I’m sitting fireside in a gorgeous, rambling finca nestled in the foothills of the Spanish Pyrenees, sipping herbal tea with a group of brilliant women, all of whom are health and wellness experts. We're discussing the painful and at times devastating ways endometriosis has ravaged my body. And also, unexpectedly, my relationship with alcohol. Because as I’m rapidly learning the two are intrinsically linked.
Indeed, the more I learn that when it comes to my health issues, all roads seem to lead back to alcohol. I quip that rather than being on a wellness retreat, it feels more like I’m in a rehab centre, or even AA!
Joking aside (and I'm not undermining the important work of rehab or Alcoholics Anonymous) after attending the Artah retreat at Can Terrades near Barcelona earlier this year, run by the impressive nutritionist and naturopath, Rhian Stephenson, my main takeaway was that I had wildly underestimated the impact that even moderate drinking was having on my reproductive health. It may sound ignorant, but after a solid 25 years of social drinking (at least a few times a week), at the age of 43, I now realise that alcohol has evidently been taking its toll on me. Especially when it comes to the agonising pain of endometriosis, which up until speaking with Rhian, I had never knew could be linked.
Practical things to help if you have endometriosis.
However, while there really are no health benefits to consuming alcohol, Rhian was quick to reassure me that if you do suffer with endometriosis, but can’t face the idea of going teetotal, there is a way to map out when you drink according to your menstrual cycle and keep the symptoms at bay. So I decided to put it to the test.
Let’s be honest, shall we? Most people will likely squirm when confronted about their drinking habits. And I am certainly no exception. I have worked in showbusiness journalism for two decades – which is a helluva lot of schmoozing with free champagne – so my 20s and 30s were pretty pickled. But increasingly, (and this happens with age, kids), the hangovers have become worse, especially in terms of the impact it has on my mental health and anxiety.
Running parallel to this, I was diagnosed with endometriosis in 2017 at the age of 36. This followed four years of agonising periods, dull throbbing in one ovary, stomach bloating and severe, rage-fuelled PMT.
Endometriosis occurs when cells mimicking the lining of the uterus are found elsewhere within the body. These cells build up and bleed, but unlike during a period, have no way of escaping causing painful scarring and adhesions, usually around your reproductive organs and bowel. It can affect your fertility and cause bowel obstructions
It was finally diagnosed when I had a laparoscopy operation to investigate my ovaries, following a frightening and agonising visit to A&E suffering with pain so severe that even morphine didn't help. When they went in they were able to remove the build up of endometriosis and a cyst on my ovary.
According to the Royal College of Nursing, endometriosis affects 1 in 10 women in the UK (around 1.5 million). And It's the second most common gynaecological condition (after fibroids). On average it still takes a staggering 7.5 years to make a diagnosis in this country.
As well as the laparoscopy (which relieved symptoms temporarily, before the endometriosis built up again over time) I have tried many other ways to cope with the pain including acupuncture, reiki and reflexology which have helped, but not significantly.
Sufferers share their stories this Endometriosis Awareness Month.
In 2020, in complete despair, I reluctantly had the Mirena hormonal IUD coil fitted which, I will admit, significantly helped the symptoms. But in September 2023, following an adverse reaction to it, I had it removed and ever since the stabbing, throbbing and gnawing pain around my period - and often at other sporadic times during my cycle - has become increasingly worse, as has my PMT, mood swings and anxiety.
Rhian, who used to be a nationally ranked competitive swimmer before training as a nutritionist and naturopath and founding the award-winning supplement company, Artah, is frank when it comes to the effects of alcohol on the body for women.
“We [women] are just very sensitive to alcohol, which is - let's not sugarcoat it - a toxin,” she tells me. “It affects our microbiome, it affects serotonin, it already uses a lot of our key nutrients and it is inflammatory.”
And it’s the inflammatory nature of alcohol that is key to understanding how it exacerbates endometriosis.
“When you think about two characteristics of endometriosis, one, it's inflammatory,” explains Rhian. “You're already experiencing more inflammation and more pain because you have endometriosis. Two, endometriosis is sensitive to extra estrogen, and alcohol is estrogenic.
“You're already more likely to be exacerbating the severity of your endometriosis because the endometrium responds to estrogen and, if you're proliferative with that (the alcohol), then it's going to be worse. Then, alcohol, of course, will increase pain and increase inflammatory cytokines [small proteins that signal cells to fight threats or maintain immune system function]. There is a link between gut, microbiome and endometriosis. Then, again, alcohol is a disruptor of the microbiome. There's almost no element that it [alcohol] doesn't impact in terms of endometriosis."
Sobering stuff for sure. But, Rhian's suggestion of menstrual mapping the time of the month that you consume alcohol could be the answer for those wanting to relieve agonising periods and horrible PMT, but not commit to a teetotal lifestyle.
In short this process involves drinking alcohol during your follicular phase - the moment you finish your period up until the day you ovulate and abstaining during your luteal phase (post ovulation up to menstruation). I find it useful to use a menstrual tracking app such as Clue or Flo to know when I will ovulate and where I am at in my cycle.
“When you look at our monthly cycle, you start in week one, that's the bleed week. That's when we reset and everything gets back to normal," explains Rhian. "Week two is when our hormones are going up. This is really when we feel our best and metabolically, we're the most robust.
“But when we ovulate, that's an inflammatory event. I think what people don't understand is that the egg will tear off and break free to circulate. Anything inflammatory (such as alcohol) has the potential to make that more painful.
“Right when we ovulate, we then see a complete change in our hormonal landscape. Our testosterone plummets, so does our estrogen and progesterone starts to go up. This is to prepare our bodies for implantation. This phase [the luteal phase] is very metabolically active. We're very metabolically sensitive because we're using a lot of our resources to build up the endometrium for implantation and prepare for pregnancy.
“Then, in the last week, because we're then in a depleted state and our estrogen is still low, we are much more inflamed. A lot of people see a worsening of inflammatory conditions in that last week too, such as eczema.”
As I tell Rhian, this is also when my endometriosis symptoms are at their very worst, pre- bleed and of course, during the bleeding phase.
“Yes,” she says agreeing, “when you look at a woman with that condition, they're already in far more pain, it's far more challenging. Alcohol, unfortunately, is usually going to make all that far worse.”
What’s interesting is that Rhian says this technique is not just reserved for those who suffer with endometriosis, but could also be a good hack to help any woman suffering with PMT and menstrual cramps.
“What I've found when I worked with people is that, for people who it's too much to say, 'Okay, I'm going to quit [alcohol] for three months,' because that's a lot, to go from being however you are in your normal life to saying, 'Okay, I'm going to go cold turkey for three months,' it's very challenging. The first change I would always say is, if your PMT is already bad and your period pain is already bad, let's just see if pulling back in that second phase helps. Nine times out of 10, it always helps.”
And so, with all this in mind, I set forth to menstrual map sobriety.
Without alcohol, my feelings rarely hit those peaks of despair anymore.
Unfortunately, unlike other times of the year such as ‘Dry January’ or ‘Stoptober’ when you can plan social events around abstinence, ovaries pay no regard to one’s social diary. In the first month of my experiment, my luteal phase and period fall - very inconveniently - on the final days of my summer holiday and the weekend of a massive 40th birthday party. But, reader, I survived. Not only that, I thrived! Yes it was tricky curtailing the wine on the penultimate day of my holiday and I got an early night at the 40th (drunk people get very boring after a few hours) but the endo symptoms were almost immediately reduced.
I still suffered with pain on the first day of my period, but without alcohol in my system, it was around a 4 or 5 out of 10 on the pain scale as opposed to 7 or 8. My PMT symptoms were still there, but only lasted a couple of days instead of nearly a week. The following month I had friends come to stay for the weekend during my sobriety phase, and this time round, I found it even easier, knowing the benefits I had in store from abstaining. Overall, abstaining from alcohol during the second half of my cycle has helped with the pain of the condition, but not so much with the hormonal side effects such as mood swings and anxiety, but they are not as acute without alcohol in my system and the symptoms don't last as long.
What did however take me by surprise was when I started drinking again, because my body had been used to a few weeks of total abstinence, my hangovers - *sigh* - were a lot worse. Especially my ‘hangxiety’. All this is of course, as Rhian points out, due to the body becoming used to no longer having the toxins to deal with, so then being shocked when they’re reintroduced.
Buoyed by three months of menstrual mapping sobriety, I have now entered a new phase which is - remarkably - near total teetotal. In the past month I have only had one alcoholic drink, of course, in my follicular phase. It’s not easy by any means, but the benefits to my hormonal, reproductive and mental health are phenomenal. I still have symptoms of endometriosis, but they are manageable. I feel happier, calmer, I have more energy and am sleeping so much better as well. I may not have cured my endometriosis, but it’s the most natural way I’ve found to manage it. And for that, I am really grateful.
Saffron
A 2016 study found that oral consumption of 15mg of saffron (crocus sativus) 2 x a day in capsule format led to a decrease of 50% of the severity of PMT symptoms in 75% of the women tested.
Artah’s Enhanced NAD+ Complex and Enhanced Fertility supplements
Although NAD+ is designed for cellular health and promoting longevity, Rhian points out that it is also fantastically anti-inflammatory. “It contains maritime pine bark, and that's something that we've used for ages for things like endo because it's so anti-inflammatory. It also has saffron in it.” Rhian also suggests taking Artah's Enhanced Fertility supplement which not only supports fertility, but overall menstrual health. “Whether you want to get pregnant or not, menstrual health affects your current health, your future health and how you feel every day. I think it's really important for a woman to be taking care of that as much as they take care of their nutrition or their fitness.”
‘Secret sneaky’ sugar audit
Sugar is also inflammatory and Rhian points out that even if you think you have a healthy diet, there are often the ‘secret, sneaky’ sugars that still creep in, or you may not realise you're consuming, such as high sugar in your daily Oat milk latte or, in my case a Leon porridge with fruit compote.
“You just want to do a bit of a sugar log. However, it doesn't have to be super accurate, whether you just look things up online, MyFitnessPal or look at the ingredients. What people often find is a couple big things, not small things, big things where they probably have it every single day or multiple times a day where actually, it's maybe only 15 grams of sugar a pop but, if you're doing that three times a day, that's 45 grams, and it's something that you don't count in your head as bad or sugary, so it's something that you're not even really registering. But it will make a difference.”
