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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. These misplaced cells are stimulated by hormones, just like the cells within the uterus, and build up and then shed blood during menstruation each month. Blood from these cells causes deposits to build up and form scar tissue, which can be painful. Endometriosis affects 10 - 20% of American women of childbearing age. It is one of the main causes of infertility in women.

Signs and Symptoms

One-third of women with endometriosis have no symptoms. 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

What Causes It?

The cause is unknown, but there are three theories.

• 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

What to Expect at Your Provider's Office

A physical examination may include gentle pushing on your abdomen and pelvic exam. 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)
• Hormone-suppressing drugs (which stop ovulation)

Surgical Procedures

Laparoscopic laser techniques help shrink lesions. Total hysterectomy (removal of the uterus and ovaries) is recommended only when necessary but does not guarantee an end to symptoms.

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 endometriosis is affected by hormones, including estrogen, many treatments are designed to reduce estrogen levels in the body.

Nutrition and Supplements

• Eliminate all known food allergens.
• Eliminate alcohol, caffeine, refined foods, sugar, and saturated fats, which can increase inflammation and pain. Avoid non-organic meat and milk, which may contain hormones. Some women find vegetarian or vegan diets lessen symptoms.
• Increase intake of whole grains, fresh vegetables, essential fatty acids, and vegetable proteins.
• Fish oil (1,500 mg per day) has been shown to reduce the severity of endometriosis in animal studies, but no studies have been done on humans.
• Vitamin C (1,000 mg three times per day) decreases inflammation. Lower dose if diarrhea develops.
• Vitamin E (400 IU per day) helps balance hormones and the immune system.
• Iron supplementation may be necessary if bleeding is severe.
• Essential fatty acids (1,000 - 1,500 mg twice a day), found in evening primrose oil, borage oil, or flaxseed oil, help reduce levels of prostaglandins, which cause cramps and inflammation.
• High doses of calcium (500 mg four times per day) and magnesium (500 mg two times per day) also may help reduce prostaglandin levels. Since this is a high dose, take it only during your period.
• Calcium d-glucarate (500 - 1,000 mg one to three times per day) can help rid the body of toxins and may help the body get rid of excess estrogen.
• Diindolylmethane (Indolplex, 1 capsule one to two times per day) helps the body to metabolize estrogen in the most beneficial form and not in harmful forms.

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 get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. 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.

Chaste tree or chasteberry (Vitex agnus cactus) taken long term (12 - 18 months) for maximum effectiveness. As a capsule, take 225 mg two times per day. It is sometimes combined with dong quai ( Angelica sinensis ) (200 mg three times per day, or 30 drops of tincture per day).

Chaste tree can also be taken with:

• Dandelion (Taraxacum officinale). Steep 2 - 3 teaspoons dried root in one cup boiling water. Strain and cool. Drinks 3 cups per day.
• Prickly ash ( Zanthoxylum americanum ). Boil 1 - 3 g in one cup water for 10 minutes. Strain and cool. Drink 3 cups per day.
• Motherwort (Leonurus cardiaca) . Steep 2 g in a cup of boiling water. Strain and cool. Drink 3 cups per day.

A lipotropic combination helps the liver remove any excess estrogen from the body. The combination should include milk thistle (Silybum marianum), dandelion, choline, inositol, and methionine.

Traditional Chinese medicine is often used as an alternative 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

Some of the most common remedies are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours.

• 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 two basins that you can comfortably sit in. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day, 3 - 4 days per week.
• Castor oil pack. Apply oil to a soft, clean cloth, place on abdomen, and cover with plastic wrap. Place a heat source over the pack and let sit for 30 - 60 minutes. Use for three consecutive days.
• Kegel exercises (contracting and releasing the pelvic muscles).

Acupuncture

Acupuncture may be helpful for reducing pain and helping balance hormone levels.

Massage

Therapeutic massage may help resolve pelvic congestion.

Special Considerations

Endometriosis often resolves during pregnancy.

Supporting Research

Batchelder HJ, Hudson T, Lewin A, et al. Therapeutic approaches to endometriosis . The Protocol Journal of Botanical Medicine 1996;Spring:25–60.

Covens AL, Christopher P, Casper RF. The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertil Steril 1988;49:698–703.

Facts About Endometriosis. U.S. Department of Health and Human Services. National Institutes of Child Health and Human Development. NIH Publication no. 91-2413.

Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol 1996;174:1335–8.

Hudson T, Lewin A, Gerson S, et al. Endometriosis (modality specific condition reviews) Protocol J Botan Med . 1996;1:30-46.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:112-114.

Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual tension syndrome with Vitex agnus-castus. Controlled, double-blind study versus pyridoxine. Phytomedicine 1997;4:183–9.

McQuade CA. Women's health workshop: endometriosis, fibroids, PMS and HRT. Medicines from the earth: exploring nature's pharmacy (official proceedings). Harvard, Mass: Gaia Research Institute; 1997:182-183.

Tureck RW. Endometriosis: diagnosis and initial treatment. Hospital Physician Obstetrics and Gynecology Board Review Manual. April 1997;3:1-8.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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