Endometriosis: A Key to Healing Through Nutrition. Michael Vernon

Such an ‘intracellular’ source of oestrogen could help to explain why some women’s endometriosis does not respond to the standard drugs which reduce oestrogen production from the ovaries. It could be said that endometriotic tissue is very devious. It could be perpetuating its own growth by making its own home-grown supply of oestrogen.²⁷ Remember too that every fat cell as well as the adrenal glands and the ovaries also produce oestrogen. The key is how the digestive system excretes the oestrogen.

      When the progesterone produced by the corpus luteum in the ovary stimulates the cells of the womb endometrium to become more secretory, the endometriotic implants also start to secrete large amounts of proteins, carbohydrates, fats and oils (lipids) and hormones. However, the big difference with endometriotic implants is that its secretions are not contained safely within the womb and excreted out of the vagina, but dumped into the abdomen or other areas of the body. The delicate organs and tissue inside the abdomen do not normally come in contact with these inflammatory secretions.

      Some of these chemical secretions can be quite harmful to abdominal function and possibly to the ova and sperm. For instance, large amounts of prostaglandin E (PGE) and prostaglandin F (PGF) are produced by the endometrium and the endometriotic implant. PGE stimulates excruciating pain. Laboratory technicians who accidentally expose a cut or the mucous membrane of their nose to prostaglandin E feel severe pain for hours, and sometimes days, after the contact. Prostaglandin F can cause increased gut motility (causing irritable bowel syndrome) and stimulate diarrhoea. Prostaglandin F can also shut down the function of the corpus luteum and interfere with the reproductive cycle by reducing progesterone output. Thus, the pregnancy would fail. Balancing the anti-inflammatory and pro-inflammatory prostaglandins seems to be another of the keys on the road to reducing inflammation and pain. This balance is dependent on the quality of fats and oils which we take into our body, and on our absorption of zinc, magnesium, vitamin B6 and biotin, as these four nutrients are all involved in the metabolism of oils.

      There is no medical cure for endometriosis. The primary reason for this is owing to the fact that the cells of the endometriotic implant respond to the same cues and chemical messengers as the uterine endometrium. If researchers developed a chemical or physical agent that destroyed the cells of the endometriotic implant, it would also destroy the endometrium lining the womb which would have very serious consequences for fertility. What we need to do is find the differences between womb endometrium and endometriotic implants so that we can destroy the endometriotic implants without harming the endometrium.

      APPEARANCE OF ENDOMETRIOSIS

      Not only does endometriosis appear in multiple sites within the body, it can also have a different physical appearance depending on its biochemical status. Several researchers have attempted to classify endometriosis by the appearance of the implant and some classification systems list over 30 types of endometriosis! Dr M W Vernon of the Woman’s Hospital of Baton Rouge, Louisiana, USA, has developed a simplified classification system of endometriosis to explain the different physical appearance and biochemical status of the endometriotic implants.²⁸ In this system the implants are divided into three types:

      1 Red or petechial implants. The first type owe their bright red appearance to a rich blood supply and look rather like a blood blister. These implants are the most biochemically active implants and may be the major culprit in the symptoms of endometriosis (i.e., pain and infertility), as they appear to secrete proinflammatory prostaglandins and the hormone oestrogen.

      2 Brown or intermediate implants. These endometriotic implants look exactly like the fluffy, reddish-brown endometrium of the womb. They are less biochemically active than the red implants and are therefore called intermediate implants.

      3 Black or powder-burn implants. These implants are virtually biochemically inactive. They have a poor capacity to secrete hormones, and they are associated with the formation of connective tissue that causes adjacent organs to become attached to each other (i.e., adhesion formation).

      Adhesions can literally tie up organs, like the intestine, and cause serious gastrointestinal problems. Stretching these adhesions may also stimulate pain receptors on nerve endings. Adhesions are usually formed from sticky blood strands that set and harden between organs. The organs can then be pulled out of alignment. This tugging may cause sharp pain. The triggering of pain impulses and the production of the PGE proinflammatory series two prostaglandins directly by the implants may be the major cause of the pain associated with endometriosis, especially where the bowel may be attached to the ovary or uterus. Many women reading this book will understand exactly how excruciating that pain can be.

      When a woman has endometriosis, the endometriotic implants are usually found in multiple locations in the body and all three types of endometriotic implants can be present at the same time. To help physicians determine the relative severity of the disease, the American Society for Reproductive Medicine (ASRM) has developed a classification system for endometriosis that has been used worldwide. This classification is based upon a scoring system that reflects the size, number and location of the endometriotic implants. Dependent upon the final score, the severity of a patient’s disease is classified into one of four stages (see Appendix A):

       Stage I or minimal disease

       Stage II or mild disease

       Stage III or moderate disease

       Stage IV or severe disease

      The ASRM classification system has recently been revised by a group of international scientists, and the new revised system also incorporates the three types of endometriotic implants into disease assessment (see Appendix A). It also records the percentage of the three types of implants, as well as the size, number and location of the implants.

      In the future, most physicians who directly examine endometriosis through surgery will be able to classify the severity of the disease by ascertaining the stage of disease and the percentage of the incidence of the various types. Your gynaecologist should be able to tell you exactly what your implants look like. Ask about this! It is important that this information is in your notes if you change consultants.

      The question arises as to how can such an important tissue as the endometrium turn into such a villain when it grows outside the womb and what can we do about it. The best way to elicit change is by helping the endocrine glands to send the right message, and to ensure that the immune system is working effectively to remove the rogue endometriotic implants and that the digestive system is excreting oestrogen correctly.

      DIAGNOSING ENDOMETRIOSIS

      The two major symptoms of endometriosis are pain and infertility. Unfortunately, to many doctors these symptoms sound vague and in themselves do not present definitive evidence of the presence of endometriosis. The pain that most women with endometriosis feel may be similar to the pain from a long list of medical problems, including extreme uterine cramps, gastrointestinal bloating (causing painful distention), childbirth contractions, stomach ulcers, pelvic inflammatory disease, kidney dysfunction, irritable bowel disease, diverticulitis, vulvadynia, cystitis and bladder infections and many others. Similarly, it is difficult to determine from a physical examination whether a patient is infertile due to endometriosis or some other reproductive problem (unless large lumps of endometriosis are palpable, but these could also be mistaken for fibroids or ovarian cysts). The only definitive proof of the presence of endometriosis is through direct observation, which means surgery.

      To diagnose endometriosis, a doctor can look surgically for the disease via laparoscopy or laparotomy (see also chapter 6 for information on these procedures).

      LAPAROTOMY

      Laparotomy is a surgical procedure involving a 10–12cm (4–5in) abdominal incision and exposure of the peritoneal cavity. This is a very invasive procedure and is often unnecessary.

      LAPAROSCOPY

      Laparoscopy or ‘belly-button surgery’ is the second and preferred surgery (see