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Endometriosis


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
 
Treatment Options
Special Considerations
Supporting Research

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 2 - 10% of American women of childbearing age and 30 - 40% 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 don't find out they have it until they have problems trying to conceive. The most common symptoms include 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

What Causes It?

The cause is unknown, but theories include:

  • Abnormal functioning of the immune system
  • 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 a 5.9% likelihood of developing the condition, while patients with no family history had only a 3% chance.)
  • Some studies suggest that being overweight during late childhood is associated with the development of endometriosis
  • Stress

What to Expect at Your Provider's Office

A physical examination may include gentle pushing on your abdomen and pelvic exam. Your doctor may order an ultrasound, Magnetic Resonance Imaging (MRI) or other imaging tests to help determine whether or not you have 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

Because there is no cure, treatments are designed to relieve symptoms.

Drug Therapies

The following drugs can relieve the symptoms of endometriosis:

  • Nonsteroidal anti-inflammatory drugs (such as ibuprofen)
  • Oral contraceptives
  • Hormone suppressing drugs (which stop ovulation)

Surgical Procedures

Laparoscopic laser techniques help shrink lesions and may improve fertility. Total hysterectomy (removal of the uterus and ovaries) is recommended only when necessary, however, this approach does not guarantee an end to symptoms. Surgical procedures are sometimes used in combination with long term medicine.

Complementary and Alternative Therapies

In addition to diet, herbs, and supplements, exercise may help prevent endometriosis. It's unknown whether exercise will help an existing condition. Because hormones, including estrogen, affect endometriosis, many treatments are designed to reduce estrogen levels in the body.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

  • Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may test for food sensitivities.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell pepper).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
  • Use healthy cooking oils, such as olive oil or coconut oil.
  • Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
  • Drink 6 - 8 glasses of filtered water daily.

Nutritional deficiencies may be addressed with the following supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoons oil daily, to help decrease inflammation and improve immunity. Talk to a health care provider before taking omega-3 fatty acid supplements if you are taking blood thinning medications, such as aspirin or warfarin (Coumadin).
  • A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
  • Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
  • L-carnitine, 500 - 2,000 mg daily, for muscular support.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully.
  • Calcium d-glucarate, 500 - 1,000 mg 1 - 3 times per day, can help rid the body of toxins and may help the body get rid of excess estrogen. If you are taking birth control pills or hormonal medication, talk to your physician before taking Calcium d-glucarate as this supplement may interfere with hormonal and other medications.
  • Diindolylmethane (DIM), 1 capsule 1 - 2 times per day, to help the body metabolize estrogen into the most beneficial form and not into harmful forms. If you are taking birth control pills or any kind of hormonal medicine, talk to your doctor before taking DIM as this supplement may interfere with hormonal medications.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune support. CoQ10 may interact with blood-thinning medications. CoQ10 may interact with blood-thinning medications.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to choose the safest, most effective herbal therapies before starting any treatment. Many of the following herbs have hormonal activity and may therefore interfere with hormonal medications. Always tell your doctor about any herbs you may be taking. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

  • Chasteberry (Vitex agnus cactus) standardized extract, 400 mg in the morning once a day, for hormonal support. Chasteberry is usually taken long-term (12 - 18 months) for maximum effectiveness. Can potentially interfere with certain medications, including hormonal, antipsychotic, Parkinson's, and other medications. Talk to your doctor.
  • Evening primrose oil (Oenothera biennis) standardized extract, 500 - 1,000 mg daily, as a source of gamma linolenic acid (GLA), for symptoms of hormonal imbalance and stress. You should not take evening primrose oil if you are taking antipsychotic medications, medications that may increase bleeding, or if you have a history of seizures.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation, immune, and antifungal activity. May increase the effect of blood thinning medications such as Coumadin; speak with your physician. Cat's claw may worsen certain conditions, such as autoimmune conditions and leukemia
  • Bromelain (Ananus comosus) standardized extract, 40 mg 3 times daily, for pain and inflammation. May increase the effect of blood thinning medications such as Coumadin; speak with your physician. Bromelain can also interact with other medications, including certain antibiotics.
  • Turmeric (Curcuma longa) standardized extract, 300 mg 3 times a day, for inflammation. May increase the effect of blood thinning medications such as Coumadin; speak with your physician. Fumeric can make gallbladder problems, such as gallstones, worse.

Traditional Chinese Medicine is often used as an alternative and/or complimentary treatment for endometriosis. Herbs often prescribed include corydalis, cnidium, bupleurum, dong quai, and perilla, sometimes accompanied by acupuncture. Because doses vary, you should talk to a licensed provider of Traditional Chinese Medicine.

Natural Hormone Replacement

A qualified natural medicine provider may prescribe natural hormone creams, such as progesterone, to balance excessive estrogen levels. This should only be done under the care of a licensed doctor skilled in the use of natural hormones. Keep all of your doctors informed whenever you use hormones of any kind.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you.

Some of the most common remedies are listed below. A common dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms improve.

  • Belladonna for menstruation with sensation of heaviness and heat
  • Calcarea phosphoricum for excessive periods with backache
  • Chamomilla for heavy menses with dark clotted blood and pains
  • Cimicifuga racemosa for unbearable pain radiating from hip to hip

Physical Medicine

Do not perform these therapies during menstrual flow:

  • Contrast sitz baths. You will need 2 basins in which you can comfortably sit. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this 3 times to complete one set. Do 1 - 2 sets per day, 3 - 4 days per week.
  • Castor oil pack. Apply oil to a soft, clean cloth, place on your abdomen, and cover with plastic wrap. Place a heat source over the pack and let sit for 30 - 60 minutes. Use for 3 consecutive days. Never use castor oil internally.

Acupuncture

Acupuncture may help reduce pain and balance hormone levels. Preliminary studies have found that acupuncture is effective in reducing pain related to endometriosis. More studies are needed.

Massage

Therapeutic massage may help resolve pelvic congestion.

Special Considerations

Endometriosis often resolves temporarily during pregnancy and lessons after menopause -- although not always. Recent evidence suggests that women who have endometriosis are at greater risk of developing ovarian cancer.

Supporting Research

Allen C, Hopewell S, Prentice A. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2005;(4):CD004753.

Anger DL, Foster WG. The link between environmental toxicant exposure and endometriosis. Front Biosci. 2008;13:1578-93.

Doyle JO, Missmer SA, Laufer MR. The Effect of Combined Surgical-Medical Intervention on the Progression of Endometriosis in an Adolescent and Young Adult Population. Journal of Pediatric and Adolescent Gynecology. 2009;(22)4.

Endometriosis Ultrasound Clinics - Volume 3, Issue 3. Philadelphia, PA: Saunders, An Imprint of Elsevier; 2008.

Ferri's Clinical Advisor, 2010, 1st ed. Philadelphia, PA: Mosby, An Imprint of Elsevier; 2009.

Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet--what is the evidence? Eur J Obstet Gynecol Reprod Biol. 2007;132(2):140-7.

Flower A, Lewith GT, Little P. A feasibility study exploring the role of Chinese herbal medicine in the treatment of endometriosis. J Altern Complement Med. 2011; 17(8):691-9.

Flower A, Liu JP, Chen S, Lewith G, Little P. Chinee herbal medicine for endometriosis. [Review]. Cochrane Database Syst Rev. 2009;(3):CD006568.

Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91(1):32-9.

Heilier JF, Donnez J, Lison D. Organochlorines and endometriosis: A mini-review. Chemosphere. 2007; [Epub ahead of print].

Jacobson TZ. Potential cures for endometriosis. Ann N Y Acad Sci. 2011;1221:70-4.

Jarrell J, Brant R, Leung W, Taenzer P. Women's Pain Experience Predicts Future Surgery for Pain Associated With Endometriosis. J Obstet Gynaecol Can. 2007;29(12):988-91.

Jiang H, Shen Y, Wang XG. Current progress of Chinese medicinal treatment of endometriosis. [Review]. Chin J Integr Med. 2010;16(3):283-8.

Kaatz J, Solari-Twadell PA, Cameron J, Schultz R. Coping with endometriosis. J Obstet Gynecol Neonatal Nurs. 2010;39(2):220-5; quiz 225-6. 

Lambrinoudaki IV, Augoulea A, Christodoulakos GE, Economou EV, Kaparos G, Kontoravdis A, Papadias C, Creatsas G. Measurable serum markers of oxidative stress response in women with endometriosis. Fertil Steril. 2009; 91(1):46-50.

Meissner K, Böhling B, Schweizer-Arau A. Long-term effects of traditional Chinese medicine and hypnotherapy in patients with severe endometriosis - a retrospective evaluation. Forsch Komplementmed. 2010;17(6):314-20.

Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25(6):1528-35. 

Moen MH, Rees M, Brincat M, Erel T, Gambacciani M, Lambrinoudaki I, Schenck-Gustafsson K, Tremollieres F, Vujovic S, Rozenberg S; European Menopause and Andropause Society. EMAS position statement: Managing the menopause in women with a past history of endometriosis. Maturitas. 2010;67(1):94-7.

Nagle CM, Bell TA, Purdie DM, Treloar SA, Olsen CM, Grover S, Green AC. Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis. Hum Reprod. 2009;24(6):1501-6.

Netsu S, Konno R, Odagiri K, et al. Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis. Fertil Steril. 2007; [Epub ahead of print].

Nezhat F, Datta MS, Hanson V, Pejovic T, Nezhat C, Nezhat C. The relationship of endometriosis and ovarian malignancy: a review. Fertil Steril. 2008;90(5):1559-70.

Rodgers AK, Falcone T. Treatment strategies for endometriosis. Expert Opin Pharmacother. 2008;9(2):243-55.

Rubi-Klein K, Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M, Wolkenstein E. Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial. Eur J Obstet Gynecol Reprod Biol. 2010;153(1):90-3.

Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008:111(6):1285-92.

Tsuchiya M, Miura T, Hanaoka T, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology. 2007;18(3):402-8.

Valiani M, Ghasemi N, Bahadoran P, Heshmat R. The effects of massage therapy on dysmenorrhea caused by endometriosis. Iran J Nurs Midwifery Res. 2010;15(4):167-71. 

Zhou J, Qu F. Treating gynaecological disorders with traditional Chinese medicine: a review. [Review]. Afr J Tradit Complement Altern Med. 2009;6(4):494-517. 


Review Date: 3/2/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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