A woman in pyjamas is curled over in pain.

Endometriosis is a painful, inflammatory condition that affects one in 10 Australian women of reproductive age. Despite being a common disorder, it takes most women an average of eight years to receive a diagnosis. Unsurprisingly, the internet is packed with alternative therapies for treating the condition, but are any of them helpful and can a gluten-free diet help? CARA BOATSWAIN investigates.

What is endometriosis?

“Endometriosis occurs when endometrial tissue, which is normally found within the uterus, is displaced in other areas of the body,” explains nutritionist and natural fertility specialist Tasha Jennings. “This displaced endometrial tissue acts and responds in the same way as endometrial tissue within the uterus. It builds up during the menstrual cycle, breaks down and bleeds during menstruation. This bleeding can cause inflammation and pain and lead to scars, which can harm the organs it is attached to.”

This scarring can build up over time and can cause damage to reproductive organs or prevent them from working correctly, explains Dr Joseph Sgroi, a Melbourne-based obstetrician, fertility/IVF specialist and gynaecologist. “For example, scarring can prevent the ovaries from being able to release an egg down the fallopian tube, which is required to achieve pregnancy,” he says.

What causes it and what are the symptoms?

“The exact cause of endometriosis is largely unknown,” says Jennings. “There is likely a genetic component, with the condition often passed down from mother to daughter. Another hypothesis is refluxed menstrual fluid, which goes back up into the reproductive system.”

According to Dr Sgroi, painful periods, ovulation and pelvic pain are common symptoms of endometriosis. “Women can also experience abnormal bleeding, bowel issues, bloating, nausea and fatigue,” he says. “Untreated endometriosis can also lead to anxiety and depression, as women are dealing with ongoing pain, without a reason for it.”

How is it diagnosed?

Endometriosis is a difficult condition to diagnose. “A definitive diagnosis is made via laparoscopy,” says Jennings. “This is a surgical procedure where the surgeon uses a laparoscope to view the internal organs.”

Dr Sgroi follows four steps to diagnose his patients. “When a woman comes to see me about suspected endometriosis, I will ask about her medical history and background, do a physical exam and perform an ultrasound scan,” he explains. “The initial scan can be effective in finding large deposits of endometriosis, but with a scan, you’re not really seeing the whole picture and only the larger sections will show up, not the smaller ones. A scan doesn’t show the whole picture that a laparoscope can.”

Endometriosis and pregnancy

“Mild endometriosis may have little to no effect on fertility and pregnancy, depending on where the displaced tissue is found,” says Jennings. “Some women may even be unaware they have it. However, for some women, it can significantly impact their ability to fall pregnant and carry a healthy pregnancy.”

Around one-third of women with endometriosis will find it more difficult to conceive due to scarring, adhesions, tube blockages and hormonal or immune issues, according to Belinda Kirkpatrick, a naturopath, nutritionist and author of Healthy Hormones.

Kirkpatrick also warns that while it won’t happen in all pregnancies, women with endometriosis have an increased risk of miscarriage and ectopic pregnancies. “Most women won’t experience ongoing issues in their pregnancy, although a small group will continue to experience pain,” she says.

The good news is that once pregnant, most women with endometriosis experience some relief from the painful symptoms associated with the condition.

“Pregnancy may provide temporary relief from symptoms of endometriosis, but unfortunately, it does not cure the condition – this is a common myth,” says Dr Sgroi. “Pregnancy provides relief from many of the symptoms of endometriosis because higher progesterone levels during pregnancy suppress the endometriosis.”

Can endometriosis be cured?

“At present, endometriosis cannot be ‘cured’,” says Jennings. “However, there are many medical and natural treatments which can be very effective in reducing the severity.

“In women with severe endometriosis, surgical treatment is the most effective option, and natural fertility specialists will often work alongside surgeons to help ensure endometriosis remains under control following surgery. Surgeons will remove displaced endometrial tissue where possible, via laparoscopy.”

Dr Sgroi recommends surgery for women hoping to conceive. “If you’re trying to become pregnant, surgery is the most effective treatment via laparoscopy,” he says. To improve your chances of conceiving, Jennings notes that women will be most fertile three to six months after the surgery to remove the endometrial tissue.

The downside to surgery is that it is not always a permanent solution. “Unfortunately, removal is not necessarily the magic bullet cure we would like it to be, as endometrial tissue generally grows back over time,” says Jennings. “How quickly the tissue regrows differs between individuals, but natural approaches can help reduce regrowth.”

What about the pill?

“Endometriosis can be effectively treated by an oral contraceptive pill which decreases the amount of oestrogen in the body,” says Dr Sgroi. “However, this obviously isn’t great if you’re trying to become pregnant.”

Can diet help?

While the link between diet and endometriosis management remains scientifically unproven, many women with the condition are convinced there’s a connection.

“There aren’t any hard and fast medically-backed recommendations for certain diets or foods to prevent or treat endometriosis,” says Dr Sgroi. “So the jury is still out on a specific diet to help treat endo. However, my patients tend to see improvement with a balanced and varied diet full of fresh vegies, fruit and the recommended meat, dairy and grains intake, limiting sugar and alcohol.

“Gluten can cause inflammation of the gut, which leads to inflammation of the pelvis and worsening symptoms of pelvic and abdominal pain.”

“What we eat can help or hinder our health,” says Kirkpatrick. “Certain foods such as gluten, dairy, sugar, corn and soy may trigger inflammation and immune activation, which may, in turn, exacerbate endometriosis and its symptoms.”

Kirkpatrick recommends including vegetables such as broccoli, cauliflower, asparagus, fennel, kale, spinach and Brussels sprouts in your diet as they can assist with oestrogen metabolism; turmeric to reduce inflammation and balance the immune system; Brazil nuts to increase selenium and oily fish for omega-3s.

Should I go gluten-free?

In 2012, Italian researchers published a study that evaluated the effectiveness of the gluten-free diet in reducing endometriosis pain and improving quality of life.

Over 200 women with severe endometriosis participated in the study and followed a gluten-free diet for 12 months. After the study period, the researchers noted that 75 percent of the women reported a significant improvement in painful symptoms. No patients reported worsening of pain.

“Gluten can cause inflammation of the gut, which leads to inflammation of the pelvis and worsening symptoms of pelvic and abdominal pain,” explains Heba Shaheed, co-founder and CEO of The Pelvic Expert. “Simply eliminating gluten can allow the digestive system to recover,” she says.

Kirkpatrick encourages her patients to try going gluten-free to ease symptoms. “Many of my clients find a gluten-free diet helps in reducing their symptoms,” she says. “It is definitely worth trialling a gluten-free diet for at least three to six months and assessing symptoms.”

There may also be a link between coeliac disease and endometriosis. In 2011, three coeliac disease experts from Europe published a study in the journal Human Reproduction in which they concluded that women with coeliac disease were at an increased risk of endometriosis. “The highest risk of subsequent endometriosis was found in the first year after coeliac disease diagnosis,” wrote the study authors, as this is before a gluten-free diet is likely to have affected the small intestinal villous atrophy and inflammation.