A Functional Medicine Approach to Endometriosis

last updated on
June 16, 2023
by
Alisa Vitti

If you or a loved one suffers from endometriosis, you don’t need me to tell you how painful and debilitating the condition can be, and that conventional medical interventions for endometriosis are limited—and far from ideal. The condition involves inflammation, estrogen excess, and an abnormal immune response—but one of the things science doesn’t know about endometriosis is the best way to treat it.

To date, Western medicine’s best tools for dealing with endometriosis are non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, or surgery. Both strategies are for pain control; neither one addresses the root causes of the condition. But no woman with endometriosis needs to live without hope. Lifestyle strategies for reducing inflammation, strengthening the immune system, supporting the liver, and balancing hormones can make a huge difference in reducing symptoms and improving quality of life.

What is Endometriosis?

It is a painful, sometimes debilitating condition that affects as many as one in 15 percent of women ages 15 to 44 in the United States. Endometriosis occurs when endometrial tissue, which is normally found in the uterus, grows in places outside the uterus—places where it shouldn’t be. Most of the time this misplaced endometrial tissue lands on the ovaries or fallopian tubes or, painfully, on the abdomen. Because endometrial tissue responds to the same hormonal shifts that trigger the menstrual cycle, the pain associated with endometriosis will follow the same 28-day cycle as your period.

Astonishingly, and tragically, many women with endometriosis aren’t diagnosed right away. The average delay in diagnosis is almost seven years. Seven years! This means many women suffer with terrible, sometimes crippling, endometriosis-related pain for the better part of a decade, thinking that it is just severe period problems.Endometriosis can happen to any menstruating women. But why the condition strikes some women and not others is not entirely clear. Some women may be genetically predisposed. Three other factors fuel endometriosis:

1. A faulty immune system response

In women with endometriosis, the immune system fails to destroy the endometrial tissue that lands outside the uterus.

2. Excess estrogen in the body

Unfortunately, and simply by virtue of the world we live in today, excess estrogen in women (and many men) is more the norm than the exception. This overload of estrogen can fuel endometriosis in some women

3. Inflammation

Inflammation, like estrogen excess, is driven by lifestyle. What we eat and the toxins we are exposed to (and how well our bodies can detox them) drive inflammation and fuel endometriosis.While you can’t control your genetics, you can reduce inflammation in your body, help your liver flush out excess estrogen, and support your immune system with the nutrition, targeted supplementation, and lifestyle.In the next several sections, I outline my favorite strategies for easing the symptoms of endometriosis. [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

The Best Foods for Endometriosis

Think of food as your best weapon in the fight against the painful symptoms of endometriosis. When it comes to hormone conditions like PCOS, fibroids, and endo, food is medicine. I’ve broken down the list of foods I recommend into four important categories (1) immune-boosting foods, (2) detox-support foods, (3) liver-support foods, and (4) healthy protein sources (for healing).[/vc_column_text][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]

Foods to help boost immune function

These foods will help boost immune function:

  • Carrots
  • Garlic
  • Ginger
  • Dark leafy greens
  • Leeks
  • Mushrooms
  • Beans, peas & lentils
  • Green tea
  • Rooibos tea
  • Yogurt with live cultures and other fermented foods like kim chi and sauerkraut
  • Rhubarb
  • Berries
  • Seeds (like flax, chia, and pumpkin)

Food for Healthy Protein

I recommend these healthy protein sources:

  • Salmon
  • Beans
  • Chicken or turkey

Note:You can maximize your benefit by emphasizing these foods.

Fiber-Rich Food for Hormone Detox

I recommend these fiber-rich foods for helping your body detox excess hormones:

  • Beans, peas and legumes
  • Brown rice
  • Quinoa
  • Low-glycemic fruits, like berries; citrus fruits; apples
  • Vegetables, especially dark leafy greens like kale; cruciferous vegetables, broccoli, and cauliflower; carrots and beets
  • Oatmeal
  • Whole grains (but NOT wheat or rye; it is important to avoid gluten)

Foods for Liver Support

I recommend these foods for liver support. The liver is the body’s main organ of detoxification and it plays a central role in helping the body detox from excess estrogen:

  • Artichokes
  • Beets
  • Burdock
  • Cabbage
  • Carrots
  • Kale
  • Lemon & Lime
  • Dandelion & mustard greens
  • Watercress

The Worst Foods for Endometriosis

As with any health-supportive diet, it’s as much about what you take out of your body as what you put in. If you have endometriosis, you’ll want to cut out or dramatically reduce the following foods:

Alcohol

Alcohol Is immunosuppressive and hard on the liver.

Caffeine

Some research has linked the intake of caffeine with endometriosis. Play it safe and avoid caffeinated beverages.

Refined and highly processed carbs

This includes pasta, white bread, candy, cookies, and other baked goods. These foods are inflammatory and high-glycemic, hence bad for any inflammatory condition, including endometriosis.

Dairy

Dairy is inflammatory and skim options are high-glycemic. Avoid all dairy if you have endometriosis, opting instead for coconut yogurt and kefir, and delicious non-dairy creamers made from nuts and seeds.

Fried foods and fast foods

Most fried foods and almost all fast food is prepared in unhealthy, inflammation-promoting cooking oils.

Red meat

Studies have linked red meat consumption to increased risk of endometriosis.

Sugar

Foods with a high-glycemic-index drive up inflammation, suppress the immune system and offer no phytonutrient support. If dark leafy greens are the win-win-win food of hormonal healing (because they address inflammation, immune function, and have fiber), sugar is the lose-lose-lose because it helps with none of those things — and actively interferes with your efforts to heal.

Processed foods with additives and preservatives

These foods introduce chemicals into the body that it neither needs or wants — and that it has to work very hard to detox from. Don’t force your body to use up precious resources getting rid of avoidable preservatives (when it could spend that time processing and eliminating estrogen). [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

The Best Supplements for Endometriosis

Food comes first when fighting endometriosis (or any hormonal imbalance). But using targeted, high-quality supplements is a close second. Here are the supplements I recommend for women with endometriosis:

Milk thistle

This herb contains the antioxidant silymarin, which helps repair the cells in the liver and protects liver cells from damage. It is also anti-inflammatory.

Evening primrose oil

Studies suggest that Evening primrose oil offers powerful support for a variety of hormonal imbalances related to female reproductive hormones. Evening primrose oil may help with pain management in endometriosis.

Vitamin B6

Vitamin B6 helps balance excess estrogen by boosting progesterone production in the body. B6 is also liver supportive.

Probiotics

A healthy microbiome is essential for the management of endometriosis. That’s because there is a colony of bacteria in the gut that helps process and eliminate excess estrogen from the body, according to research. It’s called the estrobolome and you can support by taking a high-quality probiotic.

DIM

Diindolylmethane supports the body in eliminating excess estrogen. DIM is derived from cruciferous vegetables like cauliflower and broccoli and it metabolizes estrogen into smaller components that are more easily assimilated and removed by the body.

The Emotional Aspects of Endometriosis

Research into the mind-body connection is gaining ground in mainstream science, no longer relegated to “alternative” medicine. We are coming to understand – in a deeper and more detailed way – how thoughts and feelings can directly impact our physical health and well-being. We are seeing the empirical evidence mounting when it comes to how physical symptoms can manifest in connection to emotions. This is a concept I think we all understand instinctively and often relate to in our own lives. It’s good to see the science supporting a shared experience.

When a woman comes to me at FLO Living with endometriosis I explain that endometriosis is a complex condition that needs a comprehensive strategy for management, tackling the ecosystem of the microbiome, liver health, inflammation in the body, and excess estrogen. For women with endometriosis it’s vital that we work together to prevent symptoms as soon as possible, and shifts in diet, adding supplements, and removing certain triggers can be very effective, very quickly.I also work with women to explore the emotional components of endometriosis.

Addressing the emotional aspect of health issues like ovarian cysts, endometriosis, fibroids, and PCOS can be an important part of the healing process. While these problems and their symptoms create their own emotions in women — depression, anxiety, stress, worry, to name a few — they can also be connected to existing emotions and experiences. A closer look at the emotional aspects of endometriosis (or other hormone condition) won’t solve the symptoms, but understanding the emotional components can lead to more compassion for ourselves, for other women, and an individual and collective recovery.

This is something I see often with the women I work with through FLO Living, we will be in the process of working on her health issue from a functional medicine standpoint and eventually we’ll organically reach a point of discussing her life, her past experiences, her feelings about herself, and about the things that have happened to her. It’s not all that surprising, it’s intimate work, and when women work with women outside of the doctor’s office, there’s a tendency for the mind-body connection to come up in a way that you might not see happening elsewhere.

The Feminist Mind-Body Connection

Think about your female reproductive organs — uterus, ovaries, a vagina — acting as a “low heart” and as such holding many of your unconscious, deeper emotions that the “high heart” is not yet ready to process. The emotions are held here, only to be released once a person has processed the source of these held feelings.

There’s actually a deeply feminist history to the mind-body connection and how it relates to the female experience. A student of psychologist Carl Jung, Marion Woodman, developed a concept of “feminine psychology.” Her work details how unconsciously held emotions, feelings, and thoughts can affect the female body. It’s important to note that as science progresses we are seeing more and more empirical evidence to support and back up this perspective. Woodman investigated how women feel about their bodies. Many of us are brought up to be fearful and distrustful of our bodies, and she believed this has a significant impact on our health. She believed that the unprocessed trauma experienced by many women – as the result of individually experienced acts of abuse and violence, and as the result of cultural oppression – could manifest itself in physical symptoms, especially those relating specifically to female biology.

Endometriosis: Time to Prioritize Your Needs?

One theory about the emotional component of endometriosis is that it may reflect — if even symbolically — a physical manifestation of putting others needs before your own. The uterus, by design, exists to put another person’s needs first. The material of the womb, the endometrium, is the first maternal embrace an embryo receives. So it has been interpreted by some that when endometrial tissue grows outside the womb, it is the body’s attempt to mother a woman who isn’t mothering herself, who isn’t putting her own needs first.

By creating a symptom you have no choice but to pay attention to, you must, necessarily, put your own needs first — and set aside that outward (overly) mothering behavior that leaves you feeling depleted. It’s wonderful to care for others and support them in their lives, but when we do it in such a way that puts our own needs last on the list we can become depleted. We might feel frustrated, angry, resentful, or just plain stressed and exhausted by the practical requirements of living that life. The expectations put on all women to be the care-providers, to put others first always, to do the “emotional labor” of supporting those around them can be oppressive.

Does this resonate with you? Do you ever feel like you’re keeping everyone else happy, stable, and cared-for, but that you’re not attending to your own needs and desires? Do you long for someone to take care of you? There’s a burning desire there for self-nurturance as well as connection with other women and community-centered support.These pressures can come out in the body and manifest as symptoms.

The emotional theory of endometriosis is by no means the sole root cause of the disease, but it’s an element that I have seen over and over again in my work with women at FLO Living. As I’ve said before, this has nothing to do with your personal choices in your life, and everything to do with the position of women in society, and how we are conditioned to organize our lives and act towards ourselves.  Your uterus is offering you a gift, an opportunity to reflect on your patterns and revise them for not only better health, but a happier life.  

Your 13-Step Guide to Addressing Endometriosis with Lifestyle & Diet

You can work to reduce inflammation, balance hormones, and support your immune system with food and lifestyle in a systematic way. Here’s my step-by-step guide for helping ease endometriosis symptoms. You’ll see some of the key pieces of advice that I outlined above, fleshed out with even more essential lifestyle strategies for curbing the symptoms of endometriosis:

Step 1

Start by limiting—and eventually eliminating—exposure to toxic forms of estrogen found in household cleaners, cosmetics, and bathroom products. Go through your house with a fine tooth comb and:

  • Replace cosmetic and body care products with natural alternatives, this includes, soap, shampoo, hair styling products, deodorant, lotions, cosmetics, and perfumes
  • Replace standard laundry soap with green alternatives. You can now find many clean alternatives on the shelves of big box stores, sitting side by side with the old (toxic) standbys. Clean alternatives are comparable in price and work just as well. You can opt for unscented products or products that have been scented with natural fragrance.
  • Replace household cleaning products with clean alternatives. You can buy effective products at almost all big box stores or you can make your own, which is cheaper and healthier. The main ingredients in most DIY cleaning products are vinegar and baking soda.
  • Take off your shoes at the door (and ask your guests to do the same). A lot of pesticides and other hormone-disrupting chemicals are tracked in on the bottom of shoes. Stopping those chemicals in their tracks is a great way to protect yourself.

Step 2

Just say no to pesticides and other chemicals in your food. Shop organic exclusively if you can. If you are on a budget, avoid the dirty dozen (or buy them organic) and feel okay about buying the clean 15 even when not organic.

Step 3

Emphasize dark leafy greens, cruciferous vegetables, low-glycemic fruits like berries and other high-fiber foods to support gut health and help your liver carry out important detox functions. The liver is responsible for breaking down and eliminating excess estrogen, and cruciferous vegetables directly support that detox process.

Step 4

Eat more healthy fats like those found in olive oil, coconut oil, and avocados. Healthy fats help support healthy hormone ratios in the body.

Step 5

Emphasize lean animal protein over other kinds of meat. They are less inflammatory.

Step 6

Limit red meat. Studies have linked red meat consumption with increased risk for endometriosis.

Step 7

Help kick your immune system into high gear with immune-supportive foods like carrots, kale, cabbage, broccoli, beets, artichokes, lemons, onions, garlic, and leeks.

Step 8

Limit sugar. Sugar fuels inflammation.

Step 9

Use targeted herbal support to further support liver detox and speed up estrogen metabolism. Think milk thistle, flax seeds, DIM, and dandelion root.

Step 10

Take evening primrose oil to decrease inflammation.

Step 11

Reduce or eliminate dairy, wheat, alcohol, and caffeine to improve your immune response.

Step 12

Take a probiotic to rebalance gut flora and support estrogen metabolism.

Step 13

Use Vitex and a B6 supplement daily to balance out excess estrogen.If you’re reading this article because your friend, sister, or family member is struggling with this condition, share this article with her. Too many women believe the myth that endometriosis has to ruin your life every month.

Integrative Nutritionist, Author, & Founder of FLO Living

Alisa Vitti

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