Endometriomas: Understanding Causes, Symptoms, and Holistic Management Strategies

Endometriomas, often referred to as "chocolate cysts" or "ovarian endometriosis cysts," are cystic lesions stemming from endometriosis. These fluid-filled cysts, commonly located in the ovaries, signify a more advanced stage of the condition. For many endometriosis sufferers, endometriomas are a major cause of chronic pelvic pain and infertility, presenting significant challenges to management and treatment.

In this blog, we'll explore the latest research on both medical and holistic approaches to managing endometriomas, emphasizing actionable strategies for reducing their size and impact.

Holistic Management of Endometriomas

As a functional dietitian, I focus on eight key areas to manage endometriomas holistically:

1. Glycemic Load of the Diet
   A low glycemic index (GI) diet helps stabilize blood sugar levels, directly reducing hormonal fluctuations that may influence endometrioma growth. Studies show a correlation between high-GI diets and increased risk of endometriosis. Incorporating foods with a GI score of 55 or less, paired with protein, fat, and fiber, can support better hormonal health. Additionally, a reduced stimulus for insulin release, a growth promoting hormone, is helpful for reducing the growth of things like cysts, polyps and fibroids. 

2. Testosterone Levels
   Research suggests low testosterone levels contribute to endometriomas by impairing folliculargenesis. Maintaining healthy testosterone levels is essential not only for managing endometriomas but also for overall reproductive health.

3. Estrogen Regulation
   Endometriosis lesions produce and rely on estrogen to sustain growth. Monitoring estrogen levels and optimizing elimination through a fiber-rich diet can help reduce the impact of estrogen on endometrioma development.

4. Vitamin D Optimization
   Studies show a strong link between low vitamin D levels and endometriomas. Supplementing with vitamin D or consuming vitamin D-rich foods like fortified dairy, mushrooms, and oily fish can be beneficial.

5. Improved Blood Flow
   Poor pelvic circulation contributes to both pain and cyst growth. Strategies such as acupuncture, exercise, and consuming blood flow-promoting foods (like beets and ginger) can enhance circulation.

6. Copper Levels
   High copper levels, particularly in individuals with a history of copper IUDs or vegetarian diets, may exacerbate endometriomas by increasing estrogen receptor activity. Testing and balancing copper and zinc levels are key steps in managing this risk factor.

7. Zinc Supplementation
   Zinc deficiency has been associated with ovarian cyst development. Including zinc-rich foods like oysters and pumpkin seeds or supplementing with zinc picolinate or glycinate can support ovarian health.

8. Physical Activity
   High-intensity interval training (HIIT) has been shown to reduce the recurrence of endometriomas. However, exercise regimens should be tailored to individual energy levels and physical capabilities.

Medical Management Options

While holistic strategies are powerful, medical options such as aromatase inhibitors, progestins, and dienogest also play a role in reducing endometrioma size. Research indicates that combining medical treatments like letrozole with add-back hormone therapy can lead to significant improvements. However, these treatments may not be suitable for everyone and often come with side effects. These management options are also entirely inconsistent with fertility as they prevent ovulation, and therefore, conception.

Key Supplements for Endometrioma Management

Several natural supplements have shown promise in the research in reducing endometrioma size and development. These supplements include:

• NAC (N-acetylcysteine): Proven to reduce cyst size, improve fertility, and alleviate pain.

• Magnesium: Supports blood sugar stability and reduces muscle cramping and stress. The blood sugar supporting benefits of magnesium is what helps with reducing endometrioma size.

• Ginger: Boosts circulation and provides anti-inflammatory benefits.

Lab Markers to Monitor for Endometriomas

While endometriomas can't be diagnosed through blood work, certain labs can provide insight:

• CBC/Iron Panel: To detect anemia from heavy bleeding often caused by large cysts. Endometriomas also tend to reduce egg quality. Iron is an important mineral for maintaining good egg quality.

• Ca-125 Levels: Levels tend to elevate with large endometriomas. If you report a reduction in Ca-125, this may correspond with a reduction in your endometrioma size.

• Sensitive CRP: A marker of general inflammation associated with deep infiltrating endometriosis and large endometriomas.

Take Charge of Your Endometrioma Health

Managing endometriomas can feel overwhelming, but understanding your condition and implementing targeted strategies can make a significant difference. From dietary changes to medical options and supplements, there are many ways to take control of your health.

Do you have questions about managing endometriomas or need help customizing your plan? Stay tuned for my upcoming ‘Oma Academy Course for step-by-step guidance and functional testing. Click here to be the first to be notified when the course is live.