLA than some other options, and has therapeutic benefits to lower inflammation, balance hormones, and reduce pain.

4. Magnesium capsules can help strengthen bones, relax muscles, and reduce pelvic pain and abdominal cramps. Vitamin D3 should also be supplemented.

5. A good multivitamin will contain B vitamins, vitamin C, along with minerals such as zinc and calcium to keep your body healthy. My favourite is Cytoplan’s Wholefood multi.

There are also things you can implement in your lifestyle, such as trying a sitz bath, which is considered one of the natural remedies for endometriosis. A hot bath helps reduce pain and cramping by relaxing the muscles in your pelvic area, which can be aided further by adding magnesium salts, Epsom salts, or magnesium oil. You can also add eight to 10 drops of lavender or rosemary oil.

Endometriosis UK provide support and information on endometriosis.