Endometriosis

Endometriosis Overview:

Endometriosis is characterised by the growth of endometrial tissue growing outside the uterine cavity. It can appear on the ovaries or elswhere within the pelvic cavity. Due to the endometrial tissues sensitivity to female hormones, symptoms can vary at differing points in the menstrual cycle as the tissue responds to the estrogen levels.

The most common symptom of endometriosis is pelvic pain and inflammation as a result of the "shedding" of endometrial tissue during menstruation, which then pools outside of the uterine cavity, causing irritation and inflamamtion. Adhesion is also common and can cause organ dislocation and significant pain irrelevant of menstrual cycle.

  • 5% of women affected, not all symptomatic
  • 20-40% of infertile women affected
  • Up to 50% of women with Chronic pelvic pain affected
 

Aetiology:

+ 1. Retrograde flow

This theory suggests that backwards flow of menstrual flow implants endometrial tissue outside the uterus. Since a large number of women without endometriosis also have this backwards flow, it's suggested that the immune system plays a key role with this pathophysiology.

In healthy women, the immune system is able to identify and prevent the growth of endometrial tissues outside the uterus. People with defective immune funciton may not have the capacity for preventing the growth of endometrial tissue outside the uterus.

+ 2. Migration of endometrial tissue through fallopian tissue

still compiling research.

+ 3. Migration of endometrial tissue through lymphatic tissue

Still compiling research.

 

Risk Factors:

  • 2-3x risk with family history
  • Early menarche
  • Long and heavy periods
  • Familial link – mother or sister with it increases the likelihood by 7%
  • Strenuous physical activity while menstruating increases the risk but regular
  • exercise throughout the month seems to decrease the risk
  • Full-term pregnancies – the risk lessens with each pregnancy
  • Using an IUD
  • Caffeine
  • Increased consumption of alcohol
  • Sex during menstruation
 

Stages Of Endometriosis:

Stage Definition
0 Minimal disease, no haemorrhage
1 Minimal disease, haemorrhage, no adhesion
2 Progression with haemorrhage, some adhesion
3 Progression to organ destruction, dense adhesions
4 Total loss of reproductive function, extensive organ damage, dense adhesions, frozen pelvis
 

Symptoms:

Severe dysmenorrhoea

Chronic pelvic pain

Dysparenunia

Infertility

Significant lethargy (especially before menses)

Premenstrual spotting

Heavy menstrual bleeding

Pain with bowel motion

Painful abdominal bloating

Urinary urgency

Pain on urination

Increased incidence of infection around menses

Predisposition to autoimmune disorders

No pain symptoms (Uncommon)

Prolonged menstruation

 

Diagnostic Considerations:

Diagniostic criteria require laparoscopy and peritoneal biopsy of endometriotic tissue lesions or nodules outside the uterus. 

 

Therapeutic Aims:

1. Modulate Oestrogen / Balance Hormones

  • Phytoestrogens (Hops, Soy)
  • Hepatics (Milk Thistle, Schisandra chinensis, Curcuma longa, Cynara scolymus)
  • Aromatase inhibitors (Paeonia lactiflora, Licorice)
  • Progesteronergics (Chaste Tree, Alchemilla vulgaris, Paeonia lactiflora, Alchemilla vulgaris)
  • Lymphatics (Calendula officinalis, Phytolacca decandra, Galium aparine)

2. Reduce Bleeding

  • Antihemorrhagics (Panax notoginseng, Alchemilla vulgaris, Capsella bursa-pastoris, Trillium erectum)
  • Flavonoids (Yarrow, Capsella bursa-pastoris)
  • PGE Inhibitors (Tanacetum parthenium, Zingiber officinalis)
  • Nutrients (Iron)

3. Minimise Inflammation, Scarring, And Adhesions

  • Venous Decongestants (Calendula, Iris versicolor, Thuja occidentalis, Trifolium pratense, Viola odorata, Hammelis virginiana, Aesculus hippocastanum, Ruscus aculeatus)
  • Circulatory Tonics (Yarrow, Aesculus hippocastanum, Ginkgo biloba)
  • Antinflammatories (Ginger, Tanacetum vulgare, Curcuma longa, Bupleurum falcatum, Viburnum opulus, Scutellaria baicalensis, Zingiber officinalis)

4. Alleviate Pain

  • PGE Inhibitors (Tanacetum parthenium, Zingiber officinalis)
  • Uterine Antispasmodics (Viburnum opulus, Dioscorea viollosa, Asparagus racemosa, Rubus ideaus)
  • Uterine Tonics (Angelica sinensis, Caulophyllum thalictroides, Rubus ideaus, Aletris fainosa, Asparagus racemosus)
  • Analgesics (Piscidia erythaeum, Corydalis ambigua, Zingiber officinalis)

5. Enhance The Immune Response

(Cell mediated Immunity)

  • Immunomodulators (Cat's Claw, Hemidesmus indicus, Astragalus membranaceus, Rehmannia glutinosa, Echinaceae spp.)
  • Adaptogens (Rehmannia glutinosa, Glycyrrhiza glabra, Eleutherococus senticosus, Withania somnifera, Rhodiola rosea)
 

Differential Diagnosis:

  • Chronic pelvic inflammation
  • Fibroids
  • Uterine cancer
  • Ovarian cancer
 

Cautions:

None noted.

 

Herbs For Endometriosis:

  • vitex
 

Nutrients For Endometriosis:

  • Fiber
  • Omega 3 Fatty acids
  • Bitter foods
  • Calcium
  • Magnesium
  • Iron
 

Author:

Justin Cooke

The Sunlight Experiment

Updated: July 2018


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References:

  1. Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine Third Edition. Simon and Schuster.
  2.