It’s been a rampant time for viral infections lately, and not everyone bounces back that smoothly. While the most notable viral infection in recent years has been COVID, it is not the only infection known to cause long-term health issues.

Approximately 30% of people will experience longer symptoms from viral infections (not just restricted to COVID). Some papers I have found say that long covid symptoms may affect up to 80% of people.

Up to 12 weeks after covid infection is still considered to be post-acute infection symptoms, but longer than this enters the realm of long covid.

This can be an incredibly frustrating and debilitating experience as there is often few answers as to what can be done to help, and like many chronic illnesses is poorly understood. The symptoms can also fluctuate from day to day. It’s not uncommon to feel misunderstood or dismissed.

What are the symptoms of long covid? While not an exclusive list of course, I have listed below some of the more common symptoms I have been seeing in my patients who have experienced a health decline after viral infection. While research is still ongoing, this article reviews some of the symptoms of long covid quite thoroughly.

Common post viral symptoms

• Fatigue
• Brain fog
• Hair loss
• Irregular periods
• Menstrual flow changes (usually as a heavier and/or clottier flow)
• Body aches and pains
• Endometriosis and adenomyosis flares
• Digestive issues
• POTS (postural orthostatic tachycardic syndrome)
• Pain at ovulation
• Increase in cold sores
• Skin changes e.g. acne flare-up, eczema
• Respiratory symptoms, shortness of breath
• Swollen and painful glands

What makes someone more susceptible to a post-viral illness such as long covid?

There is still not enough known about this but your immune function’s ability to clear the virus, genetics, and history of/susceptibility to autoimmune disease will have a role. While long covid can affect anyone, even children, it’s more common in women and those with a history of immune imbalance.

Given what is being learnt about the importance of the mind-body connection, it’s possible that a history of trauma or emotional stress may also have an impact.

How do you know if your health issues are due to post-viral illness? Unfortunately, common tests will not always reveal an answer. Your symptoms may also come and go, which can be incredibly confusing. Blood tests showing the presence of antibodies can give a clue towards this virus still affecting your immune system and inflammation levels to some degree.

It can help to think back on your health and symptom timeline. If you feel that your health went downhill and hasn’t recovered ever since a viral infection there’s a good chance this has an impact.

How do we recover?

Sorry to say, but it depends. It depends on how it’s affecting you, your genetics, and your health history. Consulting with a practitioner will allow you to get an individualized set of recommendations.

While I cannot give individual recommendations regarding herbal medicines or supplements without consulting with someone there are a few general recommendations I can make.

• Work on your breathing technique such as consulting with a Buteyko practitioner.
• Prioritize rest and sleep.
• Work with someone to help process unresolved fears and emotions. Like chronic pain issues, post-viral illness has a strong mind-body involvement and this is an important aspect for recovery for many.
• Keep inflammatory food to a minimum – for most people, this is wheat, and dairy, but for others, it may be a low histamine diet.
• Bring laughter into your life where possible e.g. watch funny videos or comedy shows.
• Spend time in nature.
• Incorporate gentle movement e.g. pilates and stretching.

It can be very confusing navigating the possibilities of treatments. Working with a practitioner can help you to focus on what is best for you.

Hold onto hope and the belief that your body is working to do its best for you.

The post In it for the long haul… recovering from post viral illness appeared first on Alison Mitchell Naturopath.

Guts and Girl Bits Episode #50

As we reach the end of Endometriosis Awareness Month I wanted to release a little recording I made a while ago for women’s health week, in which I spoke about Endometriosis.

Endometriosis is a condition that can significantly affect a woman’s quality of life, however, there is a lack of awareness and understanding of this condition.

It is estimated that 1 in 7-10 women may have this condition, however it can take many years to receive a diagnosis. In this video discuss some considerations of addressing this condition with naturopathic medicine, addressing the root causes of immune imbalance.

Watch the Video:

Listen to the audio:

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Related posts:

Endometriosis

10 Ways to reduce period pain

Updates on Endometriosis

Heavy periods

Choosing the right products for that time of the month

Thrush

Transcript

0:08
Hi, everyone, you’re listening to Guts and Girl Bits. I’m Alison Mitchell, a practicing naturopath and I hope to share with you all sorts of information about women’s health and digestive health to educate and empower you to make informed choices about your own health. Please remember that all information is general and does not replace consulting with a healthcare practitioner.

0:31
It’s the end of March and March is Endometriosis Awareness Month. So I wanted to share a little video that I recorded a couple of years ago for Women’s Health Week as my latest podcast because in that video, I share all sorts of information about endometriosis, and about how to get to some of the underlying drivers that causes it. So I hope that that’s helpful for you. There has been more research coming out since then, as well. But most of the new stuff that I shared in that one is still relevant. So if you want to hear more information, then please subscribe to me on @gutsandgirlbits. And stay tuned as well for all my e courses that are coming out all about how to understand yourself by understanding your cycles and understanding your hormonal balance in more depth, which you can find over at my teachable account, which is gutsandgirlbits.teachable.com

1:30
Hey, everyone, I want to talk about endometriosis today. This is the last day of Women’s Health Week. So I wanted to finish it off by talking about a condition that I really love treating and that’s that’s endometriosis. So if anyone doesn’t know what endometriosis is, basically, it’s a painful condition that affects women. And it affects almost one in seven women approximately. And it can cause quite a lot of issues. So what’s what seems to be happening is that we women get these endometrial cysts, also known as endometriomas, or chocolate cysts, which are basically the content of the lining of the uterus being where it shouldn’t be. So when we normally have our period, what should be happening is that the lining should just you know, break down and dissolve and come out as normal menstrual blood. But sometimes what’s happening is that this isn’t staying in the uterus. This is actually forming little adhesions or cysts elsewhere in the body, such as around the lining around the outside of the uterus or in the fallopian tubes or stuck to the ovaries. And it can also happen in their peritoneal cavity where it’s actually attaching to the intestines, the bowel, bladder and those sorts of things.

2:55
So back up back when I was a student naturopath, we were taught that endometriosis is a condition caused by a hormonal imbalance. But with recent research, what we’ve come to understand is that endometriosis is actually an immune condition or an inflammatory condition. So it does have a hormonal component. There is certainly a hormonal driver behind endometriosis. And that is estrogen, but the immune system is actually the biggest player when it comes to endometriosis. And so there are a lot of different factors that actually feed into why the immune system is disrupted in the first place. But what we what we’re finding is that inflammation, in particular, coming from histamine imbalance, and coming from genetic imbalances and gut health is some of the biggest issues that seem to be driving our immune immune dysfunction. So there’s currently not really a great testing option available for endometriosis. It’s unfortunately something that can only be definitively diagnosed with a laparoscopy, which is a type of keyhole surgery where there will be some small incisions made in the abdomen, abdomen, and then they go in with a little camera. And so if they can see the presence of these chocolate cysts, then that’s confirmative of endometriosis. But the laparoscopy at the same time can be used as a treatment. But that’s not that’s not always the best option for every woman. Because for some women who are particularly inflamed or have a strong immune activation, then the actual incision or the actual surgery itself can actually worsen endometriosis. There, they will find that they might actually get some further adhesions developing where those original cysts were removed. There seems to be more of an issue when the laparoscopy is performed with the laser where it’s actually burnt off rather than incised. And that’s that’s something that again, has only really been discovered recently, but it seems to be

5:00
You know, while it’s a good thing for some women, but not for every woman, and again, it goes to show that endometriosis is a really, really complex condition. And so because of that complexity, everyone needs to be treated a little bit differently. And we need to try and figure out the cause of what’s going on for those women. So there’s a few, you know, possible causes as to why women can have that particular immune imbalance. And one of those things is a gut imbalance, so and or an infection. So if you’ve got an infection, then your immune system is going to be disrupted. And then if you’ve got that genetic tendency for endometriosis to go wrong, then that’s where it’s going to go out of whack for you. There’s some some naturopaths in the field at the moment that are doing research in this and they’re finding that there’s actually a whole different microbiome, which is your bacteria balance within the peritoneal cavity, which is basically the fluid that our organs swim in, and also within the vagina itself within our reproductive organs. And so if they are out of balance, if that microbiome in that area is out of balance, and our immune system is going to be unhappy, and correcting that can be helpful. Dealing with infections can also be really helpful to under to address that underlying imbalance. Now, the other thing that can sometimes happen is because what we know that it’s an inflammatory condition, and there’s an immune imbalance going on, but there’s certain genetics that are involved in that issue. And I find that the mthfr gene, which is a pretty common gene to have, and it doesn’t having the gene doesn’t always mean that there’s an issue, but it’s if that gene is not acting properly, then it affects the enzyme that deals with a lot of different processes in the body. But in regards to endometriosis, in particular, it affects our our main antioxidant recycler, glue to fire recycling of glue to fire. And now, if we don’t have enough antioxidants in endometriosis, then we can’t really mop up all that immune damage that’s going on. So it makes the inflammation worse. And so then, as a result, that makes pain worse. And that can also, you know, make all those other sorts of reactions worse as well.

7:17
One of the things that we also find going on is that mthfr gene affects the detoxification of certain hormones throughout the liver. And if we’re not detoxifying our hormones effectively, then we get that recycling and that uptake of those hormones through through the system, and so then we lead to having too much of certain hormones where they shouldn’t be.

7:41
In the case of endometriosis, what we used to think, as I said before was that it was a excess of oestrogen. But in this case, it seems to be that it’s a displacement of estrogen. So there’s too much estrogen being activated in the area of the endometrial tissue lining going on. And that’s causing a reaction with some of our other immune chemicals. So one of these immune chemicals is histamine. So histamine, can you probably know about histamine as an allergic sort of issue like, you know, hay fever and sneezes and rashes, and, and all of those. Well, when are mast cells, the immune cell that causes the histamine to be in excess is actually in reaction to the estrogen. And that causes more of that inflammatory reaction. And so then, you know, you get the pain and the redness and, and those painful reactions, that’s so common with endometriosis. And as a result of the inflammation that takes place, then when there is that, I mean, immune activation in that area, that’s why we’re more you’re more likely to actually get adhesions forming. And so this can be a really big problem for women with endometriosis is that the adhesions can cause a lot of damage, they can stick for free, you can stick your organs together, you can get the uterus can be stuck to the bow or bits of the bow can be stuck together. It can, you can have the bladder being involved as well. And all of that can cause quite a lot of pain. And it can also affect fertility quite significantly as well.

9:14
Now, and adhesions do seem to have a bit of a problem and that they can only really be resolved with surgery. So as we were talking about before that surgery isn’t certainly a good option for some women, but it’s not not the first line option for every woman. It’s actually better if you can try and get on top of endometriosis in the early days. But the thing with endometriosis is that it’s actually a condition that a lot of people are getting dismissed and missed about, if that makes sense. What I mean is that women are going to and young girls are going to their doctors and they’re complaining of pelvic pain, period pain, and they’re basically getting dismissed and it seems to be about 70% of young women with endometriosis are getting dismissed and that’s a huge number 70% so if we can get on top of this condition in the early days before adhesions formed and things are going to actually work out a lot better for these women what we need to do is we need to have the funding into a better research system but we also need to have more awareness and women need to be more empowered and educated so that they can make make these make these choices make ask the right questions so i think the fact that the main testing method is a form of surgery is probably pretty off putting but we can do a lot in terms of natural treatment and dietary techniques to actually take this under control one of the things we need to do is to get our gut flora and underbalanced under control and we also need to look at reducing our inflammation levels throughout diet for a lot of women with endometriosis one of the main inflammatory things that’s going on is that they intolerant to certain foods and the key food that i find a lot of women are reacting to is is actually dairy or cow’s protein in particular and this can be you know pretty hard to give up for a lot of women but getting that out of the system can make a big big difference now we also need to look at supporting that mthfr gene which is the one that i was talking about before so the mthfr gene basically it works on a particular enzyme which is can never remember the name of it and let me find it – methylenetetrahydrofolate reductase – and basically that works on the conversion of our fault for late into its activated form in the body now it’s more than just taking folic acid in fact if you’ve got issues with this gene you probably shouldn’t be taking folic acid you should be taking different b vitamins or activated b vitamins and so this is where it gets pretty complicated because depending on what you’ve got going on with this whole methylation pathway taking methylated b vitamin can actually make you feel a lot worse because you can be methylating too fast or too slowly and so if you’re methylating too slowly and you take methyls then that’s going to make you feel like help so we don’t want to do that so that’s where you know seeing a practitioner can come in really handy but if you can get your methylation under control that does a few things it brings histamine into balance it improves your detoxification of your hormones through the liver and it can dampen that immune dysregulation and therefore inflamed inflammation that’s going on so those are some really key things that’s going on and one of the other things is that it really really really helps with your glue to fire and recycling which is what you need to mop up all that damage that’s taking place now there are a lot of other things that we want to work on with endometriosis and as we’ve said a few times get that inflammation level under control so one of my favorite things to do is Turmeric. now turmeric does have a little bit of a blood thinning properties so depending on what your your bleeding is like if you tend to be quite heavy bleeder it might not necessarily be the thing there’s something called VAGF which is basically your some women have a higher level of capillary growth to these endometrial lining and certainly doesn’t happen with everyone but actually getting improved mop up of that area can be quite helpful with certain again immune herbes and things like that as well we also want to again work on those antioxidant levels so working on methylation is helpful but herbs and nutrients that will actually help with your antioxidant levels can be helpful to one of those is n acetylcysteine or you potentially taking gluta thione itself but n-acetylcysteine is a lot cheaper and also it can be converted into the body in the body to glorify and so that’s something that can be quite helpful for people as i was talking about before in terms of diet you want to reduce the foods in your diet that you might potentially be intolerant to that could potentially cause some inflammatory reaction for you so those are some things that you want to do and you also want to work on while it’s not hormone only cause to condition it is hormonally affected so if we can work on getting estrogen detoxification under control then that’s going to help with the estrogen displacement that’s going on some people might know that sort of concept as estrogen dominance what’s really happening though is that there’s too much estrogen in the wrong place not that there’s necessarily a lot of estrogen everywhere going on because for women with with this sort of condition they might actually experience some symptoms of estrogen deficiency like you know brain fog or hair loss and skin dryness and thinning and that sort of thing but then in other instances they’re going to be experiencing symptoms of estrogen excess such as their their period abnormalities and or pms symptoms and those sorts of things so again it comes down to the individual so that’s where you know seeing a practitioner can actually be really helpful to get that under control

15:35
so i think i’ve kind of rambled a little bit there that seems to happen when there’s topics that i’m quite passionate about i guess one of the take home points that i really want to say with endometriosis is that we know a lot more about it now we know more about the immune involvement about the inflammatory involvement and so because of that we can actually do so much more for it we can actually get really better treatment happening and so if you know if you if you were seeing a naturopath for endometriosis five or 10 years ago you’d get completely different treatment most of the time now so i would say you know if you want to get some treatment ask your naturopath what they think is the main cause of it what they would do to treat it and if they’re talking about some of these new research that’s going on then give it another try because i have a lot of patients with endometriosis nowadays that i get real good success with and we follow these these routes of look at the infections that might be driving immune imbalance and support methylation support the detoxification of the estrogen but as less of a priority you got to get all those other factors under control get that inflammation down once that see improves things start to get better for them much quicker than it used to back when i first started trading where it would take you know a good half a year’s 12 months maybe to get things much better under control whereas now it’s it’s you know half a year mostly it does always depend on the person always depends on the severity of the condition as well you know for some women their endometriosis is so severe that you know surgery is what is really really required and sometimes even going on something taking something like the marina or getting the marina in is important because that actually helps to improve local progesterone in the uterus and so that can help to improve that imbalance and so if you’ve got less of that estrogen activity taking place then you get to have less of that histamine reaction most of that immune reaction going on so you know one of the first things i would say is get your gut the gut microbiome in the gut and also in the vagina under control is blackmores women’s bio balanced is a product that i do recommend as a retail option there’s also practitioner ones that i use Femex have you know a really fresh diet full of antioxidant rich foods lots and lots of veggies eat your rainbow every day those things are really really important and you also really want to get your stress under control because i mean as you know stress has a big role and a lot of different things so we’ve got this thing called the the hpa axis hpo axis hpt axis where all of our hormones are talking to each other all of the time and if there’s some other things going out of balance for instance our hpa axis which is where our adrenal glands are out of balance that’s going to throw out our hbo axis which is where we’re talking to our reproductive hormones so we want these to be under control and calm so doing some mindfulness and some meditation taking stress herbes taking all your nutrients those are really important too in regards to nutrients i mentioned in acetylcysteine i think that can be really helpful but i also do think that you need to get your core reproductive nutrients under control so that’s firstly get using copper ratio right because excess copper can affect your estrogen levels i also think that you need to get adequate magnesium for your stress levels also to reduce into smooth tissue cramping and calcium is important too you need to have that right ratio going on and i and is is really important so you don’t want to have too much iron because iron in excess can cause oxidative stress which can be inflammatory but if you’re into if you’ve got insufficient levels of iron then you’re going to be more likely to bleed more and that’s going to be a big factor for a lot of women a lot of women with endometriosis have really really heavy blades so we don’t want that that with iron that’s one of the things that i always recommend getting iron levels tested before starting supplementation and get the dose, right? I think vitamin D is important vitamin D is really important for your immune health. And I recommend getting your vitamin D levels over, over 80. You don’t want it to be higher than 150 or so.

20:19
And you also need to be considering things that are going to help to bring down your inflammation levels. As far as Herbs and so I’ve said, I’ve said tumeric, I do love tumeric. But again, you just got to be a little bit careful with it, depending on the periods. And I also think that good quality, facials can be helpful, but the same same sort of thing. Although they do they, we’ve always had this bit of a concern with fish oils is that you know, they can cause they can cause a blood thinning activity, or they could cause excessive bleeding. But some studies that actually measured the amount of bleeding that you create with officials has shown that it doesn’t seem to actually cause that greater quantity. So it’s not like you know, you’re going to bleed out or you’re going to have like massive amounts of blood loss or anything like that. Anyway, so activated B vitamins and stay away from synthetic B vitamins, and try and also stay away from foods that are fortified with synthetic B vitamins too, because while not everyone has this mthfr gene, if that mthfr gene enzyme gets unhappy, regardless of the genes presence or not, then that’s going to cause issues with all of those other factors. So it’s going to cause issues with the histamine, the hormones, the antioxidants. So all of those things that we want to work with. Thank you all so much for listening. I hope that you’ve enjoyed today’s episode. Please join me over at the Guts and Girl bits Instagram page and share any other words of wisdom that you would like to contribute as well. TGuts and Girl Bits now has a collection of E courses that you can view online. The primary course available at the moment is natural menopause support, which provides a whole heap of information on supporting yourself through the major symptoms of metaphors and easing through this transitional life. You can find the collection of E courses at ghttp://gutsandgirlbits.teachable.com. And then you’ll also find a course of understanding underactive thyroid, and coming up soon will be a courses called The Cyclical Woman, Navigating the teenage years, children’s health, nourishing the mother, and more. If you’ve enjoyed today, please leave a review and share this episode to help spread the word. Thank you

The post Endometriosis- Natural Management Options appeared first on Alison Mitchell Naturopath.

Do you have heavy periods? It can be a sign of a deeper imbalance.

Whatever a woman is seeing me for as a naturopath, whether it’s anxiety and stress, tummy issues, weight loss or skin health, I always ask her about what her periods are/were like. That’s because just like the digestive system, the subtle variations of your period and cycle can reveal a lot about your hormonal status and this can have a big effect on overall health.

For instance: Did you know that your balance of progesterone and oestrogen can affect your immune system? And your sleep, your mood, and your digestion? It makes sense when you realise how much your hormones do in your body, that having imbalances in your hormone levels or not ovulating properly (such as in PCOS, amenorrhoea or when using hormonal contraception like the Pill) can have a big flow on effect to the rest of your health.

So if your period is not regular, goes for too long, or is too heavy, clotted or painful, this can be a sign that something is out of balance. Many women don’t realise that their heavy periods are not something they need to ‘put up with’, and that help is available to them. I have seen herbal medicine and nutrition work well with heavy periods, usually causing a big effect within the space of a few months. In some cases, there may be something more complicated going on (such as a clotting disorder, severe endometriosis or fibroids) which can benefit from conventional medicine alongside natural medicine.

What is a normal flow

Anything greater than 80mL of blood lost in a period (which equates to roughly 16 or more soaked pads or tampons) or a period longer than 7-8 days is considered to be a heavy flow. If you are using a menstrual cup, you can use the markings within this to count how much blood you are losing during your period, however if you are using pads and tampons you can count how many you are filling up. Many women with a heavy flow are put off from the idea of using a menstrual cup because they will have to change it during the day, or are worried about leaking, however this can be backed up with liners or absorbent underwear such as those from Modibodi. I have written about this before here.

If you experience any of these signs, you may have a heavy flow:

1. Having to change a pad or tampon every hour or less.
2. Filling 16 or more pads or tampons each period.
3. Leaking while wearing pads/tampons, despite using a high absorbency.
4. Bleeding for more than 7-8 days
5. Regularly passing clots that are larger than a 50c coin.
6. Needing to change your overnight pad once or more during the night, or leaking through onto the bedsheets.

If you need to back up your menstrual cup or tampon with a pad, consider using period absorbing underwear. They are designed with technology that helps to wick moisture and smell, and can be a much more comfortable option for women who dislike wearing pads. They’re also environmentally friendly!

Got Clots?

Why so heavy?

Iron deficiency

Oestrogen dominance

Clotting disorders

Some clotting disorders can cause a women to experience very heavy periods. If your periods are heavy from menarche (when you first got your periods) it is a clue you may have a genetic clotting disorder, for example von Willebrand’s disease. If you have a family history of this condition or you have had heavy periods from a teenager, it’s a good idea to get yourself screened by your doctor for this condition, as specific medication may be required.

Fibroids

Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=fibroid of the broad ligament

Fibroids are a non cancerous growth within or attached to the outside of the uterus that can range in size anywhere from the size of a pea to the size of a melon.
They are not fully understood but often will respond to hormonal treatment that reduces oestrogen excess, along with herbs that target the excess tissue growth.
Depending on the size and location of the fibroids they may need to be surgically removed, for instance if they are in a position that blocks the cervix affecting fertility. A lot of the time fibroids will not cause any significant problems and may not need treatment.

Menopause

All women experience menopause differently, and for some they may find that their periods become very heavy in the early stages of menopause. This may respond to uterine astringent herbs in addition to herbs to support the menopausal transition (commonly this may be herbs to help with stress and oestrogen balance).

What to do about it

Address the cause

It’s always a good idea to rule out serious issues first, so see your doctor for a pap smear, and potentially further testing such as an ultrasound and a blood test that can look for clotting issues, iron deficiency or other causes of heavy bleeding. Having identified the cause, you can begin to fix the problem with natural, and/or conventional medicine.

For some people the bleeding is SO heavy that an endometrial ablation may be necessary. This is when the lining of the uterus is destroyed and removed, so that a the periods are much lighter or absent. This is not ideal if you are wishing to have children, have had a caesarean section, or cancer of the uterus, cervix or endometrium.

Herbal medicine

CC BY-SA 2.5, Link

If you want to reduce your heavy periods without surgery or going on the pill, you can consider using herbal medicine. It’s best if you can see a herbalist or naturopath who can guide you through the process of addressing the cause of the heavy bleeding and can make a herbal formula specific to you. There are herbs that can help heavy periods such as Shepherd’s Purse, Beth Root, Tienchi Ginseng and Squaw Vine, can be helpful to reduce the heaviness of the bleed.

How long will treatment take

I find that heavy periods will typically respond to herbal medicine within the first cycle with a slight reduction of flow, however it may take a few months to achieve a more “normal” flow. This may be longer if the bleeding is caused by a condition such as endometriosis or fibroids.

The post Heavy Periods appeared first on Alison Mitchell Naturopath.

Insights from the Endometriosis Symposium

I recently attended the ATMS Endometriosis Symposium, and boy did I nerd out. I have always had an interest in women’s health and period pain, having dealt with my own personal issues in this area but also because I have seen countless women who were dismissed, told to ‘put up’ with their pain, or given medication that the woman didn’t feel comfortable with.

During the seminar I went from feelings of excitement about the emerging research and treatment possibilities, to frustration that there is still so much we don’t know, to sadness about the extent to which this condition can affect a woman’s life, and anger at the issues women face in seeking effective diagnosis and treatment. A key statement during this Symposium was that women with endometriosis were frequently ‘missed and dismissed’.

What is Endometriosis?

For those that have never heard of endometriosis before, it is a condition that is currently considered to be an inflammatory disease where women can experience extremely painful periods, and 1 in 3 women with endometriosis have fertility difficulty. It is diagnosed when the tissue that is normally present in the lining of the uterus is present elsewhere, such as within the pelvis however it can possibly travel elsewhere in the body.  The only way to definitively diagnose endometriosis with via a laparoscopy, a surgical procedure, however for many women the diagnosis of endometriosis is suggested without having a laparoscopy, particularly is the risks associated with the surgery outweigh the benefits of the diagnosis.

I have written about endometriosis before here, however I would like to expand on some of the points made previously and discuss some of the newer information I received from this seminar.

A key point to remember is that endometriosis is a complex condition that we still don’t 100% understand or know the best treatment for, however we do know that holistically addressing the condition by working on it like a jigsaw puzzle provides better results.

The importance of a good laparoscopic surgeon, and excision vs. ablation.

One of the key speakers, Professor Jason Abbott who is one of the leaders of surgical treatments for Endometriosis in Australia imparted the importance of seeking an advanced laparoscopic surgeon if choosing to undergo a laparoscopy, and discussed his preference for excision (cutting) rather than abalation (lasering off of tissues), something that will hopefully become more commonplace as research supports this as well.

Neither pregnancy nor hysterectomy will cure endometriosis

If you’ve got endometriosis, chances are you’ll be told to get pregnant to cure the condition. Or maybe to have a hysterectomy.

Well unless either of these options are just what you want to do, don’t rush into it! It seems that neither option really provides long lasting relief, as the underlying causes of the condition will not be addressed and symptoms can come back, or still exist.

In the case of pregnancy, many women will find that not having a period for 9+ months is a welcome relief, and the hormonal and immunological shifts that occur during pregnancy also allow many endometriosis symptoms to ease. But the condition can come back, especially if the condition is driven from an imbalance in your immune system or pelvic muscles.

A hysterectomy should theoretically address endometriosis, but unfortunately many women with endometriosis experience problems that aren’t directly related to their period and so these issues can remain. Bowel problems, muscular problems and hormonal imbalances can still persist.

Nerve or Muscular issues in the pelvis can drive endometriosis

Having worked alongside osteopaths my entire naturopathic career I am well versed in the impact that tight muscles or structural imbalances can have on internal health. Seeing the ways that pelvic muscle tightness and nerve signalling issues can contribute to endometriosis was a lightbulb moment, as for many of my patients I have felt there was something ‘missing’ in my understanding of their complete picture, and I think this was it.

A physiotherapist who specialises in women’s health can assess the internal muscles of the pelvis to assist with conditions such as vulvodynia (pain in the vulva), dyspareunia (pain during intercourse) and dyschezia (pain with bowel motion), but it can also be extremely helpful for those with endometriosis. In my clinical experience I have also found that chronic vaginal and bladder infections may benefit from a women’s physio, as tight pelvic floor muscles can cause ongoing inflammation and tension which affects the bladder from eliminating properly.

think about what a muscle cramp in your foot or your calf feels like, then imagine this feeling as happening inside your pelvis or the vagina. The normal contraction and relaxation of a muscle allows blood to flow through, but if the muscle does not effectively contract and then relax it can cause hypoxia (reduced blood flow) which is itself very painful, and it also makes the pH of the muscle more acidic. In itself this can cause pain, but the lightbulb moment for me was realising the way this sort of issue can feed, and be fed by the inflammatory nature of endometriosis.

The constant pain in the pelvis that occurs in something like endometriosis can sensitise the nerves, so that even things which aren’t normally pain can become unbearable. The sensitised nerves can make you more likely to get pelvic pain, period pain and bladder pain, and there is actually an increase of inflammatory chemicals being produced, which worsens endometriosis, an inflammatory based condition.

On a side note, vulvodynia and dyspareunia, like endometriosis is an issue that many women feel ‘missed and dismissed’ about. These problems can have big impacts on a relationship. There may be an issue with the skin such as in chronic candida or lichen sclerosis  or there may be nerve sensitisation worsening the muscle spasms and pain signalling. If you experience these issues, or if your pelvic pain occurs at times other than ovulation and menstruation, consider that there may be a muscular component. If you experience pain when your bladder is full, then again when you have finished weeing, or pain during intercourse, a women’s physio may be able to help you.

Women with Endometriosis have a different type of immune system

There are many different types of cells with different responsibilities within our immune system, and the interplay between all of these can determine whether someone can fight off infections well, or if they are more prone to inflammatory type reactions. For women with endometriosis there have been an increase of some types of immune cells and inflammatory chemicals observed, and less activities of some immune cells which are responsible for ‘keeping things in check’. Interestingly, there is also communication between the hormones progesterone and oestrogen and our immune cells, and as women with endometriosis tend to experience progesterone resistance, the type of immune cells that these hormones normally work on are not able to be reined in.

Bacteria may affect endometriosis

The balance of bacteria within our digestive system has a dramatic effect on our immune system. Normally it can affect things such as how well we can fight off infections or whether we are likely to experience an allergic reaction, however for women with endometriosis there is also a reaction that occurs that worsens their inflammation.

On the coating of some bacteria there are substances which can break off, and the immune system reacts to this by releasing a lot of inflammatory chemicals. This substance is known as endotoxins, or lipopolysaccharides (LPS) and has been shown to be present in higher quantities in women with endometriosis, and the LPS works hand in hand with the higher levels of oestradiol  to then increase certain inflammatory chemicals.

The link between the gut bacteria and hormonal actions and subsequent severity of endometriosis is interesting. If there is an imbalance of good and bad bacteria (dysbiosis) which is very likely for those with endometriosis, it appears to be a key player that needs to be addressed for a holistic approach to endometriosis.

One of the papers referenced suggested that “there may be a direct link between pathological changes of the gut microbiota and the onset and progression of endometriosis”.

Addressing the gut bacteria can improve the severity of endometriosis, as this reduces inflammation and improves immune regulation. Specifically, using herbs that are antimicrobial to gram negative bacteria (such as those containing berberine) and using herbs and nutrients to support digestive lining health and motility, as well as promoting the presence of good bacteria are helpful treatment aims.

The role of histamine

Histamine is a chemical that works in a lot of different areas in the body. It acts a neurotransmitter affecting mood, and it is involved in immune and inflammatory responses. It’s well known for it’s role in allergic responses, causing dilation of blood vessels and stimulating white blood cell activity.

Histamine also has a role in endometriosis and period pain, as high levels of histamine stimulation oestrogen, and also feed the growth of dysbiosis. Oestrogen feeds back into this cycle by reducing the DAO enzyme, which is responsible for clearing histamine, and stabilising mast cells, one of the main white blood cells involved in the histamine response. There is also a stimulation of a chemical called VEGF (vascular endothelial growth factor) which causes the endometrial cysts to grow faster, and attracts more inflammation.

Methylation, involved yet again

Once again, methylation rears its head and as player. I have spoken about methylation before here and here, and while I consider it important to understand the role it has when not working properly, I firmly believe that addressing methylation by itself won’t solve everything.

Problems with methylation can worsen inflammation pathways, and dysbiosis can worsen methylation. Methylation problems can also affect oestrogen levels, histamine processing, and sensitivity to chemicals and toxins (such as mould, viral infections and parasites), all of which affect dysbiosis, immune balance and the inflammation levels.

Where to go from here?

It may seem confusing and overwhelming, realising how much is going on that needs to be addressed. That is completely understandable, but if you are able to find a naturopath or other health care practitioner that can help you, they will be able to guide you in your health journey. Ideally, having a team of practitioners such as a GP, a naturopath, a women’s physio, an acupuncturist and a gynaecologist and/or advanced laparascopic surgeon will mean that you are getting all your bases covered.

The first thing that should be address is pain. After the level of pain is scaled down to a bearable amount, then looking at the drivers of the condition such as gut health, diet, immune imbalance, infections, methylation, stress etc can be done.

Not everyone may want to or be able to afford the testing that can be done to get a clearer picture of the underlying imbalances and that’s okay. Your practitioner should be able to get a lot of information and ideas as to what needs addressing from a thorough case history.

The decision of what form of treatment to use is also very individual, and entirely up to you as the patient. I have not gone into detail about the forms of treatment, but there are many different options in terms of natural medicine, a variety in conventional medicine as well. Natural medicine can potentially be used alongside conventional medicine, or on its own. This is always something that is best discussed with your health care practitioner.

Resources:

Endometriosis Australia

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