Endometriosis: the big pain

Endometrial tissue is typically found in the lining of the uterus and is shed every month during menstruation. But in endometriosis, this tissue grows in other places such as the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the abdomen. “Endometrial implants”, as they are called, can even occasionally appear in the lungs, brain, kidneys, arms, legs and sinus cavities. Endometriosis is not life-threatening, but it can be the culprit behind two major life-altering symptoms: infertility and—you guessed it-- pain.

Endometriosis occurs in about 6-10% of women of reproductive age, although this is an estimate. About 20 to 50% of women with fertility problems have endometriosis, and it is also thought to be the main cause of chronic pelvic pain for 70-87% of women who suffer with this affliction. Because endometriosis occurs in an estrogen-rich environment, symptoms can temporarily retreat during pregnancy and usually resolve with menopause, but for many women this is too late!

What causes endometrial implants?

The cause of endometriosis is unknown. Many theories have been proposed, including “retrograde menustration”, where the menstrual blood flows upward into the fallopian tubes instead of downward and out of the body.

Recent research strongly suggests there is immune system involvement, possibly associated with increased inflammation.

Another theory is that other types of similar tissue somehow transform into endometrial tissue (a process called “metaplasia”).

Finally, there is evidence that endometrial tissue can travel through the bloodstream or the lymphatic system from the uterus to other parts of the body, which might explain why the most common site for implants is the ovaries [i].

How would you know you might have it?

Women with a “first-degree” female relative (mother or sister) who has endometriosis are up to ten times more likely to develop the condition, so if you have chronic pelvic pain and endometriosis is in your family, it’s certainly a consideration.

About one-third of women with endometriosis have no symptoms, adding to the mystery associated with this condition. And strangely, the level of pain experienced does not appear to be related to the number or volume of implants.

These are the most common symptoms:

·  Severely painful periods

·     Chronic pelvic pain

·     Heavy periods or bleeding between periods

·     Back pain

·     Pain during urination or defecation

·     Pain during exercise (including sex for sexually active women)

·     Bloating, nausea and vomiting

Notice that some of these symptoms are not experienced as part of the reproductive system. Endometriosis can be difficult to diagnose and can therefore sometimes be mistaken for:

·        Pelvic inflammatory disorder (a serious infection)

·        Polycystic ovarian syndrome (PCOS)

·        Chronic cystitis, interstitial cystitis or painful bladder syndrome

·        Irritable bowel syndrome or diverticulitis

·        A sexually transmitted infection (e.g. gonorrhea, chlamydia)

Endometrial implants can cause scarring, can interfere with normal function of the ovaries and fallopian tubes, and can block the movement of sperm (contributing to infertility). When implants develop in the ovaries, they can become large painful growths known as endometriomas (also called “chocolate cysts”).

Many women wait anywhere from 6 to 11 years to get an endometriosis diagnosis. Unfortunately, blood tests and imaging techniques are not useful, although they can rule out other conditions.  

This means that actually seeing the endometrial implants remains the definitive tool of diagnosis. After other explanations for symptoms are ruled out, laporoscopic surgery is done in order to look for endometrial implants[ii].

Conventional medical treatment of endometriosis

When surgery takes place for diagnostic purposes, endometrial implants can be removed at the same time. For those women experiencing problems with fertility, pregnancy rates can improve following surgery, but success depend on the stage of endometriosis as well as location of the implants[iii].

In addition to surgery, a range of pharmaceutical treatments can be used to reduce pain, address fertility problems and reduce recurrence of symptoms.

Pain medications are often recommended, though these can be notoriously ineffectual for severe endometriosis pain.

Because endometriosis is affiliated with the hormonal cycle, various types of hormonal therapy are often prescribed, including oral contraceptives and other drugs that cause the ovaries to stop making hormones. Danazol is typically the drug of last resort since it can be associated with adverse effects.   

Adjunct and natural approaches

For women who prefer to avoid the risks of surgery and/or the side effects of hormonal therapy, natural approaches can be used as an adjunct alongside, before, or after conventional medical treatment. These often take a holistic approach, which is valuable for endometriosis since it is a condition that can involve multiple body systems, including urinary, musculo-skeletal, immune and gastro-intestinal.

For pain management and amelioration, castor oil packs placed on the lower abdomen are an ancient treatment that can provide relief for some women. (There are many guidelines on the internet for making your own castor oil pack).

Other mind-body interventions can be helpful for pain management, such as deep breathing, meditation and gentle yoga routines (here is an example).

Because endometriosis is known to be an inflammatory condition, many integrative practitioners recommend an anti-inflammatory food program that involves elimination of processed foods, conventionally raised animal products, wheat, dairy and farm-raised fish; and increased intake of vegetables, non-citrus fruits, certain oils and organic/grass-fed animal products and wild-caught fish[iv] .

Finally, homeopathic care can be an extremely useful adjunct. As with all conditions, the homeopathic medicines chosen depend on an individualized assessment of the symptoms and history of the condition: the location, sensation and cyclical pattern of the pain, characteristic patterns of the menstrual cycle, modalities (what makes things better or worse), and other symptoms that seem to accompany the abdominal pain such as digestive or headaches. Since endometriosis involves multiple body systems including the immune system, low-potency homeopathic remedies targeted for organ support can also be useful.

To learn more about how I could help you with symptoms of endometriosis, call me for a free 15-minute consultation or schedule one on the online scheduler.

[i] “Endometriosis etiology »  https://emedicine.medscape.com/article/271899-overview#a3

[ii] “Endometriosis workup” https://emedicine.medscape.com/article/271899-workup#showall

[iii] Rizk, B, R Turki, H Lotfy, S Ranganathan, H Zahed, A Freeman, Z Shilbayeh, M Sassy, M Shalaby, R Malik (2015) “Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect?”  Facts, Views Vis Obgyn 7(2):109-118 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498168/pdf/FVVinObGyn-7-109-118.pdf

[iv] Laschke, M, M Menger (2016) “The gut microbiota: a puppet master in the pathogenesis of endometriosis?” Am Journal Obstet Gynecol 215(1): 68.e1-4  https://pubmed.ncbi.nlm.nih.gov/26901277/