Endometriosis & Perimenopause: Unlocking Relief with Traditional and Functional Medicine Approaches
Endometriosis is a chronic and debilitating condition affecting approximately 10% of women of reproductive age globally. [1] It is characterized by the growth of tissue similar to the endometrium (the lining of the uterus) outside of the uterine cavity.
These endometrial-like tissues can implant on various pelvic organs, such as the ovaries, fallopian tubes, bowel, and bladder, resulting in severe pain and a cascade of other symptoms, including infertility, abdominal bloating, and psychological distress. Endometriosis is often underdiagnosed, and traditional treatments may not fully address the underlying causes of the disease, which is why many women turn to both traditional and functional medicine approaches for comprehensive care.
Pathophysiology and Symptoms of Endometriosis
Endometriosis is complex and idiopathic, meaning the exact cause is unknown. However, the most widely accepted hypothesis is retrograde menstruation, in which menstrual blood flows backward through the fallopian tubes into the pelvic cavity. Other theories include hormonal imbalances, immune dysfunction, and genetic predisposition. Endometrial-like tissue that implants outside the uterus behaves similarly to normal endometrium, thickening, breaking down, and bleeding during each menstrual cycle. However, unlike menstrual blood that exits the body, this displaced tissue remains trapped, causing inflammation, the formation of scar tissue (adhesions), and cysts known as endometriomas.
Women with endometriosis often experience severe menstrual pain, pain during intercourse, and difficulties with urination and bowel movements. The inflammation caused by endometrial lesions contributes to abdominal bloating, nausea, fatigue, and even psychological symptoms such as depression and anxiety . This disease significantly affects fertility, and women with endometriosis may experience challenges conceiving due to the anatomical distortions that lesions can cause, especially in the fallopian tubes .
Traditional Medicine Approaches
Traditional diagnosis of endometriosis relies on clinical evaluation, imaging techniques, and surgical interventions. Pelvic ultrasound, either transabdominally or transvaginally, is a common first step, although it may not detect superficial or minimally invasive lesions . The definitive diagnosis is often made through laparoscopic surgery, which allows for direct visualization and biopsy of the lesions.
Pharmacological treatments in traditional medicine generally focus on hormone suppression to control the symptoms of endometriosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for pain relief, while hormone-based therapies target the hormonal regulation of the menstrual cycle to shrink endometrial tissue. Progestins, gonadotropin-releasing hormone (GnRH) analogs, and combination oral contraceptives are the most common hormone therapies used to manage the condition . These therapies work by suppressing estrogen production, which fuels the growth of endometrial tissue, but they come with significant side effects, such as hot flashes, vaginal dryness, and decreased bone mineral density.
A newer class of medications, including GnRH antagonists, helps suppress ovulation and estrogen production while minimizing some side effects through “add-back” therapy, in which low doses of estrogen or progestin are added to the treatment to reduce menopausal-like symptoms .[2] Surgical treatments, including excision of endometrial lesions, are often required when pharmacological therapies fail or when fertility is a primary concern. However, even surgery is not a cure, and recurrence rates of endometriosis after surgery remain high .
Functional Medicine Approaches
Functional medicine takes a more holistic and patient-centered approach to endometriosis, focusing on identifying and addressing underlying imbalances in the body that contribute to the disease. In functional medicine, endometriosis is viewed as an immune dysfunction and inflammatory condition rather than purely a hormonal disorder. The immune system plays a critical role in the progression of endometriosis by releasing inflammatory cytokines that exacerbate lesion growth [3].
Diet and lifestyle interventions are central to the functional medicine approach. Many practitioners recommend eliminating foods that may trigger inflammation, such as gluten, dairy, and refined sugars. Some women may benefit from following a low-FODMAP diet to reduce digestive symptoms commonly associated with endometriosis . Since up to 90% of women with endometriosis also experience bowel symptoms, addressing gut health is crucial. Functional medicine often considers small intestinal bacterial overgrowth (SIBO) as a contributor to the disease, and treating SIBO can alleviate many gastrointestinal symptoms .[4]
Supplements and herbal treatments are also widely used in functional medicine to manage inflammation and modulate immune responses. Curcumin, the active compound in turmeric, has been shown to reduce inflammation and decrease the size of endometriotic lesions by downregulating pro-inflammatory pathways . [5] Zinc and selenium are other important supplements in managing endometriosis, as they support immune function and reduce oxidative stress, which can worsen the disease .
Hormonal Imbalance in Endometriosis and Perimenopause
Endometriosis is often linked to hormonal imbalances, especially elevated estrogen levels. Estrogen promotes the growth of endometrial lesions, which is why many treatments aim to lower estrogen levels. However, during perimenopause, women experience fluctuations in estrogen, progesterone, and other hormones, which can exacerbate endometriosis symptoms in early perimenopause and, in some cases, alleviate them due to the eventual natural decline in estrogen production. This hormonal rollercoaster during perimenopause can further contribute to symptoms such as bloating, mood swings, and fatigue .
The functional medicine approach to managing endometriosis in perimenopausal women includes hormone testing to assess imbalances, followed by tailored treatments to restore hormonal equilibrium. Micronized oral progesterone, for example, is used to inhibit the growth of endometrial lesions and support the body’s natural hormone cycles .
Traditional vs. Functional Medicine: Complementary Approaches
The traditional and functional medicine approaches to treating endometriosis are not mutually exclusive; in fact, many women find relief by combining the two. Traditional treatments are often effective in providing immediate symptom relief, especially for pain, and are essential in advanced cases requiring surgical intervention. Functional medicine, on the other hand, focuses on long-term management, preventing recurrence, and addressing the root causes of the condition through diet, lifestyle changes, and immune system support.
For women suffering from both perimenopause and endometriosis, a comprehensive approach that incorporates both traditional and functional treatments may offer the best outcome. By combining the strengths of both systems — traditional medicine’s ability to control acute symptoms and functional medicine’s focus on prevention and overall wellness — women can achieve greater control over their health and well-being.
Conclusion
Endometriosis is a complex and multifactorial condition with significant impacts on women’s quality of life, fertility, and emotional well-being. Traditional treatments offer essential tools for symptom management and disease control, but they often fail to address the root causes of the disease. Functional medicine, with its focus on holistic and personalized care, complements traditional approaches by targeting inflammation, immune dysfunction, and hormonal imbalances. Together, these two medical philosophies provide a broader framework for treating endometriosis, especially in women who are also navigating the challenges of perimenopause.
REFERENCES:
- Casper, R F. (1991, January 15). Clinical uses of gonadotropin-releasing hormone analogues.. National Institutes of Health, 144(2), 153–8. https://pubmed.ncbi.nlm.nih.gov/1986827
- Khan, K N., Fujishita, A., Hiraki, K., Kitajima, M., Nakashima, M., Fushiki, S., & Kitawaki, J. (2018, January 18). Bacterial contamination hypothesis: a new concept in endometriosis. Wiley, 17(2), 125–133. https://doi.org/10.1002/rmb2.12083
- Nnoaham, K., Hummelshøj, L., Webster, P., D’Hooghe, T., Nardone, F D C., Nardone, C D C., Jenkinson, C., Kennedy, S., & Zondervan, K T. (2011, July 25). Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Elsevier BV, 96(2), 366–373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090
- Park, Y., & Han, S J. (2022, October 25). Interferon Signaling in the Endometrium and in Endometriosis. Multidisciplinary Digital Publishing Institute, 12(11), 1554–1554. https://doi.org/10.3390/biom12111554
- Vallée, A., & Lecarpentier, Y. (2020, March 31). Curcumin and Endometriosis. Multidisciplinary Digital Publishing Institute, 21(7), 2440–2440. https://doi.org/10.3390/ijms21072440
