Isolation, a mask to show the world you are ok or hiding away from the world because inside the pain and suffering are so immense and no one understands. Darkness of mood that descends with the pain. A loss of hope and not knowing where to turn for help. For some women endometriosis is something that may just stir up additional premenstrual symptoms but for others it can be a life sentence of chronic debilitating pain from several days in the month to all of them. It has the power to take over your body functions, mental state, and ability to cope with even the smallest task and yet it seems there is not much known about it nor are there seemingly any real long term solutions.
What is endometriosis?
Endometriosis is a condition that affects 1 in 10 Australian women, usually in their reproductive years (15-50 years of age). The symptoms can vary greatly both in nature and intensity, with some women experiencing intense pelvic pain and other women having no symptoms.
Endometriosis is where endometrial tissue grows outside of the uterus, usually within the pelvic cavity. When endometrial tissue grows outside of the uterus it may create a range of symptoms, with the most common symptom being severe period pain. The main sites for endometriosis are on the peritoneum of the pelvis behind the vagina and uterus, or underneath/on top of the ovaries. Extremely rare findings have detected endometrial tissue outside of the pelvic cavity altogether, with reports of endometriosis in the liver, lungs, brain and thumb. However, it is most commonly found in the pelvic cavity.
Endometriosis is becoming increasingly more common, and at Evolve Natural Medicine we are seeing more and more patients with endometriosis-related symptoms. This may be due to improvements in diagnosis (via surgery) and increased awareness of the disease, but also due to an increase in environmental pollutants and deferred child-bearing (1).
How is endometriosis diagnosed?
Investigations for endometriosis may include a pelvic examination and a pelvic ultrasound, however, a laparoscopy (surgery) is usually needed to confirm a diagnosis.
What are the causes of endometriosis?
Currently the causes of endometriosis are unclear, however there are some risk factors which are more commonly found in women suffering with endometriosis:
- Genetics is a key indicator– a family history of endometriosis makes you 8 x more likely to have endometriosis (2). This refers to first degree relatives only.
- Early menarche(first period)
- Delayed childbearing or nulliparity (no childbearing)
- Late menopause
- Shortened menstrual cycles (<27 days) with menses that are heavy and prolonged (>8 days)
- Multiple births
- Late menarche (onset of first menstrual period when a female is >15 years old)
- Use of low-dose oral contraceptives
- Regular exercise (especially if begun before age 15, if done for >4 hrs/week, or both)
- Prolonged lactation
- Mullerian duct defects (Mullerian ducts develop into the uterus, cervix and fallopian tubes in female embryos. However, about 4% of women are born with Mullerian duct defects.)
- Exposure to diethylstilbestrol in utero (Diethylstilbestrol is a synthetic nonsteroidal oestrogen which up until 1971, was commonly prescribed to women with the belief that it would reduce the risk of complications during pregnancy.)
What are the signs and symptoms of endometriosis?
The most common symptom of endometriosis is pelvic pain, which commonly occurs during menstruation (a.k.a. period pain), but can occur at other times during the month. According to Endometriosis Australia many women live with endometriosis for up to 10 years prior to a diagnosis being made because it is often disregarded by GPs as ‘normal’ period pain.
By the way, period pain and PMS may be common, but that doesn’t mean you have to live with them. Chinese Medicine views pain and discomfort as signals that the body is out of sync. Acupuncture and Chinese Herbal Medicine can assist the body back to balance.
The signs and symptoms of endometriosis may vary from person to person, but some of the general signs and symptoms include:
- Dysmenorrhoea (period pain)
- Dyspareunia (pain during intercourse)
- Dysuria (painful urination)
- Pain during defecation (pain whilst having a bowel movement)
- Abdominal pain
- Spotting before periods
- Bloating (especially around menstruation)
How is endometriosis normally treated?
- Pain-relieving drugs(NSAIDs), such as:
Ibuprofen or Naproxen
Some recent research suggests significant issues with NSAID use (3).
- Hormonal contraceptive
The birth control pill, patches or vaginal rings. Hormonal contraceptives control the hormones responsible for the growth of endometrial tissue. Most women have lighter cycles whilst using hormonal contraceptives, which can help to reduce pain in the short term. Often the birth control pill is also used to skip the menstrual cycle, which reduces pain (but may cause other problems in the future).
- Drugs to suppress ovarian function
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists block the production of ovarian-stimulating hormones, lowering oestrogen levels and preventing menstruation.
- Progestin therapy
Progestin-only contraceptive such as IUD’s (Mirena), contraceptive injection (Depo-provera) and contraceptive implants can reduce (and in some cases prohibit) menstrual bleeding, and reduce the build up endometrial tissue, therefore relieving signs and symptoms.
This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, therefore ceasing menstruation and endometriosis-related symptoms. However, danazol can cause serious side effects and potential problems with an unborn baby if a woman becomes pregnant whilst using this.
- Conservative surgery
Surgery via laparoscopy (which is also used for diagnosis) or traditional abdominal surgery, can
help to remove a lot of the endometrial tissue, whilst preserving the ovaries and uterus, which
can be helpful for women who are planning to conceive. Surgery can help to reduce pain greatly,
however, pain and endometriosis may return.
In severe cases of endometriosis, occasionally a hysterectomy is performed (to remove the ovaries and cervix) as well as both ovaries. A hysterectomy is usually a last resort, as this irreversible surgery makes it impossible for a woman to become pregnant afterwards.
The problem with pain relief medications such as NSAIDs and opioids
A 2017 article from Harvard University stated that the United States Food and Drug Authority (FDA) has increased its warning regarding NSAIDs. The main risks include:
- Heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID.
- The risk increases with higher doses of NSAIDs taken for longer periods of time.
- The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.
- Previous studies have suggested that naproxen may be safer than other types of NSAIDs, but more recent evidence reviewed by the expert panel does not confirm this.
More information on: NSAIDs and opioid medications.
How does Chinese Medicine view endometriosis?
In Chinese Medicine, endometriosis is usually referred to as a ‘blood stagnation’ pattern. The endometrial tissue outside the uterus is therefore regarded as stagnant blood that pools and forms a blockage preventing the blood from circulating through the tissues as it is meant to. With endometriosis Chinese medicine has a specific emphasis on regulating the menstrual cycle and promoting regular blood flow to reduce pain both during menstruation and throughout the cycle. It also aims to reduce the build up of endometrial tissue, decreasing inflammation and restore normal function to the reproductive system.
What does the research say on Chinese medicine and endometriosis?
A systematic review (4) of acupuncture for treating primary dysmenorrhoea (painful periods) showed that acupuncture may be effective in treating pain This has useful implications for endometriosis, as pain is a primary symptom experienced by sufferers.
How does Chinese Medicine work with endometriosis?
In Chinese Medicine we look at each patient differently and tailor a plan for the individual. Each patient with endometriosis may present with a range of different symptoms, and may have different factors that are contributing to these symptoms. We use the pulse and tongue as diagnosis tools, and consider all of the individual’s signs and symptoms. That is we treat all factors that may contribute to the symptoms and underlying condition.We may incorporate acupuncture, Chinese herbal medicine and supplementation to reduce inflammation, relieve pain, regulate the menstrual cycle and work toward achieving balance in the body.
At Evolve we work with the patient to create a treatment plan which may include:
- Acupuncture to assist with pain and circulation
- Chinese herbal medicine to improve blood flow and reduce pain
- Diet advice, aiming to reduce inflammatory foods and increase beneficial foods.
- Stress management to help manage additional stressors in the patient’s life and work together to find solutions to relieving stress.
- Lyttleton, J. & Clavey, S. (2004). Treatment of Infertility with Chinese Medicine. UK: Elsevier.
- Endometriosis Australia. Available at: https://www.endometriosisaustralia.org
- Curfman, G. (2015). ‘FDA strengthens warning that NSAIDs increase heart attack and stroke risk’. Harvard Health Publishing. Available at: https://www.health.harvard.edu/blog/fda-strengthens-warning-that-nsaids-increase-heart-attack-and-stroke-risk-201507138138
- Smith, C., Armour, M., Zhu, X., Li X., Lu Z. & Song, J. (2016). ‘Acupuncture for dysmenorrhoea.’ Cochrane Database Systematic Reviews, 4: CD007854.
- Xu, Y., Zhao, W., Li, T., Zhao, Y., BU, H. & Song, S. (2017). ‘Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.’ PLoS One, 12(10). Available at: https://www.ncbi.nlm.nih.gov/pubmed/29077705
- “Endometriosis” 2018. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
- Liu, J. & Bill, A. (2018). “Endometriosis”. Merck Manual. Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
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