Endometriosis and Adenomyosis: What They Are and How Functional Medicine Can Help

If you’ve ever struggled with painful periods – or know someone who does – you know how debilitating they can be. Both endometriosis and adenomyosis are known for causing painful menstrual cycles and they could be to blame.

Endometriosis affects around 10% of women globally, while adenomyosis affects up to 20% of women. While there are many similarities, both endometriosis and adenomyosis are unique. We’ll look at each, but first a quick overview of the female reproductive system.

The Female Reproductive System

For a woman without endometriosis or adenomyosis, the menstrual cycle occurs about every 28 days on average. Each month, the ovaries produce an egg (follicle). That egg is released and transported through the fallopian tube to the uterus. At the same time, the uterine lining thickens in response to normal hormone fluctuations. This uterine lining is called the endometrium. If the egg is not fertilized, the endometrium is shed signaling the start of the menstrual cycle.

Endometriosis

Endometriosis is an inflammatory process where the endometrial tissue grows outside the uterus. Fragments of the endometrial lining develop in other places such as the fallopian tubes, ovaries, small and large intestines, bladder, or abdominal and pelvic walls, and rarely faraway places like lung tissue. During each menstrual cycle, this aberrant tissue swells and breaks down, which is the root cause of symptoms. 

Symptoms of endometriosis can include:

• Severe menstrual cramps
• Increased menstrual bleeding
• Painful bowel movements
• Painful intercourse
• Abdominal Pain
• Infertility

The cause of endometriosis isn’t fully understood but involves inflammation, altered immunity, genetics, environmental toxins, and excess estrogen. Treatment focuses on symptom management or, in some cases, surgical removal of endometrial lesions.

Adenomyosis

Adenomyosis is another painful inflammatory condition of the female reproductive system. In adenomyosis, the endometrial tissue grows into the uterus muscle (myometrium). This causes the uterus to get much bigger than normal.  There is also an abnormal intrauterine response to progesterone due to downregulation of those receptors, and increased expression of estrogen receptors making the local environment in the uterus estrogen dominant and thus worsening symptoms. There is also abnormal generation of blood vessels in the uterus as well. 

While symptoms are not always present, they can include:

• Heavy periods with clots
• Painful menstrual cramps
• Pelvic pain
• Painful intercourse
• Infertility
• Anemia and iron deficiency secondary to blood loss during period cycles

Endometriosis and Adenomyosis: What’s the Difference?

The difference between endometriosis and adenomyosis lies in where the endometrial tissue grows. With endometriosis, the endometrial tissue grows outside the uterus. It can involve the bowel, ovaries, fallopian tubes, or the pelvic and abdominal side walls. Adenomyosis is when the endometrial tissue grows into the muscle of the uterus. 

How Do I Know if I Have Endometriosis or Adenomyosis?

Both endometriosis and adenomyosis are often difficult to diagnose. There’s no easy blood test. Many times, symptoms are the only thing a provider has to go off of. But additional diagnostics can include:

• Pelvic exam
• Transvaginal ultrasound
• Imaging such as an MRI
• Uterine Biopsy
• Laparoscopy

An official diagnosis of endometriosis is confirmed through laparoscopy, where a scope is inserted through a small abdominal incision. This allows the surgeon to look for endometrial tissue outside the uterus. In some cases, a biopsy is also done of this tissue. 

Conventional Treatment of Endometriosis and Adenomyosis

In conventional medicine, endometriosis and adenomyosis are treated using birth control, NSAIDs, and potentially surgery. Birth control reduces hormones that regulate ovulation and the menstrual cycle. While it does not get rid of endometrial tissue that’s already present, it can help reduce further growth of lesions and relieve pain.

Pain is controlled with non-steroid anti-inflammatory drugs, such as ibuprofen, which can be truly helpful in both diagnoses. 

Surgery is performed in some cases to remove endometrial lesions, and/or to do a hysterectomy (removal of the uterus). 

But conventional medicine falls short of creating a comprehensive strategy for further symptom relief. Let’s look at some of the functional medicine approaches to endometriosis and adenomyosis treatments.

The Functional Medicine Approach to Endometriosis and Adenomyosis Treatment

Nutrition

Eating an anti-inflammatory diet supports general health, but it also helps with inflammation caused by endometriosis and adenomyosis. While additional research is needed to learn more about the effect of nutrition on symptoms, some studies have shown a positive effect of dietary interventions on symptoms. Eating a whole foods diet and limiting processed foods is a great place to start.

Sleep

Poor sleep quality is associated with pelvic pain in women with endometriosis. By improving the quality of sleep, one study found that the inflammation and pain related to endometriosis improved. Getting quality sleep each night is essential!

Exercise and Stress

Physical activity has many benefits. One is the ability to achieve exercise-induced pain relief. Exercise improves the quality of sleep, reduces stress, and provides anti-inflammatory benefits. Not just a benefit for general health, it supports effective pain control. Finding an activity, you enjoy is a great place to start.

Toxin Reduction

Toxins are all around us. Many of them are hormone-disrupting and exposure can impact health. Some studies have found that these toxins may even play a role in endometriosis. Unfortunately, toxins are all around us. Common ways to be exposed to toxins are in household cleaning products, plastic, and even food. 

Here’s how to reduce toxin exposure and improve detoxification:

• Sweat often to support detoxification (Infrared sauna use is a great way to increase detoxification)
• Use natural household cleaning products
• Use toxin free personal care and skin care products 
• Eat organic when you can, especially the dirty dozen
• Make sure your fiber intake is 30 grams per day or higher
• Ensure a daily bowel movement
• Drink half your body weight or more of clean filtered water
• Avoid heating up food or beverages in plastic (use ceramic, glass and stainless steel)

Balancing Hormones

Endometriosis and Adenomyosis are associated with estrogen dominance. With an excess of estrogen, a deficiency of progesterone can also occur. Both hormones help to regulate the menstrual cycle and cause the lining of the uterus to thicken. When they aren’t in balance, things don’t work as they should.

Balancing hormones through lifestyle modifications can be successful when done consistently over time. Estrogen detoxification is one thing to focus on to support hormone balance. 

Tips for estrogen detoxification:

• Increase your fiber intake (see above)
• Increase intake of cruciferous veggies (like broccoli and brussels sprouts)

• Regular exercise, including cardio and weight training
• Reduce stress
• Limit processed foods and alcohol
• Reduce sugar intake
• Lose excess body fat
• Get high quality sleep
• Use herbs and seeds in cooking such as rosemary, mint, chives, sage, flax, pumpkin, and chia seeds

Many of these lifestyle changes also support a healthy metabolism, helping to balance estrogen and progesterone.

Supplements for Endometriosis and Adenomyosis:

NAC

N-acetyl cysteine increases glutathione, a strong antioxidant and aids in detoxification. Studies even show that NAC can help with endometriosis in the ovaries by reducing the size of cysts.

Curcumin

Curcumin, an extract from turmeric, has both anti-inflammatory and antioxidant properties. One study showed that supplementation with curcumin may help alleviate symptoms of endometriosis. 

Milk Thistle

Milk thistle is a plant with anti-inflammatory and antioxidant properties. It helps reduce inflammation and supports detoxification. Taking a milk thistle supplement can also support your liver in detoxifying estrogens and toxins. 

Sulforaphane

Sulforaphane is found in cruciferous vegetables like cabbage and broccoli. The supplement improves endometriosis by decreasing inflammation and inhibiting endometrial tissue growth. 

DIM

Diindolylmethane, or DIM, also comes from cruciferous vegetables. It supports the elimination of excess estrogen by metabolizing estrogen into smaller fragments. These fragments are then easier to remove. It also supports metabolism of estrogens down a “healthier” 2-hydroxy pathway and away from an inflammatory and DNA damaging 4-hydroxy pathway. 

Fiber

Increasing fiber levels reduces estrogen levels. It also supports healthy digestion and bowel function. Since excess estrogen leaves the body through the bowel, increasing fiber can help with hormone balance.

Painful Periods? We Can Help!

You don’t need to live without hope. Functional medicine can help. Painful periods don’t need to be your reality. If you or a loved one is struggling, our team of high-trained functional medicine providers can help. Get in touch here to make your first appointment.

Resources:

https://my.clevelandclinic.org/health/diseases/14167-adenomyosis#:~:text=The%20difference%20between%20these%20conditions,pelvic%20side%20walls%2C%20or%20bowel.

https://my.clevelandclinic.org/health/articles/9118-female-reproductive-system

https://www.medicalnewstoday.com/articles/birth-control-for-endometriosis#how-does-it-work

https://jcsm.aasm.org/doi/10.5664/jcsm.8464

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950373/

https://pubmed.ncbi.nlm.nih.gov/20185384/

https://www.ewg.org/foodnews/dirty-dozen.php

https://www.merckmanuals.com/home/women-s-health-issues/biology-of-the-female-reproductive-system/menstrual-cycle#:~:text=Luteinizing%20hormone%20and%20follicle%2Dstimulating,to%20prepare%20for%20possible%20fertilization.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662115/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560806/