Treating Endometriosis Naturally

This week we are thrilled to have Dr. Shalini Hitkari as our guest writer! Dr. Hitkari is a Naturopathic Physician practicing in Victoria BC at the Vancouver Island Naturopathic
Clinic. Dr. Hitkari has a passion for Women’s health and how it evolves over a women’s lifetime. She strongly believes in women supporting women and currently in her eighth year of practice, has focused on supporting women through transitions in life. From menarche and pregnancies to menopause, Dr. Hitkari’s approach is patient-centered, creating for them a comprehensive, individualized treatment plan to help them achieve optimal health and live their happiest and healthiest lives. I was lucky enough to work alongside this amazing doctor for 2 years at an integrated health clinic where I worked as a clinical counsellor. Dr. Hitkari and I have shared many patients over the years and I greatly value her knowledge and approach. I have also had the privilege of seeing Dr. Hitkari for my own autoimmune issues. We asked Dr. Hitkari to share some of her knowledge with us during Endometriosis awareness month, and lucky for us, she agreed! Enjoy!
Dr. Hitkari
Rachel is a 32-year-old woman who came to me for help with trying to conceive, and to manage her debilitating menstrual cramps.  Starting at the early age of 15, Rachel had been put on oral contraceptives to help with her cramps that caused her to miss school every month. In the last three months, she has discontinued the birth control pill in order to conceive but her cramps had returned and now she is missing work because of them.  It is in cases like Rachel’s, where you have to question if she suffers from endometriosis.  
Endometriosis is a disease affecting 1 out of 10 women.  It is the most common cause of pelvic pain and infertility.  It occurs when the type of tissue that normally lines the uterus, the endometrium, is found outside of the uterus, most commonly in the abdomen, where it is not supposed to be.  This misplaced tissue responds to hormonal changes that trigger our periods, in the same way, our uterine lining does and sheds or bleeds. When this shedding occurs, blood can become trapped in the abdomen and irritate nerves resulting in pain. Eventually, this chronic irritation results in the formation of scar tissue and that scar tissue can wrap itself around our ovaries, fallopian tubes and, even our bowels.   
The most common symptoms associated with endometriosis are menstrual cramps, low back pain, painful urination or defecation before or during periods; pain during or after intercourse; abnormal vaginal bleeding or heavy menstruation; and, diarrhea, constipation, bloating and nausea associated with our periods.
Conventional medicine treats the pelvic pain associated with endometriosis using over-the-counter pain relievers such as acetaminophen and ibuprofen.  There are also hormone therapies such as birth control pills that aim to stop ovulation and therefore suppress menstruation which helps to alleviate pain, like in Rachel’s case, and inhibit the growth of endometrial lesion.  Another option is surgery where, through a laparoscopic exam (inserting through a small incision(s) in the abdomen, a thin flexible tool with a light and camera on the end), they ablate endometrial lesions which may alleviate symptoms for up to two years.  Surgery can also go as far as a hysterectomy (removal of the uterus and, sometimes, the ovaries).
There are many theories as to the cause of endometriosis, but the exact cause is yet to be determined.   We so far believe that endometriosis results from inflammation and immune dysfunction and, it is triggered by our cyclical hormonal changes and affected by our estrogen levels.  
One of the principles of Naturopathic Medicine is to treat the root cause of disease. With endometriosis, we aim to balance the immune system and hormones; reduce inflammation and oxidative stress; relieve scar tissue and adhesions and, alleviate pain.  One of the best ways to combat inflammation is to start with an anti-inflammatory diet – eating a whole food diet consisting of whole grains, fresh vegetables, fresh fruit, healthy fats, and lean protein, with the avoidance of pro-inflammatory foods such as dairy, wheat, corn, and sugar.  Add 1-2 tbsp of freshly ground flaxseeds to your whole food diet.  Flaxseeds are high in fiber and fiber helps to bind estrogen in the bowel and eliminate it, reducing the exposure of estrogen to the endometrial tissue.  Also try and avoid or decrease your coffee intake and consider trying green tea instead.  Caffeine is thought to aggravate endometriosis and green tea is chock-full of antioxidants which helps to combat oxidative stress.  It is also important to reduce exposure to toxins, such as dioxin, which can mimic estrogen and feed this misplaced endometrial tissue, so we encourage patients to try and eat organic meats and produce.  If you haven’t already, refer to the Environmental Working Group’s clean 15 and Dirty Dozen to find out which fruits and veggies to eat organic.  
Outside of these dietary recommendations, your Naturopathic Physician will create individualized treatment plans for their endometriosis patients.  Some of my favorite and well-researched supplements are N-acetyl cysteine (NAC), melatonin and pycnogenol.  NAC is a derivative of an amino acid L-cysteine.  As I mentioned earlier, endometriosis can develop on our ovaries and cause a cyst called a “chocolate cyst”.  A study was conducted on women who had a confirmed diagnosis of a “chocolate cyst”, the women were either given NAC or a placebo and the study found that the NAC treatment group had a reduction in the size of their “chocolate cyst” and significant pain reduction.  Melatonin, our sleep hormone, is another well-researched natural supplement that has been studied in women suffering from endometriosis and found to decrease menstrual pain, pain with intercourse, defecation and urination, in addition to better sleep!   Pycnogenol is an antioxidant derivative from the bark of a French maritime pine tree. One study compared pycnogenol to a conventional treatment of endometriosis called gonadotropin-tropin releasing hormone agonist (GnRHa), a medication that helps to stop the production of estrogen, which then deprives the endometrial lesions of estrogen causing them to become inactive and degrade.  Pycnogenol, in comparison, is better tolerated and has fewer side effects. When compared to a GnRHa, Pycnogenol was found to have longer lasting results in regard to pain reduction while allowing women to maintain normal menstruation and estrogen levels, unlike the GnRHa group.  
This is just a small sampling of the natural treatments that have been researched and found helpful for the management of endometriosis.  One thing to keep in consideration is giving treatments enough time to make a difference in your endometriosis symptoms.  It can take anywhere from 3-12 months to show improvement.  An easy way to track progress is to keep a symptom journal or you can even keep notes on your period tracking apps.  Don’t suffer alone, seek help, ensure that it is endometriosis you are suffering from, and make informed choices as to what is the best treatment(s) for you!
Thank you Dr. Hitkari for this valuable information! For more information on Endometriosis click HERE and for more information on Dr. Hitkari and her practice click HERE.
In good health,
Lisa & Jody
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