Understanding Endometriosis vs. PCOS

It is Endometriosis Awareness Month this month. Endometriosis affects about 1.5 million women in the UK, but it remains one of the most under-diagnosed conditions. 

While we are PCOS specialists here at PCOS Clinics, we often see women with endometriosis as well as PCOS in clinic. So, what’s the difference?

Endometriosis and polycystic ovary syndrome (PCOS) are two common conditions that affect women. While both conditions can cause menstrual irregularities and fertility challenges, they differ in their underlying hormonal imbalances, symptoms, and treatment approaches. Understanding these differences is key to seeking the right diagnosis and treatment.

Endometriosis vs. PCOS: How They Differ

Both conditions can lead to heavy menstrual bleeding and issues with fertility, but they have distinct causes and symptoms:

• Endometriosis is linked to high levels of oestrogen, leading to the growth of uterine-like tissue outside the uterus.
• PCOS is caused by an overproduction of androgens (male hormones), leading to ovarian cysts, irregular periods, and other metabolic effects.
• It is possible to have both conditions simultaneously, complicating diagnosis and treatment.

Symptoms of Endometriosis vs. PCOS

Prevalence of Endometriosis and PCOS

• Endometriosis affects approximately 10–15% of women and up to 70% of those experiencing chronic pelvic pain.
• PCOS is more common, affecting 5–20% of women of reproductive age, with around 80% of ovulation-related infertility cases linked to PCOS.

What Causes Endometriosis and PCOS?

Endometriosis Causes

While the exact causes are not yet known, the following hypotheses have been put forward:

• Retrograde menstruation: Uterine tissue moves into the pelvic cavity instead of exiting the body.
• Immune system dysfunction: The immune system fails to eliminate misplaced endometrial cells
• Cell transformation: Some cells outside the uterus may transform into endometrial-like cells.
• Post-surgery implantation: Uterine cells may spread after surgeries like a hysterectomy or C-section.

PCOS Causes

• Genes: PCOS is a genetic condition
• Hormonal imbalance: High levels of testosterone and other androgens affect ovarian function
• Insulin resistance: High levels of insulin use can increase androgen production.
• Inflammation: Chronic inflammation contributes to excessive androgen levels.
• Stress: high levels of stress hormones can contribute to excessive androgen production.

Who is at Risk?

Risk Factors for Endometriosis

• Family history of endometriosis
• Early menstruation (before 11 years old)
• Short menstrual cycles (<27 days)
• Heavy, prolonged periods (>7 days)
• Infertility

Risk Factors for PCOS

• Family history of PCOS
• Insulin resistance or diabetes
• High levels of stress
• High levels of inflammation

Can You Have Both Conditions?

Yes. Studies suggest a strong link between PCOS and endometriosis, particularly in individuals experiencing pelvic pain or infertility. 

High androgen and insulin levels in PCOS may contribute to anovulatory periods (periods where we don’t ovulate), which may lead to higher levels of oestrogen, potentially exacerbating endometriosis.

Conventional Treatment Options for Endometriosis and PCOS

Endometriosis Treatment

• Hormonal therapy: Birth control or hormonal treatments to lower oestrogen levels
• Pain management: Over-the-counter pain relievers
• Surgery: Removal of endometrial tissue or, in severe cases, a hysterectomy
• Lifestyle changes: A balanced diet and exercise to help manage symptoms

PCOS Treatment

• Hormonal therapy: Birth control to regulate hormones
• Fertility treatments: Ovulation-inducing medication for those trying to conceive
• Diabetes medication: Helps manage insulin resistance
• Acne and hair treatments: Medications to manage excess hair growth and acne
• Lifestyle changes: A balanced diet and exercise to help manage symptoms

When to See a Doctor

Seek medical advice if you experience:

• Pelvic pain or abnormal menstrual bleeding
• Pain during or after intercourse
• Irregular or absent periods
• Difficulty conceiving
• Signs of excess androgen (e.g., excess hair growth, acne, hair loss)

Early diagnosis is crucial for symptom management. A gynaecologist or endocrinologist can provide a tailored treatment plan.

Final Thoughts

Endometriosis and PCOS are distinct but often misunderstood conditions that can significantly impact overall health. 

While endometriosis results from excessive oestrogen and misplaced uterine tissue growth, PCOS stems from an overproduction of androgens, leading to metabolic and reproductive complications. If you suspect you have either condition, early medical intervention can help manage symptoms and improve quality of life. And don’t forget the power of diet and lifestyle changes – if you’d like to know more, get in touch.

Cheesy flax crackers

These are a great addition to a hormone-balancing diet, as flaxseeds, the primary ingredient, contain lignans, a type of plant compound with oestrogen-balancing properties.

Plus, they’re low carb so are great for blood sugar balance. 

Makes 10

Ingredients

50g grated Gruyère cheese (Parmesan also works well)

130g ground flaxseeds

2 tsp dried oregano

½ tsp chilli flakes

½ tsp salt ground black pepper to taste

Method

• Line a baking sheet with greaseproof paper. Combine all the ingredients in a bowl and mix with 150ml water, combining to form a wet dough. Use your hands and/or a palette knife to press and spread the mixture as thinly as you can over the sheet. 
• Bake for 40 mins at 130C. Turn the oven up to 200C and bake for a further 10 mins. 
• Remove from the oven and allow to cool before breaking into crackers.
• Serve with hummus, guacamole or cream cheese.
• Enjoy!

10 Reasons Why You Need More Sleep

I’m sure you’re already aware that getting more sleep is a great idea, but here’s something I see a lot in my nutrition clinic: knowing something doesn’t mean doing it. 

Sometimes I feel it’s because people aren’t completely sure why sleep is so important for their health and, without that vital piece of information in place, it’s hard to persuade yourself it’s something you should be doing when there are so many other things calling for your attention and your valuable time.

So today I thought I would offer up some compelling reasons why making sleep a priority really is a good idea. You will likely already know many of the things you could do to make sleep more likely to happen but there is no urgency because the concept of sleep feels too far removed from the symptoms you’re experiencing. So, here’s my list, which is not exhaustive. Let me know which is the biggest reason you have for sleeping more!

Are you ready to discover the game-changer that could transform your health? Let's talk about sleep – the unsung hero of well-being – and what the lack of it is doing inside your body. 

1. Promotes weight gain

Are those stubborn extra pounds refusing to budge? Enter sleep – a star player in your weight loss journey. 

Many studies point to sleep restriction leading to increased levels of ghrelin, the hunger hormone, and decreased levels of leptin, the hormone responsible for fullness. 

Not only that, chemical changes inside the brain also alter the kinds of foods you fancy eating. So, by ensuring sufficient sleep, you're not just avoiding late-night snacking; you're setting the stage for a metabolism that works in your favour.

2. Creates more inflammation

Practically every cause of dis-ease in the body (and also disease) is related one way or another to inflammation. Inflammation can wreak havoc on your body, and poor sleep might be fanning the flames. 

Researchers found a clear link between sleep deprivation and increased inflammatory markers. So, when you prioritise sleep, you're not just easing into dreamland; you're actively reducing the risk of inflammatory conditions of all kinds.

3. Destabilises your hormones

Your body is a finely-tuned orchestra of hormones, and sleep plays the role of the conductor. Skimping on sleep can throw this delicate symphony off balance, impacting everything from stress hormones to those governing metabolism (like hunger and fullness) as well as female hormones. For women, sleeping well is not a luxury.

When you don’t sleep, what might be on the cards includes menstrual irregularities due to interruptions your body’s natural wake-sleep rhythm, exacerbated PMS as well as problems with fertility, too. A harmonious hormonal dance begins with a restful night's sleep.

4. More stress on top of your existing stress

Feel like stress and anxiety are running the show? Let sleep be your backstage pass to tranquillity. Author of the book Why We Sleep, Matthew Walker, highlights the crucial role of sleep in emotional regulation. Get less sleep, expect heightened emotional reactivity, increased stress and anxiety, and symptoms of mental health disorders like depression.

So, when you're tucked in for the night, you're not just escaping reality temporarily; you're arming yourself against the stressors of tomorrow.

5. Poor memory

Ever wondered why a good night's sleep leaves you feeling mentally refreshed? It’s because sleep contributes to memory consolidation and cognitive function. 

When you prioritise sleep, you're not just catching up on dreams; you're enhancing your brain's ability to tackle challenges, adapt to new circumstances, make better decisions, and retain information. That sounds like a win on every level imaginable.

6. Compromised immunity

Picture sleep as your body's superhero cape, especially when it comes to the immune system. 

Insufficient sleep weakens your defences, making you more susceptible to infections and worse – studies point to lack of sleep also being a risk factor in a variety of cancers. Want to stay healthy? Make sleep your immune-boosting sidekick.

7. Greater risk of heart disease

Heart disease is a leading cause of illness and death across the western world and there are a huge number of risk factors involved, from smoking to being overweight. Interestingly, there is an increasing amount of attention being given to poor sleep and cardiovascular risk. It’s thought to be linked to the non-REM sleep stages, during which your whole body slows down (heart rate, blood pressure, breathing) and this is restorative for the heart. 

Now imagine getting less sleep or interrupted sleep… Small wonder that chronic sleep deprivation is linked to a wide range of cardio conditions, like high cholesterol, stroke and heart attack. Guard your heart – prioritise those peaceful nights.

8. More likely to get diabetes

Watch out for the blood sugar rollercoaster! If you’ve been in my world for a while, you might have seen me talk about blood glucose levels being key for hormone balance. It’s a subject I never tire of talking about it and it’s easier to get under control than you might think. This is a key part of all my nutrition programmes so do let me know how I can help. 

Lack of sleep has been linked to insulin resistance, paving the way for type 2 diabetes. Plus, as I covered in my happy healthy hormones blog, balancing sugar helps balance insulin, which keeps our sex hormones balanced.

9. You’ll die earlier 

If you want to live longer (and spend more of those years in good health), sleep must be high on your to-do list. Consistent sleep patterns are key. According to the American College of Cardiology, who analysed data from a whopping 172,321 people, if you sleep well, for long enough and feel rested when you wake, you are 30% less likely to die prematurely, 21% less likely to die from cardiovascular disease, 19% less likely to die from cancer, and 40% from other causes.

Ready to feel great?

10. Get more sleep, you’ll be happier 

We all know everything looks better after a decent night’s sleep. There’s not a single pasture that is not greener. It’s official. A good night’s sleep means you’ll be happier and more satisfied with life. That’s enough for me! 

Are you struggling with sleep right now? Why not book in a call and find out how I can help.

Your hormone balancing action plan

If you’re looking to balance your hormones, here are my five top tips:

Prioritise sleep

There are some actions you can take to make a good sleep much more likely. These include things like avoiding drinks containing caffeine after lunch, going to bed at the same time every day, keeping the temperature in your bedroom comfortable, keeping the bedroom completely dark so you’re not disturbed by light and making an effort to relax for at least 5 minutes before going to bed - a warm bath, massage, meditation and so on.

The biggest tip I can give you is to really ensure that you prioritise your sleep. Make a real effort to focus on all the things you can do to improve your sleep hygiene rather than ‘kind of’ doing it.

Move your body

Exercise can have a noticeable effect on hormones and mood. You might have heard how exercise releases endorphins and the feel-good hormones dopamine and serotonin.

Instead of moving in such a way that you place excessive stress on the body, consider how your body likes to move. Focus on things like brisk walks, yoga or pilates, and weight training ahead of more punishing regimes involving spin classes and long runs.

Improve your digestive health

There might seem quite a geographical distance between your digestive system and your brain but the two are actually very closely connected. In fact, the digestive system is often referred to as the ‘second brain’. 

If you have any problems with your digestive system, it will be worth working on these with a nutrition professional. Your nutritionist will be able to advise if any functional testing might be appropriate to look for food reactions (allergies or intolerances) or a broader test to see whether you might have bacterial imbalance or infection.

For the purposes of this blog, it might be helpful to ensure you regularly eat probiotic foods like natural yoghurt, kefir and kombucha (all are now widely available even in supermarkets) or even take a probiotic supplement.

Reduce stress

Taking action to reduce stress in your life is essential but many people are concerned the specific things they might do are too much of a luxury in their already-busy lives. 

Bottom line: you can’t simply keep going the way things are. 

Taking some time to empty the ‘stress bucket’ is critical for your wellbeing. Yoga and mindfulness/meditation are proven ways to reduce stress but consider taking time out just to do the things you love to do quietly, mindfully and on your own: sitting in the garden with a cuppa, reading, colouring, knitting, or trying out a new hobby.

Balance your blood sugar

Blood sugar levels have a profound effect on our hormones largely due to the effect they have on insulin, which has a knock-on effect to our sex hormones. Balancing blood sugar could be an entire blog in itself, so do check back on previous blogs I have written.

But, in essence, try to stick to three good meals per day, and avoid snacks unless absolutely necessary. Make sure to have good quality protein with every meal and/or snack, and make sure that half your plate is covered with veggies (the green and brightly-coloured kind – not potatoes!)

And don’t forget, I’m always here if you’d like to discuss hormone testing or look further into why your hormones might be acting up right now. Just book in a call here.

Healthy, happy hormones

When you think about mental health, you’re probably thinking about your brain and how that works. The picture is often much more complex. Hormones play a big part because these chemical messengers are the background to everything that happens in your body. How you feel, therefore, is not just psychological, it’s biological.

Did you know, there are a huge number of symptoms that are common to both depression and hormonal imbalance? These include low energy, dizziness, low mood, apathy, anxiety, irritability, anger, lack of enthusiasm, despair, headaches, poor concentration, feelings of hopelessness, lack of confidence, low libido, fuzzy brain, memory loss, and insomnia (although there are others).

Rebalancing your hormones naturally is not something that happens overnight, but it can be greatly improved with the help of nutritional and lifestyle change. This blog will allow you to pinpoint where you might need help or support.

Mood and your cycle

Two of the main hormones that affect your feelings of mental wellbeing and clarity are oestrogen and progesterone, and these change throughout your menstrual cycle. It’s an over-simplification – but perhaps a helpful one – to think about oestrogen largely bringing positive effects to your mood and progesterone contributing more negative effects. With such a pronounced hormonal connection on mental health, it’s small wonder that women are twice as likely to suffer from depression than men.

According to the National Institute of Mental Health, 64% of women who suffer from depression say their symptoms get worse during the pre-menstrual period. Hormones are also likely to contribute to antenatal or postnatal depression, which affect around 10-15% of new mothers. And anxiety and depression are also starting to be recognised as symptoms of the peri- menopause on top of hot flushes and night sweats.

How it works

At certain times in your cycle (in the run-up to ovulation), there will be lots of oestrogen in your system and women tend to feel brighter and better in their mood. You might even notice at this time you feel better at talking and articulating yourself. In the second half of your cycle, oestrogen dips and progesterone comes into play. For some women, this can lead to lowered mood or depression.

PMS or PMDD

You might already experience this as Pre-menstrual Syndrome (PMS), a very common condition linked to the changing levels of these hormones, that might include feelings of bloating, breast tenderness or headaches, or manageable emotional symptoms like irritability.

For a small number of women (about 2-8%), the effect of these hormones on their mental wellbeing is pronounced. This is called Pre-menstrual Dysphoric Disorder (PMDD); an extreme form of PMS and one that, if you think might apply to you, you will want to ask your doctor about.

Why does this happen?

One of the first things to know is that the production of dopamine and serotonin (the two main brain chemicals associated with the development of depression and psychosis) is heavily linked to levels of oestrogen.

Research seems to suggest that there isn’t a noticeable difference in levels of oestrogen between those who are affected by mental health symptoms around their period or during the menopause – it seems some women are just especially sensitive to hormonal change, or perhaps also that lifestyle problems like stress may also play a big part.

Other hormones

Testosterone: 

You might think of testosterone as the male hormone and, while men do produce much higher levels, every woman needs testosterone, too. Testosterone can increase sexual desire and libido, make bones and muscles strong, and have you feeling assertive and confident. The downside can be anger and aggression. For us women with PCOS, we can suffer from an excess of testosterone and other androgens, which comes with its own set of issues. 

Thyroid:

Altered levels of thyroid hormones impact on mental wellbeing. If you just don’t feel like yourself, feel lethargic and low, it could be that your levels of active thyroid hormone are low. This can often run hand in hand with PCOS and it’s important for you to have it checked out. 

Cortisol:

Cortisol is one of the main stress hormones and, when stress levels are high, literally any of the mood-related symptoms I have mentioned in any of the above might be present.

Oxytocin:

Oxytocin directly opposes cortisol. It’s the love hormone and, if you have children, you might recognise it as the hormone that floods women after childbirth to encourage bonding. It has a direct effect on appetite, insulin resistance, weight loss – and your mood.

Impact of hormones on your blood sugar levels

Low oestrogen levels have a role to play in insulin sensitivity (that means how sensitive – or not – the cells in your body are to the fat storage hormone insulin). In fact, a lack of sensitivity to insulin (or even being resistant to the effects of insulin) is lurking behind many of the common hormonal symptoms in PCOS, like fatigue and weight gain as well as symptoms of low mood like brain fog, anxiety and depression.

“Hormones and mental health” is a complex picture in which your physiological health and mental wellbeing are inextricably intertwined. It’s best to work with a nutrition practitioner to unravel this for you. They will be able to piece together a hormone balancing food and lifestyle plan to suit your circumstances. Check out my Hormone Balancing Action Plan or why not book in a call here?

Circadian Rhythms: Influencing Hormones and PCOS

Beyond the hustle and bustle of daily life, there exists a silent conductor orchestrating the body's essential functions and processes - the circadian rhythm. This 24-hour internal clock plays a crucial role in synchronizing various bodily systems, including the well-known sleep-wake cycle. 

However, the influence of circadian rhythms extends far beyond regulating our sleep patterns. 

In this blog post, we'll explore the profound impact of circadian rhythms on hormone production and how understanding this connection can be pivotal for those managing Polycystic Ovary Syndrome (PCOS).

The Connection Between Circadian Rhythms and Hormones

At the core of our circadian rhythms lies the body's internal clock, intricately linked with environmental cues, especially light. 

While the sleep-wake cycle is a prominent circadian rhythm, it's noteworthy that other bodily systems, including hormone production, follow similar cycles. Research has shown that disruptions in circadian rhythms can have far-reaching effects on hormonal balance, impacting conditions such as PCOS.

A cross-sectional study delved into the circadian rhythm of individuals with PCOS, uncovering intriguing findings. The research revealed a delayed offset of melatonin relative to clock time and sleep time in PCOS patients. 

This delay was associated with higher serum free testosterone levels and worsened insulin sensitivity. These findings provide a glimpse into why many individuals with PCOS may experience difficulties in starting their day.

Tips for Optimizing Your Circadian Rhythm

Understanding the significance of circadian rhythms opens the door to proactive measures for improved hormonal balance. Here are some simple tips to enhance your circadian rhythm:

Set a Regular Sleep Schedule: Establish a consistent bedtime and wake-up time, even on weekends, to align your body with a predictable rhythm.

Prioritize Regular Mealtimes: Consistent meal schedules support the circadian rhythm, contributing to overall well-being.

Embrace Morning Light Exposure: Welcome natural light as soon as you wake up. Open the curtains, step outside, and let the morning light kickstart your day.

Dim Lights in the Evening: Toward evening, reduce light exposure and minimize stimulation. Create a calming environment by dimming lights as bedtime approaches.

Limit Screen Time Before Bed: Avoid phones, screens, and tablets at least 2 hours before bedtime to promote better sleep quality.

As we unravel the intricate connection between circadian rhythms, hormones, and PCOS, it becomes evident that fostering a healthy internal clock is essential for overall well-being. 

By incorporating simple lifestyle adjustments, such as regular sleep schedules and mindful exposure to light, individuals with PCOS can take proactive steps toward optimizing their circadian rhythms. 

Embrace these tips, tune into your body's natural rhythm, and pave the way for improved hormonal balance and enhanced quality of life.