ENDOMETRIOSIS

DESCRIPTION

Endometriosis is the abnormal growth of endometrial tissue outside the endometrium, the lining of the uterus, where endometrial cells are normally found. Endometrial cells somehow migrate and implant in areas outside the uterus, including the cervix, the vaginal-rectal space, the ovary, the fallopian tubes, the colon and the bladder wall. Endometrial cells also have been found in the abdominal wall muscles, the lungs, the nose, even the brain.

Endometriosis is classified according to its severity. The classification does not seem to directly determine its impact on fertility.

Mild: small, flat patches of endometrial tissue growing outside the uterine lining,
Moderate: larger, often somewhat raised implants, and
Severe: inflammation and scarring caused by the unabsorbed blood can form in bands of fibrous scar tissue, adhesions, that bind pelvic organs together restricting their movement and potentially causing pain.

SYMPTOMS

Women suffering from endometriosis often experience painful periods as they have higher levels of prostaglandins, one of the triggers of menstrual pain. They may also have pathological uterine bleeding and bleeding at sites other than the endometrium during menstruation-sometimes as distant as the nasal cavity. Other symptoms include back pain or severe abdominal cramping during menstruation, painful intercourse, painful intestinal upset or urination during menstruation and, of course, infertility. In some cases, the high levels of pain caused by endometriosis can deplete a woman's energy and cause depression and anxiety. Other times, there may be no symptoms at all associated with the condition. Around 40 percent of women diagnosed with endometriosis report no symptoms other than infertility.

Women with endometriosis often experience a sediment-like menstrual flow with dark brown, clotted blood that has oxidized. Sometimes the immune system will react to this old blood, recognizing its toxic state, and release chemicals to clean up the debris.

WESTERN MEDICAL TREATMENT

Western medical treatment for endometriosis does not take into account its cause, and can be risky for fertility. Often pain-relieving medication is prescribed to mitigate discomfort, and then either surgery or hormone-controlling drugs are administered to remove the excess endometrial tissue.

With surgery, the endometrial growths are excised or burned off with a laser. In severe cases of many growths or extensive adhesions, major surgery may be required, following which fertility may or may not be restored.

Hormonal treatments like birth control pills, testosterone-enhancing or menopause-inducing drugs are sometimes prescribed to halt menstruation altogether, the theory being that as menstruation ceases each month, the misplaced endometrial tissue will be "starved" to death. Of course, ovulation is also halted in the process. In addition, the masculinizing side effects of increased testosterone are very difficult for women to endure.

Even if the displaced endometrial tissue has been surgically removed, the toxic effects may remain. The lingering presence of endometrial cells can continue to contaminate the fallopian tubes, affecting the egg's ability to become fertilized as it travels toward the uterus. If tests reveal inflammation due to endometriosis, the only Western treatment is to use GnRH agonists like Lupron. These drugs are designed to inhibit the release of pituitary hormones, which then don't stimulate the ovaries to produce their hormones and deprive the endometrium of the hormonal stimulus it needs to prepare for implantation. A course of Lupron is often followed quickly with an IVF procedure in hopes that the endometrium cooperates and an embryo can implant. However, GnRH agonists can cause unpleasant menopausal symptoms like hot flashes, night sweats and general irritability. And of course, the underlying inflammation caused by the endometrial disorder has not really been addressed and cured.

DISCUSSION AND ROOT CAUSES

Endometriosis was first identified by Western medicine in 1860. One hundred years later, in 1960, the condition was first seen and described through the invention and use of the laparoscope. Today, diagnosis is usually accomplished through laparoscopic surgery, with vaginal ultrasound, CT scan or MRI used to confirm the extent of the condition. Endometriosis affects millions of women, and while it is most commonly diagnosed in women between thirty and forty years of age, it can begin as early as the teenage years.

Modern science does not know why endometrial cells migrate elsewhere, although several ideas are currently being investigated. One theory as to what causes endometriosis is retrograde menstruation. When a woman is supposed to menstruate, the blood should be discharged through the cervix. However, sometimes it can seep back up through the fallopian tubes and flow into the abdominal cavity. Endometrial cells in the menstrual blood then can attach to sites in the abdominal cavity outside the uterus. Western medicine theorizes that anatomic abnormalities such as a retroverted uterus or a smaller than usual cervical opening which does not allow the blood to pass through freely cause menstrual blood to back up into other areas of the pelvis. However, many women have some degree of retrograde menstruation or anatomic abnormality and still do not have endometriosis.

Triggered by estrogen, each month the endometrial cells proliferate and thicken to prepare for the possible arrival of a fertilized egg. Progesterone continues the process, cuing small blood vessels in the uterus to supply the endometrial cells with more blood. When fertilization and implantation don't occur, enzymes liquefy the endometrial cells, and the cellular matter flows out of the uterus along with the blood that has been feeding the uterine lining.

Triggered by estrogen, each month the endometrial cells proliferate and thicken to prepare for the possible arrival of a fertilized egg. Progesterone continues the process, cuing small blood vessels in the uterus to supply the endometrial cells with more blood. When fertilization and implantation don't occur, enzymes liquefy the endometrial cells, and the cellular matter flows out of the uterus along with the blood that has been feeding the uterine lining.

It's even possible that endometriosis is yet another autoimmune disease. Some women who are diagnosed with endometriosis also have high levels of antiphospholipid antibodies, which are associated with recurrent miscarriage. Endometriosis can create an inflammatory reaction in the body in response to the endometrial tissue growing outside its original intended site. In an attempt to clean up this "invading" tissue, the immune system then is reprogrammed to react to all endometrial cells as if they were not part of the body. This reaction can cause the endometrial cells in the uterus not to produce the protein marker (beta-integrin 3) needed to encourage a fertilized egg to implant, creating a toxic environment for an implanting embryo. It can also cause the endometrial glands to fail to respond to the progesterone produced during the luteal phase of the reproductive cycle.

EASTERN MEDICINE DIAGNOSES

Chinese medicine looks at how the body responds to the inflammatory reaction the body mounts to the endometrial cells outside the uterus. The process of endometriosis is seen as inhibited, stagnated uterine blood that doesn't flow freely. The menstruate has become blocked and the normal reproductive cycle is therefore obstructed.

While endometriosis is not a disease category in traditional Chinese medicine, Eastern healers have recognized this disease for far longer than Western medicine. In TCM, endometriosis is known by its symptoms an referred to as "menstrual movement pain." Just as Western medicine believes retrograde menstruation is created by pelvic and uterine anomalies including cervical stenosis (where the cervical canal doesn't open), congenital pelvic defects would be characterized as a general Kidney deficiency in TCM. Kidney deficiency is commonly diagnosed in conjunction with Blood stasis (Bl X) in women with endometriosis. Chinese medicine categorizes endometrial lesions as static Blood, or Blood that is not flowing as it should and thus is causing problems. However, since the compromised Blood is located in a vicinity where normal blood flow is often absent or minimal, our body has a tougher time resolving it. This static Blood may also trigger the inappropriate immune system response to the endometrial cells growing outside the uterus discussed above.

NATURAL TREATMENT

It IS possible to overcome the pain and infertility caused by endometriosis naturally without drugs or surgery. The Fertile Soul's treatment for endometriosis seeks to resolve its source by supporting the body in releasing the uterine lining properly so that menstrual blood flows with ease and the inflammatory reaction that is keeping your body in a toxic state comes to a halt.

Natural treatment regimens for endometriosis include:

Dietary modifications
Nutritional supplements
Acupuncture and acupressure
Uterine and pelvic organ massage
Traditional Chinese medicine herbal formulations
Qi Gong and yoga techniques

DIETARY THERAPY AND NUTRITIONAL SUPPLEMENTATION

The Fertile Soul encourages women with endometriosis to eat an organic, macrobiotic-type diet, free of dairy, wheat and most animal products, to calm the immune system. Flaxseed, evening primrose and/or fish oil supplements and bioflavonoids like pycnogenol, a super-antioxidant, help mute immune responses.

General Guidelines:

Avoid all foods that have been treated hormonally.
Consume a moderate but not excessive amount of soy and soy products like tofu.
Buy only organic fruits and vegetables.
Avoid refined and hydrogenated oils.
Use only unprocessed plant sources of essential fatty acids.
Use oils rich in both linoleic and alpha-linolenic fatty acids such as flaxseed, pumpkinseed, and chia seed oils, but only if they are recently cold-pressed and refined.
Include dietary spirulina, evening primrose oil, and oil from black currant and borage seeds.
Avoid sources of arachodonic acid, which comes from animal meats, dairy products, eggs, peanuts and seaweed.
Avoid all animal products, except fish. If you do consume meat, make sure it is organic and not hormonally treated.
Eat walnuts, dark greens, saffron, and cold climate, rooty vegetables like squash. Foods that are especially good for resolving Blood stasis include kelp, lemons, limes, onions, Irish moss, and bladderwrack.
Supplement your diet with the B vitamins and antioxidants like vitamins C, E, beta-carotene, selenium, and zinc. Include super-antioxidants (grape seed extract, pine bark extract, red wine extract, bilberry extract), which contain procyanidins and caffeic and ferulic acid. These substances have demonstrated anti-inflammatory and anti-spastic effects.
Both fibroids and endometriosis benefit from the use of Omega-3 fatty acids in the diet. Fish oil and linseed oil are good sources of these Omega 3 fatty acids. Fish oil prevents abnormal blood clotting. If your menstrual blood contains clotty tissue, supplement with fish oil, linseed oil, and evening primrose oil (which also contains gamma linolenic acid or Omega 6).

HERBAL FORMULAS

The Fertile Soul prescribes herbal formulas to clear internal Blood heat, the Chinese term for an immunologic response, and calms the uterus with acupuncture. Within a few months' time, pregnancy usually will occur naturally. Sometimes the body responds immediately; other times it can take up to eight months for patients to conceive after beginning treatments, depending on the severity of the condition and the adherence to the treatment. Herbal supplements to invigorate the Blood include Bupleurum and Angelica, which have been used together for millennia to regulate hormones and relax the nervous system. Carthamus and Persica decrease inflammation in the lower abdomen. Nettle is also good after menstruation.

ACUPUNCTURE AND ACUPRESSURE

Endometriosis is related to hormonal imbalances such as estrogen dominance. Estrogen feeds endometriosis, so it is important to help the body clear itself of excess estrogen. Since the liver metabolizes estrogen, using methods that resolve Liver Qi stagnation assist the body in clearing excess amounts of the hormone. Stimulating acupuncture points Lv 2, Lv 3, and Lv 14 helps resolve Liver Qi stagnation. Additional information is available in The Infertility Cure.

You can massage acupressure points for resolving Blood stasis (Sp 6, Sp 8, Sp 10, UB 17) and whichever other Chinese medicine diagnostic categories apply to you. Ki 3 and Ki 7 increase circulation to the reproductive organs, and Lv 2 and Lv 3 help detoxify excess hormones and resolve stagnant Qi.

When we address the underlying Blood stasis issues, the body's reaction to the endometriosis calms down. It isn't until the inflammatory reaction is soothed that the body will accept a pregnancy, no matter how it is attempted, naturally, with hormonal intervention or with IVF.

In addition to modifying internal causative factors like inflammation-triggering dietary factors, Qi Gong exercises help to open the channels which lead into and out of the uterus.

All menstrual blockages including endometriosis can prevent implantation and a healthy pregnancy. The self-inquiry process facilitated at Fertile Soul retreats helps you identify and release obstructions and open up to implantation.

LIFESTYLE CHANGES

Rest.
Wear loose, comfortable clothing.
Perform deep breathing exercises and meditative practices.
Take warm baths, with aromatherapy if you wish.
Use essential oils like frankincense, myrrh, clary sage, peppermint, lavender, rosemary, juniper and thyme.
Use a heating pad or hot water bottle on your abdomen during and after menstruation.
Avoid the use of tampons or any form of obstruction to the menstrual flow.
Apply warm castor oil packs to your abdomen to invigorate the Blood, assist the lymphatic system and balance hormone levels.
- Instructions: Apply warm castor oil to wool flannel (available at most health food stores) and place on the lower abdomen. Cover with plastic wrap. Apply a hot water bottle, if desired. Leave at least 15 minutes. Repeat two-to-three times per day during the premenstrual and menstrual period. If you are actively trying to conceive, use only during the menstrual period.
Engage in regular, moderate daily exercise to help improve circulation and ease symptoms. Qi Gong, and yoga are helpful. However, you should not perform inversion techniques during menstruation, especially if you have endometriosis. You want to encourage a descending energy flow.

For conception to occur, all of the energies of the body must be free-flowing and moving, like the water in the river that brings life to the land through which it passes. Fibroids and endometrial growths are like rocks in that river, preventing the embryo from mooring safely within the walls of your womb. By eliminating Blood stasis, balancing the body's other energies and softening the concretions (layers of sediment) within your reproductive organs, you can restore the flow of the "river of life" through you, and provide a clean, clear harbor for your unborn child.

ASSISTED REPRODUCTION

Women with severe adhesions blocking the release of the egg from the ovaries or its entrance into or passage through the fallopian tubes or into the uterus can sometimes benefit from reproductive intervention like IVF to bypass mechanical obstructions. However, further hormonal therapy can also feed the inflammatory reaction associated with endometriosis. In our experience, the reactive process associated with endometriosis can inhibit all aspects of reproduction, and especially hinders implantation. Reproductive endocrinology does not effectively ensure implantation with hormonal therapy. We have seen women with endometriosis go through multiple IVFs and have a beautiful response up to the time the eggs show up in the laboratory. However, after they have been fertilized and placed back within her, the reaction mounts and the embryos are rejected, just as they were every single month before the IVF. However, now there is more estrogen and other hormones to exacerbate the mounting inflammatory reaction. When the body is in fight mode, it cannot also be in receptive mode. A perfect embryo will not implant in a reactive uterus. So, rarely do we encourage women with endometriosis to receive hormonal stimulation during an IUI or IVF.

If you have endometriosis and are undergoing IVF, make sure you are taking natural anti-inflammatory substances like vitamin C, E, A, B12, zinc, selenium, pycnogenol, Wobenzym and omega-3 fatty acids like those found in deep sea fish oil. Use castor oil massage during your period before the hormonally stimulated cycle and try to avoid using tampons.

CASE STUDIES CLINICAL STUDIES

Chinese herbal formulas have been tested against common Western medical treatments for endometriosis with some exciting results. One such study, conducted at Osaka City University Medical School in Japan, measured immune factors in the blood of a group of women diagnosed with endometriosis. The women were found to have elevated serum levels of anti-endometrial Immunoglobulin-M (IgM) antibody titers, indicating an immune response to the endometrial tissue. One group of these women received treatment with leuproride acetate (Lupron) to suppress hormonal production. A second group received the herbal formula Gui Zhi Fu Ling Wan, which historically has been used in China to treat bleeding during pregnancy due to Blood stasis in the womb and to prevent miscarriage. In more recent times, it has been used in the treatment of immunologic and inflammatory conditions of the uterus, including dysmenorrhea, uterine fibroids, ovarian cysts, chronic pelvic inflammatory disease, inflammation of the fallopian tubes and endometriosis.

Another study done in China treated women with severe menstrual pain. The authors stated that the primary disease mechanism related to dysmenorrhea is Blood stasis-the same pattern that often creates endometriosis. A group of 125 women were diagnosed using the principles of traditional Chinese medicine and categorized into four groups depending on the patterns they were exhibiting, as follows:

Group 1: Qi stagnation with Blood stasis
Group 2: Qi stagnation, Blood stasis and cold
Group 3: Qi stagnation, Blood stasis and heat
Group 4: Qi stagnation, Blood stasis and deficiency

The study began by comparing serum levels of various prostaglandins, a contributing factor in menstrual cramps, in the bloodstreams of all three groups. Then, the women were given either Eastern or Western medical treatment. The women treated with Eastern methods received the herbal formula Jia Wei Mo Jie Tang, whose intended purpose is to invigorate the Blood, transform stasis, and move the Qi. From a Western medical point of view, the formula achieves its effect by regulating serum prostaglandins. The herbs were taken as a decoction and administered twice a day beginning two weeks before the anticipated start of the period. The other group was given the Western medicine indomethacin, a non-steroidal anti-inflammatory analgesic. In both groups, treatment was administered for three months.

In the Jia Wei Mo Jie Tang group, 80.4 percent of women experienced relief from their menstrual pain, compared to 73.3 percent for the indomethacin group. Further, Jia Wei Mo Jie Tang seemed to help balance the reproductive cycle, as indicated by markedly lower levels of a negative type of estrogen. The herbal decoction also increased the content of late phase progesterone secreted by the corpus luteum, which is essential to creating a proper climate for implantation. Indomethacin, on the other hand, had no marked effect on either estrogen or progesterone. It is clear that Chinese herbal medicines can play an important role in balancing the complex interrelated factors contributing both to the treatment of endometriosis and the promotion of a normal reproductive cycle. But what is most important is to uncover the pattern of imbalance that is the root cause of an individual patient's problem.