What is Endometriosis
Endometriosis is a disease defined by the presence of endometrial tissue outside of the uterus. Endometrial tissue normally lines the uterus and is shed during the menses. This disease is associated with pain and infertility. Diagnosis is made by laparoscopy (camera observation inside the abdominal cavity) and histological examination of lesions, but transvaginal ultrasound can often detect ovarian endometriomas (blood filled cysts - also called "chocolate cysts" present on the ovaries).
What are the signs & symptoms?
Symptoms can include:
What causes Endometriosis?
The longstanding theory is that back-flow of menstrual blood through the fallopian tubes and into the abdominal cavity causes the onset of endometriosis. There is a space between the ovary and the fallopian tube, and blood can escape the uterus during the menses through this passage.
Endometriosis is more common in women who have heavy menses, blockage of tubes, and shorter menstrual cycles. It has been found that endometrial cells can attach to and grow on the peritoneum (the lining of the abdominal wall). Endometriosis is most often found in areas which would correlate to the positions nearest to the source of backflow (the ovaries, anterior and posterior cul de sac), and can also be induced in primates after injection of menstrual fluid into the abdominal cavity.
Why then do some women develop endometriosis and others do not, when it has been found that 75-90% of women have blood outside of the uterus during the menstrual period?
Endometriosis is 6-7 times more prevalent among first degree relatives of affected women than in the general population. These genetic factors often predispose women to hormonal factors which allow the growth of endometriosis. Many women may not even be aware they have endometriosis, since there may be differing severities and since laparoscopy is ofen required to detect it. Often then, genetic factors for the disease do not become evident within families since many cases go undiagnosed (often simply as "painful periods").
Related to the genetics previously discussed, women with endometriosis have different factors that alter normal estrogen metabolism in the tissues of the endometrial lining. An enzyme known as aromatase has been found in the endometrial tissue of women who have the disease. In the endometrium of women without endometriosis, aromatase is not found. Aromatase converts androgens (male hormones) in the local tissue into estrogen. The increased estrogen then results in local growth of the endometriosis lesions. Estradiol then stimulates a COX-2 inflammatory pathway which actually creates positive feedback for the production of even more estrogen locally in the area of the lesions.
Furthermore, two forms of estrogen are altered in women with endometriosis, which is significant because estrogen causes endometriosis tissues to grow. Estrone is a weak form of estrogen, and estradiol is a much more potent form of estrogen. Estrone is converted to estradiol and vice versa by two enzymes that work with the help of progesterone. In a normal endometrium, progesterone is able to increase the conversion of estradiol (strong) to estrone (weak), thereby keeping the growth effects of estrogen on tissues under control. In endometriosis, the enzyme which converts estradiol to the weaker form estrone is not at all found in the endometrial tissue. This causes levels of the stronger estradiol to accumulate. The enzyme which converts weaker estrone to stronger estradiol, however, is fully functional. This results in even higher amounts of more powerful forms of estrogen at the level of the endometrial lesions, causing more and more growth of this tissue outside of the uterus.
Many chemicals in our environment mimic estrogens in our bodies (xenoestrogens). As well, stress can act as an internal toxin and alters your body’s production of hormones. Finally, poor detoxification (liver, bowels, kidneys) can lead to a build up of estrogens.
According to the Collaborative on health and the Environment chemicals and conditions database, PCB's and their cousin PCDD (dioxins) are linked to Endometriosis. The most common sources of human contact are through beef and dairy consumption. Is is likely why we have seen massive improvements in women with Endometriosis when they decide to completely eliminate dairy from their diet.
Endometriosis causes much pain for many women. It does this by causing inflammation in the peritoneal cavity, by the effect of bleeding outside of the uterus, and by irritation of nerves on the pelvic floor.
Endometriosis can reduce fertility in a few different ways. It can alter the normal anatomy of the area where the ovary meets the fallopian tube because of physical obstruction by lesions. This can make it difficult for the egg to enter the tube after ovulation. There are effects on the development of the egg and the embryo in endometriosis patients. This is seen when results of women undergoing IVF are considered. In women with endometriosis, there are less eggs retrieved, lower peak estrogen levels, and poorer embryo development. This is likely due to local hormonal factors. It may also reduce the ability of the egg to implant. This happens because the function of the endometrium in women with endometriosis is altered. The effect of endometriosis on fertility correlates with the severity of the disease : in patients with mild disease, effects on fertility are milder.
Principles of treatment are to reduce production of harmful estrogens and thereby reduce growth of pathogenic tissue, to reduce inflammation & pain, to enhance circulation and endometrial receptivity, to shrink deposits of endometrial tissues, and to balance the woman's reproductive health and general well-being as a whole,
Traditional Chinese Medicine & Acupuncture
Much success is obtained when acupuncture and Chinese herbal medicine is employed to eliminate pain and inflammation, balance hormones, slow the growth of pathogenic endometrial tissue, enhance blood circulation to the uterus, and optimize a woman's overall reproductive health, natural fertility, and well-being. If a woman is trying to conceive via IVF Chinese medicine and acupuncture works to help improve overall response to the medications and chances of healthy implantation. 3-6 months of weekly acupuncture and herbal medicine is recommended in most cases.
Things to Avoid
The following is a list of common estrogenic or xenoestrogenic (chemically very similar to estrogen therefore manifesting similar effects on humans) or known endocrine disrupting substances to avoid. These may aggravate Endometriosis.
1. Eat organic, download the Environmental Working Group’s ‘dirty dozen’ and ‘clean fifteen’ lists: pesticides are hormone disruptors, estrogenic, neurotoxic, and reproduction-impairing (60% of pesticides currently used are hormone disruptors)
2. Drink water from glass or steel bottles: bottled water is less regulated than tap water; plastic bottles leach Bisphenol-A (BPA) which is a hormone disruptor; water filtered at home is a good place to start
3. Do laundry differently: laundry soaps contain hormone disrupting chemicals including phthalates, artificial dyes, perfumes and petroleum-based chemicals; fabric softeners and dryer sheets contain chloroform, benzyl acetate, and toluene; Try Biovert, Ecover, Soap Factory Laundry Miracle, Nature Clean, Seventh Generation and a reusable dryer cloth such as Static Eliminator.
4. Yoga, enjoyable activity or exercise, breathing, meditation, talking, laughing, journaling, and a healthy sex life can all reduce your stress levels.
5. Support your detoxification by: drinking hot water with a slice of lemon in the morning, adding ground flax seeds to your diet, eating dandelion greens, onions, garlic, broccoli, watercress, and artichoke, drinking plenty of water, and eating a whole foods diet.