What is Endometriosis? Endometriosis is a disease which impacts approximately 10-15% of Australian women characterised by the growth of endometrial-like tissue outside of the uterus. A chronic, inflammatory condition it currently has an estimated prevalence of 750,000 women in Australia and around 176 million women worldwide.

Research into the pathophysiology of the disease has found that the aberrant endometrial-like tissue responds to hormonal cascades in the same way it does in the uterus by thickening and bleeding. The problem with Endometriosis is that, unlike the process which enables the tissue growing in the uterus to shed at each menstrual cycle, when growing outside of the uterus, there is no ability to shed or clear the tissue from the body. The endometrial-like tissue, if uncleared, can develop into lesions which can negatively impact the function of the surrounding tissue and organs.

When formed, these lesions can range from superficial implants to deep infiltrating, peritoneal lesions or ovarian cysts. Locating these lesions can be problematic and requires specialised knowledge. The sites the lesions can typically be found in, include the fallopian tubes, pelvic peritoneum, ovaries and uterosacral ligaments. Atypical sites can include the urinary tract, ocular cavity, gastrointestinal tract, chest and soft tissues. Many women can be asymptomatic, however, one of the hallmark symptoms is severe pelvic pain at menstruation. Due potentially to pelvic pain being commonly normalised symptom, diagnosis can often be delayed and done in response to investigating infertility. Symptoms can be often be severe and negatively impact quality of life throughout both menstruating years which can even continue after menopause in around 2-5% of cases.

Risk factors:

• Maternal family history

• Alcohol intake

• Precocious puberty and early onset of menstrual cycle

• Low body mass

• Shorter menstrual length

• Caffeine intake

• Infant exposure to soy formula

• Prenatal and adult exposure to endocrine disrupting compounds (i.e. xeno-oestrogens) such as Bisphenols, phthalates or organochlorine pesticides

 Aetiology & pathophysiology

The pathophysiology of endometriosis is widely debated and numerous hypothesises exist. As research progresses it is being understood that it is a disease which is complex and multifactorial. Both environmental and genetic influences may play a role in its pathogenesis and it is likely to be an interplay between multiple theories. Common theories include:

• Retrograde menstrual flow – One of the oldest endometriosis theories suggests that endometrial cells flow backward through the fallopian tubes and into the pelvic cavity during menstruation, leading to implantation. However, this "retrograde menstruation" occurs in 76-90% of women, but only about 10% develop endometriosis. Furthermore, it does not provide an explanation for how endometriosis can affect males, newborns, or pre-pubescent girls.

• Bacterial contamination – A recent theory involving the translocation and infection of microorganisms from the lower genital tract to the upper area. This theory postulates that the area is consequently contaminated, therefore negatively affecting the quality of peritoneal fluid or menstrual blood. Bacterial microorganisms then secrete a toxic substance, lipopolysaccharide (LPS) which leads to pelvic inflammation and promotes the growth of endometrial lesions. Oestradiol (E2), a woman’s primary sex hormone in reproductive years, may then also have an additive pro-inflammatory response in the presence of LPS.

• Lymphatic dissemination – a possible mechanism behind how endometrial lesions can migrate and form in distant, or less common areas. The endometrial-like tissue may be circulated via the lymphatic system where it implants and begins to form lesions.

• Coelomic metaplasia – Endometriosis, a condition often aggravated by hormonal imbalances or immune system malfunctions, arises when cells lining the abdominal and visceral peritoneum undergo metaplasia. This transformation involves regular peritoneal cells and tissue morphing into tissue resembling the endometrium. Intriguingly, some experts propose that endocrine disrupting chemicals (EDCs) may also play a role in this cellular transformation.

• Aberrant immune surveillance – Women with endometriosis have been shown to have special ‘eutopic’ endometrial cells. These cells have an increased capacity for proliferation and increased evasion from immune cell surveillance. Once cells have migrated to other areas, they can attach to the surface of the peritoneal cavity to form a lesion. These eutopic cells successfully evade immune defences in order to proliferate.

• Embryonic remnants – This theory postulates the residual embryonic cells respond to oestrogen to endometriotic lesions. However possible, this mechanism does not explain how endometriosis is found outside of Mullerian ducts.  

• Accelerated inflammation and oxidative stress – there exists a potential link between DNA impairment of endometrial cells and lipid peroxidation. With this theory, the process is triggered by accelerated reactive oxygen species (ROS) and aggravated by an iron overload due to the break-down of red blood cells in the peritoneal cavity. This leads to an immune response whereby increased cytokine production contributes to endothelial cell proliferation.

• Unopposed or inappropriate oestrogen to progesterone ratios and/or progesterone resistance – oestrogen function in part to stimulate a thickening of the endometrial lining while progesterone vascularises it, prepares the uterus for conception and moderates the proliferative effects of oestrogen. However, in endometriosis there may be an issue of progesterone receptors within the endometrium fail to respond or are insufficient for the body’s requirements to maintain healthy ratios.  

How We Can Help

We can offer further testing for hormones, offer dietary advice, pre and post operative therapies. We may also seek to do any of the following:

• Reduce inflammation by recommending you follow an anti-inflammatory diet

• Improve antioxidant status by using herbal or nutrient therapies

• Improve pelvic blood circulation and screen for pelvic congestion symptoms

• Modulate hormones

• Optimise gut function and digestion

• Reduce pain symptoms

• Support immune function and surveillance

• Supper liver function and oestrogen metabolite clearance

• Support menorrhagia, or heavy periods, if present

• Offer further functional testing

• Reduce xeno-oestrogen and endocrine disrupting compound exposure

• Support lymphatic drainage

The information provided on the Nurture Point Pty Ltd blog and greater website is for educational and information purposes. The information provided within the blogs, or anywhere else on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health. We offer personalised Naturopathic consultations as an online service. We offer nutrition care, herbal medicine and lifestyle advice. If you wish, feel free to book in a time here.