Endometriosis

woman in pain from endometriosis

What is Endometriosis?

Endometriosis is a condition where chunks of uterine lining tissue are located in the abdominal cavity (where they don’t belong), and respond to monthly fluctuations in hormones causing pain that can occur either before or during menstruation, or throughout the menstrual cycle.  Endometriosis can interfere with fertility through:

  1. Obstruction of the Fallopian tubes (the tubes that carry the egg/embryo to the uterus)
  2. Obstruction of ovulation
  3. The conditions that cause or contribute to endometriosis may make for poor egg quality or make implantation of a fertilized embryo difficult
  4. Formation of adhesions or scar tissue can alter the function of the reproductive organs

What Causes Endometriosis?

Excellent question and one which there isn’t a definitive answer for.  There are several theories:

  1. Retrograde menstruation – backwards flow of menstrual blood out the end of the Fallopian tubes and into the abdominal cavity.  This was the prevailing theory, however, there are a few bases that it doesn’t cover: 1) this backward flow occurs in about 90% of all women, but 90% of women don’t suffer from endometriosis and 2) endometriosis has been found in men and stillborn babies, clearly neither had retrograde menstruation.
  2. Coelomic metaplasia – this theory suggests that the endometriotic lesions are not from the uterine lining, but rather abdominal cavity cells that have transformed themselves into uterine lining type tissue.
  3. Dioxin exposure – dioxin is an environmental pollutant.  One study on chimpanzees found that those that were exposed to dioxin developed endometriosis.

What are the Signs and Symptoms of Endometriosis?

  1. Pelvic pain that may be present throughout the cycle or during peak times of estrogen fluctuation such as ovulation, premenstrually or during your period.
  2. Infertility.
  3. Pain with intercourse.
  4. Endometrioma on the ovaries on ultrasound.

How is Endometriosis Diagnosed?

Your doctor may diagnose this disease based on the signs and symptoms above, however, the only definitive way to know if you do or don’t have it is through laparoscopic surgery.  A procedure where the surgeon makes 2 small incisions in your abdomen and uses a laparoscope to look around your abdomen and potentially remove endometriomas if they are present.

How is Endometriosis Treated?

Conventional treatment of endometriosis involves cleaning up endometriotic lesions, scar tissue and adhesions with laparoscopic surgery and/or hormone balancing with the birth control pill, decreasing estrogen with Lupron or increasing progesterone with Visanne.

What is the Naturopathic Treatment for Endometriosis?

As with any condition, through naturopathic medicine, I aim to get at the root cause of the problem.  Many of the theories listed above as to the cause of this disease relate to estrogen dominance.  Estrogen dominance means that relatively speaking there is more estrogen than progesterone.  There are a few reasons why this can happen:

  1. Poor liver clearance of estrogen.  In order to maintain the appropriate level of estrogen in the body, the liver has to break down and remove any extra, this process called phase I and phase II liver detoxification, requires certain vitamins and minerals to run smoothly, such as 5 methyltetrahydrofolate (5MTHF). Inadequate levels of these vitamins and minerals can mean inefficient estrogen removal and therefore an estrogen buildup.
  2. Excessive estrogen activity from xenoestrogens.  Xenoestrogens are environmental pollutants like BPA from plastic, that can act like estrogen in the body.  It’s also your liver’s job to remove these from your bloodstream and process them as waste for excretion.
  3. High levels of estrogen suppress production of the remaining hormones that would otherwise balance estrogen.  There is a feedback loop where high estrogen suppresses the release of GnRH, a hormone that also stimulates progesterone production.
  4. High insulin levels provoke higher levels and activity of estrogen.
  5. Lack of vitamin B6 can cause low progesterone production.

So how I treat endometriosis as a naturopathic doctor is to supply appropriate vitamins, minerals and amino acids to support healthy liver detoxification of estrogen, including xenoestrogens, use herbs, vitamins and minerals to support normal progesterone production and balance blood sugar levels through healthy diet and exercise. It sounds like a lot and it can get complicated, but when I meet with people and explain the process it is actually fairly straightforward. Acupuncture works effectively to relieve pain and enhance fertility as well.

How Effective is Naturopathic Treatment for Endometriosis?

The vast majority of women that I have treated for endometriosis have reported improvement in pain with their period and many have conceived naturally, even those who had one or more failed IVF cycles.

Endometriosis Research

Hum Reprod. 2015 May;30(5):1059-68. doi: 10.1093/humrep/dev026. Epub 2015 Mar 4.
Increased levels of dioxin-like substances in adipose tissue in patients with deep infiltrating endometriosis.
Martínez-Zamora MA1, Mattioli L2, Parera J2, Abad E2, Coloma JL1, van Babel B3, Galceran MT4, Balasch J1, Carmona F5.

Obstet Gynecol Clin North Am. 2012 Dec;39(4):535-49. doi: 10.1016/j.ogc.2012.10.002.
Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility.
Macer ML1, Taylor HS.

Pain. 2013 Jun;154(6):874-81. doi: 10.1016/j.pain.2013.02.025. Epub 2013 Mar 5.
Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial.
Schwertner A1, Conceição Dos Santos CC, Costa GD, Deitos A, de Souza A, de Souza IC, Torres IL, da Cunha Filho JS, Caumo W.