EF#31: Listeners Endo Fertility Q&A Session

I am going to first start with your questions around Cycle and Periods as this is something I talk around with my clients, so they can learn to understand their bodies better, and I would like to do the same here.

So the first question is “If your periods have improved drastically following surgery is this a sign that fertility has improved? The lady who sent this question in previously had horrendous period pain, which was her main symptom of endo, and has since had two completely pain free cycles. This is what you would expect after surgery to have pain free periods, and depending on the extent, success and type of surgery you had, you would hope this lasts for some time to come. Pain is a symptom of inflammation, whether this is period pain or ovulation pain. By removing the endometriosis growths and scar tissue, you are automatically removing the localised inflammation that the endometrial tissues outside your womb were creating, this is why you will feel you have no or very little period pain. As I mentioned in Episode 21 on how Endometriosis affects fertility, inflammation outside the womb and ovaries and fallopian tubes can affect your ovarian reserve, egg and embryo quality. Reducing this inflammation is a really important step to improving your fertility, so yes absolutely this is a sign that your fertility has improved!

So the next question is: Can low cervical mucus during the fertile period be linked to endo? I always wondered this and since my surgery I feel like I am now producing lots compared to before. For context I was diagnosed with stage 3/4 with most of my reproductive organised fused together. All was excised and my tubes were open. Now this is a great question! Interestingly, there is a rather unusual study by Grande et al. in 2016, where they wanted to see if you could diagnose Endometriosis through looking at the protein contents of cervical mucus. What they found is that there were definitely differences in the CM proteins, there were a lot of inflammatory proteins, which you would expect as Endo causes tonnes of inflammation. Also there were key proteins missing, that were to do with anti-microbial activity, which I would understand that to mean there was an increased chance of microbial infection, which makes sense and ties in with the interview with Debbie Cotton in Episode 30 last week. Also that there were proteins missing to do with antioxidants, which protect our bodies from oxidative stress, which could apparently affect fertility – though further study is needed for this. Basically removing all the complex science, is that remove the endometrial tissue that cause inflammation, and yes your cervical mucus is likely to change composition, and if you are finding it has increased and is of a better “springy” consistency, then these are signs that yes you are more fertile, which is great news! CM is a brilliant way to track your fertility.

So the final question about your menstrual cycle is “Not typical for endo but are short/light periods a sign of some kind of deficiency?” Yes a short / light period is something that can also happen with Endometriosis. You can still have estrogen dominance, i.e. too much estrogen to progesterone, but you could have low estrogen, which can lead short / light periods. First lets define what a light period is, according to Nicole Jardim, “The Period Girl” it is where you period is say only 1 or 2 days, or less than 25ml, which is say less than 5 normal tampons or pads, or 15-40ml in a mooncup. If your period feels watery and isn’t strong, then yes it is likely to be a light period. If you have a light period it is because there isn’t enough estrogen to grow a strong enough womb lining – the question is why do you not have enough estrogen? We want to have a strong healthy womb lining, so we certainly need a good amount of estrogen for this. Now there are a couple of reasons for this. First is if you have been on the pill or coil to suppress the Endo, then this will have stopped your ovulatory cycle. Equally the pill raises sex hormone binding globulin, which binds to estrogen and reduces its levels in the body further. This is why it would be worth testing both your estrogen and SHBG, you might find you have low estrogen and high SHBG. Another reason could be nutrient deficiencies, poor gut health and sleep deprivation. If you are post-partum and trying to conceive again, then nutrient deficiencies and sleep deprivation can also cause a light period. Finally, if you are not ovulating, then you need to ask why? Are you stressed, do you have PCOS, have you lost a lot of weight recently, is your thyroid healthy, are you a vegan or vegetarian or on a low-carb diet as these can also affect your hormones. The question to ask is have you always had light periods or are the different because of a change in your situation? If you came off the pill it might take a while for your body to increase its hormones, and in this case Vitex might be a good thing to look into and also maca. There is so much more I could say here, but basically eat lots of nutritious food that is not too inflammatory, get healthy fats and enough carbs, make sure your gut is working efficiently, track your cycle to see if you ovulate, connect with your womb to show some love and care and get enough rest and relaxation. I hope that helps!

So the next part of this episode is questions about Symptoms. There are so many symptoms associated with Endo, and each one is a way for our body to tell us what might be wrong, we just need to understand how to listen to our body.

The first is about one of the most common and yet painful and embarrassing sumptoms, the “Endo belly”.This lady said “My belly triples in size whenever i put food in me. The thing is i cant eat much either. A bite or two and i feel like i am soo full! I have a feeling of fullness whenever i start eating even if its just one morsel. My self confidence is so low, i have people asking me if i am pregnant all the time!” Firstly, I understand. The pressure on your abdomen when you get bloated is really not pleasant and when it is extreme is downright uncomfortable. Bloating is another sign of inflammation, as I just mentioned that pain is also. If it occurs after you eat, this shows your gastrointestinal tract or gut is massively inflamed and it is likely your immune system in your gut is on “hyperdrive” and is literally watching out for anything that passes through your gut and putting out alarm bells as it no longer knows what is food or foe. If this is you, then you really need to start working on your gut health, and the first place to start is with your stomach acid – there are two great episodes on this, 10 and 12 in Season 1. You might have low stomach acid, and potentially low digestive enzymes and so food is passing into the gut in larger particles than it should and could have aggravated your intestinal lining. If you have a food sensitivity to gluten this could have caused inflammation and further degradation of the intestinal lining. If you have had a nutritionally poor diet and have been exposed to stress, the bacterial balance in your gut is likely out of balance, and this can cause further inflammation and also result in a poor integrity of your stomach lining. All this can lead to what is known as leaky gut – i.e. larger holes than you want in your stomach lining, so that food particles end up in your blood stream – this then causes inflammation and your body is sending in an army to deal with the issue. If this is the case you need to work on sealing the holes, and bone broth and/or collagen powder is amazing for this. You want to be consuming this on a daily basis. If you react to the bone broth, be aware you could have histamine intolerance – which can happen when you have leaky gut and an imbalance in your gut microbes. This is why an anti-inflammatory diet is also needed for a time being – that is not to say it is long term but if you are reacting so severely you definitely need to take out inflammatory foods, and add in nourishing foods. The topic of gut health is a large topic, and you should definitely listen to Episodes 6, 9, 28 and 30 for some more tips.

Another great question is about “pain down the leg, from the buttock all the way down to the heel”. This lady said she has been to her doctors and they are telling her it is nothing to do with endometriosis! She knows it is everything to do with endo because whenever she gets this pain she also feels her ovary on that side tighten, even when she sneezes she feels the pain on her ovary as well. This is common symptom of Endo and is can be related to a number of things, without a detailed health history it is hard to say what. It is bad that your doctor is saying it is nothing to do with Endo, and this shows their limited knowledge, I would ask for a referral to your specialist about this. It is commonly seen with women with sciatic pain that there could be a deep infiltrating endometrial lesion or scar tissue over the pelvic segment of your sciatic nerve. The other potential reason could be a combination of the nervous system and the pelvic muscles. If you have had extreme pain for a long time you can end up changing how you sit, lie, walk etc to manage the pain, and so your muscles change length around your pelvis to deal with this pain and trauma. This can lead to impinged nerves, such as the sciatica nerve, which is the largest nerve in the body, and which connects the spine into the back of the thigh via the pelvis and down to the feet. If you have Endo on your sciatic nerve, also termed sciatic Endometriosis, the pain is felt down the back of the leg and radiates down to the heel. One thing that could help in this instance, and shows the multi-pronged approach that is needed with Endo, is to see a pelvic health physiotherapist or physical therapist – as they can work on the myofascial and muscoskeletal pain, as well as any scar tissue that has occurred from the Endo and surgeries that you may have had.

The final question is around surgical options. It is a question about Hysterectomy. This is what this lady said: “I have been thinking about this for a while. Since i have had surgeries one after another, just to find myself back with the same symptoms or even worse. I have come to think hysterectomy would somehow ease these symptoms? Or give me a break from some of endometriosis symptoms since i wont be menstruating again. I have wanted to persue this route and i even spoke to my doctor about it but due to covid i havent been back to hospital, i am currently put on prostap injection whilst waiting for the next surgery. It is nearly a year now!” This makes me desperately sad to hear. I am sorry you have had to have surgery after surgery and are in no better place. I am sure this is not helping with your dream to give birth to a baby also?

What I will say though is that unfortunately a hysterectomy does not always fix the situation. Endometriosis is a whole body inflammatory disease, not just about the pelvic lesions, these are unfortunately a symptom, the biggest one for sure. If each surgery is not completely removing the Endometrial lesions, whether this is because ablation is being used, which is essentially taking off the top of the dandelion and not taking out the roots, or only a portion of the Endo can be taken out as it is in areas that are too hard to get then this is the key problem. Taking out your uterus is not going to stop the lesions from regrowing  as they are growing in the pelvic cavity. Yes removing your ovaries is going to reduce the estrogen, which are needed to fuel the lesions, but the endometrial lesions create localised estrogen and do not necessarily need the ovaries to produce systemic estrogen i.e. estrogen required for the whole body. Another thing with a hysterectomy is that you could end up having organ prolapse – which means organs like your bladder and intestines are no longer kept in place and will fall into the area where you uterus was and could even fall out through your vagina, which is common in women with hysterectomy’s and that comes with its own pains and problems. Further to this, if you remove your ovaries you then have to deal with menopause early.

The key is to use an integrative approach, where you have surgery with an excellent surgeon who really knows their stuff. A colleague and friend of mine said last week, as this is something I was discussing for a client of mine, that choosing your surgeon is like choosing your life partner – it is a huge decision. I would agree with this. My personal experience was that I rushed into it not knowing what I was doing, and because he had a great sell (as I went privately) and he used ablation, it meant it came back and I had more scar tissue than before the surgery. The key is speaking or working with someone who knows which surgeons are best to work with and asking the right questions. This is not my area of expertise unfortunately, but I think I might have to do a podcast episode on this subject! The other things are to make sure you work on reducing your inflammation, reducing toxins, reducing the burden on your liver, improving your gut health and dealing with stress and trauma. These are things I work on with my clients, and if you are overwhelmed by this then I would advise you to take it step by step, small changes each day become big changes over weeks and months. If you are really struggling then work with someone who knows their stuff.

Finally if I were to share one thing with you today, I would say always question things, don’t assume just because someone doesn’t believe you that there is nothing wrong or it isn’t related. Follow your gut instinct.