PDF Summary:Heal Endo, by Katie Edmonds

If you or someone you know suffers from endometriosis, Heal Endo by Katie Edmonds provides a guide to understanding and treating this complex condition. Edmonds challenges the prevailing view that endometriosis is simply a hormonal issue. Instead, she frames it as an inflammatory disease related to immune dysfunction.

Edmonds first explains how genetics, environmental toxins, and an imbalanced gut microbiome contribute to endometriosis development and progression. She then outlines an integrative approach to healing—from dietary strategies that reduce inflammation to lifestyle practices that address stress and hormone regulation. For severe cases, Edmonds evaluates medical treatments, including the importance of excision surgery by a skilled specialist.

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• Organ meats, while nutrient-dense, may not be palatable or culturally acceptable to all individuals.
• The prevalence of nutrient deficiencies in individuals with endometriosis could reflect a broader trend seen in the general population, rather than being specific to endometriosis.
• In some cases, the relationship between nutrient deficiencies and symptoms may be correlational rather than causal, meaning that while they appear together, one does not necessarily cause the other.
• Some of these nutrients, like omega-3s, can have blood-thinning effects, which could be a concern for individuals with bleeding disorders or those on certain medications.
• Long-term effects of high-dose nutrient supplementation are not well understood, and there could be potential risks associated with excessive intake of certain vitamins and minerals.
• Supplements are not regulated as strictly as prescription medications, which means their quality and potency can vary significantly between brands and batches, potentially affecting their efficacy in improving symptoms.

Balancing Macronutrients to Manage Blood Sugar

Edmonds suggests that while focusing on increasing nutrient-dense foods is paramount, properly balancing macronutrients—fats, proteins, and carbohydrates—is equally important since blood sugar imbalances in those with endo may promote endo progression, tissue damage, and even immune dysfunction. She argues that when we eat ultra-processed foods that spike our glucose levels (like pasta, bread, cereal, and sweets), we create inflammation internally, which can worsen endo.

The author recommends an eating plan that includes quality protein, healthy fats, and fiber to regulate glucose and decrease or even eliminate cravings. She encourages you to prioritize three daily meals (consumed at consistent times each day as part of your circadian rhythm regulation), eat enough at each meal to keep you satiated for a minimum of four hours, remove snacking, and to be aware of how starches break down into the same sugar glucose as sweet-tasting carbs do.

Context

• Stable blood sugar levels are crucial for overall health, as fluctuations can lead to energy crashes, mood swings, and increased hunger, which may contribute to overeating and weight gain.
• An imbalanced diet high in refined carbohydrates and low in healthy fats and proteins can contribute to systemic inflammation.
• Chronic blood sugar imbalances can lead to insulin resistance, a condition where the body's cells become less responsive to insulin. This can further disrupt hormonal balance and exacerbate endometriosis symptoms.
• Regular consumption of ultra-processed foods is linked to various health issues beyond endometriosis, including obesity, type 2 diabetes, and cardiovascular diseases, all of which are associated with chronic inflammation.
• Fiber aids in digestion and can help maintain a healthy gut microbiome. It slows the absorption of sugar, which helps in maintaining stable blood sugar levels and reducing cravings.
• Eating at regular intervals can support digestive health by promoting regular gastric emptying and reducing the risk of gastrointestinal discomfort.
• Eating enough at meals encourages mindful eating practices, helping individuals focus on meal quality and portion sizes, which can improve overall dietary habits.
• Regular meal patterns without snacking can help regulate hunger hormones like ghrelin and leptin, reducing overeating and cravings.
• Starches and sweet-tasting carbs can have different glycemic indices, which measure how quickly they raise blood glucose levels. Foods with a high glycemic index can cause rapid spikes in blood sugar.

Identifying and Removing Food Triggers

Edmonds emphasizes that there is no one-size-fits-all approach when it comes to removing foods, but encourages exploring the role food may play in your endometriosis, especially if you have a "sensitive" gut. She recommends trying a short-term elimination diet for several months to observe any changes, and if you do, reintroducing foods one by one to discover which foods are triggering your endo belly and increasing inflammation.

While the author suggests that everybody with endo should try to remove plant-based oils and alcohol because they cause inflammation throughout the body, she also highlights that some foods might benefit some, and harm others, depending on sourcing, processing, quantity eaten, and personal tolerance. These can include foods like red meat (which, when purchased from well-managed agricultural operations, is one of the most nutritionally dense options available), gluten (which can cause a systemic immune inflammatory response, and should be avoided for at least a few months to observe whether endo symptoms improve), dairy (which, if not tolerated, will contribute to endometriosis pain and inflammation), soy (which is full of inflammatory phytates unless fermented), caffeine (which can disrupt sleep and contribute to an excessive stress response), and eggs (which can be very hard to digest for some).

Context

• It is often recommended to undertake an elimination diet under the guidance of a healthcare professional, such as a dietitian or nutritionist, to ensure nutritional needs are met and to accurately identify triggers.
• The impact of dietary components like plant-based oils and alcohol can vary based on individual genetics, existing health conditions, and overall diet, making personalized dietary adjustments important.
• The amount of a particular food consumed can affect its impact on the body. Small amounts of a potentially inflammatory food might not trigger symptoms, while larger quantities could lead to noticeable effects.
• Red meat from these sources may also contain higher levels of antioxidants like vitamin E and other beneficial compounds due to the animals' varied diet.
• For those avoiding gluten, there are many alternatives available, such as rice, quinoa, and gluten-free oats, which can help maintain a balanced diet without triggering inflammation.
• Some individuals are sensitive to casein, a protein in dairy, which can trigger an immune response and inflammation, potentially worsening endometriosis-related pain.
• Common fermented soy products include miso, tempeh, natto, and soy sauce. These products often have enhanced nutritional profiles and are generally considered easier to digest compared to non-fermented soy.
• Regular consumption can lead to dependence, and withdrawal symptoms such as headaches, fatigue, and irritability can also contribute to stress.
• The way eggs are cooked can affect digestibility; for example, raw or undercooked eggs may be harder to digest compared to fully cooked ones.

Lifestyle Approaches for Holistic Endo Healing

Edmonds believes that genuine recovery requires a comprehensive method that extends past nutrition. It's about how we move, how we breathe, how we handle stress, and how we prioritize our mental and emotional well-being. By considering endo through this broader lens, we can make more meaningful changes that can significantly affect the experience of endo.

Helping Your Body With Movement

While noting the importance of physical activity, Edmonds argues that for people with endo, increased and improved movement within a framework of low-intensity exercise is critical for reducing inflammation, improving core function, rehabilitating the pelvic floor, and restoring health. She explains that too much sitting can restrict blood flow to the pelvis, leading to ischemia (low circulation of blood and oxygen), which triggers an inflammatory response.

As such, the author recommends that you make it a goal to move consistently throughout the day, standing up regularly, walking, biking, or incorporating any type of movement into your day, remembering that it takes only two minutes of moving to reverse thirty minutes of sitting damage.

The author also emphasizes the importance of core function, explaining that excessive sitting, stress, and/or bad posture can cause these muscles to become weak, inflexible, and atrophied. She further highlights how weak core muscles can lead to mismanaged pressure within the abdomen, where the natural pressure within the abdomen pushes down on pelvic organs, intensifying endo pain or even causing organ prolapse. To remedy this, she outlines five steps to rehabilitate the core: ensuring proper spinal elongation, engaging the ribs and diaphragm, relearning deep core function through hypopressive breathing, engaging the glutes, and seeking pelvic floor physical therapy when needed.

Context

• Prolonged sitting can lead to poor circulation and muscle weakness, particularly affecting the pelvic region. Regular movement helps counteract these effects and supports overall health.
• When tissues experience ischemia, the body may respond with inflammation as a protective mechanism. This involves the immune system releasing chemicals that increase blood flow and immune activity in the affected area, which can cause pain, swelling, and further complications.
• Engaging in regular physical activity helps maintain muscle mass and joint flexibility, reducing the risk of injuries and conditions like arthritis.
• Brief activity can stimulate metabolism, aiding in the regulation of blood sugar and lipid levels, which are negatively impacted by long periods of inactivity.
• The core muscles include the transverse abdominis, rectus abdominis, internal and external obliques, and the muscles of the pelvic floor. These muscles work together to stabilize the spine and pelvis.
• This refers to the pressure within the abdominal cavity. Proper management of this pressure is essential for organ support and function. Weak core muscles can lead to improper pressure distribution, affecting organs like the bladder and intestines.
• This involves maintaining a neutral spine position, which helps distribute weight evenly across the vertebrae and reduces strain on the back muscles. Techniques like yoga or Pilates often emphasize spinal alignment to improve posture and core strength.

Repairing the Microorganisms for a Harmonious Bodily Ecosystem

Edmonds emphasizes that while modifying diet and lifestyle can be very effective in nurturing a balanced microbiome, some endo patients may need additional support to address gut imbalances, leaky gut, or infections that aren't responding to lifestyle shifts alone.

The author suggests that the first step to creating optimal gut conditions is through ensuring that food is properly digested, allowing for nutrients to get absorbed and fiber to feed the good bacteria. To do so, she recommends slowing down when eating, chewing properly, and enjoying food in a calming setting. In addition, you may consider digestive enzymes, ACV, and lemon juice as tools to support this process.

The author further suggests that if you're dealing with more severe gut problems or suspect food sensitivities, you might consider briefly cutting out certain foods, such as following a low FODMAP or Paleo AIP diet, which can help identify food triggers. Once triggers are removed, you can work to combat leaky gut by eliminating inflammatory foods, supporting digestive function, repairing damage, and repopulating with beneficial bacteria.

She also recommends collaborating with an expert to test for specific types of dysbiosis, such as H. Pylori and small intestinal bacterial overgrowth, as well as other infections that should be addressed clinically.

Other Perspectives

• The focus on gut imbalances and infections may inadvertently minimize the role of other factors that can contribute to the symptoms experienced by endo patients, such as hormonal imbalances or immune system dysregulation.
• Some individuals may have optimal gut conditions despite not focusing on the mechanics of food digestion due to other health-promoting practices or a naturally resilient microbiome.
• The benefits of slowing down and chewing properly might be overstated for some individuals, as the digestive system is capable of handling a variety of eating speeds and chew consistencies, and not everyone may experience noticeable improvements in digestion.
• Some people may have acid sensitivity or allergies that make ACV or lemon juice inappropriate for their use, potentially exacerbating digestive issues rather than aiding them.
• Some individuals may experience a placebo effect, where the belief that certain foods are problematic leads to perceived improvements when those foods are eliminated.
• Repopulating with beneficial bacteria through probiotics is not always straightforward; the efficacy of probiotics can vary greatly depending on the strains used and the individual's unique gut environment.
• Over-reliance on testing can sometimes lead to overtreatment or an excessive focus on medical interventions, potentially neglecting holistic approaches and the body's natural healing capabilities.

Addressing Stress and Hormone Regulation

Given the significant impact stress exerts on the condition, Edmonds urges us to prioritize stress management as a critical component of the healing process. She recognizes that long-term stress is a widespread issue in our modern lives and emphasizes the importance of identifying those stressors and actively working to reduce them.

The author suggests making simple changes to reduce physical and mental/emotional triggers, such as eliminating caffeine, addressing underlying physical conditions, limiting exposure to negative news and social media, adopting a problem-solving mindset to address stressors, and prioritizing rest and sleep to support the body's ability to handle stress more effectively.

Edmonds also highlights how vital it is to cultivate self-compassion and positive self-talk. She describes how chronic stress may cause a loop of negative thinking, further exacerbating stress and worsening endometriosis symptoms. She encourages silencing the inner critic and replacing self-talk that is negative with supportive and encouraging thoughts. In addition, she reminds us that we're not naturally designed to handle stress by ourselves and encourages reconnecting to loved ones, building community, and nurturing a sense of belonging as important aspects of regulating stress responses.

Finally, she presents the idea of eustress, a form of positive stress that motivates and enhances performance. She suggests finding healthy activities or tasks. that spark excitement and joy, allowing for personal growth and feelings of accomplishment, which can help balance the negative stress in our lives and support healing. .

Practical Tips

• Designate a "worry time" each day to contain stress and prevent it from spreading throughout your day. Choose a 15-minute window in your schedule to focus solely on your worries. During this time, allow yourself to think about what's causing you stress and write down possible solutions or steps you can take. Outside of this time, if a worry arises, jot it down and save it for your next "worry time." This can help prevent stress from taking over your entire day.
• Design a "stress relief toolkit" with personalized activities that you can turn to when feeling overwhelmed. This could include a playlist of calming music, a list of breathing exercises, a collection of motivational quotes, or a set of stretching routines. Keep this toolkit accessible on your phone or in a small notebook so you can use it whenever you need a quick stress reduction method.
• Experiment with herbal teas as a caffeine-free alternative to your usual beverages. Start by replacing one of your daily caffeinated drinks with a herbal option and observe any changes in your trigger frequency or intensity. Options like chamomile or peppermint can be soothing and may help in reducing triggers.
• Start a "good news" group chat with friends or family where the only rule is to share positive or uplifting stories, memes, or personal victories. This not only reduces your exposure to negative news but actively creates a support network that focuses on the positive, which can be a powerful tool in stress management.
• Develop a "solution card deck" with various problem-solving strategies written on index cards. Shuffle the deck and draw a card when faced with a stressor to try a random problem-solving technique. This could include strategies like breaking the problem into smaller parts, looking for similar past experiences, or considering what advice you'd give a friend. This method introduces an element of surprise and creativity into your problem-solving process.
• Create a "rest ritual" by setting a daily 10-minute wind-down activity before bed, such as gentle stretching or listening to calming music, to signal your body it's time to sleep. This can become a cue for your body to begin its nightly wind-down process, potentially improving sleep quality and stress management.
• Partner with a friend for a weekly self-compassion exchange. Each week, share three things you've done that you're proud of and three things you forgive yourself for not accomplishing. This practice encourages you to recognize your efforts and treat yourself with kindness, while also building a support system that reinforces these behaviors.
• Create a stress and thought journal to identify patterns linking stress to negative thinking. Start by jotting down moments when you feel stressed and the thoughts that accompany these feelings. Over time, you'll be able to spot recurring negative thought loops. Once identified, you can actively challenge these thoughts or seek professional guidance to break the cycle.
• Develop a habit of "positive affirmation alarms" where you set random alarms throughout the day with supportive messages. When the alarm goes off, take a moment to repeat the affirmation to yourself. This could be as simple as an alarm titled "I am capable and strong," prompting you to pause and mentally or verbally repeat the affirmation.
• Create a "Community Skill Swap" platform online or through social media where neighbors can offer and request services like cooking, gardening, or tutoring, fostering a sense of community and mutual support which can alleviate stress.
• Start a 'one new person a week' challenge where you initiate a conversation with someone you don't usually talk to, aiming to expand your social circle and sense of community. This could be a colleague from a different department, a neighbor you haven't spoken to, or someone you see regularly at the gym. The goal is to create new connections that contribute to a broader sense of belonging.
• Volunteer for a project or task at work that is outside your comfort zone but within your capability to complete. This will introduce a manageable level of eustress, encouraging personal growth and enhancing your performance by pushing you to learn new skills and adapt to new situations.
• Create a 'Joy Journal' to track activities that make you happy and plan to incorporate at least one into your daily routine. By writing down moments and activities that bring you joy, you can identify patterns and ensure you're including these positive experiences regularly. For example, if you notice that reading before bed makes you happy, make it a nightly ritual.
• Engage in a creative hobby that results in tangible outcomes, like gardening, painting, or woodworking. The act of creating something with your hands can be therapeutic and the finished product provides a visual representation of your accomplishment. If you choose gardening, the growth of your plants can parallel your own personal growth and healing journey.

Working With Experts for Complex Cases

Edmonds acknowledges that some individuals may need additional support to manage their endometriosis and encourages consulting with experts when necessary. If following the dietary and lifestyle recommendations in the book aren't yielding substantial results, she suggests collaborating with a naturopath or a practitioner of functional medicine with expertise in complicated cases to uncover underlying issues that may be contributing to symptoms, such as other diseases, infections, or possibly toxicity, that, once treated, will help the body heal from endometriosis.

Practical Tips

• Advocate for workplace accommodations by preparing a well-researched proposal for your employer. This could include flexible working hours, remote work options, or a more ergonomic workspace to help manage symptoms. Presenting this proposal to your employer with an emphasis on how these accommodations can maintain or improve your productivity can lead to a more supportive work environment. For example, starting work later in the day might help if mornings are particularly difficult due to pain.
• Create a "Complex Case" journal where you document challenges you're facing, noting why they're complex and what expertise might be needed. This helps you identify when a situation is beyond your current knowledge and prompts you to seek expert advice. For example, if you're dealing with a legal issue, you might realize you need a lawyer with specific experience in that area.
• Use a symptom-tracking app to monitor changes in your health and share this data with your healthcare provider. Many apps allow you to log symptoms, mood, food intake, and more. This real-time data can help your practitioner spot trends and adjust your treatment plan accordingly. For instance, if the app shows that your headaches correlate with specific stressors, your practitioner might suggest stress management techniques.
• Use a problem-solving template to analyze recurring problems. Write down a symptom or issue you're facing, and then list all possible contributing factors, no matter how small or unrelated they may seem. This method encourages you to think broadly and creatively about the root causes. For instance, if you're consistently feeling fatigued, factors might include not just sleep quantity but also quality, hydration levels, mental health, and even the type of lighting in your workspace.

Medical Treatments and the Importance of Surgery

Hormonal Contraceptives and Progesterone Therapy

While acknowledging that Western medicine may not effectively treat the root cause of endometriosis, Edmonds offers a comprehensive overview of treatments commonly offered by conventional doctors that can manage symptoms and potentially buy you a window for your body to bolster its defenses against the disease. These treatments primarily involve using hormones and painkillers, which, she notes, can be effective for some while posing serious risks to others.

Benefits and Risks of Hormonal Contraceptives For Endo

Given that HCs, or hormonal contraceptives, are the most commonly prescribed treatment for endometriosis, Edmonds dedicates a significant portion of this chapter to discussing the benefits and risks of this potent intervention. She explains that contraceptives with hormones work by preventing ovulation and minimizing a woman's own hormone loop, which may offer temporary relief for sufferers who experience extreme symptoms related to menstruation and/or ovulation. This might be particularly vital to consider for those in significant pain or discomfort that prevents them from working, eating, or otherwise going about their day.

However, the author also cautions that long-term use can come with side effects, including potential nutrient depletion (which can contribute to immune issues and other health problems), gut microbiome changes (that could be influencing endo-related inflammation), and even a heightened risk of immune dysfunction, autoimmune disorders, and blood clotting conditions.

Context

• By stabilizing hormone levels, these contraceptives can help manage symptoms such as severe menstrual cramps, heavy bleeding, and pelvic pain.
• These include pills, patches, injections, and intrauterine devices (IUDs), each delivering hormones in different ways to achieve the same goal of preventing ovulation and stabilizing hormone levels.
• Other treatments for endometriosis include pain management with NSAIDs, surgical options to remove endometrial tissue, and lifestyle changes such as diet and exercise, which may also help manage symptoms.
• Hormonal contraceptives, especially those containing estrogen, can increase the risk of blood clots by affecting blood coagulation pathways, which is a significant consideration for individuals with a predisposition to clotting disorders.
• The gut microbiome consists of trillions of bacteria that play a vital role in digestion, immune function, and inflammation regulation. Hormonal contraceptives can alter the balance of these bacteria, potentially leading to digestive issues and increased inflammation.

Using Progesterone for Endo Treatment

As an alternative to the combined hormones found in HCs, Edmonds explains how progesterone therapy can also be used to address endo symptoms. She specifically suggests that it may be helpful for those dealing with luteal phase defect, intense menstruation, and some PMS symptoms. She notes that both bioidentical progesterone (the kind our body produces) and synthetic progestins (like those found in the Mirena IUD) can be used, with the specific type and dosage depending on each individual's needs and medical conditions.

Context

• Bioidentical progesterone is chemically identical to the hormone produced by the human body, often considered to have fewer side effects. Synthetic progestins, while effective, may have different side effects and risks.
• This condition involves a shorter or less effective luteal phase in the menstrual cycle, which can affect fertility and is sometimes associated with endometriosis.
• Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or adrenal issues can influence how progesterone is metabolized and should be considered when determining dosage.

Gonadotropin-Releasing Hormone Agonists

Induced Menopause and Relief From Endometriosis Symptoms

Edmonds discusses how medications like Lupron and Orlissa work by inducing temporary chemical menopause to reduce estrogen and suppress endometriosis growth. She suggests that this method may provide temporary help for individuals experiencing severe symptoms who haven't found relief through other methods, such as HCs or the hormone progesterone. She also notes that GnRH agonists may be used to help control endometriosis prior to an IVF embryo transfer, to reduce inflammation and potentially increase the chances of successful implantation.

However, Edmonds strongly cautions against using GnRH agonists casually, as the adverse effects can be extreme for certain individuals. These drugs mimic menopause and can therefore cause issues like hot flashes, bone loss, mood swings, vaginal dryness, and numerous other symptoms. She recommends that those considering these drugs should carefully research the potential side effects and consult with a specialist before making a decision.

Context

• Consulting with a specialist, such as a gynecologist or reproductive endocrinologist, ensures that the treatment plan is tailored to the individual's specific health needs and that they are fully informed about the benefits and risks.

Other Perspectives

• While Lupron and Orlissa can reduce estrogen and suppress endometriosis growth, they do not address the underlying cause of endometriosis and are not a cure for the condition.
• Long-term use of treatments that induce menopause can lead to significant health risks, such as osteoporosis, which need to be carefully considered.
• While GnRH agonists may reduce inflammation associated with endometriosis, their use is not a guarantee of successful implantation, as IVF success depends on multiple factors including egg quality, sperm quality, and the uterine environment.
• The adverse effects of GnRH agonists, though significant, can be managed or mitigated with proper medical supervision and adjunct therapies, such as hormone replacement therapy for bone density preservation.

Managing Pain: NSAIDs, Opioids, LDN, and Cannabis

Nsaids: Benefits and Risks for Endo Pain

Edmonds acknowledges that pain relief is often a necessary part of managing endometriosis and discusses typical pain management options, starting with the widely used NSAIDs (anti-inflammatory medications that don't contain steroids) such as ibuprofen, aspirin, and naproxen. She explains that while these medications can be effective in blocking pain-inducing prostaglandins (immune components linked to pain and inflammation in endometriosis), prolonged, regular use can lead to serious side effects, including stomach bleeding, ulcers, gut damage, and potential fertility issues.

Other Perspectives

• Overemphasis on pain relief can sometimes lead to the under-treatment of the disease itself, potentially allowing it to progress.
• NSAIDs block the production of all prostaglandins, not just the pain-inducing ones, which can disrupt normal bodily functions that rely on prostaglandins, such as protection of the stomach lining and kidney function.
• Monitoring and regular check-ups with a healthcare provider can help mitigate the risks associated with long-term NSAID use, allowing for adjustments in therapy or the addition of gastroprotective agents as needed.
• The potential fertility issues associated with NSAIDs are typically reversible upon discontinuation of the medication, and not all users will experience this side effect.

Using Opioids to Control Endometriosis: Risks and Concerns

Edmonds discusses how opioids such as hydrocodone and oxycodone, potent medications used to manage severe pain, come with the serious dangers of being addictive and taking a fatal amount. While acknowledging that certain individuals who have endometriosis might need these drugs to manage their pain, she stresses the importance of using them cautiously and for limited periods. Additionally, she explains how opioids, while helpful in reducing acute pain, can actually worsen long-term pain in some cases by heightening pain sensitivity over time. Furthermore, opioids can weaken immunity, increasing the risk of infections, which is especially concerning for those who have endometriosis or similar chronic inflammatory conditions.

Context

• Due to their addictive nature, opioids are classified as controlled substances, meaning their distribution is strictly regulated by law.
• Taking a fatal amount of opioids can suppress the respiratory system, leading to decreased breathing or complete respiratory arrest, which is the primary cause of death in opioid overdoses.
• Educating patients about the risks and safe use of opioids is crucial to prevent misuse and ensure they are aware of potential side effects and alternatives.
• As the body becomes accustomed to opioids, tolerance develops, necessitating higher doses for the same effect. Withdrawal symptoms can include increased pain sensitivity, which can persist even after stopping the medication.
• Understanding the impact of opioids on the immune system underscores the importance of exploring alternative pain management strategies, such as physical therapy, acupuncture, or non-opioid medications, to reduce reliance on opioids.

Alternative Pain Relief Options

Edmonds suggests that for temporary or passing endometriosis pain, mindfulness techniques that involve concentrating on your breathing and shifting your attention away from the pain sensation may be enough to get you through. However, if you are struggling with constant or severe discomfort that is negatively impacting your life quality, you may need additional support. The author discusses two alternative pain management approaches that are helpful for those with persistent pain conditions, including endo: Low-dose Naltrexone (LDN) and medical cannabis.

She explains that LDN, though not typically prescribed for endometriosis, is being increasingly used to manage pain from other inflammatory conditions and might be helpful for endo pain too. Additionally, she notes that medical marijuana might also help manage endometriosis pain through its interaction with the endocannabinoid system, which is involved in regulating inflammation and pain.

Practical Tips

• Develop a 'mindfulness pain diary' where you document your pain levels before and after engaging in mindfulness practices. Note the duration of your mindfulness sessions, the techniques used (like focusing on breath or visualizing a serene place), and any changes in your perception of pain. This can help you identify which mindfulness strategies are most effective for you and track your progress over time.
• Develop a personalized "pain emergency kit" that includes items and remedies that you've found to alleviate your pain. This could be a physical box or a digital list that contains things like heat packs, over-the-counter pain medication, a list of stretches or yoga poses, and soothing music or guided meditations. Having this kit ready means you're prepared to manage flare-ups no matter where you are.
• Create a self-care routine that includes cannabis as a potential pain management tool. This might involve setting aside time for relaxation and stress reduction, which could include cannabis-infused baths, topical applications, or other methods that you find beneficial for your symptoms.

Addressing Pain That Seems Imaginary and Central Sensitization

The Nervous System's Part in Endometriosis Pain

Edmonds argues that while endometriosis lesions can cause real pain, chronic pain may persist even when lesions are removed, primarily due to the nervous system’s role in that pain. When a body lives with chronic pain for long enough, the nervous system becomes overstimulated with pain signals and can become confused or overactive, leading to central sensitization. In this case, the pain we feel may no longer be directly caused by endometriosis tissue, but from an overstimulated nervous system. This may be why some women continue to experience pain even with no endo or experience what's called phantom pain, a genuine feeling of pain originating from a place where there is nothing to directly cause the pain. This is among the most confusing and frustrating aspects of pain management for people with endo, and many medical professionals don't understand or properly address it.

Context

• Endometriosis lesions can infiltrate nerves or grow near them, directly irritating nerve fibers. This can lead to sharp, shooting pains and heightened sensitivity in affected areas.
• Some individuals may have a genetic predisposition to heightened pain sensitivity or chronic pain conditions, which can affect how they experience pain post-surgery.
• The nervous system's ability to reorganize itself by forming new neural connections. In chronic pain conditions, this can mean that the brain and spinal cord adapt in ways that perpetuate pain signals.
• Chemicals like glutamate and substance P can increase in response to chronic pain, enhancing pain perception and contributing to nervous system overstimulation.
• With central sensitization, the threshold for what is perceived as painful is lowered. This means that even minor stimuli, such as light touch or temperature changes, can be perceived as painful.
• Traditional pain management often focuses on treating the physical source of pain, which may not be effective for pain originating from nervous system dysfunction, necessitating alternative approaches like cognitive-behavioral therapy or neurofeedback.
• Phantom pain is a phenomenon where individuals feel pain in a part of the body that is no longer present or has no apparent cause. It is often discussed in the context of amputees who feel pain in a limb that has been removed.
• The brain's map of the body, known as the homunculus, can still retain the representation of the missing part, leading to sensations that feel real.
• Many women experience a significant delay in diagnosis, often waiting years for a proper identification of their condition. This delay can lead to prolonged suffering and complicates effective pain management.

Relaxing Your Nerves to Manage Pain

To address a hyperactive nervous system, Edmonds encourages an integrative approach, emphasizing techniques that soothe and calm the nervous system, such as mindfulness practices, reducing stress, and pelvic floor physical therapy. These methods focus on conditioning the mind to more effectively handle pain cues.

She specifically suggests the app "Curable," which offers guided programs to alleviate central sensitization and phantom pain. She also strongly recommends physical therapy focused on the pelvic floor, as an overly tight, spasmodic, or atrophied pelvic floor can dramatically contribute to pain and even perpetuate the cycle of central sensitization.

Context

• This involves combining multiple therapeutic techniques to address both the physical and psychological aspects of pain, recognizing that pain is a complex experience influenced by various factors.
• Apps like "Curable" use cognitive behavioral therapy (CBT) and other psychological strategies to help users manage chronic pain by changing their thought patterns and emotional responses to pain.
• This specialized form of physical therapy targets the muscles of the pelvic floor, which can become tense or weak, contributing to pain. Therapy may include exercises, manual therapy, and biofeedback.
• Dysfunction can occur when these muscles are too tight, too weak, or not coordinated properly. This can lead to symptoms such as pelvic pain, incontinence, and pain during intercourse.

Excision Surgery: Top-Tier Treatment for Endometriosis

Importance of Wide Excision Surgery by a Specialist

Edmonds argues that while integrative care can significantly improve endometriosis, surgery, as the sole way to fully remove the disease, is an essential tool in the endo toolbox. However, she emphasizes that surgical procedures vary, and only wide excision surgery conducted by specialists in endometriosis offers the potential for long-term relief. She notes that excision refers to the complete removal of endometrial growths, rather than simply burning or ablating the disease, which frequently leaves some behind to grow back. These surgeries involve not just skill, but also take more time than a general surgery (while often being paid less by insurance), so most general OB-GYNs do not offer this service.

Edmonds further explains that, due to the limitations of visualization when a laparoscopy is performed, a skilled endometriosis surgeon can often more accurately diagnose endometriosis, ensuring that no lesions are missed or misdiagnosed.

Other Perspectives

• In certain cases, hormonal treatments or other medical management strategies may be more appropriate for a patient than excision surgery, depending on their specific circumstances and health conditions.
• There may be initiatives to improve the training of general OB-GYNs in wide excision surgery to address the shortage of specialists.
• While skilled endometriosis surgeons may have a higher accuracy rate in diagnosing and treating endometriosis lesions, it is not guaranteed that all lesions will be identified or that the disease will be fully eradicated, as endometriosis can be highly variable and unpredictable in its presentation.
• Alternative imaging techniques used in conjunction with laparoscopy, like ultrasound or MRI, can help preoperatively map the lesions, thus compensating for any potential visualization issues during surgery.

Achieving Endo Remission Using Integrated Care Approaches

Edmonds postulates that the best way to treat endo involves embracing both holistic and conventional medicine, starting with a six to twelve month commitment to an integrated care approach (diet, lifestyle, complementary, and alternative medicine), with surgery considered afterwards if needed.

If, after six months to a year, a woman's symptoms have subsided and her quality of life has returned, surgery may be unnecessary. But if symptoms don't improve or wellness isn't restored (and depending on how severe her case is), it's time to see an endometriosis excision surgeon for removal of the disease. To help you find a qualified surgeon, Edmonds recommends contacting your insurance provider to obtain a list of in-network and/or geographically covered surgeons, using online databases like icarebetter.com, asking for recommendations from others in endometriosis support groups, interviewing surgeons to discuss their approach and experience, and ensuring the surgery is photographed to obtain visualization and second opinions.

After having the operation, you should continue with integrative care to prevent the remaining microscopic endometriosis and/or the symptoms from returning. This proactive approach can bring the body to a state of remission, where endo symptoms no longer pose a daily burden.

Edmonds concludes that the optimal method to treat endometriosis involves both removing it and addressing the underlying issues that are compromising a patient's health. She believes that the combination of an educated patient, who diligently uses a comprehensive method for treating endometriosis and demands quality care, and an equally educated and skilled surgical team who can remove the endometriosis, offers the best hope for regaining one's life from this devastating disease.

Context

• Specific diets, such as anti-inflammatory or low-FODMAP diets, may help reduce symptoms by minimizing foods that trigger inflammation or digestive issues.
• The integrated care approach not only aims to alleviate current symptoms but also to prevent future flare-ups by maintaining a balanced and healthy lifestyle.
• Navigating insurance coverage for endometriosis surgery can be complex, and understanding what is covered, including potential out-of-network options, is important for financial planning.
• Holistic medicine focuses on treating the whole person, including physical, emotional, and lifestyle factors, while conventional medicine often involves pharmaceuticals and surgical interventions.
• As with any surgery, there are risks involved, including infection, bleeding, and potential damage to surrounding organs. Recovery time and outcomes can vary based on the individual and the extent of the disease.
• Requesting that the surgery be photographed is a way to document the procedure. This can be useful for obtaining second opinions and ensuring that all visible endometriosis is addressed during the operation.
• Techniques like yoga, meditation, and herbal supplements may help in reducing pain and improving quality of life, contributing to sustained remission.
• Even after achieving remission, ongoing management is important to prevent recurrence. This might include continued lifestyle adjustments and regular medical check-ups.
• Educated patients are better equipped to make informed decisions about their care, advocate for themselves, and work collaboratively with healthcare providers to manage their condition effectively.
• Encouraging patients to join support groups and advocacy organizations can provide emotional support and practical advice from others with similar experiences.
• Clear communication between the patient and the surgical team is crucial to ensure that the patient's symptoms and concerns are fully understood and addressed during the surgical planning process.