How To Manage Your Period If You’re An Endo Warrior


The Highlights:


  1. Endometriosis affects more than just the menstrual cycle. In addition to the endocrine system, it also impacts the digestive and nervous systems. So we must tend to them all!

  2. Surgery is really the only treatment available. Most other options help manage symptoms, but they don’t rid the body of lesions.

  3. Severity of endometriosis symptoms and endometriosis pain depend on the severity and location of your lesions, but practicing habits like eating an anti-inflammatory diet, practicing self-care routines and rituals, and tending to your mental health, can only help!



The Full Read:


For many #endowarriors (and there are many: Two hundred million worldwide, according to the Endo Foundation of America) the #struggleisreal. (1) So real in fact, that it is considered one of the twenty most painful conditions according to the National Health Service U.K. We got you.




Quick recap: Here’s Why It’s So Painful


Remember, endometriosis is when tissue similar to that in the uterus grows on neighboring friends like the rectum, pelvic cavity lining, fallopian tubes and ovaries, or more distant places like the intestines or abdomen (which is why endo can also affect digestion).


While that displaced endo tissue may not live in the uterus, it still responds to the hormonal changes of the menstrual cycle. Research shows endo lesions are fueled by, and rely on, estrogen, and therefore grow when these levels rise, especially during your cycle. (2)


While uterine contractions, aka menstrual cramps, help rid the body of the uterine lining it builds each month in the uterus (that’s your period!), those contractions can’t work their magic elsewhere. This means the endo tissue outside of the uterus doesn’t get excreted each month, and stays in the body to disrupt hormonal signals. This leads to heightened inflammation, pelvic pain, and decreased chances of embryo implantation for those trying to conceive. (3)


To make matters worse, the immune system responds by producing substances and antibodies that inflame endo lesions even more, thereby further promoting their growth. (4)


Talk about a vicious cycle.


Endometriosis can affect all bodily systems, but most directly the reproductive, digestive, endocrine/hormonal, immune, and nervous. And these systems are all connected. So, we must give some TLC to them all!




Treatments Available Now

Surgical:

There are three types of surgical procedures to treat the tissue itself: Excision, ablation, or cauterization.

Excision is when a surgeon removes the entire endo lesion(s), including the tissue that grows below the surface. A recent randomized and double-blind study showed that excision reduces symptoms for up to five years. Plus, a review article showed that twelve months after excision surgery, painful symptoms showed a significant improvement, depending on the location of that surgery. (5)

Ablation and cauterization are similar, but ablation uses a laser, whereas cauterization burns the tissue. While these are more common surgery methods, Dr. Heather Bartos, OBGYN shares that they can only remove full lesions if they are superficial. She also adds that this is the only option for those with lesions in certain areas like the bladder or bowels.



Ways to manage symptoms:

Nutrition to feed all systems:

A helpful endometriosis diet is one with fewer inflammation-provoking foods, since there is already so much inflammation thanks to that tissue. You can start by removing from your diet these inflammatory foods:

  • Gluten

  • Dairy

  • Soy

  • Alcohol

  • Sugar

  • Soybean oils and vegetable oils (which are in most processed foods and even salad dressings)

We know this can be hard. But, instead of thinking about everything you are removing from your diet, focus on all the delicious anti-inflammatory foods you can add to your diet to better support your flow and normalize immune function! These include the following.

  • Cooked veggies. Licensed Acupuncturist Laura Erlich shares that raw vegetables can further tax an already-weakened digestion. (6)

  • Soaked nuts and seeds - soaking nuts and seeds before eating (a minimum of 20 min.; we recommend you soak overnight for ease) can help with your already potentially-sensitive digestion, because doing so neutralizes phytic acid and enzyme inhibitors. (6)

  • Small, wild-caught fish high in Omega-3s and/or fish oil. Fat from these sources can help combat inflammation. In fact, consuming this type of fat has been shown to reduce period pain by 30% after two months. (7)

  • Turmeric. Add it to everything (or take a supplement). Turmeric has been shown to reduce the size and activity of endometriosis lesions. (8)

  • A Multivitamin. While you don’t really get to eat this, think of it as insurance that you’re getting enough of the essential micronutrients, such as iron, vitamin D, zinc, the various Bs, and Magnesium, that help support all systems. This helps you get more bang for your buck from the foods you are actually eating! (9)


Hormonal Birth Control

While hormonal birth control does not address the root cause of endometriosis, it is often prescribed to help manage symptoms. Dr. Annie DePasquale, physician partner of Twentyeight Health, shares that they usually recommend progestin-only pills over combined estrogen-progestin contraceptive pills, because progestins have demonstrated benefits in reducing pain and suppressing the anatomic extent of endometriotic lesions. Plus, some researchers posit that people with endometriosis have higher-than-usual levels of estrogen in the first place (which they think promotes the growth of the endometrial lesions in the body). Dr. Bartos also recommends progestin IUDs and Nexplanon (the implant) for the same reason.

Medications

There are two main medications being used to address endo symptoms by helping suppress estrogen production: Orlissa, a new, FDA-approved pill, and Lupron, which is injected. While both have demonstrated success in managing symptoms, neither can be taken indefinitely (meaning, they are not long-term solutions), and both potentially have some real side effects that should be discussed with your care provider if you are considering going in this direction.

Pelvic Floor Physical Therapy

Pelvic Floor Physical Therapy is a deep tissue massage for your pelvis performed by a trained specialist. By holding pressure on certain trigger points, tension can be released both internally (inside the vagina) and externally (hips, back, internal thighs). Pelvic wands are encouraged for patients to use at home for a more internal release. This can really help for those who experience painful penetrative sex.


Reduce environmental toxins

Endocrine disruptors are synthetic chemicals that, as the name suggests, disrupt your endocrine system. One way in which they do this is by mimicking estrogen and impairing estrogen detox -- and, remember, those with endo tend to have too much estrogen already, so this is definitely not what you want. (10)


Certain insulation, oil-based paints, pesticides, mercury, BPA (in plastic), and phthalates (in cosmetics, lubricants, packaging) are common culprits. (11) You may also want to check what your period products are made of.


Try replacing these items with glassware, non-toxic products, and organic foods, where possible. The Environmental Working Group (EWG) is a great resource for this, as their Dirty Dozen report lists the produce highest in pesticides, and their app breaks down toxicity for every household, beauty, and food product. (12)

Mental Health

Endometriosis is taxing physically and emotionally. Carrying out regular tasks like exercising, going to work, having sex...the activities that can typically help our mental health can be more difficult to actually do. Additionally, for those using hormonal birth control as part of their symptom management, there have been studies linking depression as a side effect. (14)

So, it is not uncommon for those with endometriosis also to experience anxiety and depression.

For those who have endometriosis, taking care of your mental health is just as important as taking care of your physical symptoms! In addition to seeking out a cycle-literate therapist, joining community groups for those with endometriosis (like Nancy’s Nook on Facebook) can be a big help.



Best period products actual endo warriors swear by:

  • Be You Period Patches to help relax muscles on the go.

  • CBD rubs, tinctures, and suppositories to help alleviate pain and anxiety. Look for full-spectrum and organic.

  • NSAIDs like Ibuprofen to slow inflammatory response

  • Infrared heating pad. If you’re into crystals, jade and tourmaline stones are said to enable deeper muscle penetration.

  • Period underwear and/or organic pads for those who don’t want any insertables. For those who prefer an insertable option, try menstrual discs.

  • Phendo app to track your symptoms. Plus, the data goes toward more research, and can be downloaded as a chart to share with your doctor.

  • TENS unit. This applies small pulses of electrical stimulation through sticky pads placed on or near the site of pain for external relief.



Best self-care rituals actual endo warriors swear by:

  • Meditation and mindfulness apps

  • Infrared saunas

  • Float tanks (Hey, why not?!)

  • Magnesium and/or Epsom salt baths

  • Gentle yoga

  • Good sleep hygiene!





We know this is a lot to take in. The good news is that all of the symptom management here genuinely feels really good! In fact, everybody would likely benefit from this kind of serious self care. Start simple and build as you go to sustain a lifestyle that actually sustains you. And reach out to the endo community for support!



Written by: Gretchen Decker

Medically Reviewed by: Dr. Heather Bartos, OBGYN




APPENDIX:

  1. “What Is Endometriosis? Causes, Symptoms and Treatments.” Endometriosis : Causes - Symptoms - Diagnosis - and Treatment, 8 Mar. 2020, www.endofound.org/endometriosis.

  2. Kitawaki, J, N Kado, H Ishihara, H Koshiba, Y Kitaoka, and H Honjo. “Endometriosis: the Pathophysiology as an Estrogen-Dependent Disease.” The Journal of Steroid Biochemistry and Molecular Biology. U.S. National Library of Medicine, December 2002. https://www.ncbi.nlm.nih.gov/pubmed/12650711.

  3. Marquardt, Ryan M, Tae Hoon Kim, Jung-Ho Shin, and Jae-Wook Jeong. “Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis?” International journal of molecular sciences. MDPI, August 5, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695957/.

  4. Eisenberg VH, Zolti M, Soriano D. Is there an association between autoimmunity and endometriosis? Autoimmun Rev. 2012 Sep;11(11): 806-14. PubMed PMID 22330229

  5. Orbuch, Iris Kerin/ Stein Amy. Beating Endo: How to Reclaim Your Life from Endometriosis. HarperCollins, 2019. Martin Healy, et al., “To Excise or Ablate Endometriosis? A Prospective, Randomized, Double Blinded Trial After 5-Year Follow-Up,” Journal of Minimally Invasive Gynecology, vol. 21 (2104): 999-1004. J. Pundir, MD, et al., “Laparoscopic Excision Versus Ablation for Endometriosis-Associated Pain: An Updated Systematic Review and Meta-analysis,” Journal of Minimally Invasive Gynecology, vol. 24, no. 5 (July/August 2017).

  6. Bartlett, Emily, and Laura Erlich. “Feed Your Fertility: Your Guide to Cultivating a Healthy Pregnancy with Traditional Chinese Medicine, Real Food, and Holistic Living.” (10, 91). Beverly, MA: Fair Winds Press, 2015.

  7. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Genecol. 1997. Apr; 174 (4): 1335-8.

  8. Turmeric : curcumin as anti-endometriotic agent: implication of MMP-3 and intrinsic apoptotic pathway. Biochem Pharmacol. 202 Mar 15;83 (6) 797-804

  9. Briden, Lara, and Jerilynn C. Prior, MD. Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. Greenpeak Publishing (pg 222, 661)

  10. “Feed Your Fertility: Your Guide to Cultivating a Healthy Pregnancy with Traditional Chinese Medicine, Real Food, and Holistic Living.” 116–18, 162.

  11. Dioxin and Endometrial Progesterone Resistance, Kaylon L. Bruner-Tran. Ph.D. Tianbing Ding, Ph.D., and Kevin G. Osteen, Ph.D. (page 807)

  12. Environmental Working Group; Dirty Dozen

  13. “Endometriosis Stages: Understanding the Different Stages of Endometriosis.” Endometriosis : Causes - Symptoms - Diagnosis - and Treatment, Endometriosis Foundation of America, 29 May 2018, www.endofound.org/endometriosis-stages.

  14. Kulkarni J, Liew J, Garland KA. Depression associated with combined oral contraceptives--a pilot study. Aust Fam Physician. 2005 Nov; 34(11):990. PubMed PMID: 16299641 (page 342)

  15. “Endometriosis.” Mayo Clinic. Mayo Foundation for Medical Education and Research, October 16, 2019. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656.

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