Recently I received an email asking if I work with women with Endometriosis. Of course, I have but until the past couple of years, the support recommended for endometriosis has always been hormonal. It seem, if you mention women and uterus in the same sentence, the answer is always “hormones”. Granted endometriosis occurs frequently in women during their reproductive years and there is a link to a hormone imbalance. However in my office, women with hot flashes have been commenting that the neurotransmitter support has been reducing or eliminating their hot flashes better and more consistently than hormone support.
This email prompted me to take a fresh look at Endometriosis. Imagine my amazement when I found that the immune system stimulators – cytokines and chemokines – involved in autoimmune diseases are also involved in endometriosis. A quick Internet search using “endometriosis autoimmune” resulted in a large quantity of results.
What is Endometriosis?
Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis is also commonly found on other organs of the pelvis.
What are the Symptoms of Endometriosis?
A common symptom of endometriosis is pain, mostly in the abdomen, lower back, and pelvic areas. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or there is scarring and adhesion formation. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis.
General symptoms of endometriosis can include but are not limited to:
- Extremely painful or disabling menstrual cramps; pain may get worse over time
- Chronic pelvic pain includes lower back pain and pelvic pain.
- Pain during or after sex.
- Intestinal pain.
- Painful bowel movements or painful urination during menstrual periods.
- Heavy menstrual periods.
- Premenstrual spotting or bleeding between periods.
- Infertility not being able to get pregnant.
- Women who have endometriosis may have gastrointestinal symptoms that are like those of a bowel disorder, as well as fatigue.
“Clean Up In The Abdomen”
In normal menstruation, the uterine lining sheds flowing down through the vagina. When retrograde menstruation occurs, some blood and tissue flow backward up the fallopian tubes into the abdomen. If endometrial tissue clogs the fallopian tubes or reaches the peritoneal cavity, inflammation and illness can occur. These endometrial implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity.
Call today! 530-615-4083
Endometrial tissue set free by retrograde menstruation is sometimes not only alive – but may actually continue to grow if transferred to situations favorable to its existence. Capable of developing its own blood supply, the invasive endometrial tissue will respond to hormones in the blood just as the lining of the uterus.
During a period, if a gynecologist inspects the internal pelvic organs, there is almost always a little blood that has tracked up through the Fallopian tubes. This blood may irritate the lining of the abdomen resulting in pain from inflammation by inflammation producing cytokines and histamines released by white blood cells signaling a clean-up of the spilled blood.
It is very common for abdominal adhesions to form in women who suffer from endometriosis. This can happen either when two deposits of endometriosis touch in the abdomen and become fused and cause adhesions. Inflammation can also promote the formation of adhesions. They can also form because of scar tissue following surgery for C-section, endometriosis, gallbladder, etc. Adhesions may cause infertility, painful sexual intercourse, chronic pelvic pain but also intestinal obstruction and complications at subsequent surgery.
Uterine adhesions are a different condition than uterine fibroids or endometrial polyps, and are treated differently. Women with adhesions may not experience any symptoms, and some women may only experience absent, light, or infrequent menstruation cycles. The more significant effects of uterine adhesions can be inability to get pregnant or recurrent miscarriages. In more rare cases, the menstrual flow may be blocked by the adhesions, causing pelvic pain or dysmenorrhea (painful menstrual periods).
Hormones Influence the Immune System
Estrogen and progesterone are responsible for changes in the inside lining of the uterus during the menstrual cycle. These endocrine and paracrine hormones are perturbed in women with endometriosis, contributing to inflammatory responses, abnormal tissue remodeling, and hormone replacement therapy is hard or impossible to manage.
Outside of the uterus, estrogen and progesterone play a remarkably different role. Estrogen therapy is pro-inflammatory, promoting an invasion of neutrophils and macrophages immune cells. Estrodiol can stop periods from occurring and stimulate an immune attack on the uterus and nearby organs.
Estradiol is proinflammatory, preventing the endometrial cells from shedding and these effects appear to be exacerbated in women with endometriosis. In women suffering from endometriosis, even normal estradiol concentrations are able to induce an enhanced inflammatory response with chemicals that attract and direct the immune cells to attack certain tissues (cytokines and chemokines) and reinforce endometrial cell survival both within and outside of the uterus.
Progesterone has potent anti-inflammatory effects within the uterus; but a loss of normal progesterone response would likely lead to a more inflammatory-like situation. Excess progesterone provokes a hostile effect with immune cell movement, resulting in a weak immune response, while in more extensive endometriosis stronger immune cell activation by the estrogen may be related to a proinflammatory effect.
Ultimately, the hormone imbalance promotes adhesion formation and the clinical symptoms of pelvic pain and infertility. Adhesions can form within the uterus and on the outside of the uterus. Filmy adhesions between movable organs and the peritoneum appear to be worse in terms of generating pain.
Endometriosis: An Autoimmune Disease
In women with endometriosis, there appears to be an alteration in the behavior of the immune cells, with production inflammatory chemicals that attract and direct the immune cells to attack certain tissues (cytokines & chemokines) in the fluids of the abdominal cavity. Chronic endometriosis is often found in the patients with unexplained infertility were the uterine lining is invaded by immune cells.
Endometriosis is coupled with significantly increased levels of peritoneal IL-1, IL-6 and IL-8, which are autoimmune promoting cytokines. Break up and removal of the endometrial tissue by Lactoferrin and myeloperoxidase (MMP) is reduced because their concentrations are significantly lower in women with endometriosis.
Endometriosis and Bacteria
Bacteria promote increased inflammation through COX2 and PGE2, which play an important role in delivery softening the cervix and uterine contraction. PGE2 also stimulates osteoporosis and elevated body temperature (hot flashes?). Invasive bacteria also significantly induce cytokine and chemokine secretion in uterine lining.
Call today! 530-615-4083
Endometriosis and PCOS
Many women with PCOS suffer year after year before their illness is correctly diagnosed. The story is just as dismal for endometriosis, a painful condition that, like PCOS, affects as many as 10 percent of young women, takes seven years on average to be diagnosed and is a leading cause of infertility.
Many women supplement with flax or borage for hormonal imbalances. However, insulin resistance, the cause of PCOS, will cause increased production of PGE2 when vegetable based EFAs, i.e. flax, borage, hemp, primrose, are used.
Support for Endometriosis
It seems those with endometriosis are trapped in a vicious cycle involving several common denominators:
- Hormone imbalance causes Immune cytokine imbalance
- Immune cytokine imbalance causes Neurotransmitter imbalance
- Neurotransmitter imbalance causes Hormone imbalance
Although substantial evidence indicates that endometriosis at least shares many similarities with autoimmune diseases, endometriosis is primarily treated by using compounds that reduce estrogen. This may be beneficial to reduce the effects of estrogen on the immune system.
However, control of the immune system must be restored in autoimmune conditions. Simply reducing the estrogen is like turning down the burner on the stove with the pan still on fire. Think of your immune system like a police department. There should be checks and balances to allow them to do their job without stopping them completely. Quenching the inflammation, restoring neurotransmitter and cytokine balance may provide better long-term relief than supporting the hormones.
Inhibitory neurotransmitters and anti-inflammatory cytokines control autoimmune responses. Neurotransmitters also control hormone responses. Using hormone replacement or supplements may not be the most effective treatment. I have had so many women tell me that initially they felt better on hormone replacement or other hormone supplements. But it stopped working to the point where increasing the dosage doesn’t help. On the other hand, those same women using the neurotransmitter support are able to eventually maintain themselves through diet and lifestyle.
If you have been diagnosed with Endometriosis, Infertility or PCOS, you are invited to call my office for a complimentary 15-minute consultation. This will answer your questions concerning which lab tests are appropriate for you and what the recommendations would be.
Call today! 530-615-4083