Getting your first period is a pivotal moment for any woman. But for Shireen Masani, now 40, it marked the start of two decades of debilitating pain, and the end of 'normal' life as she knew it.
The cause of Shireen's pain was endometriosis, a condition in which tissue similar to the lining of the womb (endometrium) is found elsewhere in the body—most commonly in the ovaries, fallopian tubes and abdomen. This tissue behaves just like the endometrium, bleeding every month, and can cause severe pain, heavy periods and infertility.
When Shireen was first struck with the pain of the condition, at age 16, it was so bad she ended up in hospital. "The endometriosis had caused my appendix to rupture," said Shireen. "The pain was crippling."
Shireen was prescribed various hormone treatments, including the Pill and Depo-Provera, a contraceptive injection, to manage her endometriosis—the standard approach—but she couldn't cope with the side-effects of the drugs. "I got terrible migraines and weight gain," said Shireen. "My body doesn't get on with hormonal medication at all."
With no other treatment options open to her at the time, besides painkillers, Shireen was told she'd just have to 'live with it'. And so she did. "I have no idea how I coped," Shireen said. "It felt so unfair."
Then at the age of 21, Shireen got a job at a health spa and became interested in complementary and alternative medicine. "I did a massage course and then studied other forms of manual therapy like cranial sacral therapy. I had various treatments myself, and they really helped me."
Shireen felt fine for a while and was able to live life relatively normally. But in 2005, when she was 28, her close friend and mentor died, and the endometriosis pain came back with a vengeance. "It was an incredibly stressful time," said Shireen. "And absolutely nothing worked for the pain."
Despite being put on a cocktail of powerful painkillers, Shireen struggled with even simple day-to-day tasks because of the agony she was in. "I became depressed and suicidal," said Shireen. "I wasn't coping at all."
By 2007, by which time Shireen had given up work because of her symptoms, a hysterectomy was on the cards. Shireen was only 30 years old, and although she was a mum to her partner's daughter, she hadn't yet had any children of her own. "I wanted to have a baby, but I felt like there was no choice but a hysterectomy. I couldn't carry on as I was."
Shireen went through with the operation. But, unfortunately, her troubles didn't end there. "When I woke up from the operation I had a feeling that something was wrong. That feeling never went away."
Shireen later discovered that the surgery left her with internal bleeding. What's more, the surgery didn't get rid of the endometriosis. She actually felt worse than before.
"I had no energy to do anything and was in so much pain," Shireen said. "I was housebound and had to sit on a skateboard to wheel myself to the toilet. Even chewing food was an effort."
Another operation in 2012 gave her some relief, as it "cleaned up" some of the damage done by the hysterectomy. But a month later, the endometriosis pain was back with full force, and Shireen was still suffering with chronic fatigue, only able to leave the house with the aid of a wheelchair.
The turning point came when a counsellor Shireen was seeing told her she just needed to accept her situation. "I couldn't accept it because that meant I'd given up," said Shireen. "I decided to stop trying to get everyone else to fix me and take responsibility for my own health."
Shireen started doing her own research into endometriosis and soon realized that what she was putting into her body was doing nothing to help her condition. "I had no energy to prepare food so I'd grab things like cereal, sandwiches, biscuits and chocolate. Chocolate was ideal for me as I could just melt it in my mouth. I didn't even need to chew it."
But Shireen started to crave fresh, nutritious foods like fruit and vegetables, so she asked for a Vitamix blender for Christmas. "I thought I could make soups and smoothies, which wouldn't be too much effort to make or eat."
Her mum bought her the blender and Shireen started using it straight away. She'd have a smoothie for breakfast, a solid-food lunch and a smoothie for dinner. "I'd pack loads into my morning smoothies," said Shireen. "Fruit, green veg, seeds, superfood powders, protein powder, coconut oil . . . They were designed to give me energy for the day."
The evening smoothies, on the other hand, were designed to be lighter on the digestive system. "I'd have a small amount of fruit and lots of green veg and herbs like kale, celery, cucumber, lettuce, parsley, coriander and mint."
Within two weeks, Shireen felt a lot better, so much so that she was able to stop taking her pain medication.
In that time, Shireen also decided to cut certain foods from her diet: gluten, refined sugar, artificial sweeteners, corn, peanuts, eggs, soy, dairy and white potatoes. "I was listening to webinars, watching YouTube videos and researching my health via books and websites. It made sense to follow an anti-inflammatory diet."
After six weeks of drinking the smoothies and sticking to her new diet, Shireen was virtually pain free. "I felt so much better. I was bouncing out of bed in the morning and could think clearly again."
By the following year, Shireen felt well enough to start thinking about her career again—something she'd had to put on hold for the last 10 years—and decided to study nutritional therapy at the College of Naturopathic Medicine. "I threw myself into the course," said Shireen. "I started to feel like myself again."
But Shireen suffered a setback in her second year. Her endometriosis pain returned after more than two years of being pain free, and she once again found herself struggling with fatigue and exhaustion. Fortunately, though, she was surrounded by people with the knowledge and experience to help, and was able to manage her symptoms.
"One of my lecturers told me I was putting too much pressure on myself and pushing myself past what I was physically capable of. Once I started to relax and not work myself as hard, I started doing so much better."
Today, Shireen is worlds away from her former self. She's completed her course in naturopathic nutrition and is looking forward to setting up her own business and getting started as a practitioner.
She still has endometriosis, but knows how to remain pain free with a healthy diet and by managing stress with daily walks and meditation, and her energy levels have improved dramatically. "I struggle with exercise, but apart from that I wouldn't class myself as chronically fatigued," says Shireen.
The most important thing, Shireen says, is that she's living her life. "I felt robbed of my life for so long. Now I'm able to go back to work and live normally. It's amazing."
Shireen's painkilling diet
Shireen followed an anti-inflammatory diet omitting dairy, gluten, refined sugar, artificial sweeteners, soy, eggs, peanuts, corn and white potatoes, and incorporating two nutrient-rich smoothies a day. Typically, Shireen's daily diet would include:
High-protein smoothie: small handful of raw fresh coconut; one tablespoon of raw organic virgin coconut oil; pinch of cinnamon; one tablespoon of homemade protein mix (hemp seeds, flaxseeds, sunflower seeds, pumpkin seeds, sesame seeds, goji berries); small handful of raw activated almonds, handful of buckwheat or millet flakes, one cup almond milk, one banana, one tablespoon of lucuma or baobab powder; one tablespoon of chia seeds; either raw cacao nibs and powder (plus one date to sweeten) or a handful of berries (blueberries, raspberries, strawberries or blackberries); half to one tablespoon of maca root (3 weeks on and one week off).
Cup of hot water with fresh lemon and turmeric, followed by a freshly made juice like carrot, ginger and apple or cucumber, celery and parsley.
Vegetables/salad (60 per cent); fish/beans/lentils/meat (15 per cent); rice/quinoa (25 per cent). Raw and sprouted foods as much as possible.
Green smoothie (80 per cent veg, 20 per cent fruit): using ingredients such as kale, spinach, cabbage, chard, broccoli, celery, cucumber, parsley, coriander, mint, basil, rosemary, carrots, beetroot, parsnips, apple, avocado, pear, grapes, plum, peach, dates, oranges, kiwi, pineapple, ginger, turmeric, spirulina and chia seeds.
One of the following: protein balls (date, coconut, nuts and cacao), olives and anchovies, carrot and celery with houmous, cucumber and celery juice or a few nuts, or raw fresh coconut.
Endometriosis: the links with diet and lifestyle
Growing evidence suggests that what you eat, drink and do can have an impact on endometriosis. Based on the research so far, the following self-help steps may be useful for sufferers.
Eat more fruit and veg. Women with low intakes of fresh fruit and green vegetables have a significantly higher risk of endometriosis, as do those who eat a lot of beef and red meat, according to an Italian study.1
Increase antioxidants. Women with endometriosis tend to have lower intakes of antioxidants (vitamins A, C and E, zinc and copper) than women without the condition, so getting more of these nutrients through either diet or supplements may make a difference.2 And for women with pelvic pain possibly due to endometriosis, taking vitamins E (1,200 IU/day) and C (1,000 mg/day) for two months can lead to pain improvement in more than 40 per cent of cases.3
Boost omega-3 fatty acids. Animal and test-tube studies show that omega-3s can help by reducing inflammation,4 although whether supplements can benefit women in real life remains to be proven. However, a daily supplement of omega-3 (1,080 mg of eicosapentaenoic acid and 720 mg of docosahexaenoic acid) plus 1.5 mg of vitamin E has been shown to improve symptoms of dysmenorrhoea (painful menstruation), which can be related to endometriosis.5
Stay active. Women who reported frequent bouts of high-intensity physical activity had a 76 per cent lower risk of developing endometriosis than their less-active counterparts.6
Cut the caffeine. Women who consume more than 5 g/month of caffeine (about 1.5 cups of coffee a day) are nearly twice as likely to have endometriosis and be infertile as a result.7
Avoid alcohol. In one study, the risk of endometriosis was 50 per cent higher in women who indulged in any amount of alcohol compared with teetotallers.8
Avoid toxic chemicals. Certain environmental pollutants, such as dioxins and polychlorinated biphenyls (PCBs), appear to play a role in endometriosis.9 Experts believe that more than 90 per cent of human exposures to these chemicals come from food, mostly animal fat, so eating an organic, whole-food diet low in animal fats may be beneficial. Sunscreen chemicals have also been linked to endometriosis,10 so consider using only natural formulas based on zinc oxide or titanium dioxide instead.