The Natural Medicine approach to Endometriosis

Endometriosis affects 10% of American women of childbearing age and up to 90% of women with infertility. It is one of the main causes of infertility.

Endometriosis occurs when endometrial cells, the cells that make up the lining of the uterus, travel outside the uterus to other parts of the body. Even though these cells no longer reside within the uterus, they are still stimulated by a woman’s reproductive hormones and shed blood during menstruation each month. Blood from these cells causes deposits to accumulate and form scar tissue, which can be painful. Endometriosis affects 10% of American women of childbearing age and up to 90% of women with infertility. It is one of the main causes of infertility in women.

Signs and Symptoms

Many women with endometriosis have no symptoms, and they often do not find out they have it until they have difficulties trying to conceive. The most common symptoms of endometriosis includes the following:

Pelvic pain, especially during menstruation
Heavy or irregular menstruation
Pain during sexual intercourse
Infertility or miscarriage
Pain with bladder or bowel function, or intestinal pain
Chronic low back pain
Diarrhea, constipation, nausea, or bloating that worsens during menstruation
Severe pelvic pain that radiates to the legs
Severe pain with menstruation that can lead to fainting

What Causes It?

The cause is unknown, but a few theories include:

Abnormal functioning of the immune system (reduction in natural killer cells, t-lymphocytes and macrophages)
Retrograde (or reflux) menstruation, in which some menstrual blood flows backward through the fallopian tubes
Genetic or heredity factors (Some studies put the risk of endometriosis as 10-fold higher among women who have a first degree relative with endometriosis, but at least one study has found the risk to be closer to 2 times as high. In this study, women who had a close relative with endometriosis had double the chance of developing the condition, compared to patients with no family history.)
Some studies suggest that being overweight during late childhood is associated with the development of endometriosis (due to increased levels of estrogen being produced by fat cells)
Stress

Diagnosing Endometriosis

Definitive diagnosis is made with laparoscopy, a surgical procedure that inserts a fiber-optic rod and camera into the abdomen through a small incision in the belly button.

Treatment Options

Pharmaceutical Medications

The following medications are frequently used to treat symptoms of endometriosis:

Nonsteroidal anti-inflammatory drugs (such as ibuprofen)
Oral contraceptives
Hormone-suppressing drugs

Surgical Procedures

Laparoscopic laser techniques help shrink lesions and may improve fertility. Doctors typically only recommend total hysterectomy (removal of the uterus and ovaries) when necessary, however, this approach does not guarantee an end to symptoms because endometrial implants can be present outside of the pelvic cavity. Studies suggest medication combined with surgical therapy offers an advantage over surgery alone.

Complementary and Alternative Therapies

Since hormones like estrogen affect endometriosis, many treatments are designed to reduce estrogen levels in the body. Other targeted areas include supporting the immune system, decreasing the presence of prostaglandins (inflammation), ensuring normal uterine function and menstrual flow to improve fertility.

Nutrition

Increase dietary fiber intake to help decrease circulation of excess estrogens.
Consume bitter foods like chicory and radicchio to help to increase the secretion of bile. Bile is important for removing the substances (toxins, hormones, drugs, etc.) that are broken down by the liver cells.
Eat more lean meats, cold-water fish, or beans for protein. Red meats tend to encourage the production of prostaglandin E2, which increases uterine muscle spasms and increases blood loss by dilating blood vessels.

Supplementation

Omega-3 fatty acids, such as fish oil, to help reduce inflammation and improve immunity. The omega 3’s positively impact prostaglandin E2 production.
Probiotic supplement(containing Lactobacillus acidophilus), a recent study suggests that endometriosis is associated with changes in normal bowel flora. Notably, lower concentrations of lactobacilli and higher gram-negative bacteria concentrations were found. The GALT (gut-associated lymphoid tissue) possesses the largest mass of lymphoid tissue in the human body.
Diindolylmethane (DIM), to help the body metabolize estrogen into the most beneficial form and not into harmful forms.

Herbs

Ruta Graveolens is an emmenagogue. Ruta is most helpful for supporting a sluggish menstrual flow that is thick, tarry and dark, which is a common symptom of endometriosis. Ruta is indicated for pelvic pain that tends to be heavy and dragging in nature.
Paeonia lactiflora is a spasmolytic herb. It helps to reduce uterine muscle spasms and relieve pain. Paeonia is frequently used along with licorice to assist in harmonizing reproductive hormones.

Acupuncture and Traditional Chinese Medicine

Acupuncture can help reduce pain and balance hormone levels. Preliminary studies show that acupuncture is effective in reducing pain related to endometriosis. Additional studies are currently underway.Traditional Chinese Medicine (TCM) is often used as an alternative and/or complementary treatment for endometriosis. Herbs often prescribed include corydalis, rehmannia, bupleurum, dong quai, and perilla.Endometriosis is a very complex disorder and clients should be approached as an individual. Naturopathic medicine provides effective therapies to help enhance patients overall quality of life and health.

References:

Endometriosis: Overview

Implications of immune dysfunction on endometriosis associated infertility

The burden of endometriosis symptoms on health-related quality of life in women in the United States: a cross-sectional study

Leong FC. Complementary and alternative medications for chronic pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):503-10

Nagle CM, Bell TA, Purdie DM, et al. Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis. Hum Reprod. 2009;24(6):1501-6.

Schrager S, Falleroni J, Edgoose J. Evaluation and Treatment of Endometriosis. American Family Physician. 2013;87(2).

Disclaimer: This advice is for informational purposes only. It is not meant to replace a consultation with your healthcare provider. Your naturopathic doctor will choose individualized therapies that are most appropriate for you and for your current needs.