Today's post is for women with endometriosis that wish to know more about why they have the disease, and those enviable 'normal folk' (ha ha, I know, we've all got our own challenges!) who wish to know why I or others have this disease. If you find this page helpful, you are welcome to use it, but please email me for permission, and do not forget to give credit to the researchers I have acknowledged here.
Endometriosis is hypothesized to be caused by a combination of genetic vulnerability and environmental toxins. A sort of innate combination of bodily defects and immune dysfunction and negative influences of foreign bodies. For non-biology folks, think of it this way. A person is a glass of water, partially filled by their own genetic vulnerabilities (prior problems that make them more likely to experience a disease).
Those with high vulnerability are something like 80% full, while those with low vulnerability are 20% full. The less full cups have fewer innate problems and are more likely not to be overflowed by environmental influences. Environmental toxins, a different fluid, let’s call it orange soda, is added by experiencing exposure. Say everyone experiences about 40% (of their cup’s original volume) of environmental toxins. According to this theory, those with high vulnerability will reach 100%, even overflow, and will have endometriosis. Those with low will only reach 60% (or 50, 70, or whichever % that lies below 100), and not overflow. Make sense? Here, I’ll add in pictures! Look at them!
So what makes up the differences between those people with a 20% full glass and 80% full glass? What the heck did they do to earn that lesser predisposition to this horrible disease? Well, as it's innate qualities that determine the fill of your glass, they didn't do anything to earn it, but they sure do benefit from it. From my understanding, here are some of the negative bodily qualities that 'add more liquid to your vulnerabilities glass' and make endometriosis more likely. First, physical characteristics that make the outflow of menstrual lining more difficult, which increases the likelihood of retrograde menstruation, are linked to endometriosis. Retrograde menstruation is when the contents of menstrual lining flow back and out into the pelvic cavity and is cited at the primary cause of endometriosis (1) . Outflow defects (like a narrow or partially obstructed cervix and heavy menstrual flow) and failure of the immune system to clean up menstrual debris that do not make it out of the body, are linked to increases of endometriosis (2). The important fact here is that although 70-90% of women experience some retrograde menstruation in their lives (3), only about 7% of women develop endometriosis (though the amount of retrograde may vary). I mean, think about it--fallopian tubes (uterine tubes, using the correct term) are not directly attached to ovaries, and are open to the pelvic cavity. If the uterine lining flows up the tubes, it would be easy to escape into the cavity. The immune response is able to clean this debris in most women, preventing it from becoming a problem. So the second important innate characteristic is failure of the immune system to properly clean up the debris.
(Personal note here, although there is disagreement between scientists about endometriosis occurring in higher rates in women with autoimmune diseases, I have both moderate chronic asthma and colitis. My colitis and asthma flare up when I have worse problems with my endometriosis. Hormones have a pretty powerful effect on the body, and I personally believe in a strong link between these three diseases.)
A variety of environmental toxins have been linked to endometriosis. An environmental toxin can be defined as any contaminant that enters an organism or ecosystem that introduces harm or disruption to that system. Some identified toxins that have been linked to endometriosis are stimulants (coffee, amphetamines, and nicotine), xenoestrogens, phthalates (plastics), PCBs, dioxins.
The exact relation of stimulants is complicated, and as I am only a neuropscyhology student with only a years experience in microbiology, the papers were a little beyond my scope (without spending 3 hours each reading them). This is what I gleaned from the papers though. Stimulants affects both the control of growth of the endometrial cells spreading out from the uterine cavity and the behavior of immune cells responsible for their clean up (4). Most importantly, monocytes that help control the spread of migrating tissue are signaled by stimulants. One article I read seemed to indicate that certain macrophages (think of these as the giant garbage eating immune cells that clean up foreign/dangerous/dead tissues) differ in women with/without endometriosis in their levels and activity being affected by stimulants! The take home message from this, without any mumbo-jumbo? Limit your stimulant intake. Do yoga in the morning instead of drinking coffee. Stop smoking if you do. And if you have ADHD, try to either stop adderall/ritalin in favor of behavioral therapy, or try reduce your stimulant treatment by incorporating behavioral therapy.
I will do one more paragraph for the day--trust me, these take quite a while to research and write up! So, what are xenoestrogens, and what do they mean? Xenoestrogens are widespread in the environment and mimic estrogenic signaling. They interfere with proper estrogen function in the body. In the reproductive system, they cause improper and accelerated proliferation (spreading) and growth of endometrial cells (5). Essentially, they mimic estrogen and function by binding at estrogen receptors (parts of cells that are affected/signaled to act by estrogen binding to it) and consequently disrupt the balance and functioning of the endocrine (hormone) system of the body (6). When any balance is upset in the body, it is asking for trouble--in the case of endometriosis, unchecked growth of endometerial tissue outside of the uterus.
What does that mean for us? Well, the take home message is to avoid as much xenoestrogen as possible. According to wikipedia, "Xenoestrogens are "foreign" estrogens often widely used industrial compounds such as PCB, BPA and Phthalates, that have estrogenic effects on a living organism even though they differ chemically from the naturally occurring estrogenic substances internally produced by the endocrine system of the organism." They are found in commericial, non-organic meats, pesticides, cleaners, some lotions/creams--essentially can be found in most commercial products made from (or containing) added artificial chemicals. I will post a couple links to handy lists for either what contains them or how to avoid them. For myself, I cut out red meats (mammal meat, or 'furry friends'), non-organic meats, limited myself to organic produce and groceries as best I could, and am careful with my use of cleaners/lotions. They are difficult to avoid, but it's best to avoid them as much as possible. They are perhaps some of the most dangerous agonists (essentially chemical increasers) of endometriosis around.
To be continued!!
(1) Sakura, Y., Masaki, T., Sudo, K, Nomura, M., and Shino, A. (1990). Histological studies on the therapeutic effect of sustained-release microspheres of a potent LHRH agonist (leuprorelin acetate) in an experimental endometriosis model in rats. Endocrinol. Jpn. 37, 719–729.
(2) Olive, D. L., and Henderson, D. Y. (1987). Endometriosis and mullerian anomalies. Obstet. Gynecol. 69, 412–415.
(3) Halme, J., Hammond, M. G., Hulka, J. F., Raj, S. G., and Talbert, L. M. (1984). Retrograde menstruation in healthy women and in patients with endometriosis. Obstet. Gynecol. 64, 151–154.
(4) Wu MH, Sun HS, Lin CC, Hsiao KY, Chuang PC, Pan HA, Tsai SJ 2002 Distinct mechanisms regulate cyclooxygenase-1 and -2 in peritoneal macrophages of women with and without endometriosis. Mol Hum Reprod 8:1103–1110
(5) Steinmetz R, Mitchner NA, Grant A, Allen DL, Bigsby RM, Ben-Jonathan N. The xenoestrogen bisphenol A induces growth, differentiation, and c-fos gene expression in the female reproductive tract. Endocrinology. 1998;139:2741–2747.
(6) Sonnenschein C, Soto AM. An updated review of environmental estrogen and androgen mimics and antagonists. J Steroid Biochem Mol Biol. 1998;65:143–150.