Here’s the bottom line:
Endometriosis is a treatable condition and you don’t have to use drugs or surgery to fix it
(If you want my 10 steps to help you right away jump to the bottom of this article)
Here’s how to treat endometriosis naturally without drugs…
But first, let’s start with some general information.
Understanding Estrogen Dominance
Endometriosis is considered part of the spectrum of ‘estrogen dominance’ which is a condition of too much estrogen relative to progesterone.
Remember that estrogen and progesterone are like yin and yang to one another. To simplify, think of estrogen as a hormone that causes growth (growth of fat cells, breast tissue, and uterine lining) and think of progesterone as a hormone that causes thinning (decreases weight, diuretic, helps burn fat, etc.)
As you might suspect, the symptoms of estrogen dominance include all of the symptoms you would see when a woman has too much estrogen: PMS/PMDD, painful and prolonged menses with heavy flow, breast tenderness, fibrocystic breast disease, uterine fibroids, weight accumulation on the hips/butt/thighs and of course endometriosis.
When the ying and yang of progesterone and estrogen are not in balance that’s when your body begins to have symptoms of estrogen dominance. This state of too much estrogen leads to all of the problems listed above and can even increase your risk of breast and uterine cancer.
This image will help you understand why it’s important to have the right balance of estrogen to progesterone and how they directly oppose one another.
If you have one or more of these symptoms or conditions listed above there is a good chance you are suffering from estrogen dominance.
Estrogen dominance is extremely (and unfortunately) very common in many women due to lifestyle, diet, stress, and toxins.
Why do you have too much estrogen?
When evaluating anyone with estrogen-dominant symptoms I always evaluate these areas…
Hormone balance and estrogen
There are several different types of estrogens in your body and most of them are at least partially active. Meaning they sit on the estrogen receptor and cause the effects listed above (recall that estrogen is a ‘growth’ hormone).
The most potent of the estrogens is estradiol, but just because it’s the most potent doesn’t necessarily mean that you have too much of it or that it is responsible for your symptoms.
Estradiol is metabolized into less active estrogen molecules that still sit on active estrogen receptors.
As you can see from the image above estrogen has many metabolites that need to be excreted and eliminated by the liver.
If you have any problems eliminating the estrogen metabolites they can build up over time and cause activation of estrogen receptors and the symptoms of estrogen dominance.
Your diet, lifestyle, and genetics help determine how your body is going to eliminate estrogen. Also, If you have any issues with your liver, certain genetic polymorphisms, or problems with methylation then you will also likely have problems detoxifying estrogen.
The “good” estrogen metabolites (meaning they protect you from developing cancer) are how you want your body to get rid of your excess estrogens. That means you want your body to turn estradiol and estrone into 2-OH estrone and 2-OH estradiol.
The catch is that after you have created those metabolites you have to go one step further by methylating them for complete elimination. This can be troublesome for 50% of people who have genetic MTHFR defects.
As you might expect most women tend to go down the “bad” pathways and increase their risk of developing estrogen-dominant symptoms as well as breast and uterine cancer.
The good news?
Detoxify to eliminate extra estrogen
There are ways to push your estrogen down the healthy pathways. By eating brassica vegetables (cauliflower, broccoli, kale, Brussels sprouts) or by taking the supplement diindolylmethane/indole-3-carbinol.
If you decide to go this route make sure to also take a supplement like milk thistle to boost your liver’s ability to detoxify. And don’t forget below we will go over my top treatment recommendations.
So how do you see what your estrogens are metabolized into to target treatment?
The best (and only) way to test for estrogen metabolites is with the 24-hour urine test or with DUTCH urine testing. Traditional blood and serum are not accurate enough because they don’t test for estrogen metabolites and the only serum test you can get is estradiol which can vary from hour to hour.
The bottom line: don’t let your doctor tell you your labs are normal if they only test for estrogen.
Also, it’s worth pointing out that the best time to accurately test for estrogen and progesterone to get an idea about estrogen dominance is the mid-luteal phase (around day 19-22 on the standard 28-day cycle).
Get your thyroid levels checked accurately
I can’t stress this enough.
You don’t have an estrogen problem if you have a thyroid problem!
In fact, an older doctor taught me that giving 30-60mg of Armour thyroid to women with PMS/PMDD would drastically improve their symptoms.
Back then I didn’t know why it was working only that it helped so many women.
I can now say that hypothyroidism is commonly missed by traditional labs, so unless your doctor understands the complexity of the thyroid don’t let them tell you it is “normal”.
You need to have your thyroid evaluated properly with more than just TSH testing
Hypothyroidism will commonly cause menstrual abnormalities because estrogen and thyroid play together in the body.
If you want to correctly look at your thyroid you need the following tests:
TSH, free t3, free t4, reverse t3, and thyroid antibodies.
It’s possible (and common) to have undiagnosed Hashimoto’s thyroiditis or thyroid resistance that is missed by doctors that don’t know how to interpret thyroid tests.
As a quick primer you can evaluate your own labs (you can find more information here):
- If your TSH is > 2 you are hypothyroid, a TSH < 2 doesn’t mean you aren’t hypothyroid
- Your free t3 level should be in the upper 1/3 of the normal range
- Your free t4 level should be in the upper 1/3 of the normal range
- Your reverse t3 should be < 15
- Your antibodies should be < 30
It’s also worth pointing out that if you have fibrocystic breast disease (or painful breasts) you likely have too little iodine in your body.
Replacing iodine may boost your thyroid and in most cases will resolve your breast tenderness. The iodine in salt is not enough for many people and I commonly find up to 80% of my patients are iodine deficient.
If you have fatigue, constipation, weight gain, dry skin, brittle hair, depression, or menstrual issues it’s worth looking into your thyroid and even a trial treatment based on symptoms alone.
Find out if you are ovulating
Are you ovulating?
You may be having your cycle (probably at irregular times) but that still doesn’t mean you are ovulating.
The majority of progesterone in a woman’s body is there because of ovulation, so if you don’t ovulate you have constant unopposed estrogen, and that sets you up for estrogen dominance and potentially breast/uterine cancer.
You can evaluate if you’re ovulating by checking LH levels mid-cycle with urine sticks or by checking your basal temperature daily.
Your body temperature increases by around 1 degree after you ovulate and stays there for about 10 days before returning to normal.
By checking your basal temperature you can also assess your thyroid function.
If your body temperature doesn’t raise or fluctuate wildly then you may not be ovulating and you may have either thyroid or adrenal problems or both.
Your body temp should be no less than 97.8 degrees.
The image above is from one of my patients, you can clearly see the fluctuation of body temperature at the beginning and what happens after getting thyroid medication.
Diet influences estrogen levels
Diet certainly plays a huge role because of the metabolic implications that occur with a poor diet!
The major goal of diet should be to help eliminate estrogens so your body can metabolize them efficiently.
To start cut out refined grains (cereals, bread, pasta, anything containing white flour, etc.), dairy products, sugar, artificial sweeteners, all processed foods, caffeine, and alcohol.
Focus on eating real whole foods, lots of plants (vegetables and fruits), nuts, and healthy fats (coconut oil, olive oil, wild-caught fish, etc.). Eat at least 2 cups of brassica vegetables (broccoli, cauliflower, cabbage, Brussels sprouts, kale, etc.) because they contain DIM (diindolylmethane) which helps drive estrogen metabolism down the protective anti-cancer pathway.
The following foods will help correct any gut issues (constipation, gas, bloating, etc.): lots of vegetables (any kind), fruit, nuts, seeds, beans, and ground flax.
Foods high in omega 3 fatty acids will help cool inflammation: sardines, herrings, wild salmon, omega 3 eggs, and walnuts.
Cut back on any foods with synthetic or added hormones/antibiotics (especially nonorganic dairy products or non-grass-fed animal protein).
Stress and lifestyle increase estrogen levels
Excess stress leads to dysregulation of cortisol, insulin, estrogen, and thyroid. Remember that all hormones in your body play together, if one is low or not regulating properly it will take down others.
Make sure you take time out of your day to meditate, do yoga, relax in a detox bath, or do whatever it takes to reduce the stress of everyday life.
You should exercise at least 1-2x per week using high-intensity interval training. Work up to a good sweat and at maximal capacity. Exercising changes your epigenome, improves mood, and helps get rid of toxins.
Look for nutritional deficiencies
You can try the following vitamins/supplements to help regulate hormonal metabolism: magnesium, vitamin D (get your labs checked), all co-factors of methylation (activated folate, b6, b12), omega 3 fatty acids like fish oil, indole-3-carbinol/diindolylmethane, and extra antioxidants.
Are you detoxifying at 100%?
No matter what you do you come into contact with xeno-estrogens on a daily basis. These activate the estrogen receptors on your cells and they make your body think you have more estrogen than you really do.
They include things like: bisphenol A (in hard plastics like water bottles), hormones added to milk and dairy products, pesticides and herbicides on nonorganic foods, and antibiotics/xenobiotics found in nonorganic/grass-fed animal protein.
In order to detoxify at 100% make sure your body has the right vitamins (methylation co-factors), and nutrients (from food) and that your liver is functioning optimally.
If you consume the right foods, take the vitamins above, and make sure to sweat frequently (infrared saunas or intense workouts) you should be covered.
10 Actionable Tips You Can Start with Today:
- Consider getting a 24-hour urine test to evaluate your: estradiol, estrone, estriol, DHEA, testosterone, and cortisol metabolites.
- Get your thyroid tested – Ask your doctor to check your TSH, free t3, free t4, reverse t3, and thyroid antibodies. Get treated if you are low.
- Check your basal body temperature – Right when you wake up check your temperature either under your arm or in your mouth and record it. Anything less than 97.8 is an issue that should be evaluated.
- Eat clean – Cut out sugar, refined grains, white flour, caffeine, alcohol, bread, pasta, artificial sugars, and hormone-filled foods like nonorganic dairy and non-grass-fed animal protein. Eat foods to help you detox your body (broccoli, cauliflower, kale, Brussels sprouts). Eat healthy fats like flax and wild-caught fish.
- Exercise often – Focus on high-intensity interval training to boost fat metabolism. 15-20 minutes 1-2 times per week should do the trick. On days you don’t exercise stay active by walking or taking frequent breaks at work.
- Avoid environmental toxins and xenoestrogens – Eat organic foods, drink filtered water out of glass containers, avoid plastic drinking bottles and storing food in plastic containers, and stop touching receipts (have the cashier put it in the bag). Check out the clean fifteen and the dirty dozen to find out which foods you should buy as organic.
- Detoxify your body by sweating – Take a hot bath, go into an infrared sauna, or sweat during exercise. It doesn’t matter how you do it, just make sure you sweat frequently.
- Reduce stress and increase sleep – Make sure to get at least 7-8 hours of sleep every night to reduce inflammation and cortisol levels. Reduce stress by practicing daily yoga, meditation, or prayer for at least 20 minutes.
- Supplement wisely – Try taking diindolylmethane or indole-3-carbinol which help your body eliminate estrogen down the anti-cancer pathway. Cool off inflammation with fish oil and omega-3 fatty acids. Take probiotics to help heal your gut (I recommend soil-based organisms). Help your liver detoxify estrogen with calcium D-glucarate and milk thistle.
- Consider bioidentical progesterone therapy – Adding in bioidentical progesterone can help restore the balance of estrogen to progesterone. Use progesterone (start with 20mg daily and increase as needed slowly) on days 14-27 of your cycle (stop if you start menstruating). If you decide to use progesterone make sure you also follow the other recommendations above to get the maximum benefit!
For diet recommendations, you can find more here.
An Integrative Approach to Fibroids, Endometriosis, and Breast Cancer Prevention
Nutritional Influences on Estrogen Metabolism