Can Endometriosis be related to Autoimmune Thyroid Diseases? YES!
Endometrium is the inner epithelial layer found in the uterus. It changes during menstrual cycles: it thickens and sheds during menstruation. During pregnancy it is crucial to provide blood to the unborn baby.
Endometriosis is a chronic gynaecological disorder that affects 2–10% of women of reproductive age. Most women can also be affected by a 'silent' form. Thus, diagnosis could be challenging. The exact reason why endometriosis occurs is not yet known but the eldest and most approved theory is the "retrograde menstruation".
It suggests that during a woman's menstrual flow, some of the endometrial debris flow backwards through the Fallopian tubes and into the peritoneal cavity, attaching itself to the peritoneal surface (the lining of the abdominal cavity) where it can proceed to invade the tissue as endometriosis.
However, because not all women with reflux menstruation also have endometriosis, the retrograde menstruation theory cannot explain all cases of endometriosis. One theory to complement the retrograde menstruation theory is the autoimmunity theory. As a matter of fact, endometriosis is characterised by chronic inflammation and presence of autoantibodies, typical features of autoimmune diseases.
What's more peculiar is that in patients with endometriosis, thyroid peroxidase antibodies are more present than in patients without endometriosis. This would suggest that there is a connection between endometriosis and Autoimmune Thyroid Diseases (AITDs).
Furthermore, a large cross-sectional study conducted in the United States concluded that the prevalence of autoimmune diseases, including hypothyroidism, was higher among patients with endometriosis than in the general population (1).
A study published in 2016 (2) aimed to compare the prevalence of thyroid diseases, including autoimmune thyroid diseases, between women with endometriosis and women without endometriosis. This was the largest study performed to check the relationship between AITDs and Endometriosis.
What they found was a striking association of Graves disease with Endometriosis. Here I report what they stated:
This study found a higher prevalence of Graves disease among women with endometriosis than among the control group. Characteristics that distinguish Graves disease from other thyroid diseases may be a link between Graves disease and endometriosis. One of these potential links between Graves disease and endometriosis is autoimmunity. Endometriosis shares many characteristics with autoimmune diseases, including polyclonal B cell activation, abnormal functions of T and B cells, and inflammatory tissue damage.
The second possible link between Graves disease and endometriosis is estrogen. Endometriosis is an established estrogen-dependent disease. Estrogen also plays a role in the pathogenesis of Graves disease by modulating the autoimmune response. (3) Graves disease is 5-fold more prevalent among women than men, reflecting the possible effect of estrogen.(4)
This would explain why many women suffering from Endometriosis are later diagnosed with Graves or vice versa.
What are most common Endometriosis symptoms?
painful periods (also known as dysmenorrhea) or irregular periods
increased pain during bowel movements
increased pain during urination
spotting and bleeding between cycles
chronic lower back and abdominal pain
How to diagnose Endometriosis:
Pelvic examination. It is usually the first exam done.
MRI. Performed when your gynaecologist cannot assess endometriosis extent properly
Laparoscopy. More invasive but more precise at establishing the extension.
This association is important because by modulating and controlling Graves we may be able to limit Endometriosis.
The problem is that still we do not know what's the cause of Endometriosis and lots of research is being done to eventually find its roots.
However, being already more comfortable to assess a connection between AITDs and Endometriosis, can help physician establishing guidelines on how to treat it in the near future.
Treatments for Endometriosis:
Apart from medical treatments (oestrogen's and progesterone creams or pills, surgical treatments), you should start by modifying you diet and lifestyle (of course depending on your endometriosis staging):
Eliminate processed food, refined carbohydrate and sugar.
Favour anti inflammatory food (celery, broccoli, walnuts, berries, pineapple, bone broth, turmeric, ginger, coconut oil, fibers, etc)
Following a thyroid friendly diet could help you improve your symptoms
Supplements like omega 3, magnesium, iron (especially is you have heavy bleedings), vitamin B complex, antioxidants, and castor oil.
Let us know about you:
How do you treat your Endometriosis?
Have you also been diagnosed with Graves disease?