Endometriosis

 

endometriosis woman with painful period

What is Endometriosis?

by Dr. Pamela Frank, BSc(Hons), ND

Endometriosis is a condition where portions of the lining of the uterus have escaped their normal environment inside the uterus and have lodged somewhere within the abdominal cavity.  This tissue is sensitive to hormonal changes.  It grows in response to increases in estrogen levels just as the uterine lining would.  This growing tissue causes pressure on surrounding tissues and nerves leading to intense pain.  Contrary to the information some of my patients have received, the pain can be present throughout a woman’s menstrual cycle, not just at menstruation.  The pain can be both excruciating and debilitating.

Do You Have Endometriosis?

Symptoms:

  1. Intense abdominal pain that may be aggravated before and/or during menstruation.  Women with endometriosis generally have to take painkillers during their periods and even then may experience incapacitating pain. Menstrual cramps of any severity may indicate mild, moderate or severe endometriosis.
  2. Rectal or bladder pain, again may be worse around menstruation
  3. Bladder irritability – symptoms may be similar to a bladder infection, but keep recurring despite antibiotic treatment

Naturopathic Treatment for Endometriosis

  1. Preventing the escape of uterine tissue from the uterus
  2. Resolving tissue that has already lodged in the abdomen
  3. Relieving pain
  4. Reducing excess estrogen
  5. Aiding liver detoxification (not the kits from the health food store!) of hormones and hormone mimicking pollutants
  6. Ensuring intestinal health so that toxins are efficiently excreted

Preventing Uterine Tissue from Escaping the Uterus

There are many theories as to why this tissue has found it’s way outside the uterus:

  • Gravity – headstands, yoga during heavy menstruation
  • Dioxin – research on monkeys exposed to dioxin, a byproduct of bleach, shows an increase in endometriosis. A study by the Environmental Protection Agency determined that exposure through bleached products like sanitary napkins and bleached coffee filters was insignificant relative to exposure through consumption of beef and dairy products.
  • Retrograde flow i.e. menstrual flow going the wrong way, rather than down and out of the uterus through the cervix, menstrual blood and tissue is going up and out through the fallopian tubes.  Intercourse during menstruation and use of tampons are thought to contribute to retrograde flow. Retrograde menstrual flow occurs in approximately 90% of all women, so this theory alone is insufficient to explain why some women have endometriosis and others don’t.
  • Decrease activity of overly active uterine lining cells.  An enzyme called telomerase has been found to be overly active in women with endometriosis.
  • Autoimmune – more recently theories have emerged suggesting that endometriosis may be an auto-immune disorder due to high levels of circulating anti-endometrial antibodies in endometriosis patients. This seems like a chicken and egg situation.  The antibodies may be present because of the endometriosis, not as a cause of it.  If endometrial tissue is in the abdominal cavity where it does not belong, the immune system would be expected to target it as foreign and create antibodies against it.

Resolving Endometriosis Tissue

The immune system is responsible for identifying and resolving this foreign.  Acupuncture can be used to help stimulate immune system activity in the abdomen and enhance resolution of this tissue.  Diet can either enhance or inhibit immune system function; we want to optimize your diet to help the immune system to work better.  Immune enhancing herbs can also help expedite resolution of endometriosis tissue.

Pain Relief

Acupuncture works amazingly well to relieve pain of any type, including endometriosis pain.

Reducing Excess Estrogen

Estrogen activity is increased when insulin levels are higher, so maintaining a steady blood sugar and increasing insulin sensitivity can modulate estrogen activity.  Estrogen-like chemicals from pollution, plastics, pesticides and other chemicals can cause symptoms of excessive estrogen activity so reducing intake of these can help.

Liver Detoxification

It’s the liver’s job (among about 200 others) to detoxify chemicals, toxins, and excess hormones to prepare them for excretion. Only once these substances have been sufficiently processed by the liver will they be removed from your body.  If the liver is overwhelmed or undernourished, these toxins can build up in your system indefinitely.  Many natural substances can aid liver detoxification.

Intestinal Health

Once toxins have been processed by the liver they get excreted through the bowels.  Unhealthy digestive tracts from antibiotic use or a diet heavy in animal products that contain traces of antibiotics, can cause problems such as Candidiasis or dysbiosis.  An enzyme from certain bacteria known as beta glucuronidase, can allow these toxins to get recycled rather than excreted.   Commercial intestinal cleanses often do little to correct the intestinal bacteria and improve intestinal health, most only stimulate bowel movements with laxative herbs and/or fiber supplements.

Benefits of Naturopathic Treatment of Endometriosis

  1. Addresses the underlying cause of endometriosis in order to cure the condition on a longer term basis
  2. Prevents recurrence of endometriosis. The rate of recurrence of endometriosis after laparoscopic surgery is estimated to be between 30 and 40% within 5 years.  Many women experience recurrence within 1-1.5 years.
  3. Shrinks existing cysts and reduces pain
  4. Avoidance of side effects from drugs
  5. Better overall health and hormone balance
  6. Improved fertility.  Endometriosis can impair fertility by blocking the ovary from releasing an egg or blocking the opening of the fallopian tube so that an egg can’t make it’s way to the uterus to be fertilized.  The condition also makes the lining of the uterus less receptive to implantation.  Naturopathic treatment can address both issues without invasive procedures.

Endometriosis News and Natural Treatment Research

Teenage girls who are too skinny are more likely to develop the painful reproductive disorder endometriosis than their heavier peers, research shows.
Source: Queensland Institute of Medical Research

Did you know that endometriosis problems can continue even after a hysterectomy?

August 5, 2008

Scientists have identified an enzyme abnormality that may be the cause of endometriosis

Women who have endometriosis express an enzyme called telomerase in both the early and late stages of the menstrual cycle rather than only in the early stages as is normal.  This means that the cells of the uterine lining will continue to divide and lose their ‘focus’ in supporting the establishment of a pregnancy.  As a result the lining of the womb may be more hostile to an early pregnancy, and the cells that are shed at this late stage in the menstrual cycle may be more ‘aggressive’ and more able to survive and implant outside the uterus, causing pain in the pelvic or abdomen area.  To read more click here – http://www.liv.ac.uk/news/press_releases/2008/08/endometriosis.htm

The good news is that there are natural ways to suppress telomerase activity.

August 21, 2008

NF-kappaB inhibition shows promise in endometriosis

There are herbs that I have used to inhibit NF-kappaB

October 1, 2009

Aromatase inhibitors improve pain control in endometriosis

Pharmaceutical aromatase inhibitors can cause uncomfortable side effects about half the time.  Natural aromatase inhibitors are much better tolerated and provide overall health benefits.

April 12, 2011

The Traditional Chinese herb Guizhi Fuling capsule plays an important role in the regression of endometriotic implants by immunological regulation in the rat model.
Source: Journal of Ethnopharmacology Volume 134, Issue 3, 12 April 2011, Pages 624-629

Resveratrol: Supplementation with resveratrol as well as an oral contraceptive was found to significantly improve and even resolve dysmenorrhea and pelvic pain in endometriosis patients.

Source: Int J Womens Health. 2012;4:543-9. Epub 2012 Oct 10

Vitamin D: Low vitamin D status was found to be associated with impaired fertility, endometriosis and PCOS.

Source: International Journal of Womens Health, Volume 3, Pages 25-35, 2011

N-acetylcysteine (NAC): Supplementation with N-acetylcysteine was found to decrease cyst mean diameter, compared to a significant increase in untreated patients.

Source: Evid Based Complement Alternat Med. 2013;2013:240702.

Resveratrol: Supplementation with resveratrol may improve the effect of oral contraceptives in the treatment of endometriosis-associated dysmenorrhoea.

Source: Int J Womens Health 2012; 4: 543-549.

Resveratrol: Supplementation with resveratrol as well as an oral contraceptive was found to significantly improve and even resolve dysmenorrhea and pelvic pain in endometriosis patients.

Source: Int J Womens Health. 2012;4:543-9. Epub 2012 Oct 10

Stem cells: Stem cells have been identified in several tissues, including the endometrium, and may be involved in the development of endometriosis.

Source: Histol Histopathol. 2012 Jan;27(1):23-9.

Genes: A combination of the GSTM1 null genotype and CYP1A1 MspI polymorphism was found to be associated with a small increased risk of endometriosis.

Source: Mol Hum Reprod. 2001 Nov;7(11):1073-8.

Immune System: Excess p40 in the peritoneal fluid of endometriosis patients may be related to the natural killer cell defect that is associated with the condition.

Source: J Clin Endocrinol Metab. 1998 Mar;83(3):911-6.

Pollutants: Exposure to environmental pollutants, particularly dioxins and polychlorinated biphenyls, were found to increase risk of endometriosis in women.

Source: Environ Health Perspect. 2009 July; 117(7): 1070–1075.

Genes: The NRIP 1 gene encodes for the RIP140 protein and is essential for female fertility. NRIP1 gene variants were found to possibly act as predisposing factors for human endometriosis.

Source: J Exp Clin Assist Reprod. 2005; 2: 11.

PCBs: In women aged 20-40, the sum of all polychlorinated biphenyl (PCB) congeners were 1.6 times higher in the 40 women diagnosed with endometriosis than in controls.

Source: Environ Health Perspect. 2006 July; 114(7): A404.

Genes: Women with endometriosis were found to not demonstrate the expected mid-luteal rise of HOXA10 protein expression, which may explain the infertility observed in many patients.

Source: J Assist Reprod Genet. 2010 Dec;27(12):701-10. Epub 2010 Sep 7.

Protein: Abnormally high levels of DJ-1 protein expression may stimulate endometrial cell survival, proliferation, migration and invasion.

Source: PLoS One. 2011; 6(3): e18074.

Gene expression: IGF2, ACTN4, AXL, and SHC1 are genes found to be differentially expressed between endometriosis and normal endometrium

Source: Reprod Biol Endocrinol. 2008; 6: 59.

Hormones: Loss of progesterone signaling in the endometrium may be part of the development of endometriosis, and progesterone resistance is commonly observed in endometriosis patients.

Source: Semin Reprod Med. 2010 Jan;28(1):36-43. Epub 2010 Jan 26.

Dioxin: Dioxin, a contaminant of industrial combustion processes, is largely thought to play a part in the etiology of endometriosis. However, this study found that serum levels of 100 ppt or higher did not have significant risk for endometriosis.

Source: Environ Health Perspect. 2002 July; 110(7): 629–634.

Immune Response: Inadequate immune and neuroendocrine responses are thought to play a part in the pathophysiology of endometriosis, particularly adhesion molecules, protein-glycan ineractions and pro-angiogenic mediators.

Source: Semin Immunopathol. 2007 June; 29(2): 193–210.

Stem cells: Research suggests that stem cells may be responsible for the cyclic regeneration of the endometrium during the menstrual cycle and therefore play a part in the development of endometriosis.

Source: Ann N Y Acad Sci. 2008 Apr;1127:106-15.

Iron: Iron overload has been observed in the peritoneal fluid, endometriotic lesions, peritoneum and macrophages of endometriosis patients, suggesting it may a contributing factor in the development of endometriosis.

Source: Mol Hum Reprod. 2008 Jul;14(7):377-85. Epub 2008 May 28.

Immune system: Development of endometriosis is facilitated by quantity and quality of endometrial cells in peritoneal fluid (PF), increase inflammatory activity in PF, increased endometrial-peritoneal adhesion and angiogenesis, and increased production of autoantibodies against endometrial cells.

Source: Reprod Biol Endocrinol. 2003; 1: 123.

Pollutants: Level of exposure to polybrominated biphenyls (PBBs) was found to not increase risk of endometriosis. But, higher levels of polychlorinated biphenyls (PCBs) exposure did increase risk.

Source: Ann Epidemiol. 2007 July; 17(7): 503–510.

Dioxin: In a study of infertile women with endometriosis, 8 individuals with endometriosis were found to be dioxin positive compared to 1 woman in the control, suggesting a link between dioxin exposure and endometriosis.

Source: Hum Reprod. 1997 Feb;12(2):373-5.

Inflammation: Exposure to environmental toxicants induces an inflammatory-like endometrial response that may advance the development of endometriosis.

Source: Fertil Steril. 2008 May; 89(5 Suppl): 1287–1298.

Pollutants:  Polychlorinated biphenyls (PCB’s) were found to not be associated with endometriosis risk.

Source: Environ Health Perspect. 2010 September; 118(9): 1280–1285.

Phytochemicals: The phytochemicals Diindolylmethane (DIM), its precursor Indole-3-carbinol (I3C), and cogener, 2-(Indol-3-ylmethyl)-3,3’diindolylmethane (LTR-1) were found to prevent or reduce symptoms of mastalgia and endometriosis.

Source: United States Patent 7,384,972; June 10, 2008

N-acetylcysteine: Supplementation with N-acetylcysteine was found to decrease cyst mean diameter, compared to a significant increase in untreated patients.

Source: Evid Based Complement Alternat Med. 2013;2013:240702.

DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested in this web site.

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