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| Endometriosis |
Last updated: May 12, 2008 |
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations
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Endometriosis is a disease affecting many millions of women and teens worldwide and a leading cause of female health problems. This condition causes tissue such as the endometrium (the tissue inside the uterus which is shed each month during menses) to build up outside the lining of the uterus, or in other parts of the uterus or other areas of the body. These implants respond to hormonal commands each month, break down and then bleed. Unlike the endometrium, however, these tissue deposits have no way of leaving the body.
The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas, expression of irritating enzymes and formation of scar tissue. In addition, depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the pelvic cavity can occur. Endometriosis has even been found in the skin and at other extra-pelvic locations like the arms and legs, and even in the brain.
The symptoms can be very diverse depending on where the implant is located. Symptoms which seem to come and go with the menstrual cycle are suspicious. The implant responds to the same hormonal messages as other uterine tissue, swelling and changing during the cycle. Because symptoms are so inconsistent and non-specific, it can easily masquerade as several other conditions, including adenomyosis, appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer, and pelvic inflammatory disease. Pain tends to increase with time and begins progressively earlier in each successive menstrual cycle.
Conventional drugs used in the treatment of endometriosis primarily to lower estrogen production include danazol, gestrinone, some gonadorelin analogues (leuprorelin; nafarelin; triptorelin), and some progestogens (dydrogesterone; medroxyprogesterone).
Contrary to common misconceptions about the disease, there is no cure. There are, however, several methods of treatment which may alleviate some of the pain and symptoms.
Phytoestrogens may block or stimulate estrogen receptors, making the condition better or worse. Here is a collection of rules to help prevent excess stimulation.
- Avoid Coffee, Decaffeinated Coffee, and Beer.
- Avoid Sunflower Seeds, Red Clover Tea, Camomille Tea, Alfalfa Sprouts, Queen Anne's lace, Pomegranate, Fennel,Licorice, Red Clover, Yucca, Hops (Beer) and Motherwort.
- Avoid Phytoestrogens that block and interfere with the action of Natural Progesterone. Avoid Bloodroot, Ocotillo, Mandrake, Oregano, Damiana, Pennyroyal, Verbenna, Nutmeg, Tumeric, Yucca, Thyme, Calamus rt., Red Clover, Goldenseal, Licorice, Mistletoe, Cumin, Fennel, Camomille, Cloves.
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Signs, symptoms & indicators of Endometriosis: | |  | | | | Lab Values - Cells | High ESR or elevated ESR | Symptoms - Bowel Movements |
(Frequent/significant) blood in stools
Regular/occasional/frequent painful urge to defecate | Symptoms - Gas-Int - General |
(Severe) abdominal discomfort
Constant/slight/intermittant abdominal fullness
Meal-related bloating | Symptoms - General |
Fatigue on light exertion | Symptoms - Metabolic |
Having a slight/having a high/having a moderate fever | Symptoms - Reproductive - General |
Painful deep penetration during sex
(Possible) ectopic pregnancy |
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Conditions that suggest Endometriosis: | |  | | | | Pain | Low Back Pain / Problems | Uro-Genital |
Dysmenorrhea, Painful Menstruation
Female Infertility | It has been estimated that some 25-50% of infertile women suffer from endometriosis. The cause of infertility is believed to result from the scarring and adhesions that form in the reproductive tract as a result of inflammation. Scar tissue and adhesions may reduce fertility by either obstructing or distorting the shape of the fallopian tubes, which in turn impedes the passage of sperm to the egg. In the event that sperm do reach the egg, they may encounter a hostile environment unfavorable to fertilization. Finally, scarring from endometriosis may obstruct the fallopian tubes so that if an egg is fertilized, it may be unable to travel to the uterus for implantation.
Women with endometriosis conceive at lower rates than women without endometriosis and miscarriages are more common in endometriosis patients than in those who do not have the disease.
Women with ASRM stage I-II disease have pregnancy rates which are significantly lower than patients without disease. These rates are improved with surgical therapy and are optimized with a combination of good excisional therapy and medical suppressive therapy if there is any suspected residual disease.
Women with ASRM (formerly AFS) stage III-IV disease have pregnancy rates which are 50-60% lower than others who do not have the disease. Medical or surgical therapy does not strongly change these rates. |
Susceptibility To Miscarriages
Menorrhagia (Heavy Periods)
Metrorrhagia
Increased Urinary Frequency |
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Risk factors for Endometriosis: | |  | | | | Habits | Aerobic Exercise Need | Symptoms - Allergy |
History of adult allergies | Symptoms - Reproductive - Female Cycle | Counter-indicators:
Total/radical/partial hysterectomy or hysterectomy with both ovaries or hysterectomy with one ovary | Symptoms - Reproductive - General |
Normal age at/late birth of first child | A first pregnancy at a young age seems to protect against its development; the disease is more common in women whose first pregnancy, if any, is later in life. |
Endometriosis in the past | Unless the mislocated entometrial tissue was removed surgically and completely, symptoms could return in the future inspite of there being periods of time when you were symptom-free. |
Counter-indicators:
(Very) early birth of first child | A first pregnancy at a young age seems to protect against its development; the disease is more common in women whose first pregnancy, if any, is later in life. |
(Several) successful pregnancies or a successful pregnancy
Absence of endometriosis |
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Endometriosis suggests the following may be present: | |  | | | | Hormones | Low Progesterone or Estrogen Dominance | Current scientific theory points to estrogen dominance as a major factor in endometriosis. Bringing progesterone and estrogen into natural balance will frequently result in symptom relief and, on occasion, even shrink endometrial tissue. This usually means using natural progesterone, either orally or as a cream and avoiding the use of or excessive exposure to estrogen. |
Hypothyroidism | Endometriosis often have their symptoms aggravated by low progesterone levels, estrogen levels that are too high, or have ongoing xenoestrogen exposure. This can result in symptoms of hypothyroidism and they may need thyroid supplements even though measured TSH, T3 and T4 are normal. After taking progesterone for several months, thyroid function may become normal and thyroid supplements can be reduced and possibly eventually discontinued. |
| Risks |
Increased Risk of Breast Cancer | Endometriosis has been linked to the environmental contaminant dioxin and a lack of physical activity, both of which are associated with an increased breast cancer risk. |
Increased Risk of Ovarian Cancer | Endometriosis has been linked to the environmental contaminant dioxin and a lack of physical activity, both of which are associated with an increased ovarian cancer risk. |
Increased Risk of Melanoma | Endometriosis has been linked to the environmental contaminant dioxin and a lack of physical activity, both of which are associated with an increased risk of melanoma. |
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Recommendations for Endometriosis: | |  | | | | Botanical | Vitex | Vitex (as a hormone normalizer) may be considered the most appropriate of the herbal remedies for the underlying processes involved in endometriosis. |
Black Cohosh (Cimicifuga racimosa) | As a uterine tonic, it may help relieve symptoms. |
| Diet |
Caffeine/Coffee Avoidance
Vegetarian/Vegan Diet | Drug |
Conventional Drugs / Information | Hormonal therapy that attempts to mimic either menopause or pregnancy can often provide relief of symptoms. Lupron, Zoladex and Synarel are medications called GnRH-agonists. They lower your estrogen level which should suppress endometriosis.
Birth control pills to mimic pregnancy may relieve symptoms and these may be quite effective for many women, though side effects are common. When any medication is stopped, symptoms return, since the problem causing tissues were not removed - just kept under control. |
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Fibrinolytic Enzymes | Hormone |
Progesterone | Progesterone intravaginally can reduce the bleeding and pain associated with endometriosis. |
Not recommended:
Estrogen Replacement | The use of supplemental estrogen may make the symptoms of endometriosis worsen. |
| Lab Tests/Rule-Outs |
Test / Monitor Hormone levels | Estrogen excess or progesterone deficiency may contribute to the severity of the symptoms. |
Tests, General Diagnostic | Endometriosis is a notoriously difficult condition to diagnose, the conclusion often being reached only after excluding other problems. The presence of endometriosis can only be confirmed through examination of the tissue. Fiberoptic laparoscopic techniques allow a direct look at the problematic tissue. The average age at diagnosis is 37 years, and the majority of cases occur in women between the ages of 25 and 40. Endometriosis is rare before the onset of menstruation and after menopause but not unknown. |
| Surgery/Invasive |
Surgery | Laser techniques to destroy endometrial tissue are currently popular in conventional medicine as is removing the uterus, ovaries (and perhaps appendix) thus stopping the menstrual cycle altogether.
Endometriosis is usually diagnosed on the basis of a history of pelvic pain, a physical examination, and a laparoscopy. Laparoscopy is the most important diagnostic tool for endometriosis, but not all women require a laparascopy. Patients with mild or moderate symptoms often choose hormonal treatment. If hormones are successful, laparascopy is not necessary. A laparascopy is necessary if initial hormone treatment does not work or if endometriosis is severe or debilitating.
Imaging tests may be used to locate endometrial lesions. Pelvic ultrasound or MRI may be used to identify individual endometrial lesions, but they are not used to determine the extent of the condition. The implants are not easily identified using these tests.
Looking for a biochemical marker that is indicative of endometriosis may also be helpful. The use of biochemical markers may eventually replace the need for laparascopy. |
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KEY |  | Weak or unproven link |  |  | Strong or generally accepted link |  |  | Strongly counter-indicative |  |  | Very strongly or absolutely counter-indicative |  |  | May do some good |  |  | Likely to help |  |  | Highly recommended |  |  | May have adverse consequences |
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