It is estimated that between 10% and 20% of American women of childbearing age have endometriosis.
Endometriosis is defined as endometrial tissue that grows outside of the uterus and implants itself on adjacent pelvic organs, such as the ovaries, Fallopian tubes, vagina, sigmoid colon, pelvic ligaments, ureters, rectum, or bladder. Because of their responsiveness to hormonal stimulation, these tissue implants may become inflamed or swollen, cause bleeding or pain, or produce scar tissue around the area of endometriosis. Another concern is the ability of the implants to create structural changes in the pelvic cavity that can affect functioning of the reproductive organs and have a negative impact on fertility.
Chinese medicine treatment of endometriosis
Chinese medicine, acupuncture, herbs, dietary and nutritional therapy, and reproductive organ massage are effective in managing symptoms and slowing the progression of endometrial tissue growth, while preserving fertility for those who wish to become pregnant. A number of different treatment options are prescribed, depending on the specific presentation involved for each patient:
Acupuncture can be used to control pain associated with endometriosis as well as improve fertility, regulate blood flow and address immune system imbalances. Due to acupunctures effect on the endocrine system, it can also be used to help normalize hormonal disorders.
Herbal formulas are prescribed to help the body regulate abnormal cellular growth and slow the progression of the disorder. They can also be used at specific times in the menstrual cycle to control pain.
Massage and physical therapy can prevent and attempt to correct structural imbalances caused by endometrial implants.
Nutritional and dietary therapy are used to improve the functioning of the immune system. Certain foods may also regulate estrogen and progesterone balance and contain prostaglandins to help with inflammation.
Food allergies and intolerances are common in patients with endometriosis. Removing the offending food from the diet can reduce the burden on the immune system and thus alleviate symptoms.
Avoiding products containing xenoestrogens is important, since they can increase growth of the endometrium.
Coffee, alcohol and recreational drug use can impact liver clearance of estrogen and make symptoms worse.
Serotonin modulation can be used to increase the pain threshold in low-serotonin patients.
Possible causes of endometriosis
While the cause of endometriosis is still unknown, many theories exist that help explain its pathology and progression. These theories include:
Retrograde menstruation — This theory suggests that endometrial debris exits the uterus through the Fallopian tubes during menstruation, and attaches itself to the lining of the abdominal cavity, proceeding to invade the tissue as endometriosis.
Genetic predisposition — It is well recognized that women with a first-degree relative affected by endometriosis are about ten times more likely to develop the condition themselves than are women with no family history of endometriosis. It is thought this may be due to inherited hormonal imbalances that contribute to the proliferation of endometriosis.
Immune system malfunction — There appears to be a correlation between autoimmune disease, allergic reactions, and the impact of toxic exposure with endometriosis. However, more research is needed to explore the subtle interrelationship of these factors. The immune system is also closely involved with the retrograde menstruation theory.
Estrogens — Endometriosis is an estrogen-dependent condition seen mainly during the reproductive years, when women have higher estrogen exposure. Occasionally endometriosis continues after menopause or hysterectomy; this may be related to aromatase, an estrogen-synthesizing enzyme produced by endometrial implants.
Environmental factors — Many scientists believe that pesticides and hormones in our food supply, as well as cooking with certain types of plastic containers, contribute to endometriosis.
Transplantation — In certain patients endometriosis can spread directly, or can grow invasively into different tissue layers. On rare occasions it may be transplanted via blood or lymphatics into peripheral organs such as the lungs or brain.
Metaplasia — One theory suggests that endometriosis is not caused by transplanted endometrium, but originates from local stem cells. These cells would be formed at around 8 to 10 weeks of embryonic development, and lie dormant until puberty, when ovarian estrogen production stimulates their growth.
Endometriosis and fertility problems
Both mild and severe forms of endometriosis can have a negative impact on fertility, and it is often considered to be one of the three major causes of infertility in women. Severe endometriosis with extensive scarring, anatomical distortions, or organ damage may affect fertility from a structural perspective. Mild endometriosis is a common finding among infertile women, yet how it affects fertility is still not clear. It is possible that endometriotic lesions release factors that are detrimental to gametes or embryos, or that endometriosis is more likely to develop in women who are unable to conceive, due to unrelated reasons.
Symptoms of endometriosis
The symptoms of endometriosis vary according to the stage of progression of the disorder. The most commonly encountered include:
- Severe menstrual cramps
- Pelvic pain apart from menses
- Painful intercourse
- Painful bowel movements
- Pain with exercise
- Painful pelvic exams
- Painful and frequent urination
- Nausea or vomiting
- Frequent or short menstrual cycles
- Heavy or long menstrual periods
- Mood swings
- Complications can include:
- Internal scarring
- Pelvic cysts
- Chocolate cysts
- Ruptured cysts
Diagnosis of endometriosis
Diagnosis of endometriosis can only be definitively made by laparoscopy, a minor surgical procedure that shows the location, size and extent of the endometrial implants. A health history and physical exam will lead a physician to suspect endometriosis in many patients, and imaging tests often reveal endometriotic nodules or cysts.
Western treatment of endometriosis
While there is no cure for endometriosis, a number of options are available for managing symptoms, providing pain relief, and treating associated infertility.
Oral contraceptives offer a regulated, low-dose combination of estrogen and progesterone to prevent ovulation, reduce menstrual pain and menstrual flow.
Progesterone is usually given in a long-acting form via injection (depo-provera). Progesterone can also prevent ovulation and reduce circulating estrogen levels and therefore growth of the endometrium.
GNRH analogs (Synarel, Lupron, Zoladex and Danocrine) are drugs that decrease estrogen, FSH, and LH levels. They may induce menopausal side effects and lead to osteoporosis.
Pain medications are used to control pain associated with endometriosis. NSAIDS also reduce menstrual flow. In more severe cases narcotics may be required.
Aromatase inhibitors block the formation of estrogen.
Steroids suppress growth of endometriosis, but may have androgenic side effects.
Surgical treatment is often necessary for endometriosis patients. The type of surgery is dependent on the extensiveness of the implants. Women are often treated conservatively during the reproductive years, and laparoscopy to remove implants is usually performed at the time of diagnosis. Radical surgical techniques such as hysterectomy are generally reserved for women with disabling and treatment-resistant pain who do not wish to become pregnant.