Pain, Infertility, Hormone Problems?

I met Mary in the spring of 2004. Through tears she explained her history of endometriosis: years of repeated surgeries, pain, drugs to suppress estrogen, and the inability to ovulate due to scar tissue on her ovaries.

Now, with a complete hysterectomy necessitated by her condition, she feels a great loss at not being able to have children. This is an all too common story in Canada today, as almost 20 percent of the female population suffers from the effects of endometriosis.

What is Endometriosis?

Cells that normally line the uterus (the endometrium) grow outside the uterus on the ovaries, causing painful or incomplete ovulation. They form cysts on the fallopian tubes, the pelvic ligaments, the outer surface of the uterus, the bladder, the large intestine, and the covering of the abdominal cavity. Women are often misdiagnosed with irritable bowel syndrome, bladder infections, appendix attack, PMS, or cramps. Endometrial cells, responding to a woman's monthly hormonal signals, bleed and cause inflammation, pain, cysts, scar tissue, and infertility.

Until recently, endometriosis was explained as "retrograde menstruation." Tiny fragments of normal endometrial tissue (from the lining of the uterus) were thought to travel up the fallopian tubes and reside in the abdominal or pelvic cavity.

Careful Diagnosis

Pelvic examinations by a skilled gynecologist may disclose nodules or lesions on the ovaries, but ultrasound tests rarely confirm endometriosis. The only way to know for certain is through a procedure called laparoscopy. This surgery, performed under general anaesthetic, involves inserting a light-containing telescope through a small incision in your navel and another one or two small incisions along the bikini line for the instruments.

Remember, a laparoscopy is only as good as the surgeon who performs the exam. Removal of all the endometriosis tissue requires a physician who is committed to performing a biopsy and getting rid of all suspicious abnormalities. Endometrial tissue can look like tiny blueberries or black spots; white, yellow, or red cysts vary from tiny bluish or dark brown blisters to large cysts up to 20 centimeters in diameter. Only biopsy can confirm which tissue is truly endometriosis.

The Hormone Connection

Medical therapy for endometriosis has concentrated on altering a woman's hormonal chemistry with drugs, including Danazol and gonadotropin-releasing hormones (GnRH) such as Nafarelin and birth control pills. Sometimes these drugs are successful in controlling the symptoms of endometriosis but not without side effects: oily skin, acne, decreased breast size, growth of facial hair, weight gain, and depression. Some cause menopausal symptoms like hot flashes, decreased bone density, vaginal dryness and decreased libido. None of the drugs cures the disease. After the drug is stopped, the endometriosis symptoms return. Many women are also prescribed birth control pills containing estrogen yet endometriosis is an estrogen-dominant condition that should be treated by controlling estrogen and balancing the hormones. A holistic approach to treatment is safer and more effective.

Xenoestrogens Linked to Endometriosis

Convincing evidence has now linked xenoestrogens (environmental pollutants mimicking the action of estrogen in the body) to the development of endometriosis. Carolyn DeMarco, in Take Charge of Your Body (Well Women Press, 1994) states that dioxins, one of a group of xenoestrogens, are used to make PVC plastics. Our drinking water runs through pipes made from PVC plastics. Solvents, pesticides, refrigerants, and chemicals used in the pulp and paper industry also contain xenoestrogens. These chemicals persist in the fats of meat and dairy products, as well.

Change Your Eating Habits

The mainstay of any endometriosis treatment is a diet that decreases the amount of estrogens in the bloodstream enough to reduce symptoms but not enough to cause pseudomenopause.

Emphasize whole grains, fresh vegetables, and fruits in your diet. Cut down on fats from milk and meat products. Buy organic foods whenever possible. A vegetarian diet containing no more than 20 to 25 grams of "bad" fats (trans fats and hydrogenated fats) per day and eliminating all dairy products is recommended by some holistic practitioners. The fats you do eat should come from organically grown nuts and seeds and their oils.

Women should also look for unbleached sanitary products toilet paper, sanitary napkins, and tampons that do not contain dioxin residues. Don't use PVC plastic containers to store and microwave food.

The Immune System is Key

New research points to a glitch in the immune system. Dr. David Redwine, director of the St. Charles Medical Center, Bend, Oregon, believes that some women are born with abnormally located endometrial cells. When something damages the immune system, these cells become active. The most effective treatment for endometriosis is to reduce estrogen levels and regulate hormonal activity.

Helpful Herbs

• Indole-3-carbinol (I3C) is found in cruciferous vegetables. Research has shown that I3C helps to remove xenoestrogens and balance the ratio of good to bad estrogens in the body.
• Calcium D-glucarate is a powerful detoxifier of excess estrogens from the liver.
• Curcumin is the yellow pigment of turmeric. It is a powerful anti-inflammatory agent, and it works to inhibit all stages of abnormal cell formation: initiation, promotion, and progression. Remember, endometriosis is abnormal cell growth.
• Milk thistle enhances detoxification of toxic estrogens from the liver.
• Rosemary extract, a potent antioxidant, inhibits abnormal cell growth, and it helps to detoxify carcinogenic estrogens.
• Sulfurophane, from broccoli sprout extract, has been shown to stimulate the body's production of detoxification enzymes that eliminate harmful xenoestrogens.
• Vitex helps to enhance progesterone thereby inhibiting high levels of estrogen. It also supports proper ovulation.

Seven Early Warning Symptoms of Endometriosis

1. menstrual cramps that increase in severity
2. intermenstrual pain, usually at mid-month
3. painful intercourse or dyspareunia
4. infertility of unknown origin
5. symptoms of bladder infections but, when tested, negative results
6. severe pelvic pain
7. history of ovarian cysts