As a specialist in women's health, I appreciate the complex and multifaceted nature of endometriosis. It is one of my favorite conditions to treat because it responds remarkably well to naturopathic medicine.
Endometriosis affects 5-15% of women, and possibly more since many women are never diagnosed. It’s a disease where endometrial tissue is growing outside of the uterus. Essentially, the tissue that normally grows inside the uterus and is released every month through menstruation is growing other places in the body. All endometrial tissue responds to estrogen and progesterone throughout the menstrual cycle, and when normal menstruation occurs, the tissue occurring outside of the uterus also breaks down and bleeds. This breakdown can cause swelling and inflammation, as well as scar tissue.
While suppressing conventional treatments can successfully slow progression of the disease and reduce symptoms, it doesn’t address the underlying cause of the disease and rarely leaves the patient feeling vibrant and healthy. Even after surgery, up to 40 percent of patients will have a recurrence of endometriosis. Natural treatments can really shine by both addressing the symptoms and treating the whole person.
What are the most common symptoms?
Painful menstrual periods
Pain during or after sexual intercourse (commonly felt deep in the pelvis)
Pelvic pain throughout the month, not just during periods
Bowel pain during menses
Heavy menstrual bleeding
How is it diagnosed?
Diagnosis is made by surgically visualizing the uterus and endometrial tissue, often confirmed by biopsy. Endometriosis is often not diagnosed for a long time because the symptom picture is unclear
Since definitive diagnosis is invasive, many clinicians treat presumptively, striving to reduce symptoms without surgery
What causes endometriosis?
The cause of endometriosis is currently unknown. However, in the future endometriosis may be considered an autoimmune disease. It meets many of the criteria for classification as ‘autoimmune’ including increased polyclonal B cell activity, familial inheritance, abnormal immune cell function, reduced natural killer cells, and presence of antiendometrial antibodies. If the natural killer immune cells are deficient, the body isn’t able to remove the endometrial tissue that is out of place. Also, studies have found that compared to the general population, women with endometriosis are significantly more likely to have other conditions related to abnormal immune function including hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune disease, allergies, asthma, IBS, and SIBO.
Genetic factors increase the likelihood of developing endometriosis. Women with a mother or sister (first-degree relative) who has endometriosis are seven times more likely to develop the condition.
Environmental toxin exposure is also implicated in the disease. Toxins linked to endometriosis include: dioxins, polychlorinated biphenyls (PCB’s), bisphenol-A (BPA), pesticides, solvents, formaldehyde, and the heavy metal cadmium.
Retrograde menstruation is an older theory to explain endometriosis that some of the endometrial cells shed during menstruation travel through the ovarian tube and implant outside the uterus. However, retrograde menstruation has been observed in women who do not have endometriosis, so it is unlikely to be the sole contributing factor.
In my practice, I always want to understand a patient’s full health history in order to understand any personal risk factors. Rarely is there one cause of any disease. Typically with endometriosis there are multiple risk factors implicated in the illness. This information is extremely helpful in guiding me in creating an optimal individualized treatment program.
How is it treated in conventional medicine?
Typically the first line treatment includes:
Hormonal contraceptives (pill, patch, shot, IUD, etc)
Over the counter or prescription pain medication
In more advanced cases, treatment may include hormonal suppression medications, such as Lupron
Surgical removal of the endometrial tissue (often at the time of diagnosis) is sometimes performed
Conventional treatment sometimes works very well for women with endometriosis, and I rarely recommend against it. However, my practice tends to attract women who desire pregnancy and therefore can’t be on hormonal contraceptives, women who experience significant side effects, or women who don’t want to be on any hormonal or conventional treatments. Many of my patients are able to successfully manage their endometriosis without any conventional medicine, while others utilize the best of both worlds.
What are some natural medicines that can help with endometriosis symptoms?
Melatonin—a 2013 randomized controlled trial found that taking high doses of melatonin daily had significant benefits for women with endometriosis. The women who took the melatonin used less pain medication and cramping, painful intercourse, and bowel pain all improved.
N-acetyl cysteine—a 2014 study in rats compared NAC with conventional endometriosis treatments. All three treatments caused significant reduction in inflammation and regression of endometrial tissue. A follow-up study in humans found that NAC reduced the size of endometriomas, while the diameter of these lesions increased in the placebo group. It seems to be a suitable option for women desiring pregnancy, as this has occurred in several of the studies.
Other therapies that may be considered:
Anti-inflammatory botanical medicine
Supporting estrogen and progesterone levels to get them back into balance
Natural pain relief
Physical or manual therapies to break up adhesions, address muscle tone, and reduce pain
There is no one size fits all treatment approach for endometriosis, and the best plan for one patient might be inappropriate for another. While all treatment programs should be individualized, that is especially true for endometriosis. If you think you may have this condition and are curious about natural treatment options, I welcome the opportunity to discuss treatment options with you. Schedule a free 15 minute consultation or call 503-719-4806 to make an appointment with me for a health intake and to discuss the best treatment options for you.
Schenken, Robert S. Pathogenesis, clinical features, and diagnosis of endometriosis. In: UpToDate, Post TW (Ed), UpToDate. [Accessed Nov 16 2014].
Dharmesh, K. Medscape. Endometriosis. Updated 2014 Apr 21 [Accessed 2014 Dec 1]. Available from http://emedicine.medscape.com/article/271899-overview#aw2aab6b2b2.
Sinaii, N., Cleary, SD., Ballweg, ML., Nieman, LK., Stratton, P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 2002 Oct [cited Nov 16 2014]. 17(10):2715-24. Available from: http://humrep.oxfordjournals.org/content/17/10/2715.long
Kohama, T., et al. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. Journal of Reproductive Medicine. 2007 Aug;52(8):703-8. http://www.ncbi.nlm.nih.gov/pubmed/17879831
Onalan, G., et al. Effects of amifostine on endometriosis, comparison with N-acetyl cysteine, and leuprolide as a new treatment alternative: a randomized controlled trial. Arch Gynecol Obstet. 2014 Jan;289(1):193-200. http://www.ncbi.nlm.nih.gov/pubmed/23880890
Porpora M, Brunelli R, Costa G, et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-Based Complementary and Alternative Medicine. 2013; April. Article ID 240702, 7 pages http://dx.doi.org/10.1155/2013/240702
Schenken, Robert. Pathogenesis, Clinical features, and diagnosis of endometriosis. In: UpToDate. (Accessed 24 September 2014).
Schwertner, A., et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled study. Pain. 2013, June; 154(6): 874-81. http://www.ncbi.nlm.nih.gov/pubmed/23602498