I did an instagram post the other day after I was tagged by a well meaning woman suggesting to another that by following my advice she’d never have to have a surgery. I said how this was incredible hope, but not 100% realistic because, while diet + lifestyle changes are imperative for full-body healing, they’re not a stand-in for surgery if you really need one.
This resonated with a lot of women, and I received a flood of questions, comments, and insight into this form of medical intervention since most of my Heal Endo tribe is really about holistic healing, and most of us want to avoid the dreaded surgery as much as possible. So I thought I’d do a wee little blog post to shine light on some of the information and misinformation out there.
Here’s the thing: some women are hell-bent on getting better without surgery, while others lump all their eggs into one basket - so to speak - that surgery will fix everything. Truth is, it’s all so complex (isn’t is always with endo?? ANNOYING). Overall surgery is awesome when done correctly but can expensive for the good ones, scary for the bad ones, doesn’t come without certain costs, and no one wants to go under the knife unless necessary. I have had clients that got better symptomatically from dietary changes alone, and those who felt loads better but still needed a surgery to remove the scar tissue literally searing their organs together.
Why the big divide in symptom changes with diet/lifestyle changes? Lots of reasons. Let’s chat surgery!.
1) Why does someone with endo need surgery in the first place?
Here’s the a simple #endoschool recap. Endometriosis is super-duper complex and very unique in how it operates in the body. Although it’s an auto-immune related disorder (autoimmune disorders attack a tissue, cell, or organ in your body), instead of tissue being attacked, tissue is instead being grown. Your endometrium tissue, obviously, growing where it shouldn’t. This is weird and, even more, this incorrectly placed tissue causes more issues as it grows - such as scar tissue and adhesions - and also often correlates with big, painful cysts. This means now you have a bunch of stuff growing in your pelvis that shouldn’t be there.
This environment can also fuel itself to become quite sickly. Endo lesions aren’t like a normal endometrium tissue and they’re progesterone resistant, meaning the whole pelvis can become overly estrogenic, fueling more endo growths, inflammation, and scarring. Endo is also stimulated by LPS bacteria (from bad gut bacteria migrating into your pelvis), so it can also become colonized by inflammatory yuckies like e.coli. Now in this realm of pathogenic bacteria, free flowing blood, and too much estrogen fueling the fire, scar tissue and adhesions can stick your organs together.
This is the basic reason why someone may need surgery: rampant endometriosis tissue growth, scar tissue, adhesion, and cysts.
2) There are studies showing that diet and lifestyle aids can help endometriosis lesions to minimize or disappear, though. So, if I did this would I not need surgery?
Totally depends! There are so many levels of endometriosis, from very minimal amounts of lesions to an entirely frozen pelvis. So while some studies show some bodies able to reverse lesions through targeted lifestyle approaches, there’s still the issue of scar tissue, adhesions, and sometimes enormous or painful cysts which aren’t so easy to dissolve.
Truthfully, some women I work with have been able to reclaim their lives through diet and lifestyle alone. And I mean totally. No pain, no fatigue, no bloating, they got pregnant. Other women I’ve worked with felt certain symptoms abate, felt better in one way, but still had pain or an issue to resolve - and in this case I’ve recommended surgery as a next step with total symptom management (i.e. remission) always as the goal.
One perfect example of how we may need surgery after all is said and done is Angie Alt, one of the leading members of the Paleo Autoimmune Protocol community, who has endo amongst other autoimmune issues. I mean, who understands the importance of diet lifestyle more than this woman?? Unfortunately, she writes in her blog that after so long of being, like, uber healthy, working to reverse deficiencies, heal the gut, etc, she still had to have another surgery because the endo creeped back. Bummmmmer.
As for me? I had 2 poorly done surgeries and felt like I was signing up to be on the “surgery treadmill” when I had another horrible STAB of endo-growing-back-pain just 10 months after my second surgery. For me, that’s when I finally did a huge (and I mean huge) diet and lifestyle 180 that threw my body into full remission for 4 years now. What did I do? Everything on this site. And more.
3) Endo and you, endo and me, we are different as can be
It’s so important to remember your journey is going to be TOTALLY different than all your endo-sisters, and to get to a point of full or partial remission your journey is going to be your own. You may need a surgery or two.
That’s because endo affects women differently, and I do believe there is such a thing as more aggressive endo (although it may stem from lifestyle more than the endo itself). You also inherited a set of genetic characteristics from your parents that may make your body more susceptible to certain health issues, meaning you may have associated autoimmune disease, mental health issues, or physical barriers on top of your endo.
That being said, it’s soooo important to know that you’re not a failure if you need surgery or other medical help while Susie just needed to stop eating gluten to feel totally fine.
4) But surgery may still only be one part of the solution
Important message: a well-done surgery may throw you into full remission, or it may not. There’s been a huge push these past few years of well-meaning folk repeating “One Surgery One Time”, meaning one expertly done surgery to remove all the endo and give you a state of full remission - and yet this isn’t totally true for every woman.
In my clientele, I’ve had a handful of women so far who had an advanced, expertly done endo surgery and still needed my services for alllllll the associated issues they thought the surgery would fix. They can’t digest properly, they’re fatigued out of this world (spoonies), they may still oddly have pelvic pain. These are associated issues of endo, and ones that surgery can’t just pick out of your body and toss in the trash (that would be too easy, hah! oh wait, you’re not laughing - yah endo is a bully).
There’s also the social justice issue of “One Surgery One Time”, since many women will not be able to afford such a surgery, nor even qualify for a loan to afford the surgery. Since there are only a certain amount of expert surgeons in the world most of us will find ourselves forking over personal funds for these experts. Even if you have insurance, a skilled surgeon may still leave a hefty co-pay in your mail, something not every woman can fathom when just making rent (with a chronic disease) is hard enough. I know when I was looking into specialty surgery years ago I threw in the towel as $40k was beyond my comprehension at the time.
5) What’s a girl to do in the face of all of this?
Learn!!! Learn about endometriosis in its totality (Like, READ THIS PAGE), then learn about how it’s affecting your own body. First, follow your symptoms and unique diagnosis, get opinions and second opinions, aim to avoid surgery at all costs, and then get surgery if you need one.
In the meantime, do everything you can to heal your body and associated symptoms in hopes of avoiding a surgery or preventing yourself from needing another one. Remember that endometriosis is affected in severity by:
Immune regulation issues - work to recalibrate your immune system so it functions normally. Consider the PaleoAIP diet.
Malnutrition - so aim to eat to reverse chronic disease by doubling your nutrient intake rather than worrying about whipping your thighs into shape.
Gut-Issues - we now know that bad bacteria in the gut shed something called LPS, it leaks out of the gut, and falls into your pelvis, stimulating more inflammation and more growths of endo. This means you need to absolutely heal and seal your gut to help your endo severity. Each woman may have her own unique set of gut issues and infections, but 2 places to consider starting are with a lowFODMAP diet (if you have IBS) or a PaleoAIP diet if you don’t have IBS. Both should be considered short-term, therapeutic diets, not long-term lifestyles.
Movement - sometimes I wonder if the recurrence rate of endo in super healthy people has to do with incorrect movement and breathing patterns, or stagnant flow of blood to the pelvis. Indeed we need to eat nutrients and then GET THEM TO THE PELVIS, which only happens with correctly blood flow. A recently published study “suggested that pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain”, so take your core + pelvic floor function seriously ladies.
No matter now much you want to avoid it, surgery may be a huge part of your endo puzzle. One that demands respect. One that is never a failure when needed. One that even a woman currently in remission and doing everything under the sun to heal may need in the future, because endo is one-heck-of-a-disease. But also one that may not be the perfect solution depending on your disease severity and symptoms, and one that should be approached with caution to avoid the risks and costs that inherently come with surgery. Do your research, talk to other women, find a surgeon you believe in and who believes in you. Healing from endo is holistic, meaning using all the tools in your kit, and sometimes your holistic road will also need some professional surgical help. That being said, surgery is also no replacement for dietary and lifestyle shifts :) This is why healing must be balanced. So is life.