Endometriosis

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.

 


Signs, symptoms & indicators of Endometriosis

Lab Values - Cells  

High ESR or elevated ESR



Symptoms - Bowel Movements  

(Significant/frequent) blood in stools



 

Regular/frequent/occasional painful urge to defecate



Symptoms - Gas-Int - General  

(Severe) abdominal discomfort



 

Slight/intermittant/constant 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




Conditions that suggest Endometriosis

Pain  


Uro-Genital  

Dysmenorrhea, Painful Menstruation

Endometriosis is the most common cause of menstrual cramps.



 

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.



 


 


 


 


Counter Indicators
Uro-Genital  



Risk factors for Endometriosis

Habits  

Aerobic Exercise Need

Endometriosis has been linked to a lack of physical activity.



Symptoms - Allergy  

History of adult allergies



Symptoms - Reproductive - Female Cycle  

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
Symptoms - Reproductive - General  

(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

Endometriosis often regresses during pregnancy.



 

Absence of endometriosis




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.




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.

Some report that the benefits of Vitex are short lived. A short period of use may produce short-term benefits, but long-term use may actually make symptoms associatted with estrogen dominance worse.



 

Black Cohosh (Cimicifuga racimosa)

As a uterine tonic, it may help relieve symptoms.



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.



Extract  


Hormone  

Progesterone

Progesterone intravaginally can reduce the bleeding and pain associated with endometriosis.



 

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.



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

Glossary

Endometriosis

A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.

Enzymes

Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Scar Tissue

Fibrous tissue replacing normal tissues destroyed by injury or disease.

Ovarian Cysts

These occur in two forms, namely "functional" and "organic". may not be present but can include pressure or pain in the abdomen, problems with urine flow or pain during sexual intercourse. Rarely, a very large cyst can become twisted and stop its own blood supply, possibly causing nausea, fever or severe abdominal pain. Functional ovarian cysts form part of the normal functioning of the ovary and are always benign. They may be either "follicular cysts", produced by all menstruating women every month and reaching up to 2-3cm in diameter before they rupture at ovulation, or "corpus luteum cysts", which appear after ovulation and may grow to produce "hemorrhagic cysts" if ovulation does not occur or is delayed. Rupture of such a cyst can sometimes cause painful ovulation or bleeding, which is often moderate and resolves by itself. Organic ovarian cysts may be benign or malignant and are not linked to the functioning of the ovary. They occur as either "dermoid cysts", which are benign tumors that may nevertheless recur on either ovary and contain elements derived from the skin (hairs, sebum, teeth), or other organic cysts.

Colon

The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Cancer

Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Diverticular Disease

Some people develop small pouches (diverticula) that bulge outward through weak spots in the colon. Diverticulosis is the condition of having these pouches; diverticulitis is an inflammation or infection in these pouches. The conditions diverticulosis and diverticulitis are both referred to as diverticular disease. Diverticulosis may not cause any symptoms but could include mild cramps, bloating and constipation - all of which are common to other conditions such as IBS or ulcers. The most common symptoms of diverticulitis are abdominal pain and tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.

Gonorrhea

A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.

Irritable Bowel Syndrome

(IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.

Pelvic Inflammatory Disease

(PID) A Purulent (pus-like) vaginal discharge with fever and lower abdominal pain.

Estrogen

One of the female sex hormones produced by the ovaries.

Hypothyroidism

Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Thyroid

Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.

T4

Thyroxin, thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.

Melanoma

A life-threatening type of skin cancer that occurs in the cells (melanocytes) that produce melanin, the pigment found in skin, hair, and the iris of the eyes.

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