Decoding Endometriosis, how practitioners can help webinar

This webinar aims to give practitioners a thorough, clinically applicable overview of endometriosis - from key statistics and diagnosis to functional nutritional support. Hosted by Ella Kaur (practitioner lead) with guest speaker Emma Dawson, a registered nutritional therapist specialising in eating disorders and endometriosis.

Key Points Discussed

Burden, impact, and diagnosis delays

• Global prevalence and QoL impact: Endometriosis affects an estimated 190 million women globally, reducing quality of life and affecting social, sexual, work/school participation, and mental wellbeing.
• Long diagnostic waits: Many face 8–9 years from first symptoms to confirmed diagnosis.
• Rising burden: The number of people living with endometriosis and disability-adjusted life years increased substantially over time (with figures discussed for 1992 to 2021).
• Economic cost (UK): UK estimated annual cost to the economy (£8.2 billion) linked to health costs and lost productivity.

What endometriosis is and why it’s complex

Endometriosis was described as a multisystem, inflammatory, chronic condition involving tissues resembling endometrial tissue growing outside the uterus.
It is framed as both hormone-responsive (lesions responding to hormonal signalling) and driven by inflammatory mediators (e.g., prostaglandins, cytokines), with genetic contribution discussed.

Symptoms and clinical presentation

Pain presentation was emphasised as often resistant to traditional pain relief, including:

• Pain during menstruation
• Pain with urination, bowel movements, sex
• Post-sex pain
• Endo-bloating
• Chronic pelvic pain and pain elsewhere

Remember that even partial support can be meaningful.

Prevalence, diagnostics, and equity concerns

At least 10% of women were stated as affected (focus on menstruating years).

Diagnostic delays were highlighted again, including that diagnosis can be harder for Black and brown women, linked to systemic/unconscious bias.

Gold standard diagnosis: laparoscopy (keyhole surgery) with possible removal of tissue.
Mentioned additional tools: ultrasound, MRI and discussion of CA-125 as a marker (not diagnostic).

Classification and types

The ASRM four-stage system (stages 1–4) was explained as used in America but noted as not used in the UK, partly because staging may not correlate with risk/severity.

Types covered included:

• Endometrioma / 'chocolate cysts' (ovarian)
• Superficial endometriosis
• Deep infiltrating endometriosis, including potential impacts on nearby organs

Medical treatment overview and possible consequences

Treatments discussed included hormonal approaches (e.g., progesterone/progestogens, contraceptive pill/IUS, hormone antagonists) and surgery/hysterectomy considerations.

Potential broader impacts emphasised: chronic pain, fatigue, mental health impacts, infertility risk, GI symptoms, and possible side effects tied to hypoestrogenic states and other hormonal changes.

Functional nutrition support: trauma-informed approach and diet and supplements

Emma strongly recommended a trauma-informed nutritional stance:

1. Validating experiences of delayed diagnosis/dismissal
2. Creating safe, collaborative support
3. Avoiding overly restrictive nutrition approaches (due to risk of anxiety, depression, eating disorders, and overwhelm — especially with history of anorexia)
4. Coordinating with other care providers (e.g., pelvic floor therapists, physiotherapists, Endometriosis UK)

Nutrition interventions covered included:

1. Emphasise on anti-inflammatory and antioxidant support
2. Checking/considering labs such as vitamin D, iron, B12, folate
3. Aiming for measurable change over 8–12 weeks
4. Supportive dietary patterns: more plant-based, antioxidant-rich foods
5. Caution around low FODMAP: potentially helpful but noted as restrictive and evidence timing limited; concerns raised for GI/vaginal microbiome effects

Targeted nutritional nutrients and mechanisms

Antioxidant-focused nutrition strategies referenced supporting evidence for:

• B vitamins
• Vitamin D
• Polyunsaturated fatty acids
• Dietary fibre
• Reducing saturated/trans fats and caffeine (opposite effects described)

Specific supplement/food strategy examples included:

• Vitamin C and Vitamin E (described as downregulating inflammatory mediators; discussed with suggested dosing ranges)
• Omega 3 fatty acids (including links to inflammation reduction, GI/anxiety support, and endometriosis relevance)
• Green tea / EGCG
• Curcumin (from turmeric) and ginger
• Vitamin D and possible genetic consideration (e.g., VDR variant)

Environmental toxins and oestrogen metabolism

Environmental toxin discussion included evidence that urine samples showed differences between endometriosis patients and controls, with a practical nutrition angle: reduce exposure where possible.
The session also addressed oestrogen handling:

• Progesterone resistance and local hormone dysregulation may not show in blood tests
• Nutrition supports suggested for oestrogen metabolism, glucuronidation, sulfation, and excretion, plus hydration, gut motility, fibre, and supporting the microbiome (including beta-glucuronidase considerations)

Genetic links and vaginal microbiome

Genetics: described as potentially useful for tailoring support to help clients optimise methylation and understand influencing factors.
Vaginal microbiome: endometriosis associated with lactobacillus depletion and increased pH was noted.
Practical guidance included considering vaginal pH testing and lactobacillus probiotic strategies.

Key Takeaways

1. Use a trauma-informed, collaborative approach and avoid unnecessary dietary restrictions for endometriosis clients, especially those with eating disorder history.
2. Think beyond hormones in blood tests: local tissue hormone dysregulation and progesterone resistance may require functional nutrition strategies to support oestrogen metabolism/elimination.
3. Prioritise inflammation and microbiome support through an antioxidant-rich diet, appropriate micronutrients, targeted probiotics/PH support, and evidence-informed supplements over 8–12 weeks.

Conclusion
This webinar delivers a structured clinical-and-functional roadmap for practitioners: understand endometriosis impact and diagnostic realities, adopt trauma-informed nutrition care, and apply targeted evidence-based nutrition strategies (antioxidants, omega 3, vitamin D, specific nutraceutical approaches, oestrogen metabolism support, and vaginal microbiome considerations). 

This webinar is fully approved by BANT® and accredited for CPD hours.