Endometriosis

Endometriosis is the presence of uterine tissue (endometrium) outside its usual location on the inner lining of the uterus. Endometrial tissue may implant itself on the ovaries, fallopian tubes, pelvic ligaments, abdominal organs, old scars and in rare cases, the chest, lung, spinal cord and extremities. The site of implantation of the endometrial tissue will largely control the degree or severity of symptoms. Over time the implants may enlarge, bleed, cause scarring and form tough fibrous adhesions between pelvic and abdominal structures.

The exact cause of endometriosis is unknown. One theory suggests that some of the lining of the uterus during menstruation moves backwards through the fallopian tubes into the abdominal cavity where it attaches and grows. Some studies have pointed to environmental factors as contributors to the development of endometriosis, specifically related to the way toxins in the environment have an effect on the reproductive hormones and immune system response, though this theory has not been proven and remains controversial. Other theories point to problems with the immune system and/or hormones. There is also some evidence that the condition may be inherited. Some of the other factors that may affect the disease process are poor liver function which contributes to the overall toxic load of the body and stress. But no matter what the original cause is, endometriosis is estrogen dependent and generally diminishes after menopause.

Endometriosis is common among women of reproductive age; it affects 10-15% of women between the ages 24-40. Its prevalence increases to 30–40% among infertile women.

Places where endometriosis is commonly found are: the outside surface of the uterus, fallopian tubes, ovaries, the lining of the pelvic cavity, and the area between the vagina and the rectum.

Symptoms

Some of the symptoms of endometriosis are painful periods (dysmenorrhoea), especially if this begins after several years of pain free menses, lower abdominal or rectal pain, pain before and during menstrual periods (usually worse than the pain in “normal” menstrual cramps). Pain during or after sexual intercourse may also be common as well as painful urination or pain with bowel movements or loose stools with menstrual periods. There is frequently a constant pelvic soreness and tenderness. However, pain, however, is not always present. Other symptoms include: premenstrual vaginal spotting of blood, abnormally heavy or long menstrual periods and infertility.

Diagnosis and Pharmaceutical Interventions

Diagnosis

The diagnosis of endometriosis is often strongly suspected from a patient’s initial history. For the vast majority of patients, endometriosis is included in the differential diagnosis of infertility or pelvic pain. An accurate diagnosis of endometriosis must be made by your gynecologist. He or she may perform a laparoscopy, which is an outpatient surgical procedure. A slim telescope is inserted through a very small opening made in the navel. This allows your doctor to examine the abdominal and pelvic organs and evaluate the extent of the disease. A biopsy is needed to make a definitive diagnosis, and that can be done during a laparoscopy or laparotomy (a more invasive surgical procedure which consists of pelvic or abdominal surgery).

Medications

Frequently medications are given that suppress ovulation and the normal menstrual process, usually birth control pills. Birth control pills have many problem attributed to them, including women who smoke and use OCs have a five-times greater risk of dying from a myocardial infarction than OC users who do not smoke. The use of the pill has been linked to circulatory problems especially blood clots. Oral contraceptives deplete the body of certain nutrients, mainly folate, pyridoxine which is vitamin B6, riboflavin, vitamin B12, vitamin C, magnesium and zinc.

Occasionally other drugs such as Nafarelin, a gonadotropin releasing hormone agonist are used which produce a relative menopausal- like state. These medications may induce breakthrough bleeding, bone loss and depression, the use is limited to 6 months or less.

Another drug that may be used to instill a low estrogen state is danzol, an analog of androgen, the male hormone. These drugs have the adverse effects such as weight gain, body hair growth, male pattern baldness, voice changes, edema and irritability.

Conservative surgery, where only the endometrial lesion are removed and the uterus and ovaries are left intact, is an option for those with significant pelvic adhesions, fallopian tube obstruction or incapacitating pain. Unfortunately most surgery increases the chance for new adhesions to develop. At times hysterectomy is warranted for women who have completed childbearing. If hysterectomy is performed on younger women hormone replacement therapy (i.e. premarin) may be advised.

Women should not accept drug therapy without a confirmed surgical or biospy diagnosis of endometriosis.

Lifestyle and Dietary Modifications

Since stress may be a factor, stress reduction and positive emotional health are very important. According to some reports, regular meetings with other endometriosis sufferers may help women with endometriosis learn about the disease and cope better with the many psychological and emotional issues that often accompany this condition.

It has also been found that physical activities can ease tension and release endorphins (the body’s natural painkiller). Women who exercise regularly have a less chance of getting endometriosis then women who do not, or start exercise later in life.

Try eliminating caffeine, alcohol, sugar, red meat, fried foods, and wheat from your diet just before and during menstruation.

Nutritional Factors Shown to be Beneficial

Vitamin C

As immunity is a theoretical factor in endometriosis, vitamin not only can help the disease progression but has been shown to reduce the associated pain.
Dose: 1-10 grams a day, starting with 1 gram and increasing to bowel tolerance

Vitamin E

Vitamin E helps to correct abnormal progesterone and estrogen ratios in some women. Vitamin E also blocks the formation of leukotrienes, chemical mediators involved in the inflammatory process which can lead to pain.
Dose: 400-800 IU a day.

Fish Oils

Fish oils may reduce the severity of endometriosis, and have been shown to improve symptoms of dysmenorrhea (painful menstruation), which may be caused by endometriosis.
Dose: 3-6 grams a day

Calcium D- Glucarate

This compound, a calcium salt of D-gluaric acid, is found naturally in fruits and vegetables. It helps with the excretion of excess estrogen (and other toxins) via glucuronidation by the liver.
Dose: 1000 mg 2 -3 times a day

Acupuncture

Acupuncture has been reported anecdotally to help control the pain associated with some cases of endometriosis. Some women have found that auricular acupuncture (acupuncture of the ear) was as effective as hormone therapy in treating infertility due to endometriosis.