Everything you need to know about endometriosis and how to relieve it

The first pains can generally appear:

• During menstruation, in particular radiating into the lower back in the sacral region
• During sexual intercourse or when inserting a tampon
• During urination
• When having a bowel movement during your period

Other possible symptoms include colic or diffuse pain in the lower abdomen.

Lorsque des adhérences et des cicatrices apparaissent, les douleurs surviennent de manière plus indépendante du cycle.

Les symptômes varient d’une femme à l’autre, selon les organes touchés.

Ces douleurs au niveau des foyers d'endométriose peuvent également s’accompagner de troubles comme : une fatigue importante, une sensation de malaise, une baisse de l’humeur.

L’endométriose peut s’accompagner également de problèmes d’infertilité, notamment d'une réserve ovarienne faible. En cas de désir d’enfant, si vous rencontrez des difficultés pour concevoir, on peut vous proposer de commencer un parcours PMA (procréation médicalement assistée).

Certain genes may predispose women to endometriosis [5]. A woman is more likely to develop endometriosis if her mother or sister is affected [6].

Toxic substances in the environment, such as dioxin, may also be linked to its onset [7].

There is a "mechanical" cause that may be involved in its development. During a period, most of the blood flows towards the vagina and out of the body. In most women, some blood also flows into the abdominal cavity by travelling back up through the fallopian tubes. This phenomenon is known as "retrograde menstruation". The blood that flows back into the abdominal cavity contains cells from the uterine lining. 

For a long time, retrograde menstruation was thought to be the cause of endometriosis, but this theory is increasingly being called into question, as most women experience retrograde menstruation, yet only 5 to 10% of them go on to develop endometriosis.

Some researchers believe that endometriosis tissue may in fact be present from birth, lying "dormant" until hormones at puberty "activate" it, or that certain women may have abnormalities or dysfunctions in the endometrium itself, or in the environment of the abdominal cavity, which allow the disease to develop[8]. The endometrial cells that have flowed back must indeed adhere, implant, proliferate, and form new blood vessels before endometriosis can be said to be present.

One increasingly studied avenue is the immune pathway [9]. Endometriosis is thought to share many features with other autoimmune conditions [10], in which lesions can establish their own blood supply.

Most of the time, endometriosis goes hand in hand with digestive problems. Approximately 90% of women with endometriosis are affected by irritable bowel syndrome [11]. 

Lesions and adhesions can indeed appear on the intestines, causing digestive problems. At the same time, digestive problems can worsen endometriosis, as our digestion is closely linked to our immune system. When digestion is disrupted, the immune system activates and produces inflammatory cytokines.

A "leaky gut" (when the intestinal barrier becomes too permeable, allowing harmful bacteria to pass through and activate our immune system) can develop. An inflammatory toxin, LPS (lipopolysaccharide, an endotoxin produced by Gram-negative gut bacteria, including Escherichia coli), can then leak into the bloodstream, placing excessive pressure on the liver which, overburdened, becomes unable to manage hormone detoxification. 

This can lead to inflammation and a risk of autoimmune disease [12], and may stimulate endometriosis [13][14].

Analgesics may be used to reduce symptoms.

Endometriosis is primarily an inflammatory condition, not a hormonal one. However, hormones do play a role in its development. The aim of medical treatments is to deprive the body of oestrogen, which promotes the growth of the endometrium and endometriosis lesions.

The first step is to suppress periods, to prevent endometriosis lesions scattered throughout the body from bleeding, which would create further adhesions and contribute to the spread of the condition.

To induce this amenorrhoea, a continuous contraceptive pill may be prescribed, or a levonorgestrel-releasing intrauterine device (IUD) may be fitted.

If this treatment proves insufficiently effective, the next option is to induce an artificial menopause in order to completely suppress ovarian function.

This treatment, using medications known as "GnRH analogues", induces an artificial menopause by inhibiting oestrogen synthesis directly at the level of the pituitary gland, thereby blocking ovulation.

This treatment works by drying out endometriosis foci. It can help relieve pain and prevent the formation of new foci. The use of these treatments temporarily induces a state comparable to menopause, with associated symptoms such as hot flushes and mood fluctuations.

• They are contraceptive
• They do not cure the condition — they simply put it into remission
• They carry significant side effects, including issues such as fertility problems, weight gain, and an increased risk of cancer with long-term pill use
• By inhibiting the natural production of hormones and introducing a significant dose of synthetic hormones into the body, these treatments disrupt the delicate hormonal ecosystem. As a knock-on effect, the production of other hormones is also impacted (see our article on the hidden side of the pill on this topic)

Surgery is the reference treatment for endometriosis as it allows the removal of lesions as thoroughly as possible, especially in the early stages of the disease. In most cases, painful symptoms can disappear for many years, or even completely.

However, results depend on the progression of the disease (it will be difficult to eliminate all islands of uterine lining if the disease has advanced) and on the surgeon's experience. The recurrence rate after surgery is 21% after 2 years and 40–50% after 5 years [15], but in some cases surgery can almost eradicate the lesions. 

During a laparoscopy that will confirm the diagnosis, all visible foci of endometriosis are surgically removed while preserving healthy tissue. This technique requires great precision and is performed using a laser or an electric current.

Preference should be given to unprocessed, organic foods and so-called "anti-inflammatory" foods such as turmeric, foods rich in omega-3s, green leafy vegetables, seaweed and sprouted seeds, for example. 

Conversely, "highly inflammatory" foods should be avoided, such as meats (particularly red meat), gluten-containing cereals and dairy products. 

It should be noted that the ideal diet will remain individual, for example raw foods will not suit everyone. It is therefore advisable to consult a naturopath for personalised guidance.

A New Zealand study examined the effects of a low-FODMAP diet, traditionally prescribed for irritable bowel syndrome, on the symptoms of endometriosis [16]. This diet limits foods containing carbohydrates or sugars described as "fermentable", such as fructans (onions, garlic, wheat, rye, peaches, watermelon), lactose (milk, yoghurt, ice cream, cheese), fructose in excess of glucose (honey, fruit juices, dried fruits...), mannitol (polyol) and sorbitol.

You can also support your liver by regularly eating bitter vegetables such as dandelion, chicory, rocket and artichoke. A sluggish liver that does not eliminate oestrogen efficiently enough contributes to an excess of oestrogen, which in turn contributes to the condition.

Several ways to achieve this: physical exercise, reflexology, breathing exercises, osteopathy.

The pelvic area is freed from pressure to avoid stagnation, in order to reduce the duration and intensity of menstrual pain.

Constipation will be addressed if needed.

Osteopathy for adhesions.

There are osteopaths who specialise in pelvic osteopathy. 

During the session, the osteopath will be able to work on the gynaecological and digestive systems, as well as the lumbar region. The osteopath's role will be to release adhesions.

 They will also focus on stimulating blood circulation and releasing ligament tension that has built up, particularly in the pelvic area, to restore greater mobility to the internal tissues. Relief will come quickly as the body releases endorphins, producing a sense of calm, and the techniques applied will have a lasting effect over time [17].

Endocrine disruptors are often xenoestrogens: they act on our hormone receptors, influencing the processes of synthesis, secretion, transport, storage, release, action or elimination of hormones. They can thus "disrupt" the hormonal cycle.

 So say goodbye to food additives, plastic packaging, and plastic or non-stick coated kitchen tools.

Switch to stainless steel, stone or glass utensils and containers; cook as much as possible from scratch at home; ventilate well every day; move to organic cosmetics, free from BPA, parabens and phthalates; stop drinking water from plastic bottles.` And as a bonus, it does your health a world of good!

You can drink herbal teas made from plants such as yarrow (Achillea millefolium), fennel (Foeniculum vulgare), chamomile (Matricaria chamomilla), or raspberry leaves.

 Yarrow has antispasmodic and anti-inflammatory properties. As a herbal tea: 2 g of flowering tops in 200 ml of water.

Chamomile may also have an anti-inflammatory effect.

Fennel is thought to have antispasmodic properties. As a herbal tea: 1.5 to 2.5 g of crushed seeds steeped in 150 ml of water, to be drunk 3 times a day.

Raspberry leaf herbal teas can be helpful for easing period pain.

Other plants of interest for your menstrual health [18]:

Chasteberry (Agnus castus), which has a progestogenic effect (do not take if you are on the pill!) 

Lady's mantle (Alchemilla vulgaris) is a plant with astringent and haemostatic properties that helps regulate the menstrual cycle and supports progesterone production. Be aware of the risk of constipation.

Or anti-inflammatory plants such as ginger (Zingiber officinale).

For painful periods, a blend of peppermint, clove and clary sage essential oils (30%) can be diluted in sweet almond oil (70%). Apply by massaging onto the lower abdomen three times a day. Peppermint has antispasmodic properties[19]. 

True lavender essential oil and May rose can also be used, as they act on pelvic congestion.

A study assessed the intensity of dysmenorrhoea in women performing a ten-minute abdominal massage with essential oils (n=184) compared to women performing the same massage with a neutral oil (n=178). The results showed an improvement in pain scores from the first days of menstruation in the women in the experimental group.

Be careful with essential oils if you are breastfeeding!

To help relieve endometriosis symptoms, it is important to support your emunctories (liver, lungs, skin, intestines, kidneys), which are responsible for cleansing and eliminating toxins. Think, for example, of dry brushing or various reflexology methods.

Looking after your gut microbiome is key to managing endometriosis. A balanced microbiome helps regulate the immune system and inflammation that are implicated in endometriosis, supports the integrity of the gut barrier and thus helps prevent the "leaky gut" effect (intestinal permeability), and helps regulate circulating oestrogen levels. An insufficiency of "good" bacteria and/or an overgrowth of "bad" bacteria can disrupt these mechanisms and contribute to endometriosis. In particular, intestinal permeability can allow LPS to enter the bloodstream, potentially triggering chronic inflammation that plays a role in the pain associated with endometriosis. To care for your microbiome, you can avoid or limit certain medications that may be harmful to it, such as antibiotics (except when necessary, of course), the contraceptive pill, and anti-inflammatory drugs; reduce stress; reduce or avoid refined sugar (which "bad" bacteria thrive on); eat a variety of fibres (which "good" bacteria feed on) if your digestion allows; avoid foods to which you are sensitive, as these may promote intestinal permeability; and consider supplementing with pre- and probiotics. A healthy microbiome means a healthy immune response and a healthy liver, and an organism better equipped to manage endometriosis.

Zinc is a powerful immune regulator that may help to reduce inflammation. Researchers have highlighted that a zinc deficiency could play a role in the development of endometriosis [20].
Best sources: seafood, liver, lentils: not commonly consumed.

A note on supplementation: do not supplement with zinc over the long term as this can lead to copper deficiency. As a general rule: do not self-supplement and seek advice from a healthcare practitioner. 

Selenium also plays an anti-inflammatory role.

It modulates and normalises the immune response. It is also essential for the production of progesterone, which reduces the growth of lesions (in contrast to oestrogen) [21].
It also plays an important role in thyroid function, which is itself important for regulating the cycle and sex hormones. A study showed that sufficient selenium levels were correlated with a reduced risk of developing endometriosis [22].
Where to find it: Almost everywhere. Just 1 Brazil nut per day is enough to meet your daily requirements.
Please note that too much selenium can be toxic, so do not exceed 200 mcg per day, including from food sources such as Brazil nuts.

Resveratrol is a phytonutrient found in grapes and red berries, among other sources. It may reduce the inflammatory response of cytokines. It may also play a role in regulating aromatase, an enzyme that synthesises oestrogen [23][24].

N-acetyl cysteine (NAC) is an amino acid studied in a recent study for its effects on endometriosis. NAC is a precursor to glutathione, one of the body's antioxidants and an immune regulator. It may therefore have an effect on inflammation. In the study, of the 47 women who received NAC treatment, more than half cancelled their surgery following the disappearance of their pain, their cysts, or the onset of a pregnancy [25]. Caution is advised if you have a stomach ulcer, as NAC may worsen it. Do not self-supplement and seek guidance from a healthcare practitioner.

Curcumin, found in turmeric, may slow the development of endometriosis by inhibiting the activity of certain subtypes of matrix metalloproteinases (MMPs). These MMPs play a role in the process by which endometriotic tissue invades surrounding tissues. It may also have an impact on Nuclear Factor Kappa-B, which is thought to be responsible for inflammation of endometrial cells [26]. Furthermore, it may suppress local oestrogen production at the level of the lesions [27], and inhibit the vascularisation of new blood vessels on the lesions [28]. A word of caution regarding turmeric as a food supplement: people taking anticoagulants should seek advice from their doctor, as is the case with many plants. Avoid consuming it the day before surgery. The EFSA also advises pregnant women against taking turmeric formulas concentrated in curcumin.

A study (randomised controlled trial) was conducted on antioxidant supplementation, as oxidative stress is thought to play a role in the development of endometriosis. One group of women received 1,200 IU of vitamin E and 1 g of vitamin C over eight weeks; compared with patients who received only a placebo, one third of the women in the experimental group reported an improvement in pain [29]. The study also noted a reduction in inflammatory markers.