Is a condition in which endometrial tissue (the lining from the inside of the uterus) is found in sites outside the uterus. This can cause significant pain and can affect many aspects of reproductive health; endometriosis can even cause infertility.
Risk factors… developing endometriosis
A number of dietary, inherited and lifestyle factors seem to contribute. Not all factors carry the same weight and some risks need to occur in combination with others for a cumulative effect to occur.
Menstrual characteristics such as starting to menstruate at an early age, long (more than 7 days) and heavy periods are associated with an increased risk of endometriosis. Long and irregular cycles are associated with a lowered risk.
Family history of endometriosis is also believed to contribute to an increased risk as well as women who engage in strenuous physical activity during menstruation had an increased risk of endometriosis, thought to be related to an increased volume of retrograde flow. Conversely, women who do regular exercise may have a reduced risk of endometriosis because exercise is believed to decrease the rate of oestrogen production.
The use of the IUD has been associated with an increased incidence of endometriosis, possibly because the device increased the degree of retrograde flow and may temporarily alter prostaglandins levels.
It is not clear if there is a link between taking th Pill and endometriosis. Other factors may include caffeine and alcohol intake, cigarette smoking as it alters oestrogen levels as well as abnormal bowel flora and engaging in sexual intercourse during menstruation.
Menstrual Cycle & Endometriosis
Endometrial tissue, irrespective of its location, is continually influenced by the cyclic variation of hormones. During the follicular phase, oestrogen has the major effect on endometrial tissue. This is particularly so for the most stimulatory form of oestrogen, oestradiol. Increasing levels of this hormone during the first weeks of the cycle are responsible for the normal thickening of the endometrium, as well as for the growth of endometriosis and adenomyosis.
During the luteal phase edometrial tissue starts to produce microscopic glandular structures under the influence of progesterone. This caused an increase in the volume of endometrial tissue and the increase in tissue mass can cause bloating and pelvic discomfort or pain before the period.
When menstruation begins and the (normally placed) endometrium is shed vaginally, the misplaced endometrium also starts to break down and is shed into the pelvic cavity (endometriosis) or between the muscle fibres of the uterus (adenomyosis)
What it feels like – the symptoms
Adenomyosis and (especially) endometriosis are both extremely variable diseases with diverse symptoms ranging from debilitating and recurrent pain, pelvic discomfort, painful sex, abnormal bleeding, premenstrual tension and infertility, to no symptoms at all.
The quality, timing and severity of pelvic pain is extremely variable; and there is no relationship between the severity of endometriosis and the severity of the pain. About one-third of women with endometriosis experience no pain.
The quality of pain is often described as a congestive, heavy, or a dull, dragging sensation in the pelvis. During the period the pain can become sharper, more crampy and labour like – sometimes pain is severe enough to cause fainting, vomiting and diarrhoea. The timing of pain appears to vary from woman to woman, it can occur before or after periods or all the time. Diarrhoea is often experienced, especially in the earlier stages of endometriosis. Many women also experience cyclic leg pain, which is thought to be referred pain from the pelvic peritoneum.
Some women with endometriosis have long cycles, but a short cycle with a heavier period is common. The flow is characteristically slow to start and may be thick, black and tarry at first. Irregular cycles, spotting and/or mid-cycle bleeding can be common.
Most women with endometriosis have symptoms of PMS including anxiety, mood swings, bloating, breast soreness, constipation, food cravings and headaches. These symptoms are believed to be associated with an imbalance between oestrogen and progesterone. These symptoms may occur from a few days premenstrually or start just after or at ovulation and last for up to two weeks.
The ‘suggestive’ signs and symptoms
These symptoms in decreasing order of significance are:
- severe dysmenorrhoea
- pain associated with sexual activity
- pain increasing in severity towards the end of the period
- pain before period and at ovulation
- one-sided pelvic pain
- a mother or sister with endometriosis
Pelvic examinations and ultrasounds may aid in a diagnosis, however, a definitive diagnosis can only normally be made by a laparoscopy.
Naturopathic treatment of endometriosis
The aims of treatment are to improve relative oestrogen excess and immune system irregularities; normally we would request a saliva hormone test for you to ascertain specific levels of estrogens and a live blood screening test to assess cellular health and inflammatory produces such as ‘fibrin’ which may indicate a need for liver support which in turn would improve estorgen metabolism.
We also aim to regulate prostaglandin synthesis; to ensure normal uterine function and menstrual flow; and when appropriate, to improve fertility. Dietary and lifestyle changes usually need to be ongoing to minimize chances of recurrence.
The amount of pain and the desire for pregnancy at the time of consultation will be a determining factor as to the type of treatment chosen for you. For instance, some categories of herbs (such as emmenagogues) would not be given to a woman desiring a pregnancy, however, if there is severe pain, it will be given priority of treatment.
The medical approach involves surgery whereby the endometrial lesions or small cysts are removed. Drugs may also be used depending on the woman’s history and desire for a pregnancy.