Stress and Endometriosis Pain: What's the Connection?

This week’s episode is the first part of our two-part series on stress and its effects on endometriosis! Stress is a crucial topic when it comes to managing endometriosis, so we're diving deep. This episode focuses on the connection between stress and endometriosis and its impact on your body. Part 2 will cover why stress happens and how to manage it effectively.

In this episode, you’ll hear:

-Identifying Stress Impact: How to recognize if stress is affecting your body and the signs and symptoms of cortisol imbalances.  

-Understanding the HPA Axis: What the Hypothalamus Pituitary Adrenal (HPA) Axis is, its role as a feedback loop responding to stress, and how it becomes dysregulated.

-Adrenal Fatigue Explained: Why what’s often called adrenal fatigue is actually HPA Axis dysfunction. 

-Cortisol Levels: The implications of both high and low cortisol levels and how they indicate the duration of your body's stress response.

-Endometriosis and Cortisol: The significance of adrenal and cortisol release in relation to endometriosis.

-Autonomic Nervous System: The importance of the parasympathetic and sympathetic nervous systems and the need for your body to balance between the two.

-Parasympathetic State: Why being in a parasympathetic state is essential for digestion, healing, repair, and immune health; which is all critical for managing endometriosis.

-Sex Hormones and Adrenal Health: How adrenal health directly impacts your sex hormones and their production.

-Blood Sugar and Stress: The effect of stress and cortisol on your blood sugar levels.

-Nutrient Depletion: How the stress response depletes essential nutrients needed for a healthy stress response.

-Cortisol as an Anti-inflammatory: The role of balanced cortisol levels in helping your body manage inflammation.

Next week, we’ll explore why cortisol imbalances and HPA Axis dysfunction occur and what you can do about it. Don’t forget to subscribe and tune in for Part 2 to get the complete picture.


Resources:
Episode 21
Episode 37

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Disclaimer: This podcast is for educational purposes only. This may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Transcript

Alyssa Chavez [00:00:01]:
Hello and welcome back to the Endo Belly Girl podcast. I can't believe that it is summertime already. It is getting quite hot where I live. I'm in southern California, but I'm inland a little bit, so I'm not right by the ocean. And we are feeling it. It is getting hot. I got myself my first sunburn of the season the other day, so I'm suffering from that. Anyway, I hope that your summer is off to a wonderful start and hopefully you're able to even de stress a little bit because that's actually what today's episode is all about.

Alyssa Chavez [00:00:40]:
So I was planning out this episode and started to realize as I was planning it out, that really this needed to be a two part episode because there's just a lot to say on this topic and I want to make sure that I cover it thoroughly without just, you know, bombarding you with information. So really, what we're going to talk about today is the connection between stress and endometriosis. And talking on a more scientific level, the connection between your adrenals and endometriosis.

Alyssa Chavez [00:01:15]:
Right.

Alyssa Chavez [00:01:15]:
Your adrenals are these two little glands that sit right on top of your kidneys on either side of your body. And they are the glands that produce the stress hormones, your cortisol, as well as your adrenaline, noradrenaline. And they're very important.

Alyssa Chavez [00:01:34]:
Right.

Alyssa Chavez [00:01:34]:
It's one of those things. I think it's a wonderful reminder of how everything in our body is connected. Right. Everything. There's no system in your body that works completely independently from everything else. Right. Even though we're kind of taught that way in school, or at least I was, you know, we learned about the digestive system and we learned about the endocrine system and we learned about the nervous system, but we never really learned how all of those systems are connected. And that's something that I've really been learning a lot over the years that I've been taking a deep dive into all things endo.

Alyssa Chavez [00:02:09]:
And so I wanted to share some of that with you today. I think it's something that's under talked about, or if it is talked about, it's kind of talked about in the wrong way.

Alyssa Chavez [00:02:19]:
Right.

Alyssa Chavez [00:02:19]:
You hear a lot these days about toxic positivity, and it's definitely a thing, right. Especially when you're have a chronic condition like endometriosis and, or you're struggling with fertility and some of the other things that can come up with that. And you hear comments like, just stay positive and you'll feel better or just think positive and you'll get pregnant or, you know, just stop stressing. Just relax a little bit. Right. And it's. That's not helpful.

Alyssa Chavez [00:02:47]:
Right.

Alyssa Chavez [00:02:48]:
I don't know anybody who's ever been told to stop stressing. Who actually stops stop stressing. That's unfortunately not how it works. It's just not that easy. And that's not where we're going today. I'm not going to sit here and just give you a pep talk on, you know, why you need to have a positive mindset, right. I do believe in a positive mindset, and it's something that I work on on a daily basis myself because I'm by no means perfect at that. I don't know that any human being it is.

Alyssa Chavez [00:03:16]:
But really what we're going to talk about today is I want to really give you an understanding, understanding of how the stress response actually works in your body. We're going to take a look at the actual physiology and how stress actually impacts your body and what you can do about it besides just think positive and relax. We're going to take a look at that stress response and how it impacts your endo health and so much more. So that's really what we're going to cover in today's episode, and then we're going to come back next week and I talk a little bit more about why this happens and most importantly, what you can do about it. So that's going to be on next week's episode. So make sure that you hit subscribe so that you get notified when next week's episode comes up. All right, now, today's episode, just fair warning, it's going to get a little bit sciency. But bear with me.

Alyssa Chavez [00:04:13]:
I promise you, I'm not just going to throw a bunch of technical jargon at you, but I, I do want to kind of break things down in a way that you can really understand how your body actually works because I think that's important so that, you know, you're making informed decisions for your own body. So first of all, first thing I want to cover today is how do you know if stress is really impacting your body? And because we all have stress, right. I don't think I've ever talked to a single human being out there, certainly not an adult one, who doesn't have stress in their life. Right? We're all stressed on some level or another, right? And so what we're really looking at is how much that stress in your life is impacting your body. And for that, we're looking at signs and symptoms of cortisol imbalance. So cortisol, which we're going to talk about a lot here, cortisol is your main stress hormone, so it's a triggered to be released from the adrenals in times of stress. And we'll circle back to that in a bit on how that whole process works. But that's basically the gist of it.

Alyssa Chavez [00:05:27]:
Right.

Alyssa Chavez [00:05:27]:
And so cortisol levels in your body can sometimes be too high, sometimes be too low. Either way, it's going to leave you not feeling great. And actually, either of those can be caused by stress. And we'll take a look at that also. Actually, we're going to touch base more on that part next week. But signs of imbalanced cortisol can include things like feeling stressed or overwhelmed, being unable to relax, feelings of burnout, fatigue, anxiousness, irritability, trouble sleeping, difficulty waking up, relying on coffee, caffeine or sugar to keep going, or all of the above. They're having no energy or motivation to exercise, getting chronic headaches, feeling lightheaded, getting low blood pressure, weight retention around your middle, depression, feeling emotionally exhausted, having a poor immune system, blood sugar, dysregulation, low libido. It's certainly not an exhaustive list, but certainly can give you an idea of some of those signs of imbalanced cortisol.

Alyssa Chavez [00:06:38]:
If any of those, or, you know, anything on that list, you're checking the box. This episode is for you. This is what we're going to be looking at today. So those are the signs that cortisol might be imbalanced in your body, and we're going to take a look at how all of that works. So let's dive in. First of all, we're going to need to start off with talking about the HPA axis. So that's referring to the hypothalamus, pituitary and adrenal axis. And that really is a feedback loop between those three parts of your body.

Alyssa Chavez [00:07:18]:
They talk to each other, there's a conversation that happens. So your hypothalamus and your pituitary are both parts of your brain. And basically what happens is your hypothalamus, when your body is perceiving some type of stress, your hypothalamus then sends a signal to your pituitary, letting it know that there's some stress happening. And your pituitary then signals the adrenal glands to release that cortisol. And then the cortisol levels circulate in the blood and end up sending feedback back to the hypothalamus to then adjust. Do we need more cortisol? Do we need less cortisol? And then that loop just continues.

Alyssa Chavez [00:08:01]:
Right?

Alyssa Chavez [00:08:02]:
And this is normal? This is all normal, right. We need to be able to respond to stress. And so that HPA axis, the hypothalamus, pituitary, adrenal axis, that feedback loop is a normal stress response. The thing is, though, it's intended to be an acute response, meaning I always go back to the old, classic example of being chased by a tiger, right? And when that's happening, right, that tiger's coming, you're running, and then you manage to get away, hopefully. And then that stress response is able to calm back down. So you have that moment, that period of time where your body is going crazy, your heart starts racing, all your blood is flowing to the muscles. All of your energy is going towards you being able to run away. And then once you get to a safe space, you get to stop.

Alyssa Chavez [00:08:58]:
You breathe, and your heart rate starts to slow down, and you kind of get back to that normal state. What's not normal and what we see so much in our. I'll just say our general society these days is that we're doing this all the time.

Alyssa Chavez [00:09:17]:
Right?

Alyssa Chavez [00:09:17]:
It becomes not so much an acute response, but it becomes something that's happening all day, every day, and that's where it can lead to issues in your body and kind of has a cascade of effects that includes impacting endometriosis. Yes. Because I know that's why you're here at the end of the day. So take a moment, ask yourself, are you in a chronic state of stress?

Alyssa Chavez [00:09:44]:
Right?

Alyssa Chavez [00:09:45]:
Are you the woman who likes to take, or maybe not likes to, but does take on the weight of the world? Is that you? Is that your life?

Alyssa Chavez [00:09:54]:
Right.

Alyssa Chavez [00:09:55]:
Because, spoiler alert, this will impact your health, especially when you're already struggling with a chronic condition like endometriosis. So let's dig in a little bit deeper. Let's unpack all that and see what that really looks like. Okay, so, for starters, there is a term that's been around for quite some time, but, you know, I feel it. Like, it pops up every now and again in pop culture. There's a term called adrenal fatigue, and it's been. It used to be that was just what it was referred to as, even in the medical world. But that term has essentially kind of been debunked because originally they thought that the adrenals kind of became fatigued over time and stopped producing cortisol and it turns out that that's not really what happens.

Alyssa Chavez [00:10:49]:
What actually happens is, remember that HPA axis that we talked about, which is that hypothalamus pituitary adrenal feedback loop becomes dysregulated. Basically, that communication system where the hypothalamus talks to the pituitary and the pituitary pituitary talks to the adrenals, which releases cortisol, and then that sends signals back to the hypothalamus, that communication system gets dysfunctional. It's broken. Right. And that's what had been previously referred to as adrenal fatigue. That's what that really is. So nowadays, the new term, which isn't quite as fun to say, admittedly, is HPA axis dysfunction or dysregulation.

Alyssa Chavez [00:11:35]:
Right.

Alyssa Chavez [00:11:35]:
That's really what that is. So the way I like to picture it when we're talking about that communication system issue, is imagine that you're a kid and living at home. Your mom is just always yelling all day, every day. She's yelling at you about this, she's yelling at you about that. When that's just happening all day, every day, eventually it just starts to fall on deaf ears, where you almost just don't even hear her, right. Because it's just, you're just hearing that all the time. However, if your mom just yells once in a while when it's really important, like, she sees you running out towards the street and she yells at the top of her lungs, and you've never heard that before, it's like you're going to stop in your tracks because it really catches your attention. And it's kind of the same idea with this feedback loop.

Alyssa Chavez [00:12:27]:
When that dysregulation happens, the hypothalamus is just constantly yelling at the pituitary. The pituitary is just chronically yelling at the adrenals to release that cortisol. And over time, it just kind of stops listening somewhere along that pathway because it's like, okay, I get it. Right. It just almost becomes numb to that. It becomes less sensitive to those signals, is basically what happens. Now. The crazy thing is that when this dysregulation happens, you can actually end up with high cortisol or low cortisol if you are getting tested for that now, I know some doctors will test serum levels of cortisol, which can give you some idea.

Alyssa Chavez [00:13:16]:
Of course, that's really just a snapshot in time. In my practice, I actually really like to use a touch called the dutch test, which is a dried urine well, depending on the version of it, a dried urine saliva test, and that actually allows us to see both pictures.

Alyssa Chavez [00:13:35]:
Right.

Alyssa Chavez [00:13:35]:
We could see a high cortisol picture. We can see a low cortisol picture, and it also allows me to see some really important things, like how cortisol is metabolized. Now, what we're really looking at, if I'm seeing either a high cortisol or a low cortisol picture in a client, what I'm really looking at thinking about is just how long has your body been in a stress response and how has that impacted your body? So, oftentimes, when I see a high cortisol pattern, it really means that maybe that stress response hasn't been happening quite as long because the adrenals are still releasing cortisol much more regularly.

Alyssa Chavez [00:14:17]:
Right.

Alyssa Chavez [00:14:18]:
Whereas when I see a low cortisol pattern, I. That often points to having been in a stress response for a longer period of time. And so your body is just depleted, and those cells just aren't listening anymore. Right. The communication system is offline. And so even though there's a lot of stress, your body's just not necessarily responding super well anymore. Now, as you're listening to this, you know, yeah, you can listen to some of the signs and symptoms and get some idea, but the thing is that having high cortisol and having low cortisol are things that you would actually address differently. And we'll talk about this more next week.

Alyssa Chavez [00:15:02]:
But I always recommend testing where you actually are so that you know.

Alyssa Chavez [00:15:06]:
Right.

Alyssa Chavez [00:15:07]:
And like I said on that dutch test, which is the way that I like to see that, you can also see how cortisol is being metabolized. You can see some of the metabolites. You can see cortisone. It gives you a much better overall picture of the. Oh, and the cortisol rhythm throughout the day.

Alyssa Chavez [00:15:25]:
Right.

Alyssa Chavez [00:15:25]:
How it is first thing in the morning compared to 30 minutes after waking, compared to midday compared to nighttime, because there should be a nice pattern in the way that your cortisol is released throughout the day. So it kind of gives us a much better general picture of that. Okay, now let's take a moment to unpack why this really matters for endometriosis. So hopefully, you're kind of getting some picture, some idea of why all this adrenal stuff matters, why this stress response or the cortisol release in your body is important in the first place. But I really wanted to get into some specifics today also on why this matters for endometriosis. So one thing I want to start out by saying is that your automatic nervous system has two different branches. It has the parasympathetic nervous system and the sympathetic nervous system. And you need both, right? It's not a one or the other kind of thing.

Alyssa Chavez [00:16:31]:
You need both. That sympathetic nervous system state is that fight or flight type response, that stress response, whereas the parasympathetic nervous system is kind of more of the calmed, restful state.

Alyssa Chavez [00:16:46]:
Right.

Alyssa Chavez [00:16:47]:
And ideally, we want to be able to easily navigate back and forth between the two as needed based on what's happening in your environment right now. That parasympathetic state in particular is really needed for things like your digestive health.

Alyssa Chavez [00:17:04]:
Right.

Alyssa Chavez [00:17:05]:
I talk a lot about rest to digest, meaning you are helping to bring your state into a calm. I'm sorry. It's helping to bring your body into a calm state when you're going to eat a meal in order to be able to digest. So we actually talked about this. I unpacked this a lot more in episode 37 called ten simple ways to support your gut health. And I can link to that in the show notes. But if you find yourself struggling with symptoms like endo belly bloating, constipation, you know, or really any gut symptoms, your parasympathetic nervous system needs to be turned on, right? That's like a step one. Like, yeah, we can do some enzymes and different things to support your digestion.

Alyssa Chavez [00:17:52]:
But if that parasympathetic nervous system state is not being turned on and you're not bringing your body into a restful state when you're eating, all of those symptoms are going to struggle. You also need that parasympathetic state for healing, for repair, for your immune health, all things that are so needed for endometriosis. And guess what? Your adrenal health also directly impacts your sex hormones, your estrogen and your progesterone. Yes, when you are a cycling female, most of those sex hormones are produced in your ovaries. However, a small amount is produced in the adrenals. And as you get into menopause phase, actually, all of your hormone production shifts to your adrenals. And even when your sex hormones are being produced by your ovaries, they still are responding to your body's stress levels.

Alyssa Chavez [00:18:53]:
Right?

Alyssa Chavez [00:18:53]:
It's all, again, it's all interconnected because your sex hormones are being produced basically to prepare your body for reproduction. At the end of the day, whether that's your goal or not, that's what your body's trying to do. And when your body is under that kind of chronic, stressful state, it's not going to be prioritizing reproduction. That's going to be like, last thing on the list. It's trying to just stay alive and prepare yourself for a fight or a flight. So something like creating a new human being is just not going to be high on the list. So I do find it common, when I'm looking over labs with clients, I find it super common, actually, to see low cortisol along with low sex hormones. So it's kind of like an overall depletion picture.

Alyssa Chavez [00:19:45]:
Yes. Even with endometriosis, I know that we're often taught that everybody with endometriosis has too much estrogen in your system. That's not necessarily the case.

Alyssa Chavez [00:19:56]:
Right.

Alyssa Chavez [00:19:57]:
And even when we're thinking about an estrogen dominance picture, which I would say is fairly common with endometriosis, what we're really thinking about is your estrogen in relation to progesterone, right? Because estrogen can actually be low, but still be high in relation to progesterone. So it can still be an overall depletion picture and have estrogen dominance symptoms, which I know it's just a lot going on there, but I just wanted to touch base on that. That stress and cortisol picture also has huge impacts on your blood sugar.

Alyssa Chavez [00:20:35]:
Right.

Alyssa Chavez [00:20:36]:
High stress impacts your blood sugar just as much as eating sugary foods.

Alyssa Chavez [00:20:42]:
Right.

Alyssa Chavez [00:20:43]:
Basically is the same stress or the same response in your body. I actually recorded a whole episode on this as well, episode 21 titled Blood Sugar the key to hormonal Balance. So I'll link to that one in the show notes as well, if you'd like to go back and check that one out to really hear about how blood sugar impacts your hormones. But it's really like a number one thing. If I have somebody coming to me with hormone imbalance of any kind, blood sugar is one of the first things that I'm going to be looking at. So just to give you a little perspective on that and also that stress response, that action that's happening in your body, that depletes nutrients.

Alyssa Chavez [00:21:29]:
Right.

Alyssa Chavez [00:21:30]:
Nothing in your body is free. Anything that your body is doing requires nutrients of. That's why nutrients are important. That's why I talk a lot about nutrient density in the food that you're eating. So when your body's under stress, when you have that chronic stress response going on, some of these really key nutrients, like vitamin C, magnesium, zinc, B vitamins, they get depleted very quickly. And fun fact, those are also common deficiencies that I see with endometriosis. So interesting, but crazy thing is that you also need those nutrients in order to respond to stress. So it becomes kind of a vicious cycle, right? You need those nutrients for the stress response, but then as you're using them, then they become depleted quickly, and so then, well, we need more.

Alyssa Chavez [00:22:29]:
And if you're not getting them, then that can lead to issues. When cortisol is being released, it does mobilize some nutrients in your body, like glucose free fatty acids and amino acids, because it's basically mobilizing all of that for energy. Because, again, when cortisol is being released, your body's assuming that there's some kind of threat. You're going to need to fight or run away, and so you're going to need resources for that. And so it starts to mobilize some of those resources into your bloodstream, and those can end up being depleted as well. One of the many reasons that eating a nutrient dense diet is so important. In next week's episode, we're going to be talking a little bit more about how to eat to support your adrenals and your stress response. But just know that it is super important right.

Alyssa Chavez [00:23:23]:
Now. Here's the crazy thing, though, is that cortisol is actually an anti inflammatory hormone, right? So it's not, you know, cortisol in and of itself is not going to necessarily contribute to that inflammatory state in your body that we see so much with endometriosis. Think like cortisone shots, if you're familiar with that. I feel like that's pretty commonly known these days. If you have, say, a knee injury or something, and it's just really inflamed and causing pain and issues. One of the common things that a doctor will do is give you a cortisone shot in that area where it's painful. And that cortisone is a form of cortisol, which helps to anti inflame. So cortisol itself is anti inflammatory, and that's really why a low cortisol picture can contribute to overall inflammation.

Alyssa Chavez [00:24:19]:
Right.

Alyssa Chavez [00:24:20]:
If you don't have that cortisol in your body to help with that anti inflammation, that can be potentially an issue, you know, especially when you already have an inflammatory condition happening. However, having high cortisol for a long period of time has a very similar effect. So more is not better. We just want to have a balanced amount of cortisol. That's it. Not too high and not too low. Balanced cortisol in your body.

Alyssa Chavez [00:24:51]:
Right?

Alyssa Chavez [00:24:53]:
Okay, my friend, I feel like we unpacked a lot today. We talked about how the stress response in your body actually works. We talked about the impacts of that stress response and that cortisol release on the rest of your body and on some of those, you know, endometriosis symptoms that come up next week. We are going to come back here and we're going to talk about why cortisol imbalance and HPA dysregulation can happen and what you can do about it.

Alyssa Chavez [00:25:25]:
Right.

Alyssa Chavez [00:25:26]:
Super important stuff. So you don't want to listen to part one and then just leave yourself hanging, because you're definitely going to be missing some crucial information. Make sure that you come back for part two next week. So be sure to hit subscribe so that you don't miss out.

Alyssa Chavez [00:25:42]:
All right.

Alyssa Chavez [00:25:42]:
I will see you there, my friend. I look forward to it. In the meantime, have a wonderful day.