Chronic inflammation is a subtle and insidious force that, like a rogue ember, can spark a constellation of health issues. For women in particular, this hidden fire often finds its tinderbox in the hormonal shifts of perimenopause, the complex webs of Polycystic Ovary Syndrome (PCOS) and endometriosis, and the shadows of depression.
The women who come for acupuncture, seeking support with their menstrual problems, often carry within them the subtle hints of chronic inflammation. It might show in their irregular cycles, their stubborn weight gain, the fog of low mood, and the painful and debilitating period pains.
Today's blog post is going to examine chronic inflammation and its role in PCOS, perimenopause, and endometriosis and as always it will give you ways you can make changes to your chronic inflammation.
My messages are always open so if you have questions then feel free to get in touch
Andrea
The Period Acupuncturist, Hertfordshire
What is inflammation?
Acute inflammation is an amazing thing. It is critical to the human race's survival. At its simplest inflammation is the body's natural defense mechanism (immune system) against injury, infection, and irritation. If you cut your hand this initiates a series of mechanisms including:
Redness & heat: Cytokines cause blood vessels near the injured or infected area to dilate, leading to increased blood flow. This brings more immune cells and other substances to the site to fight the threat and will create redness and heat
Swelling: The body will build a wall of white blood cells and fluid around the inflamed area to contain the infection or injury and prevent it from spreading to other parts of the body.
Pain: discourages movement and activity, which could worsen the injury or infection and it draws attention to the affected area, prompting us to seek medical care if necessary.
This would be considered acute inflammation and as I said, is a lifesaver.
What is chronic inflammation?
Chronic inflammation is unfortunately where the body is being tricked into thinking it's got to fight against an unknown intruder. This ongoing inflammation can damage healthy tissues and organs over time, contributing to various chronic diseases.
If you have long-term inflammation for years rather than just days or maybe months, it can increase your risk of serious diseases like heart disease and cancer.
Chronic inflammation could also be the root cause that ties together PCOS, endometriosis, and perimenopause:
blocks hormone receptors
impairs oestrogen metabolism
prevents ovulation
hinders the production of progesterone
Some general symptoms of chronic inflammation can include
headaches
joint pain
chronic skin conditions such as psoriasis and eczema
fatigue
And how chronic inflammation can impact your period and menstrual cycle
PMS
Period cramps
Menstrual migraines
Impaired progesterone levels
Affects the thyroid
Increased aromatase and oestrogen levels
Poor egg quality
What causes chronic inflammation?
Chronic inflammation can be caused by several factors including
Stress: large bodies of literature and research point to the evidence that stress activates an inflammatory response in the brain and body
Insulin resistance: chronic inflammation is seen as a key way that we develop insulin resistance and conversely too much insulin creates inflammation
Environmental toxins: these might come from a wide range of places including food, cosmetics, and household products. These endocrine-disrupting chemicals alter the function of the endocrine or hormonal systems
Diet: sugar, alcohol, wheat, dairy, and vegetable oil may all be inflammatory (although not for everyone)
Digestive problems: gut dysbiosis can ramp up inflammation. A leaky gut (also called intestinal permeability) allows toxins and undigested food particles to enter the bloodstream, potentially triggering an inflammatory response
Poor sleep: sleep loss has been shown to increase chronic inflammation markers
Chronic infections just as Epstein Barr virus
Smoking
Perimenopause and Chronic Inflammation
Perimenopause, the prelude to menopause is a natural physiological transition that sees oestrogen and progesterone begin to decline as women age.
To understand more about perimenopause you can read my blog post here.
However, notably, in the West women appear to experience detrimental signs and symptoms during perimenopause. So, could inflammation be a root cause of why?
In the book Hormone Repair Manual, by Lara Briden, she explores the role of inflammation and how reducing it is an essential part of a healthy perimenopause.
Chronic inflammation in perimenopause has an unwanted impact of hindering an already declining progesterone and can:
stimulate more hot flashes
make periods heavier
contribute to poor mood
effect sleep
Lara Briden recommends reducing inflammation in perimenopause by including the following in your day-to-day:
Magnesium: this includes nuts, seeds, dark chocolate, and dark leafy green. If you are not getting enough magnesium you can supplement with a glycinate powder
Zinc: zinc citrate, picolinate, or bis-glycinate taken directly after food
Avoiding or eliminating all the causes of chronic inflammation such as stress, poor sleep, ultra-processed foods, environmental toxins, smoking, etc
PCOS and Chronic Inflammation
Polycystic Ovary Syndrome, or PCOS, is a hormonal enigma.
The most common hormonal disorder in women of reproductive age, PCOS is called a syndrome, rather than a disease, as there is a wide range of ways that it can present.
To read more about PCOS you can read my blog post here.
But could chronic inflammation be an underlying element of PCOS?
Research published in 2021, found a significant association between PCOS and elevated levels of C-reactive protein, a key inflammatory marker.
Our meta-analysis provides further strong evidence for a moderate elevation in circulating CRP in PCOS women with a decline in adiponectin, which are indicative of a low-grade chronic inflammation
In the book "8 Steps to Reverse Your PCOS" by Dr Fiona McCulloch she has a whole chapter dedicated to the importance of cooling inflammation saying
Inflammation is not just a side effect of PCOS, as thought previously. It is the central factor in the condition.
Dr McCulloch suggests that tests can determine the level of inflammation
Hs-CRP: this protein can be elevated in PCOS and the higher the level, the more intense the inflammation. This test shouldn't be taken when you are ill with a cold/flu as this will be falsely elevated
ESR: a useful test for inflammation related to autoimmunity. Again this shouldn't be taken in a state of illness
Anti-Tg, Anti TPO: antibodies that attack the thyroid gland and could be raised if Hashimotos (an autoimmune condition) is found. As women with PCOS have an increased incidence of Hashimotos it is good to test for this
Conventionally inflammation could be addressed with metformin or Low-dose naltrexone (LDN).
But other methods are:
Eating an anti-inflammatory diet:
Reducing Ultra Processed Foods (this is an interesting and useful group on Facebook called Reducing Ultra Processed Foods (UPFs) UK and the book Ultra Processed People by Chris van Tulleken
Try to build a balanced diet that incorporates a variety of plant foods. These contain polyphenols, which are great for fighting inflammation. In addition to plant foods, diets rich in lean proteins and healthy fats also tend to have lower DII scores.
Minimise leaky gut: if you suspect you have a leaky gut (bloating, indigestion, food sensitivities, inflammatory bowel disease, thyroid disease, inflamed skin, depression, anxiety) eliminate or reduce gluten whilst also looking at allergies such as:
dairy
wheat
corn
soy
Supplements she recommends include:
Trans-Resveratrol: this minimises the secretion of cytokines TNF-alpha and IL-6 and also reduce NK-kappa B
Omega-3 fatty acids: fish oils reduce TNF-alpha, IL-17 and IL-6
Bioflavonoids: such as grape seed extract, green tea, and dark red berries all reduce NK-kappa B and TNF-alpha
N-Acetyl Cysteine: protects against insulin resistance, improves ovulation, reduces androgens through its anti-oxidant function
Curcumin: a powerful anti-inflammatory extracted from turmeric, however, this shouldn't be used if you are trying to get pregnant.
Vitamin D: therapeutic doses of Vitamin D can be anti-inflammatory. It can decrease TNF-alpha and IL-6
Endometriosis and Chronic Inflammation
Endometriosis is now understood to be an immune-related chronic inflammatory disease. Your immune system plays a big part in what happens as it produces inflammatory cytokines and other immune factors that inflame the endometriosis lesions.
Decreased T cell reactivity and NK cytotoxicity
Polyclonal activation of B cells
Increased antibody production
Increased number and activation of peritoneal macrophages
Changes in inflammatory mediators
This condition can create many symptoms including:
Pain
Periods
Sex
Shoulder
Bowel movements
Urination
Back
Infertility
Heavy periods
Fatigue
Bloating
Constipation
Nausea
Vomiting
Anxiety
Depression
Shortness of breath
What can you do if you have endometriosis?
Eliminate red meat
Increase omega-3 intake
Eliminate butter
Work towards a high anti-inflammatory diet
Work towards 8-10 servings of fruits and vegetables per day.
Reduce exposure to environmental toxins
In a study published in 2023, they looked at the efficacy and safety of acupuncture in the treatment of endometriosis-associated pain
They found that
"Acupuncture is an effective and safe method of relieving dysmenorrhea, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain, although its efficacy fades after treatment is discontinued"
Pain: significantly lower mean VAS score at week 12 and a significantly larger change in the VAS score from baseline to week 12 BUT there were no significant differences in the mean VAS score at week 24 or the change in VAS score from baseline to week 24 between the two groups
Physical function, emotional state, and quality of life: significantly lower mean MPI, BDI, POMS, and EHP scores at week 12 and significantly larger changes in these scores from baseline to week 12 BUT no differences were found in the mean scores, and changes in scores on the MPI, BDI, POMS, and EHP at week 24.
Satisfaction: compared with the sham acupuncture group, women in the acupuncture group had better satisfaction regarding treatment efficacy
Acupuncture and chronic inflammation: a hidden tool?
Acupuncture can have a profound anti-inflammatory effect. Studies demonstrate acupuncture's ability to reduce inflammatory markers
“Many biochemical and signaling pathways have been identified as playing a direct role in how acupuncture achieves its clinical effects, but perhaps the most central pathway that acupuncture uses, one that helps explain how it is effective in such a diverse array of clinical areas, is that acupuncture has been demonstrated to directly initiate a process called purinergic signaling”
Purinergic signaling has been demonstrated to play a central role in diverse clinical areas such as inflammation"
In a paper published in 2021, they found that
Studies from the last five years revealed that acupuncture suppresses systemic inflammation, completely or partially via the activation of vagal efferent nerves, CAIP, or vagus-adrenal medulla-dopamine pathway. Along with this, the sympathetic pathway or HPA axis also plays crucial roles....and that early intervention with acupuncture can inhibit excessive inflammatory responses and reduce the risk of “inflammatory factor storm”.
Conclusion
Chronic inflammation is an insidious force that not only impacts menstrual conditions such as perimenopause, polycystic ovary syndrome (PCOS), and endometriosis but has widespread repercussions for our health including cardiovascular disease and inflammation.
General signs and symptoms to be aware of are
Joint pain
Headaches
Fatigue
Chronic skin conditions
Testing will allow you to ascertain how much (if any) inflammation your body is experiencing.
If you have chronic inflammation here are some things you should be considering
Acupuncture (of course)
Dietary changes including:
reducing ultra-processed foods
eliminating certain foods
adding in omega-3
eating an anti-inflammatory diet
Stop smoking (if applicable)
Reduce stress
Prioritise sleep
Reduce environmental toxins