Endometriosis and Joint Pain/Muscle Aches

Endometriosis is a pelvic inflammatory disease, most of us know this. Peritoneal fluid (the lubricating liquid that lines the abdominal cavity and organs of the abdomen) in women with endometriosis tends to have elevated macrophages (a type of white blood cell) that produce pro-inflammatory cytokines and other factors that cause inflammation in the abdomen and, also, show evidence of aiding in the spread of endometrial lesions. I already reviewed this a bit in my post about endometriosis and autoimmune disorders.  Also many medical therapies women with endometriosis are administered (some forms of BC, Lupron, Orlissa etc..) decrease systemic estrogen. Estrogen is a hormone that plays a vital role in bone strength and without it bone pain and arthritis can occur.  It doesn’t stop there though! Recently there has been evidence that women with endometriosis have sub-clinical elevation of pro-inflammatory cytokines in the blood that pumps throughout their entire body.

Some of these factors include: CRP, SAA, TNF-α, MCP-1, IL-6, IL-8 and CCR1.1 Do you have endometriosis and complain that some days you feel like a 90 year old trying to get out of bed? Like all your joints and tissues are swollen and aching? Well, according to recent research, this could be more than just a feeling. Systemic inflammatory factors, such as the the ones mentioned above, can have many physiologic side effects with chronic subclinical elevations including hot flashes, increased likelihood of adhesion formation2, swelling of joints, arthritis, generalized pain,3 loss of appetite, increased risk of cardiovascular disease4, disrupted sleeping patterns, chronic fatigue,5 increased risk of cancer, and increased risk of cancer progression6.

In short, endometriosis has been long thought of as a local disease only affecting areas where endometriotic lesions are present but now there is evidence that endometriosis actually has a variety of systemic effects on the body. So before you blow off your aching joints and chronic fatigue to just being a wimp, think twice. These are real symptoms of a real disease.

The good news is that there are things we can do to balance our systemic inflammation. First, we can exercise. Who wants to exercise when everything hurts? I know! Yet, there are currently over 50 research papers stating that exercise lowers inflammatory markers REGARDLESS OF IF PATIENTS LOST WEIGHT OR NOT. The benefits of exercise were not dependent upon actual weight loss when it comes to inflammatory markers.7 Secondly, consumption of eicosapentaenoic acid (fish oil) and  alpha-linolenic acid (flax-seed oil) have been linked to a significant decrease in pro-inflammatory cytokines.8 It is not only oils that can help keep inflammation at bay though. Our entire diet effects our systemic inflammation. There are a lot of aspects to an anti-inflammatory diet but the primary take home when it comes to reducing pro-inflammatory cytokines that I am going to cover at this moment is to consume a diet low in polyunsaturated fatty acids9 and high in dietary flavonoids10. I will get into some more foods and therapies that are believed to be beneficial for systemic inflammation but for now I think I have give you enough to think about.

I hope this can inform others about the less talked about side effects of endo. Such a multifaceted disease process can often leave you feeling worn out and in pain. Without an understanding of the full physiological effects of endometriosis this can feel overwhelming. The belief that it is just painful periods can also lead others to make you feel like your pain is not valid leaving you feeling frustrated at yourself. At Least that has been my experience from time to time. So I hope this post can help you understand more about why you feel the way you do so you can embrace the warrior you are.

1Agic A, Xu H, Finas D, Banz C, Diedrich K, Hornung D: Is Endometriosis Associated with Systemic Subclinical Inflammation? Gynecol Obstet Invest 2006;62:139-147. doi: 10.1159/000093121
2Y.C. Cheong, J.B. Shelton, S.M. Laird, M. Richmond, G. Kudesia, T.C. Li, W.L. Ledger; IL-1, IL-6 and TNF-α concentrations in the peritoneal fluid of women with pelvic adhesions, Human Reproduction, Volume 17, Issue 1, 1 January 2002, Pages 69–75,
3Per Alstergren, Sigvard Kopp; Insufficient endogenous control of tumor necrosis factor-alpha contributes to temporomandibular joint pain and tissue destruction in rheumatoid arthritis, The Journal of Rheumatology, Sep 2006, 33 (9) 1734-1739;
4Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004 Apr 1;350(14):1387-97.
5Okun, M. L., & Coussons-Read, M. E. (2007). Sleep disruption during pregnancy: How does it influence serum cytokines? Journal of Reproductive Immunology, 73(2), 158-165. doi:10.1016/j.jri.2006.06.006
6Balkwill, F., & Mantovani, A. (2001). Inflammation and cancer: Back to Virchow? The Lancet,357(9255), 539-545. doi:10.1016/s0140-6736(00)04046-0
7Paul M. Ridker,. C-reactive protein, inflammation, and cardiovascular disease: clinical update. Texas Heart Institute journal, 32(3), 384-6.
8Balkwill, F., & Mantovani, A. (2001). Inflammation and cancer: Back to Virchow? The Lancet,357(9255), 539-545. doi:10.1016/s0140-6736(00)04046-0
9Adam, O., Beringer, C., Kless, T. et al. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int (2003) 23: 27.
10Pan, M., Lai, C., & Ho, C. (2010). Anti-inflammatory activity of natural dietary flavonoids. Food & Function, 1(1), 15. doi:10.1039/c0fo00103a

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