Understanding the Depths of Endometriosis: A Functional Medicine Approach to Comprehensive Healing

March is Endometriosis Awareness Month, and as we set on this crucial journey of understanding and support, I am eager to share not only my professional insights into this challenging condition but also my deeply personal experience of grappling with it firsthand.  

For years, I have navigated the physical and emotional toll of endometriosis, enduring debilitating pain that often disrupted my daily life. This experience has not only shaped my professional approach but also fueled my passion to help others facing similar struggles—whether they be family, friends, or now, my patients. My understanding of the impact of endometriosis stems from my personal and professional journey, driving me to offer compassionate and effective care to those in need.

If you're a woman grappling with menstrual cramps, infertility, or irregular periods, you're not alone.  

Understanding Endometriosis

Endometriosis, a distressing gynecological condition, affects between 2-10% of women of reproductive age in the USA. It occurs when the tissue normally lining the uterus grows outside of it. In its natural location within the uterus, endometrial tissues undergo monthly growth in response to hormonal fluctuations, preparing the uterus for potential embryo implantation. If implantation doesn't occur, this tissue sheds during the menstrual cycle, exiting the body through the cervix and vagina along with blood and mucus.

However, in endometriosis, the displaced endometrial tissue remains sensitive to hormonal changes. Because of that, wherever it is located outside the uterus—whether on the ovaries, fallopian tubes, bladder, rectum, or other pelvic or abdominal areas—it continues to grow and shed during menstruation. Unfortunately, this shedding and bleeding outside the uterus becomes trapped within the pelvis, leading to inflammation, potential swelling, and scarring.

Though the exact cause of endometriosis remains elusive, a functional medicine approach emphasizes identifying and addressing root causes for proper diagnosis and symptom management to prevent further disease progression. In functional medicine, it is regarded as a manifestation of inflammation, poor  hormone metabolism, and impaired detoxification pathways. Some practitioners may even classify it as an autoimmune condition.

Signs and Symptoms:

Endometriosis can manifest through various signs and symptoms, with severe pelvic pain and cramping being the foremost and most prevalent indications. This intense discomfort typically occurs around the menstrual period, surpassing the expected level of cramping and often escalating in intensity over time.

Additional common signs and symptoms include:

• Lower back and abdominal pain during the menstrual period
• Excessive bleeding, presenting as heavy menstrual periods or bleeding between menstrual cycles
• Discomfort during or after vaginal intercourse
• Painful urination and/or bowel movements during menstruation
• Challenges with fertility
• Gastrointestinal disturbances like diarrhea, constipation, bloating, or nausea coinciding with the menstrual period
• Profound fatigue

While pelvic pain is frequently the dominant symptom, not every woman with endometriosis experiences extreme pain. Ironically, the severity of pain does not correlate with the severity of endometriosis. Some women with severe cases may feel minimal or no pain, while others with milder instances may endure substantial pain.

Prevalence and Diagnostic Challenges:  

Endometriosis affects up to 10% of American women, with a staggering 70% of those experiencing chronic pelvic pain (nih.gov). Because of the infiltration of uterine cells into the abdominal cavity, it poses diagnostic challenges, often taking years to identify.  

Diagnosing Endometriosis

Endometriosis has overlapping symptoms with other conditions such as irritable bowel syndrome (IBS), ovarian cysts, or pelvic inflammatory disease (PID). This similarity often leads to misdiagnoses.

To accurately diagnose endometriosis, conventional healthcare providers usually employ various diagnostic tools including ultrasounds, MRIs, CT scans, and pelvic exams. They also lean on laparoscopic surgery and hormonal therapies to manage endometriosis symptoms.  

In contrast, functional medicine sees endometriosis as a complex interplay of hormonal and immune factors, sometimes categorized as an autoimmune disease. We explore contributing factors, aiming for comprehensive healing. Functional medicine offers hope by addressing root causes. This comprehensive approach ensures an accurate assessment and facilitates appropriate treatment planning.

Mystery of Endometriosis Causes

While retrograde menstruation, a process where endometrial tissue cells travel through the fallopian tubes and implant in the pelvic cavity, is widely considered a contributing factor, it fails to fully explain the development of endometriosis.

During retrograde menstruation, these displaced tissue cells, despite being outside the uterus, remain responsive to hormonal changes, leading to bleeding during menstruation. Research indicates that retrograde menstruation occurs in a significant portion of women, regardless of their endometriosis status.

This discrepancy suggests that additional factors are at play in the pathogenesis of endometriosis, warranting further exploration and research to unravel the complexities underlying this condition. Genetic predisposition, fetal epigenetic influences, and exposure to endocrine-disrupting chemicals like dioxins and phthalates are crucial factors to consider in endometriosis. At Gandhi Health & Wellness, we thoroughly explore these aspects through detailed patient histories, exposure assessments, and gut microbiome evaluations.  

• Investigating Factors Influencing Endometriosis: Influenced by lifestyle factors such as stress, nutrient deficiencies, and environmental toxins, we aim to positively modulate estrogen metabolism through optimizing nutrition, stress reduction, and detoxification.
• Hormonal Imbalance: Traditionally viewed as an estrogen-dominant condition, endometriosis is now understood to initiate progesterone resistance, subsequently leading to estrogen dominance. This disruption in hormonal balance, pivotal in a healthy menstrual cycle, contributes to various pathologies associated with endometriosis, including infertility. As a first step, we run medical labs for our patients. Understanding estrogen metabolism is crucial in addressing endometriosis.
• Immune Reactions: Emerging research dives deep into the immune system's role in endometriosis. Studies analyzing peritoneal fluid from endometriosis-positive patients reveal inflammatory responses post-retrograde menstruation, shedding light on the immune component of the condition.
• Gut Microbiome: Another intriguing avenue of inquiry explores the relationship between the gut microbiome and endometriosis. Findings indicate notable disparities in gut bacteria between women with and without endometriosis. However, the causal relationship—whether altered gut bacteria contribute to endometriosis or vice versa—remains unclear.
• Genetics: Evidence suggests a familial predisposition to endometriosis, hinting at a genetic underpinning to the condition. Studies exploring familial patterns further underscore the role of genetics in endometriosis development.
• Lifestyle Modifications: Essential lifestyle changes, including adopting an anti-inflammatory diet, stress reduction techniques, and ensuring adequate sleep, play a pivotal role in managing endometriosis. Phthalates, ubiquitous environmental chemicals classified as endocrine disruptors, have garnered attention for their potential association with endometriosis. Research suggests a link between exposure to these chemicals and endometriosis development, highlighting the impact of environmental factors on the condition's pathogenesis.
• Hopeful Alternative: Through a personalized approach involving lifestyle changes, targeted supplementation, and detoxification strategies, individuals can regain control of their health. We will explore interconnected factors contributing to endometriosis.

Managing Endometriosis with Functional Medicine

Functional medicine offers a multifaceted approach to alleviate symptoms and mitigate further progression of endometriosis, acknowledging its complex nature and the myriad factors at play.

1. Anti-Inflammatory Diet: A cornerstone of functional medicine treatment involves adopting an anti-inflammatory diet. Emphasizing plant-based foods rich in fiber and low in saturated fats, while reducing intake of red meat, alcohol, dairy, and sugar, helps combat inflammation associated with endometriosis. Opting for organic produce minimizes exposure to pesticides, aligning with evidence suggesting environmental factors' role in endometriosis development.

2. Incorporating Anti-Inflammatory Herbs: Integrating anti-inflammatory herbs like rosemary, ginger, milk thistle, burdock, garlic, green tea, and turmeric into daily cooking or as herbal teas aids in reducing overall inflammation levels.

3. Omega-3 Fatty Acids Supplementation: Omega-3 fatty acids, particularly EPA found in fish oils, exhibit anti-inflammatory properties crucial for managing endometriosis. Supplementation with omega-3-rich oils such as flaxseed, evening primrose, and borage oil complements dietary strategies to alleviate inflammation.

4. Vitamin D Supplementation: Given the correlation between low Vitamin D levels and endometriosis, supplementation with Vitamin D is recommended. Individualized assessment of Vitamin D levels informs appropriate dosage for optimal management.

5. Environmental Modifications: Addressing environmental factors involves minimizing exposure to plastics, particularly in food and water storage. Transitioning to glass or stainless-steel containers for water and food storage reduces potential exposure to endocrine-disrupting chemicals like phthalates. Using wooden cutting boards in place of plastic is another positive change. Additionally, selecting natural and organic personal care products free from harmful chemicals supports overall health and wellness.

Leveraging Functional Medicine Labs in Endometriosis Assessment

As mentioned earlier in my blog, we typically like to run a thorough assessment, including detailed labs to understand the status of our patients. The labs often include Complete Blood Count (CBC), High-Sensitivity C-Reactive Protein (hs-CRP), Comprehensive Stool Test, Hormone Analysis, CA-125, and others.

Given the prevalence of heavy bleeding in endometriosis, a CBC is instrumental in evaluating anemia, a common consequence of excessive blood loss. Since the pivotal role of inflammation in endometriosis, assessing hs-CRP, a specific marker of inflammation, is imperative for comprehensive evaluation. Given the established link between the gut microbiome and endometriosis, comprehensive stool tests offer valuable insights into the gut microbiome's status, informing holistic treatment strategies for endometriosis patients. We run comprehensive tests to provide insights into estrogen-progesterone balance and hormone breakdown processes. The CA-125 results serve as a noninvasive marker for endometriosis diagnosis. It offers specificity in confirming endometriosis, although a negative result does not rule out the condition. These tests aid in identifying specific chemicals triggering adverse reactions, facilitating targeted interventions to mitigate environmental influences on endometriosis.

Note: CA-125 is utilized in various diagnoses, emphasizing the importance of comprehensive clinical evaluation alongside laboratory testing in diagnosing endometriosis.

Here are my top 10 tips to help you manage endometriosis:

1. Get your labs drawn: To get a comprehensive view into your overall well-being.  

2. Anti-inflammatory diet and blood sugar balance: Incorporate fresh veggies, fruits, herbs, omega-3 fats, and phytonutrients to alleviate pain and reduce inflammation. Choose low glycemic index foods and maintain regular meals with a mix of protein, healthy fats, and veggie-based carbs for hormonal balance.

3. Avoid pro-inflammatory and gluten foods: Say no to caffeine, refined sugar, gluten, dairy, trans-fats, non-organic meat, soy, and processed foods. In fact, a groundbreaking 2012 study, women with endometriosis experienced noteworthy improvements by adopting a gluten-free diet, shedding light on potential dietary interventions (Marziali et. al, 2012).

4. Encourage healthy estrogen metabolism: Consume cruciferous veggies (broccoli, cabbage, Brussel sprouts) to boost detoxification and balance hormonal activity.

5. Low-impact exercises and use a dry sauna: Embrace activities like yoga, tai chi, dry sauna, and walking for immune support, endorphin release, and overall well-being.

6. Prioritize sleep: Ensure a good night's sleep for the body's healing processes and overall health.  

7. Stress-reduction practices: Adopt regular practices like meditation, yoga, dry sauna, or deep breathing to manage cortisol and inflammation.

8. Mindful lifestyle choices: Opt for natural skincare, and organic foods, avoid plastic for food storage, and drink filtered water to support hormonal regulation.

9. Complementary approaches: Consider acupuncture and massage for alleviating chronic pelvic pain, providing a complementary approach to managing symptoms.

10. Nutritional support: Explore supplementation with vitamins (C, E, A), magnesium, essential fatty acids, B vitamins, selenium, and Pine Bark Extract for holistic support. Some of my favorite supplements to manage endometriosis include:
    • RelaxMax® by Xymogen: This blend of ingredients supports the body's natural synthesis of catecholamines, the inhibitory neurotransmitter GABA, hormonal balance, and healthy glucose metabolism. RelaxMax® aims to promote a calm, relaxed, well-balanced emotional and physiological state.
    • Inositol: Consider incorporating Inositol, known for its potential benefits in improving ovarian function and hormonal balance. Inositol is a form of sugar found in your body, in some foods, and as a supplement. Your body needs inositol for the development and growth of cells but research suggests that inositol may have many health benefits such as metabolic syndrome and polycystic ovary syndrome (PCOS), among other health conditions.
    • OptiMag Neuro® by Xymogen: This specialized magnesium formulation can aid in easing pain and cramping associated with endometriosis.  
    • PCO-PX by Restorative Formulations: An exclusive mix of natural compounds featuring Vitex for optimal hormone balance and maintenance of healthy ovarian function, providing general support for the female reproductive system.
    • CDG EstroDIM by Orthomolecular Products: Specifically formulated to support estrogen metabolism, CDG EstroDIM® includes the combined power of two metabolites to support estrogen balance, breast, and even prostate health.

Your well-being matters and these supplements serve as tools that can be tailored to meet your unique needs. However, it's important to note that this is a general guide, and you should always consult with a professional healthcare provider before incorporating any supplements into your routine.

For those navigating the complexities of endometriosis or hormonal disorders, we leverage a functional medicine approach to offer a comprehensive and effective solution at Gandhi Health & Wellness. Our focus goes beyond merely treating symptoms; we dive into the multifaceted aspects of endometriosis, addressing root causes for lasting results.

Should you have specific questions or seek personalized guidance, please do not hesitate to reach out through our patient inquiry form or call us at (561) 247-3311.  

Your well-being is our priority, and we are here to support you on your journey to optimal health.

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About Dr. Kunal P. Gandhi

Dr. Gandhi, a board-certified family medicine practitioner and distinguished functional medicine expert, is committed to uncovering the root causes of illnesses and providing care to patients nationwide. With a comprehensive, root-cause-centered approach, she addresses not just symptoms but foundational imbalances. Drawing from a wealth of knowledge, Dr. Gandhi employs cutting-edge laboratory testing for personalized care, offering specialized detoxification programs, and addressing concerns like intestinal dysbiosis, Lyme disease, and more.