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, building up and shedding blood during menstruation each month. Blood from these cells causes deposits to accumulate and form scar tissue, which can be painful. Endometriosis affects 6 - 10% of American women of childbearing age and 30 - 45% of women with infertility. It is one of the main causes of infertility in women.
One-third of women with endometriosis have no symptoms. The most common symptoms include the following:
The cause is unknown, but theories include:
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.
Because there is no cure, treatments are designed to relieve symptoms.
The following drugs can relieve the symptoms of endometriosis:
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.
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.
These nutritional tips may help reduce symptoms:
Nutritional deficiencies may be addressed with the following supplements:
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; speak with your physician. 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.
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.
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.
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.
Do not perform these therapies during menstrual flow:
Acupuncture may help reduce pain and balance hormone levels.
Therapeutic massage may help resolve pelvic congestion.
Endometriosis often resolves during pregnancy. Recent evidence suggests that women who have endometriosis are at greater risk of developing ovarian cancer.
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.
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].
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.
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
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.
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.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885