Endometriosis

In honor of Endometriosis Awareness Month, I have written from two perspectives on endometriosis-one from a Western medical point of view and one from an Eastern medical point of view.

A Western Medical Perspective

Endometriosis is a condition in which the tissue that is similar to the lining of the uterus (endometrium) grows in other areas of the body. The endometrium is the innermost lining of the uterus and it contains endometrial cells. Endometriosis tissue growth can be referred to as implants and/or lesions.  The lesions typically occur in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. These lesions can also be found in casearin-section scars and laparoscopy scars. However, the implants can occur in other areas of the body, too-although this is rare. Endometriosis affects 1 in 10 women during their reproductive years (between menarche and menopause).

Every month during a menstrual cycle, a woman's ovaries produce hormones that stimulate the cells of the endometrium to multiply and prepare for a fertilized egg. The lining swells and becomes thicker. If the endometrial cells grow outside the uterus, endometriosis is the result. There are many cells normally found in the uterus that are shed during menstruation. Although, the ones outside the uterus (these endometrial cells) stay in place. They sometimes bleed, but then they heal and are stimulated again during the next cycle. This continual process from month to month may lead to symptoms of endometriosis and can cause scarring on the fallopian tubes, ovaries, and surrounding structures in the pelvis. The endometrial implants are sensitive to estrogen so the monthly fluctuations of estrogen that occur with every monthly menses lends to more endometriosis symptoms.

Although the cause of endometriosis is unknown, there are a number of theories. One theory is called retrograde menstruation. This is when the endometrial cells that become loose during menstruation may "back up" through the fallopian tubes into the pelvis. After they have traveled into the pelvic area, the cells implant and grow in the pelvic or abdominal cavities. Although the retrograde flow happens in a large percentage of women who do not have endometriosis. So it is thought that endometriosis may also be associated with an immune system abnormality.

Research does show that first-degree relatives of women who have endometriosis are more likely to develop it as well. A few other theories that are thought to possibly be a cause of endometriosis are lymphatic and vascular distribution, metaplasia, immune system disorder, and environmental influences. Environmental toxins such as PCBs and dioxin have been mentioned as possible causes linked to the symptoms.

The most common symptom for women with endometriosis is pelvic pain, also referred to as dysmenorrhea. The pain usually correlates with the menstrual cycle but it can occur anytime throughout the month. The pain can occur during ovulation, with bowel movements, during or after sexual intercourse, and in the low back. Sometime the symptoms are so severe and become debilitating for many women. Other symptoms include constipation and diarrhea, bloating, irregular bleeding, and fatigue. On the other end of the spectrum, for some women, there are no symptoms at all. Their diagnosis of endometriosis only occurs when infertility testing or other testing may come about. Infertility is one of the more common symptoms among women with endometriosis.

Research shows that 5-10% of all women have endometriosis, although most of these women are not infertile. It also shows that 30-40% of infertile women have endometriosis. Since endometriosis may implant on the fallopian tubes and ovaries, it can prevent pregnancy. The implants may block the tubes or the ovaries may contain endometrial cysts that may adhere to the uterus-all of these symptoms may lead to infertility.

Several tests are used to diagnose endometriosis. They include pelvic exam, transvaginal ultrasound, and laparoscopy. Laparoscopy is the definitive test in which a biopsy of the tissue is taken as well. A thorough discussion of a woman’s medical history and symptoms can also conclude to an endometriosis diagnosis.

Treatment for endometriosis depends on each individual’s symptoms, age, and fertility wishes.
To treat the pain, analgesics and mild narcotics may be prescribed. Since endometriosis is thought to be exacerbated by estrogen, hormone therapy is an option-such as the birth control pill and danazol. Other treatments include laparoscopic surgery, hysterectomy, nutritional therapies, and specific exercises.

A Traditional Chinese Medical Perspective

Traditional Chinese Medicine (TCM) is an umbrella of many therapies and modalities. Acupuncture being the most commonly known treatment. TCM also includes Chinese herbology, tui na, cupping, moxibustion, and qi gong. Along with these TCM therapies, meditation is woven into treatments-as it serves well to treat the mind, body, spirit. TCM is a holistic therapy that treats the symptom and its’ causes. It is the root and branch of an illness that is treated-the “root” is the cause and the “branch” is the symptom. TCM theory states that when there is an imbalance of qi, “life energy”, along the meridians of the body, then there is disease. Acupuncture and the like therapies encourage harmonious flow of the qi throughout the body, which eliminates the symptoms and brings about health.

A traditional Chinese medical diagnosis is made by determining a characteristic pattern from symptoms presented by the patient along with pulse and tongue diagnosis. The named TCM patterns of endometriosis symptoms are categorized the same according to symptom differentiation of Western diagnosis. For example in TCM terms, pelvic pain can be referred to as “painful periods”. In TCM, the primary pattern that causes endometriosis is blood stasis. Blood stasis can be brought about by emotional disturbance, chronic illness, exposure to cold temperatures, surgery, and genital infections. When the pattern of disease is blood stasis, the treatment is to invigorate blood and remove the stasis. By using both acupuncture and Chinese herbs there is an increase of circulation, which will eliminate the blood stasis. These two modalities encourage the smooth flow of qi and blood throughout the body to bring about a balance of health. Blood stasis can occur in a variety of patterns causing a myriad of symptoms-one of the primary ones being pain. Rather it is pain associated with endometriosis, headaches, back pain-the actual stagnation of blood is what causes the pain and discomfort in the body. Acupuncture is known to successfully treat pain caused by many different sources and reasons. Other patterns that may lead to endometriosis are phlegm-damp, blood deficiency, qi stagnation, and qi deficiency. These different patterns can be caused by many internal and external factors. For example, along with other dysfunctions, phlegm-damp can be a result of consuming too much dairy-especially from ice cream. This may result in stagnation of the energy and blood in the pelvic area causing abdominal cramping and low back discomfort. All of these patterns can lead to painful endometriosis symptoms. A study conducted by Lorno and Burani presents the positive effects of acupuncture to decrease dysmenorrhea in patients whose symptoms were resistant to traditional treatment with NSAIDs (1). This study describes how acupuncture can decrease the pain in intensity and the duration of how long the pain occurred for the participants.

Along with acupuncture and herbs, Chinese nutritional recommendations, yoga, and meditation are strongly recommended. Food choices are an important element in controlling endometriosis. Chinese nutritional perspective looks at the yin and yang of a food and how it affects the yin and yang of our bodies. This perspective addresses the hot and cold properties of foods and how they are digested by the body. Poor digestion can easily lead to a slow circulation throughout the body-including the circulation to the reproductive system and its’ organs. A low-fat, high-fiber, dairy-free diet is recommended, along with the addition of certain foods such as daikon radish and kelp. Gentle and nourishing exercises and breathing techniques practiced through yoga have calming affects on endometriosis symptoms. Yoga incorporates deep breathing and stretching that can decrease pelvic pain and also enhance deep sleep. Meditation has been shown to have dramatic physiological affects that restore balance and peace through the mind, body, and spirit. Meditation is a relaxation technique that calms the mind, allowing all bodily processes to slow down and work more efficiently. The relaxation brought on through meditation can move through the entire mind, body, spirit allowing the nourishing energy to flow in a harmonious course. A study conducted by Meissner, Bohling, and Schweizer-Arau (2) demonstrates the positive affects of acupuncture and hypnotherapy on severe endometriosis. This research concluded a decrease in the painful symptoms along with increased birth rates from the research participants.

Research cited:

(1)Lorno, V; Burani, R; Bianchini, B; Minelli, E; Martinelli, F; Ciatto, S. (2008); Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment;
Evidence-based Complementary Medicine (Online) 5(2), p.227-230 Retrieved 2008 June,http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396472/?tool=pubmed

(2) Meissnera, K; Barbara, B; Schweizer-Arauc, A (2010); Long-Term Effects of Traditional Chinese Medicine and Hypnotherapy in Patients with Severe Endometriosis-a Retrospective Evaluation; Forsch Komplementmed (Online) 17(6), p.314-20 Retrieved 2010 Dec 9,http://content.karger.com/produktedb/produkte.asp?DOI=000322890&typ=pdf

Caroline Jung, MSOM, Dipl. Ac.