Endometriosis is a frustrating condition. For many women it may take up to 10 years to receive a proper diagnosis. Sometimes, the diagnosis comes about because a couple has been struggling with unexplained infertility and after many years a health care provider finally decides to look into endometriosis as an explanation. Endometriosis ranges from 5-15% of all cases of female factor infertility.
Endometriosis is difficult to find a targeted treatment that is going to work in everyone diagnosed with it because it is still unknown how the pathology comes about in the first place. Please check out my Women’s Health Wednesday post for more information on the signs and symptoms of endometriosis.
For the remainder of this post, I want to highlight some of the ways endometriosis can impact fertility, and some possible approaches to increase chances of pregnancy.
“In women with endometriosis, there is a reduced monthly fecundity rate (2-10%) compared with fertile couples (15-20%). Although endometriosis impairs fertility, it does not usually completely prevent conception”
I wanted to highlight this statistic, yes the monthly pregnancy rates are lower in women with endometriosis then women with no known infertility, however what is important to take away from this stat is that women with endometriosis DO GET PREGNANT.
In women with mild or minimal endometriosis the following factors could potentially be contributing to infertility:
- Chronic inflammatory environment impacting gametes, embryo development, implantation
- Inflammation impact on healthy follicle development
- Increase of peritoneal macrophages resulting in destruction of sperm before fertilization can happen
- Decrease in endometrial receptivity due to the persistent local inflammation
In addition to the listed factors, moderate to severe endometriosis also have:
- Impairment of ovulation due to pelvic adhesions and endometriomas
- Impairment of tubal transport due to endometrial tissue
- Endometrial tissue that blocks sperm migration
For a mild or minimal endometriosis diagnosis – the theme amongst the factors that are impairing fertility can be linked to inflammation. The goal is to work on mitigating the inflammation in the abdomen, pelvis as well as systemic inflammation, to calm down the immune system producing inflammatory cytokines. The goal is to produce as neutral of an environment as possible to reduce the damage inflammation can do to the ovulation, fertilization and implantation process.
So what are some ways we can reduce abdominal, pelvic and systemic inflammation?
Diet is going to be at the foundation of anything else you are doing to help your body. As the saying goes, “You can’t out supplement a bad diet” – meaning you can be taking all the anti-inflammatory, antioxidant supplements you like, but if you are consuming inflammatory foods, or foods that your body may be negatively reacting too, you’re really fighting an uphill battle. Everyone is going to have different foods that agree with them, and different foods that are more inflammatory in their system, but in GENERAL, the following foods are shown to be inflammatory – so these foods would be a good place to start at reducing or eliminating them from your diet:
- Sugar– this isn’t really a food per-say, but it is added into everything. If you can cut this one out, or at least reduce its prevalence in your diet, your body will thank you. Constantly having an influx of sugar into your system results in constant spiking and dropping of your blood sugar, and after a while your can become insulin resistant – which is highly inflammatory.
- Dairy– a lot of people have problems with digesting dairy. As we age, we stop producing adequate amounts of the enzyme required to break down the sugar found in dairy, resulting in a larger-then-it-is-supposed-to-be protein working its way through our digestive system, becoming available for our gut bacteria to consume and ferment, resulting in gas, bloating and local gastro-intestinal inflammation. If our gastro-intestinal tract is inflamed, our uterus and ovaries being in close proximity to the GI system, will become exposed to the inflammation, and may exacerbate endometriosis lesions in the area. Commercial dairy products also have added sugar in them, so as well as the lactose protein that we can digest, there’s also sugar – a double whammy of inflammation.
- Gluten– There is some research out there that has connected the same inflammatory cytokines (IL-8, IFN-gamma) that maintain a Th1 dominant immune response in Celiac disease (autoimmune condition resulting in extreme gluten allergy) and There has been more research, not just in women with celiac disease and endometriosis, but just endometriosis and the benefits of a gluten free diet. The study observed statistically significant reduction in pain experienced in patients with endometriosis in 75% of the patients in the retrospective study.There was also an increase in the overall quality of life of those patients.
- Avoiding known food sensitivities– if you eat a certain food, and you know it gives you gas and bloating, causes urgent bowel movement, or heartburn. Avoid it! That is your GI system telling you that your body does not agree with that food. The more you eat it, the more your GI system will become irritated and inflamed – and again that local GI inflammation may extend over to the uterus, ovaries and extra-uterine endometrial lesions exacerbating the inflammation.
2. Moderate Exercise
The last thing you usually want to do when you’re feeling bloated, cramping and having unpredictable bowel movements is get out of bed and get some exercise – but hear me out. Regular physical exercise has been shown to increase the body’s production of cytokines (chemical messengers) that have anti-inflammatory properties. This is useful information, now that we’re looking at endometriosis as more than just a hormonal condition, but also an inflammatory condition. There are no current studies out that evaluate exercise and the occurrence or progression of endometriosis, however exercise has been shown to cause the release of endorphins that improve mood, increase circulation as well as produce anti-inflammatory cytokines so even though the research doesn’t point specifically to the treatment of endometriosis, you are still doing your body good by getting in some mild to moderate exercise.
3. Key supplementation
To complement a healthy diet, there are a few key supplements to consider in endometriosis
- NAC (N-Acetylcysteine) – there was an observational cohort study that evaluated ovarian endometriomas and their response to NAC. After three months of intervention the study showed a slight decrease in the endometrioma size in the NAC treated group, and a significant increase in the endometrioma size in the untreated group. The study also proved that NAC was more effective at shrinking the endometrioma size in comparison to oral contraceptive pills (a typical first line treatment!). As well as shrinking the endometriomas, there was a reported reduction in subjective symptoms experienced such as dysmenorrhea, dyspareunia and chronic pelvic pain. The conclusion of the study said, “NAC can be a simple and effective treatment for endometriosis without side effects and suitable approach for women desiring pregnancy”.
- Resveratrol – a phyotochemical naturally found in soy, grapes, wine, peanuts and berries has been studied as an isolated compound in the treatment of endometriosis. It is a potent anti-oxidant, immune-modulator and anti-angiogenic. Studies have found that resveratrol significantly reduces the size of endometrial lesions visualized on laparoscopic examination, and at high doses reduce the proliferation and growth of the endometrial lesions!
- Melatonin – typically known as the “sleep” neurotransmitter, melatonin is also a potent antioxidant found in the body. A randomized double-blind placebo-controlled trial demonstrated that melatonin reduced overall pain, dysmenorrhea, dysuria, dyspareunia, improved quality of sleep in women with endometriosis as well as reduced analgesic use in these women.
The information in this post is not a substitute for medical advice. I would recommend speaking with your naturopathic doctor or gynaecologist to figure out a treatment plan that is right for you in order to minimize the inflammation in your body resulting in a reduction of the symptoms experienced by endometriosis and maximize your chances of conception!
Bonocher, C.M., Montenergro, M.L., Rosa e Silva, J.C., Ferriani, R.A., Meola, J. (2014) Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol.Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895811/
Dull, A.M., Moga, M.A., Dimienescue O.G., Sechel, G., Burtea, V., Anastasiu, C.V. (2019). Therapeutic approaches or resveratrol on endometriosis via anti-intlammatory and anti-angiogenic pathways. Molecules. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30781885
Fadhlaoui, A., de la Joliniere, J.B., Feki, A. (2014) Endometriosis and Infertility: how and when to treat? Fronteirs in surgery. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286960/
Marzaili M., Venza M., Lazzaro S., Micossi C., Stolfi V.M. (2012). Gluten Free Diet: Potential role in the reduction of symptoms experienced by endometriosis patients. Minerva Chir. 67: 499-504. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23334113
Mormile R., Vittori, G. (2013). Celiac disease and endometriosis: what is the nexus? Arch Gynecol obstet 288: 1197-1198. Retrieved from: http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=3&sid=1c4797
Porpora, M.G., Brunelli, R., Costa, G., IMperiale, L., Krasnowska, E.K., Lundegerb, T., Nofroni, I., Piccione, M.G., Pittaluga, E., Ticino, A., Parasassi, T., (2013) A promise in the treatment of endometiosis: an observational cohort study on ovarian endometrioma reduction by N-Acetylcysteine. Evidence based complementary an alternative medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662115/
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