Treating Endometriosis: Western and Eastern Toolkits


One of the things I most love about practicing natural medicine is that I have so much in my toolkit to work with.  Depending on the condition, the circumstances, and the available resources, I can draw from nutrition, vitamins/supplements, acupuncture, Western or Chinese Herbs, and mind-body techniques such as meditation and breath-work to design a protocol that best works for each patient.  All of these options can have powerful impacts and bring about sweeping change in health, especially when used in combination.

As patients, we need to be informed about our options because sometimes the tools in our doctor’s toolkit just aren’t enough.  This is often the case when it comes to the treatment and management of endometriosis.

Endometriosis is an inflammatory disorder in which endometrial tissue (lining of the uterus) grows outside of the uterus.  It’s been found in every organ of the body with the exception of the spleen. Endometrial tissue has been found in the sciatic nerve and even the brain.  Crazy! Though it has not officially been categorized as an autoimmune disorder (yet), it may increase your likelihood of developing other autoimmune diseases and has links to celiac disease, upper respiratory disorders, increased frequency of vaginal infections, and rheumatoid arthritis.

Diagnosing Endometriosis

Endometriosis is said to affect 11% of women but this is likely underestimated as there is no conclusive way to diagnose endometriosis other than laparoscopic surgery.  There are clinical signs and symptoms such as severe menstrual cramps, cramping throughout the cycle, pain with bowel movements or urination, and infertility that can give us an indication (often a very strong indication) that endometriosis may be present but no imaging, blood test, or exam that will give us a definitive diagnosis.

Dismissing Pelvic Pain

The clinical challenges of diagnosing is coupled with a tendency in the medical community to dismiss female pain.  Joe Fassler wrote a powerful piece called, “How Doctors Take Women’s Pain Less Seriously.” It’s a terrifying account of his wife’s experience of being ignored in the emergency room with an ovarian torsion – a medical emergency that if left untreated can result in the loss of an ovary.  Unfortunately, her experience of not being taken seriously by medical providers is not unique and many women seeking help from their doctors because of pelvic pain are turned away, undiagnosed, misdiagnosed, and shamed.

With studies showing between 3 and 11 year delays in receiving a diagnosis and the Endometriosis Association’s claim that it can take up to 10 years from the onset of pain to receive a diagnosis, I wouldn’t be surprised if we are chronically and historically under diagnosing women.  

In my own case, I’ve suffered from debilitating menstrual pain since I was 14-years-old but didn’t receive an official diagnosis of endometriosis until I was 40-years-old, two years into my infertility journey.  I remember the surgeon doubting it even as I was being rolled into surgery despite years of pain, trips to the emergency room, ultrasounds showing multiple endometriomas (cysts on the ovaries filled with endometrial tissue), and infertility.  In the end, I was diagnosed with stage IV endometriosis and had large endometriomas/chocolate cysts removed from each of my ovaries.

Birth Control Pills

The Western medical community does not offer many options for women who are dealing with endometriosis.  Treatment is pretty much limited to birth control pills and surgical removal of endometrial tissue. Most women, myself included, are prescribed birth control pills at the first mention of menstrual cramps, often in their early teen years.  It’s not uncommon for women to be on birth control pills for several decades. I have two primary concerns with this.

Firstly, when women are not properly diagnosed, they do not receive proper or timely treatment.  This is important not only for quality of life for women living with endometriosis but also for preservation of fertility.  Young women don’t usually think about fertility preservation when they are teenagers and they are desperate for pain relief.  Endometriosis can be a debilitating and destructive disease. It must be taken seriously and addressed from the onset of symptoms in order to decrease chances of comorbidities, protect against mental/emotional repercussions of chronic disease and pain, and preserve fertility.

Secondarily, young girls are not being adequately counseled on the potential risks of long-term use of birth control pills.  Some of the more well known risks include increased potential for blood clots, blood clot induced stroke, and cervical cancers.  These risks are small but significant. Especially concerning to me is the list of other side effects that accompany the pill. I’m talking about the increased occurrence of depression and anxiety, increased weight gain and metabolic syndrome, interference with thyroid hormones, increased headaches and migraines, and post-pill hormone imbalances. These side effects may sound less scary than “stroke” and “cancer” but they are very common and  contribute to why 64% of women discontinue taking the pill.

Surgery

Surgical removal of endometrial lesions is the other option in Western medicine’s toolkit, but it is not fool-proof.  Endometriosis does not look the same for everyone. The disease varies widely in severity from minimal lesions to abdominal cavities riddled with endometriosis, lesions torquing and/or adhering organs to each other, endometrial tissue growing inside the ovary or inside ovarian cysts, and invasive endometrial lesions growing through the endometrial lining or actually perforating organs like the bladder and/or intestines.  There are several different techniques to remove lesions but doctors/surgeons don’t agree on which techniques are best. For some women surgery is life saving, for others it’s effective but only temporarily with lesions regrowing after only months or years, and for others surgery isn’t enough. In the worst case scenarios surgery is performed by inexperienced doctors leaving women injured, with compromised fertility, and still in pain.

As patients, we must be our own self advocates.  If you are considering surgery for endometriosis be sure to thoroughly research the doctor and work with someone who specializes in endometriosis and has advanced medical degrees.  Your local gynecologist is not experienced enough. Finding the right doctor may even require looking out of state. For many women, surgery is a wonderful option and they experience relief of their symptoms, often long-term.  This is not true for every woman so take the time to understand your condition and the doctors you choose to work with.

Make sure your doctor explains how their technique will…

  • Remove misplaced tissue most effectively
  • Prevent re-occurrence in the long-term
  • Decrease risks of surgical injury or post-surgical complications such as uterine scarring, perforated organs, and damage to the ovaries
  • Preserve and/or enhance fertility

The Natural Medicine Toolbox

If you’ve been diagnosed with endometriosis or you suspect you have endometriosis the tools in the natural medicine toolbox can help manage symptoms, decrease or in some cases eliminate pain, and prevent the disease from worsening.  It’s important to reiterate that there is a huge spectrum of severity in endometriosis. Deep infiltrating endometriosis where the renegade tissue is found to invade organs such as the bladder and bowels is much harder to treat than endometriosis which is limited to endometrial lesions in the abdominal cavity.  

At its root, endometriosis is considered an inflammatory disease with immune dysfunction which is aggravated by high levels of estrogen.  Estrogen strongly stimulates endometriosis lesions no matter where they are located within the body. Given these two components of the disease, natural methods of managing endometriosis are beneficial across all stages.  Let’s review the most useful natural medicine methods of managing and treating endometriosis.

Nutrition

Food is truly our best medicine and it plays an important role in treating and managing endometriosis.  Endometriosis focused nutrition should be aimed at two main principles: 1) reducing inflammation and 2) ensuring healthy metabolism of estrogen.

I recommend eliminating dairy and gluten, both inflammatory foods, and following a Paleo based diet.  The Whole30 is also a wonderful option but it may not be necessary to be quite that strict on a long-term basis.  Diets rich in foods such as dairy, gluten, sugar, processed carbs, and trans fats can fuel inflammation, disrupt ovulation, and alter the delicate estrogen to progesterone ratio.  Removing them from the diet can at best eliminate pain and at worst keep the disease from progressing.

Many women see a huge improvement in pain levels and accompanying symptoms, especially digestive complaints, after four to six weeks of eliminating these foods completely.  If you don’t see improvements after a week or so, don’t get discouraged. The digestive tract is slow to heal and decreasing inflammation levels can take some time. Don’t give up too soon!

Be sure to regularly include foods that contain sulforaphane. Sulforaphane is a natural compound found in cruciferous vegetables shown to help support optimal estrogen detoxification. Cruciferous vegetables are a family of plants that include broccoli, cauliflower, kale, Brussels sprouts, cabbage, and bok choy.  Healthy detoxification of estrogen is essential for preventing high estrogen levels that aggravate endometriosis.

If you suffer from painful periods or endometriosis, managing symptoms with diet is a must.  Do your research and learn about low-inflammation diets (like Paleo, Keto, and Whole30) and estrogen dominance to help figure out which is best for you.  Unfortunately, doctors are not trained in nutrition and may not mention the many benefits of eating a low-inflammation diet.

If you want to learn more about how choosing the right foods can balance and heal hormonal health please read my post, Nutrition, the piece of the puzzle almost every fertility clinic is missing.

Vitamins and Supplements

Supplements are another amazing tool in the natural medicine toolbox and they shouldn’t be overlooked.  However, it’s again important to do your own research and choose quality products. Those purchased at your local drugstore (CVS, Riteaid, GNC) are simply not high enough quality and should be avoided.  I have spent more than a decade researching and recommending nutraceuticals, otherwise known as vitamins and supplements, and know that taking the right products at the right time can be life changing. Though there are many nutraceuticals that can help endometriosis, I recommend three across the board to anyone with period pain or endometriosis: Magnesium, Omega 3, and Zinc.  

Magnesium Glycinate (300mg/day in divided doses) can reduce prostaglandins which are released when the endometrial lining is shed.  Too many circulating prostaglandins, which is the case with endometriosis, causes pain, inflammation, and uterine contractions.  Magnesium has also been found to help relax the uterus.

Omega 3 (2000mg/day) is a power anti-inflammatory supplement.  It’s essential in hormone production and regulation, including estrogen, and improves insulin sensitivity which again helps control inflammation levels.

Zinc (20 to 50mg/day with food) is crucial in supporting a healthy immune system and adequate levels help keep inflammation under control.

Acupuncture

Of course as an acupuncturist, acupuncture is my favorite tool in the toolbox.  Personally, it’s been part of my endometriosis management protocol for over 20 years. Looking back, its affect on my own health was part of why I became an acupuncturist. I have seen acupuncture provide women relief not only from cramping but also a wide array of symptoms that often accompany endometriosis.

Acupuncture, a Chinese Medicine, looks at the body from a completely different paradigm than what we are used to in the west. The Chinese Medicine paradigm is a complete and complex system that has been used successfully to treat patients holistically for hundreds of years. Chinese Medicine considers endometriosis pain to be the result of stagnant Qi and Blood. Qi is our life energy, the force that fuels and propels our bodily functions and supports the vitality of our spirit.  When Qi and Blood are not able to flow freely, the result can be pain in the body. Chinese Medicine treats endometriosis by utilizing carefully chosen acupuncture points to restore proper balance to the menstrual cycle to keep Qi and Blood flowing freely.

Chinese Herbs

Chinese Herbal Medicine is a complex, deeply individual, and effective treatment for many women’s health concerns, including endometriosis.  Because herbal prescriptions are specific to each individual, they can be mixed in a way that will move stagnant qi and blood to help improve symptoms specifically while also treating underlying constitutional imbalances for long term relief. Ultimately, these underlying constitutional imbalances are the drivers for symptom expression, making Chinese herbs an incredibly powerful tool.  In my practice, I use a wonderful line of Herbal Medicine tinctures called Conceivable. If you want to learn more about how I use Herbal Medicine check out my blog, Using Chinese Herbal Medicine to Regulate Menstrual Cycles.  I’ve used Chinese herbs for years personally and professionally with my patients.  Time and time again Chinese herbs provide the fastest and most significant improvements in endometriosis pain.

Meditation/Breath-work

Meditation and breath-work are arguably as important as any of the already mentioned techniques.  As with any chronic pain disease, endometriosis takes its toll on us emotionally and we need to take deliberate steps to manage that impact.  Stress and chronic pain often leads to a pattern of holding and or protecting which invites muscle tension.

It can be as simple as five minutes a day of quiet attention to the breath.  Clearing our thoughts and focusing on our breath allows us the opportunity to sink back into our bodies, let down our defenses, relax tense muscles, and restore the free flow of healing energy to our tissues.  Without this daily practice, muscle tension goes unchecked and contributes to painful pelvic bowl dysfunction which can worsen the pain of endometriosis.

Conclusion

Managing endometriosis is a practice of unwavering self-care.  Though each one of the techniques above can aid in the treatment of endometriosis, both Western and Eastern alike, it’s the combination of these methods that is life changing.  I encourage women with endometriosis to be strong self-advocates by learning about endometriosis and how shows up and impacts your body and life. There are many wonderful doctors and natural medicine practitioners who are informed and able to help.

On A Personal Note…

Endometriosis is deeply personal for me.  Writing this blog was surprisingly emotional as it’s hard to look back and see how significantly the disease has impacted my life.  It’s with a heavy heart that I think of all the young girls and women suffering with very few resources to call on.

Symptoms of endometriosis began with my very first menstrual cycle when I was 14 years old.  I was given narcotic pain medication as a teen before my doctor recommended birth control pills.  Throughout my life I’ve felt dismissed and uncared for by the doctors I sought out for help. I’ve spent time in emergency rooms, rode in ambulances, had surgeries, and cancelled rounds of IVF all because of endometriosis.  Symptoms beyond menstrual cramps have always been present and somewhat mysteriously connected to endometriosis – fatigue, digestive problems, headaches, sciatic pain/drop foot, leg pain, pelvic pain, ovary pain, infertility, ovarian cysts, and sensitivities to hormone shifts.

Living with endometriosis can be challenging, scary, frustrating, and isolating.  I hope that this blog points out a few of the resources that we now have to call upon.  They have been invaluable to me over the years. I know they truly can help us get healthy, conceive and carry our babies, and thrive while living with endometriosis.

If you ever have questions about how the mentioned natural medicine modalities can help you manage endometriosis, please don’t hesitate to reach out.