Why I Recommend Ibuprofen to Women with Endometriosis

March is Endometriosis Awareness Month… and I feel like I’ve been spending most of this month talking to women who have more-than-usual pain when it comes to their periods. Many women can experience pain lingering from a dull ache, to so severe they cannot leave a fetal position for multiple days in a row. Endometriosis isn’t just a “pull yourself together dear” diagnosis, it can literally impact every part of a woman’s life. 

 But here’s the deal, research on endometriosis is severely lacking. We barely know why some women develop it, let alone how to treat it. In fact, many women don’t even get diagnosed with endometriosis until they’re having trouble trying to get pregnant. Lo and behold, when a proper history is taken, it turns out that the pain that woman has been suffering during her periods has never been taken seriously. The question then becomes, what do you do about it?

Gold Standard of Treatment

In Canada, the gold standard treatment for endometriosis is something known as excision surgery; and it’s not even available here in Atlantic Canada. If you want to experience relief, you usually have to fly to the States for surgery. Not cool. If you can’t afford it, you’re left with a few options.. painkillers, a birth control pill or IUD, Visanne (similar to a progesterone-only OCP) or a hysterectomy. Really not cool. 

This is where naturopathic medicine comes in. 

It’s interesting to me, how we’re not always following the research when it comes to increasing Quality of Life in women with Endometriosis. That’s why my first recommendation always throws women off. No matter what stage of Endometriosis, I always recommend Ibuprofen. 

No, not for the reason you think. Let’s face it; when you’re suffering from that much pain Ibuprofen isn’t going to cut it. You and I both know that. But Ibuprofen is known as a prostaglandin inhibitor. And inhibiting prostaglandins is critical when you have endometriosis. 

What is a Prostaglandin? 

Prostaglandins occur naturally, in response to injury or disease, and cause pain and inflammation.  They have a number of functions including making the womb contract during a period (which helps with the shedding of the lining). These contractions can cause pain and the (unfortunate) link to endometriosis is actually quite interesting. See, the endometrium (the tissue that lines the womb) is an important endocrine gland and secretes a family of hormones called prostaglandins (PGs). PGs are lipid (oil based) hormones that are directly responsible for most of the cramps and pain associated with menstruation and endometriosis.

In women with endometriosis, however, that endometrium isn’t just specific to the uterine area. The endometriosis deposits throughout the body also respond to hormones the same way that the uterine endometrium does. GREAT (please note the sarcasm). 

This means that you’re not just experiencing cramps and pain in one area; it can be EVERYWHERE.

The Pain Connection

There are 2 types of prostaglandin’s that we focus primarily on when it comes to the menstrual cycle. Prostaglandin F (PGF) stimulates strong uterine contractions or cramps, and Prostaglandin E (PGE) stimulates that excruciating pain. Large amounts of PGF and PGE are produced by the endometrium and also endometriosis deposits spread throughout your body. The endometrium and its straying implants are very responsive to the levels of these hormones circulating in your blood.

It’s incredibly important to note that there is a natural surge of PGF at the end of the menstrual cycle, causing the effects of the corpus luteum of the ovary to die down, signaling the start of the menstrual cycle. The longer it takes for you to start your period (aka if you spot for multiple days) or the larger the ratio between your estrogen and progesterone levels, the worse this pain gets. This surge is part of the reason that the start of your period is generally more painful that the end of your period. 

PGF also causes increased gut motility leading to Irritable Bowel Syndrome (IBS) and diarrhea, which is why many women (with or without a diagnosis of endometriosis) experience looser stools as their periods start. 

What’s Estrogen Have to Do With Endometriosis? 

You know that nice little ratio between estrogen and progesterone I mentioned above? Keeping that ratio as close together as possible is critical for keeping prostaglandins low. Endometriosis deposits throughout the body not only respond to estrogen like the endometrial lining of your uterus, they also produce estrogen on their own. 

This means that, in women with endometriosis, you see high high high levels of estrogen. High levels of estrogen equates to high levels of inflammation; which equates to heavier bleeding, more clots, and… you guessed it, higher levels of prostaglandins being released. 

So, why Ibuprofen?

As you’ve probably summarized, endometriosis is a complicated process in which no one pill, diet, or even surgery, can guarantee an outcome. That’s why we take a few different options and piece them together and then tweak and make changes off of genetics, symptoms and changes. 

My main focus when working with women with endometriosis is Quality of Life. Let’s say your pain is at a 9.5/10; we’re going to focus on dropping that to a 6/10, and then lessening it from there. You have 2.5 bad weeks a month (or more?), we’re going to aim to get that down to 1 week. And then keep working. 

But step one, is to drop the prostaglandins and try to lessen the bleeding (less bleeding = less inflammation = less pain = better periods). This is where Ibuprofen comes in, as taking ibuprofen not only reduces the prostaglandin release, it also reduces bleeding by 20-40%. But here’s the deal… ibuprofen only works effectively if they are taken BEFORE the body starts to produce prostaglandins. Which means you sometimes have to start taking them a few days before your period actually starts (if your stomach can handle it).

Once pain isn’t controlling your daily life, we then focus on adding in natural anti-inflammatories (like omega-3 fatty acids, SPMs, curcumin and boswellia), reducing foods that are high in linolenic acid (which increases prostaglandins), and bringing the ratio of estrogen and progesterone closer together by decreasing estrogen levels and increasing progesterone. 

If you’re interested in chatting more about how we can improve your Quality of Life, feel free to contact me using the form below. 

-Dr. Ashley