Endometriosis is a painful condition in which small islets of endometrial tissue (cells that normally line the inside of the uterus) somehow migrate into the muscular wall of the uterus, out along the Fallopian tubes, and even to the surface of the ovaries and the pelvic contents, including the nearby colon. Being endometrial tissue, they respond to the monthly surges of estrogen and progesterone exactly like the endometrium within the uterus, i.e., they swell with blood during the month and then bleed at menses time, causing considerable pain starting shortly before menstruation and not subsiding until after menstruation. (When confined to the muscular wall of the uterus, the condition is called adenomyosis and can cause significant pain with menstruation).
What are the most common symptoms?
The most common symptoms of endometriosis are: Period pain, pelvic pain, spotting before the period, ovulation pain (mid cycle pain), infertility and changes in bowel, bladder and sexual function.
A more detailed picture of symptoms can include some of the following:
- Painful periods
- Abdominal or pelvic pain
- Bleeding (spotting) between periods
- Irregular periods
- Heavy bleeding with periods
- Low back pain
- Abdominal cramps
- Nausea and possibly vomiting
- Pain during sexual intercourse
- Changes in menstrual pain: increasing severity or duration of pain, pain not responding to drugs such as Ponstan or Naprogesic, pain which interferes with normal daily activities or employment.
- Bowel symptoms of pain, constipation or diarrhoea at time of the period. Sometimes blood or mucous may be passed with the stools.
- Frequency and pain when passing urine, pain when the bladder is full in the morning. Sometimes blood may be passed in the urine.
- Menstrual changes including heavy bleeding, prolonged or shortened periods or periods which stop and start.
- Ovulation pain
Is it endometriosis?
Does the fact that I have some of these symptoms mean that I have endometriosis?
Not necessarily. There could be other causes depending on your symptoms, such as musculoskeletal problems causing back pain and/or pelvic pain, simple dysmenorrhea (period pain), pelvic inflammatory disease and others.
What are the methods of diagnosis for endometriosis?
A protein CA-125 is sometimes helpful following the course of the disease when it is severe. However this method is less reliable as an indicator in the early stages.
Although ultrasound will not detect most types of endometriosis, it is useful in picking up endometriosis that has formed a lump inside the ovary which cannot be seen from the outside, and detecting endometriosis in the uterus which is called adenomyosis.
Laparoscopy is a reliable way of diagnosing endometriosis. This may be necessary to establish the diagnosis, recurrence, or the possible effect of the endometriosis on fertility.
Laparoscopy is a minimally invasive operation, where a small telescopic instrument is passed via a small incision in the umbilicus (belly button) to view the organs in the pelvis. Two to three other small incisions may be made to insert instruments so that deposits of endometriosis can be removed. Most women recover quickly after laparoscopy and are back to work and normal activities within a short period of time. Recovery however, will be determined by the amount of endometriosis present and the length and extent of surgery performed.
Endometriosis and Infertility:
Endometriosis is commonly associated with infertility. It is associated in about 30% of women who have infertility.
Endometriosis causes infertility in different ways. If the endometriosis damages the tubes and the ovaries then this will significantly reduce the woman’s ability to conceive. This will significantly alter the movement of the egg and sperm.
Where the tubes and ovaries are not damaged the endometriosis can still affect the movement of sperm, egg pick up by the tube, egg fertilisation, embryo growth and implantation.
Infertility is not always a consequence of endometriosis, however if left untreated the risk is higher.
Risk of endometriosis
Some women are at greater risk of developing endometriosis. The following present a higher risk of endometriosis and/or the chance of having a more severe form of endometriosis.
- Have not had children
- Have heavy or prolonged periods
- Are overweight
- Have had commencement of their period at an early age (before the age of 12)
- Have a family history of endometriosis (mother, sister etc)
- Use intra uterine devises
- Are on a high fat diet
- Have hormonal imbalances
- Have high stress levels
Medical treatment options
While the purpose of this article is to present the natural therapy options, it is also useful to gain knowledge of some of the current medical treatments and their limitations.
The most common treatment here is to provide drugs that lower the oestrogen level – a hormone that “facilitates” the growth of endometriosis. Drug treatments may reduce the symptoms of endometriosis and make them more bearable, but this pretty much is the limit of their usefulness. Once treatment is withdrawn, symptoms usually recur in the majority of cases. This treatment is sometimes used to shrink large endometrial tissue and make surgery less complicated.
Surgery requires the complete excision of endometrial deposits in order to have the best results. An on-going management plan is also required, including the use of the contraceptive pill and dietary changes. Research suggests there is a 25% recurrence of symptoms over 3 years.
This is a last option when other methods have been exhausted. Hysterectomy is also not a complete answer to endometriosis, as there may be endometrial tissue located outside the uterus that will still produce symptoms after the surgery. These may also be removed, however there may be microscopic tissue that cannot be seen and therefore not removed during the surgical procedure. It is very unfortunate that regardless of the person’s age, in order to be as “successful” as possible, a full hysterectomy may be performed, removing the uterus, both ovaries and fallopian tubes. There are many health implications to this procedure that are beyond the scope of this article and we strongly recommend any such step to be taken only after very careful consideration and when all other methods have been exhausted.
The natural treatment of endometriosis needs to be undertaken by an experienced practitioner and it needs to be as always tailored to the needs of the individual, depending on their history, symptoms and contributing factors that produce the disease. While the treatment needs expert planning and the use of specific herbs and supplements, there are lifestyle changes that can also assist. The ideas discussed here are not to provide a cure but to alert you that there are natural methods that may assist you and give you some general examples. Do not embark in self treatment without professional advice.
There is ample evidence that chronic exposure to the environmental chemicals dioxins and polychlorinated biphenyls (PCBs) is associated with an increased prevalence and severity of endometriosis (not to mention the many other diseases also related to this). One way to reduce intake of these chemicals is to cut back on animal fat, especially high-fat dairy, red meat, and fish. Dioxin and PCBs both accumulate in animal fat, and it is our main route of exposure when we consure high quantities of these foods.
Put an emphasis on vegetables and flaxseeds in your diet. Celery and parsley are excellent, as are broccoli, cauliflower, cabbage, kale, Brussels sprouts. These foods he;p tp improve oestrogen metabolism which in turn may assist with endometriosis.
Use Omega 3 fatty acid rich foods, such as salmon, mackerel, sardines, and anchovies. You may wish to take the option of supplementing your diet with good quality fish oil capsules. There are several studies that indicate the beneficial effect of omega 3 for endometriosis, that includes the slowing down of endometrial tissue.
Yeast overgrowth – There are some studies that indicate a high percentage of women with endometriosis have a yeast overgrowth. This needs about 8 weeks of treatment with a good quality acidophilus supplement, where in many cases there was an indication of reduction of endometriosis symptoms.
There is ample evidence that stress levels adversely affect endometriosis. Cortisol is a hormone involved in the stress response but is also needed to make other hormones such as progesterone. Prolonged stress can lead to elevations in cortisol, which may decrease the available progesterone and result in a hormonal imbalance. Please look under the stress management part of our website for more information on reducing stress levels.
There are a number of herbs that have been reported to assist with endometriosis. This needs specialist knowledge in order to ensure the best quality, dosage combination and efficacy of these natural medicines. They include hormonal balancers, herbs that reduce stress and herbs that remove “blood stasis”, a term used in Chinese Herbal medicine.