Using Functional Medicine to Treat Endometriosis

According to Yale Medicine, on average, women have to wait 10 years before being properly diagnosed with endometriosis - which is a massive problem for a few reasons.

First, because endometriosis is not uncommon - an estimated 10-15% of women suffer from it - and I mean suffer. Endometriosis can be an absolutely debilitating disease, and is also a common cause of infertility (which is deeply painful in itself).

This means millions of women go without appropriate and life-changing treatment for literal decades, not only dealing with disabling pain every month, but also suffering the social and economic repercussions of being regularly unable to work, care for their families, and just plain function in their daily lives.

The second reason this lack of proper diagnosis is a problem is because the sooner you know you have endometriosis, the more you can prevent its progression.

Meaning, if women get early treatment - especially if it’s root-cause treatment - we can not only resolve symptoms, but also keep it from spreading.

A Functional Medicine approach always begins by asking why dysfunction is happening, and what systems or factors could be contributing to a disease or disorder. So, that’s what we’re going to do first!

Endometriosis results from something called retrograde menstruation, where endometrial cells move out of the uterus and attach themselves to other organs and tissues in the abdomen.

What are endometrial cells? Well, they make up the lining of the uterus - specifically, the tissue that builds up and then sheds every month or so, causing menstruation (or what we commonly call a period).

Endometrial tissue is very vascular or bloody - I know, it’s kinda gross but important to note - and it also makes and releases lots of hormones and other bioactive compounds that are supposed to nurture a fertilized egg, in the case of pregnancy.

You can imagine if this is all going on outside of where it’s supposed to, for instance, on the intestines or colon - all this swelling and growing and bleeding and secreting - it creates some big problems like severe pain, cramping, nausea, bowel issues, anxiety, depression, and like I already mentioned, infertility and damage to organs like the bladder, ovaries, fallopian tubes, and even muscles and tendons.

So, what makes endometrial tissue attach to organs in such an unfriendly, unwelcome way?

It’s not just chance! 

Studies show that women without endometriosis have the same rate of retrograde menstruation as those with endometriosis, meaning that the internal environment in which this happens is the problem. And, believe it or not, this is great news for us! Because it means that there are things we can modify or change to reduce the formation of endometriosis, and how damaging it is.

The biggest thing you need to know about endometriosis is that it’s an estrogen-dominant condition. So, if you have too much estrogen, or if your estrogen isn’t being metabolized and excreted from your body fast enough or down the right pathway, it can create an internal environment that is ripe for endometriosis.

Now, before we get too far down this story, let’s remember that estrogen isn’t the bad guy - it’s an essential hormone for female health and it does all sorts of important things like maintain the strength of our bones and protect our brains from dementia. And without estrogen, reproduction doesn’t happen!

So, the problem isn’t estrogen itself - in the case of endometriosis, we’re overexposed to it, and not great at removing it when needed. 

Estrogen detoxification happens in three phases.

Basically, what the body does in order to get rid of something it doesn’t need anymore - like estradiol, for example - is wrap it up into a little package by changing it slightly, chemically, over a series of several steps.

But don’t be fooled, there’s nothing simple about the process. A three-hour workshop wouldn’t be long enough to get through the nitty-gritty of estrogen detox, so we’re just going to hit the high notes here.

Phase 1 happens in the liver, and it involves the formation of three different estrogen metabolites, 2-hydroxyestrone, 4-hydroxyestrone, and 16-hydroxyestrone. These metabolites are reactive, meaning they can cause damage to the body if they’re not packaged up further, especially 4-hydroxyestrone, which can damage your DNA and cause cancer. 

But the one we’re really interested in when it comes to endometriosis is the 16-hydroxyestrone, because it’s the most proliferative, meaning that it promotes growth by rapid production of cells. Proliferation is great for bone health, but not so great for endometrial cells. So, if your body prefers to make 16-hydroxyestrone, you’re going to be more prone to endometriosis.

And this is measurable, by the way.

In women with endometriosis, studies do find elevated levels of 16-hydroxyestrone, especially in urine. This is one of the reasons I recommend the DUTCH test for clients who have symptoms of endometriosis - it shows us which of these metabolites their body is preferring so we know whether or not we need to encourage a shift in these pathways.

Another reason I like this test is that it tells us about Phase 2 of estrogen detox as well - specifically, how well we’re packaging up those hydroxyestrones by adding a compound called a methyl group.

This helps the estrogen leave the liver cell and make its way, through the gallbladder, into the intestines where it can be excreted.

Some folks have trouble with Phase 2 because they have genetic insufficiencies or defects that make them sluggish methylators - and while the DUTCH test doesn’t give us the genetic information, it does tell us how efficiently we’re performing Phase 2, and if we might need a little boost.

How well Phase 3 goes depends on how healthy your gut is, especially your gut microbiome - the microbes that live in your digestive tract.

If things aren’t balanced, that tiny estrogen package can get unwrapped and re-circulated instead of eliminated, which adds to your overall estrogenic burden. Imagine how frustrated and exhausted your liver would be to see that estrogen, which it so neatly packed up for you, come back around again! It’s like the worst re-gift ever!

So, now that we understand one of the biggest root causes of endometriosis, we can come up with science-based solutions.  But the first step is data.

By that I mean knowing what your individual hormones are doing, and which detox pathways might be causing your endometriosis and making your symptoms worse. I already mentioned that I like the DUTCH test for this, because unlike a blood hormone test, it gives you all of this crucial information in one simple, at-home test. Once you know your specific needs, you can develop a plan to address them.

If you have high estrogen, you may need to work on lowering your body fat percentage using a personalized nutrition plan or by adding resistance training to your workout routine. Or perhaps you need to get to the bottom of your gut microbiome issues or chronic constipation, because it’s causing that dreaded unpacking and recirculating of estrogen metabolites.

If your Phase 1 is producing a ton of 16-hydroxyestrone, you might use quercetin, indole-3-carbinol, or sulforaphane (from broccoli) to help make more 2-hydroxyestrone instead. Or maybe you need some Phase 2 support because you have low magnesium, choline, or SAMe, and you’re not methylating very well. Click HERE to check out my favorite estrogen metabolism supports like these.

Here’s the thing. Endometriosis is an overwhelming and exhausting disease, and conventional medicine doesn’t have a ton of great answers or options for resolving it, especially long-term.

It’s not an easy thing to treat, and it’s definitely not easy to live with. But you need to know that a Functional Medicine approach can help - especially if it’s personalized and guided by solid data and complete lab testing.

I help my clients order and interpret DUTCH testing all the time.

So if you're interested in doing some DIY Functional Medicine testing, click HERE.

If you'd like to learn more about working with me one on one, click HERE.