Endometriosis

What is Endometriosis?

Endometriosis is a condition where chunks of uterine lining-like tissue are located in the abdominal cavity (where they don’t belong).  This tissue responds to monthly fluctuations in hormones causing pain.  Endometriosis tissue builds, breaks down, and bleeds, just like the uterine lining does. Endo pain can occur either before or during menstruation, or at any point throughout the menstrual cycle. Endometriosis interferes 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 for which there isn’t a definitive answer.  There are several theories:

1. Retrograde menstruation – This means a backward 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 tissue has been found in men and 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 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?

The signs and symptoms of endometriosis include:

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 or dyspareunia.
4. Endometriomas on the ovaries on ultrasound.  Although endometriosis is often not picked up on ultrasound. It is only visible on ultrasound if the tissue is attached to the ovaries, often it is not.

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.  This is a surgical procedure where the surgeon makes 2 small incisions in your abdomen.  He or she then uses a laparoscope to look around your abdomen.  They may use this to diagnose endometriosis and remove endometriomas and clean up adhesions if they are present.

How is Endometriosis Treated?

Conventional treatment of endometriosis involves cleaning up endometriotic lesions, scar tissue, and adhesions with laparoscopic surgery. Or hormone balancing with the birth control pill, decreasing estrogen with Lupron, or increasing progesterone with the drug 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 is called phase I and phase II liver detoxification. Low levels of vitamins and minerals that are needed for liver detoxification means inefficient estrogen removal and therefore an estrogen buildup.
2. Excessive estrogen activity from xenoestrogens.  Xenoestrogens are environmental pollutants like BPA from plastic.  These can act like estrogen in your 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 the 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 causes low progesterone production.

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.  I also use herbs, vitamins, and minerals to support normal progesterone production.  I would balance your blood sugar levels through a healthy diet and exercise. It sounds like a lot, but when I meet with people and explain the process it is actually fairly straightforward. Acupuncture also works well to relieve pain and enhance fertility.

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.  Many have conceived naturally, even those who had one or more failed IVF cycles.

Severe, Debilitating Endometriosis

In seeing one of my endometriosis patients this afternoon I’m reminded of just how severe this condition can be.  I first saw her years ago when her lungs were collapsing with each period.  Let me repeat that, her lungs were collapsing with her periods!  It’s a condition called catamenial pneumothorax.  It’s caused by endometriosis tissue affecting the lungs.  Yes, it can get that far up and affect the lungs. At the time her periods were also extremely heavy and painful.  She came to me to treat endometriosis.  Her periods became lighter, not painful and the lung collapse issue stopped. Fast forward through a few years where she was doing well and I didn’t see her.  Today she came in again. Her lungs are no longer collapsing and her periods are still not as heavy or painful as before treatment, but a little while ago she started coughing up blood with her period. Her surgeon wants to remove one lung.  After a reassessment today, we are tackling endometriosis again and we’ll probably add nebulized glutathione to her treatment to help heal her lungs.  I hope if you are affected by this debilitating condition, it isn’t as severe as it is for this woman, but if it is, even in severe cases naturopathic treatment can help.

3 Things that Help Treat Endometriosis

1. Avoid dioxin exposure.   According to the Environmental Protection Agency, our most significant dioxin exposure comes from the consumption of beef and dairy products.
2. Check hormone levels.  Excess estrogen is often the culprit with endometriosis, but it is also important to have healthy levels of all the estrogen-balancing hormones like progesterone, testosterone, and DHEAs.  Deficiencies of these will appear as an excess of estrogen because they aren’t keeping estrogen in check.
3. Help the liver with detoxification.  As I mentioned above, healthy liver function is vital to maintaining hormone balance and toxin removal. Whether it’s estrogen or dioxin or estrone that is causing the problem, it is your liver’s responsibility to break these down through phase I and phase II liver detoxification so that your body can get them out.  Healthy phase I and phase II detoxification require pyridoxal-5-phosphate, 5-methyltetrahydrofolate, vitamin B12, magnesium, indole-3-carbinol, and calcium-d-glucarate.

I measure hormone levels and identify imbalances.  Once we know the exact imbalance you are dealing with, I formulate an individualized treatment plan using natural therapies like diet, lifestyle, herbs, vitamins, minerals, and other natural plant extracts.  This works far better, is better for your long-term health and fertility, and addresses the root of the problem rather than masking it.  Call me at 416-481-0222 or email PFrankND@ForcesofNature.ca.

Medically Reviewed By Dr Pamela Frank

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.