Endometriosis

Throughout history, women with invisible painful conditions have been accused of “hysteria” or imagining their problems. Sadly, this is sometimes still true today for women with endometriosis, a disease that is often poorly understood. Here is what you need to know about this disease, which affects one in 10 women.

Challenging and complex

Endometriosis is a challenging and complex disease with no known cure. People diagnosed with endometriosis often face unappealing options such as repeated surgeries, hormonal therapies, or chemically induced menopause. However, there are also many natural approaches that can significantly mitigate some of the symptoms of this painful disease.

What is endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus grows abnormally elsewhere in the body—most often on the ligaments or lining of the pelvis, or on organs in the pelvis such as the ovaries, intestines, or bladder. However, more rarely, it can occur outside of the pelvis, such as on the diaphragm, lungs, or even the skin.

Endometriosis growths are stimulated in response to normal hormonal changes, leading to pain, inflammation, internal bleeding, and scarring. One common long-term consequence of endometriosis is the development of adhesions, which are gluelike bands of scar tissue that form between organs, binding them together, causing additional pain, and sometimes affecting their function. Another common complication in those who have had untreated endometriosis for many years is the development of other painful diseases of the pelvic area, such as interstitial cystitis.

What are the symptoms?

A person suffering from endometriosis can have various symptoms, depending on where the growths are located. The most common experience is pain: disabling or increasingly painful menstrual cycles, chronic pelvic pain at any time of the cycle, pain with sexual activity, back or leg pain during menstruation, and pelvic pain with exercise.

Some people also suffer from symptoms such as constipation, diarrhea, abdominal bloating, nausea and vomiting, painful bowel movements, bladder pain/dysfunction, infertility or pregnancy loss, and fatigue.

What causes endometriosis?

How and why endometriosis develops is not well understood. There are probably multiple causes, including genetic, environmental, and developmental factors. Research is ongoing into the contributions of all of these causes.

Diagnosis and treatment

Endometriosis can only be definitively diagnosed through a surgical procedure called a laparoscopy. This same type of surgical procedure is often used to treat the disease, by removing the endometriosis growths. Treatment options vary; however, due to the complex nature of this disease, the best relief from symptoms is often obtained when patients combine a variety of treatment strategies, including various natural approaches.

Nutrition

Changes in diet are often the first alternative approach tried by many endometriosis patients. The value of this approach, already recognized anecdotally by many in the endometriosis community, was recently validated by a study examining the effect of a gluten-free diet on endometriosis pain. Seventy-five percent of the patients in the study reported a statistically significant decrease in pain symptoms on a gluten-free diet.

Other diet changes can also be extremely helpful. Holistic nutritionist Erin Luyendyk recommends, “The first place to start is an anti-inflammatory diet that eliminates personal food sensitivities. Common sensitivities include wheat and/or gluten, dairy, soy, red meat, MSG, sugar, alcohol, caffeine, and heated oils/oils high in omega-6.

“Some people, especially those with bowel endometriosis or adhesions also find too much insoluble fibre worsens pain and symptoms. Many patients find that eating more fresh leafy dark greens (particularly when freshly juiced or blended into smoothies), cruciferous vegetables, and foods high in omega-3 to be helpful.”

If it seems overwhelming to eliminate so many foods, or to make many dietary changes at once, Luyendyk suggests starting by “using a food diary to identify foods and drinks that flare your symptoms. Additionally, consider working with a nutritionist well versed in endometriosis nutrition to develop a personalized diet plan for you to maximize results.”

Physiotherapy

Although physiotherapy is not often suggested by medical doctors as a potential treatment for pelvic pain and other endometriosis-associated issues, it can be an extremely valuable and noninvasive treatment method, when practised by physiotherapists with specialized knowledge and experience in treating the pelvic area.

Traditionally, the only way to treat adhesions caused by endometriosis is using surgery to cut the adhesions; however, surgery itself is a leading cause of adhesion formation. Therefore, noninvasive methods for treating adhesions are particularly important.

“Using specialized forms of manual physical therapy, therapists can improve function and pain levels in patients by treating the adhesions caused by endometriosis, and increasing organ and connective tissue mobility. Studies on this subject have been published, and additional studies are ongoing,” says physical therapist Dr. Leslie Wakefield.

Stress reduction techniques

A variety of stress reduction techniques can help one cope with the emotional stress of having a chronic illness and reduce pain at the same time. There are many practices that can be beneficial, including yoga, tai chi, qigong, meditation, and guided imagery/visualization. Which practice to use is a matter of personal preference, but regular practice is important.

Acupuncture and traditional Chinese medicine

Acupuncture is one of the oldest healing practices in the world. Although studies examining the effectiveness of acupuncture as a treatment for endometriosis pain are limited, many endometriosis patients find it helpful as part of their treatment plan.

Studies of acupuncture for other chronic pain conditions support its use for pain management, and it is also beneficial for stress relief. Traditional Chinese medicine doctors treat endometriosis with a combination of acupuncture and herbs tailored to an individual’s specific needs.

Naturopathic medicine

Endometriosis patients also turn to naturopathic medicine for an integrative approach. Pamela Frank, a naturopathic doctor with a practice focusing on women’s health, says, “The naturopathic doctor’s role in endometriosis is to facilitate the creation of an individualized, comprehensive, integrative approach to overall health care and management of the disease.

“A combination of expert excision surgery, appropriate nutritional changes, pelvic physiotherapy, acupuncture, stress reduction, and supplements can be extremely effective in relieving pain, improving fertility, and addressing the root cause of endometriosis.”

For supplements and other natural approaches helpful for pain relief recommended by Frank, see the sidebar. More information on these supplements can be obtained from health food stores and natural health practitioners.

Assembling a great health care team

Endometriosis is different for every individual, and everybody responds differently to particular treatments. While one person may find amazing relief from diet changes, acupuncture, and supplements, another may find relief from physiotherapy and meditation.

It is important to personalize treatment with the right health care team, which might include a laparoscopic surgeon, naturopathic doctor, nutritionist, acupuncturist, physiotherapist, or any combination of those. The most important factors in finding great health care practitioners are empathy, compassion, and knowledge about endometriosis.

With a tool box full of options to try, and expert health care practitioners to help, relief from difficult or even debilitating endometriosis symptoms is possible.

Natural methods for pain management

Diindolylmethane (DIM) is a compound found in cruciferous vegetables. DIM, or its precursor indole-3-carbinol (I3C), in supplement form, helps the liver remove excess estrogen from the body. Since endometriosis growths are stimulated by hormones, these supplements may help relieve endometriosis symptoms.

Pycnogenol is a powerful antioxidant from the bark of the pine tree. In endometriosis patients taking birth control pills, Pycnogenol reduced endometriosis pain.

Resveratrol, a compound found naturally in the skin of grapes, acts as an antioxidant and anti-inflammatory. In supplement form it may reduce endometriosis pain.

Melatonin is a naturally occurring hormone that is secreted in response to darkness. A recent study showed that supplementing with 10 mg of melatonin nightly reduced pain and improved sleep quality in endometriosis patients.

Vitamin D3 has been shown in animal studies to cause endometriosis growths to shrink.

Curcumin, a substance found in the spice turmeric, is available as a supplement, and acts as an anti-inflammatory. In animal studies it caused endometriosis growths to shrink.

Fish oil may help reduce menstrual pain and also may reduce adhesion formation.

Castor oil packs consist of a piece of flannel soaked in castor oil that is placed on the skin of the abdomen, with a hot water bottle on top to aid in absorption of the oil through the skin. The oil acts as an anti-inflammatory and can also improve digestion and reduce bloating.