The Fertility Health team listens to your concerns about endometriosis, fertility, pain and your future. We offer insight, assessment, and treatment using ancient Chinese medicine theories of ‘patterns of disharmony.
We aim to alleviate your symptoms, teach you how to understand why endometriosis develops, and plan with you a strategy to help avoid its reoccurrence.
Encouragingly, we have seen very good clinical evidence for the treatment of endometriosis with Chinese herbal medicine and acupuncture (Ding and Lian, 2015; Flower et al., 2012; Brown and Farquhar, 2014).
What is it?
Endometriosis is defined as the presence of endometrial tissue outside the normal uterine cavity. In endometriosis, the kind of tissue that is normally found inside of the uterus grows outside of it. It is a common gynaecological disease that affects 10% of women and 40% of women with infertility.
What causes endometriosis?
There are various theories about what causes endometriosis and it is recognised that several factors probably play a role. According to a theory known as the ‘transplantation theory’, cells from the lining of the uterus migrate to other parts of the body and multiply there, these are referred to as endometrial implants. It is thought that the cells either travel through the bloodstream or move through the fallopian tubes to the abdomen in menstrual blood.
Every month during the menstrual cycle, endometrial implants outside of the uterus build up and shed in response to hormonal fluctuations. Since the blood and shed tissue cannot leave the women’s body through the vagina they stay near the endometrial area. Here they cause inflammation, which in turn can lead to the development of scar tissue and adhesions.
In biomedicine it is not clearly understood why the endometrial cells grow outside the uterus in some women and not others. It is believed that other factors play a role in its development, including a problem with the interaction between hormones and the immune system, as typically the immune system ensures that the tissue from a particular organ does not grow elsewhere in the body.
What does Chinese medicine say about the cause?
According to Chinese medicine (CM) theory endometriosis results from the slow down and stagnation of blood flow in the pelvis. CM recognises several causes of this as well of many contributing risk factors that accompany this pathology that need to be addressed in order to effectively treat the disease. The liver, spleen, and kidney meridians travel through the pelvis and as such any issues within these meridians can affect blood flow in the pelvis.
What are the symptoms?
The symptoms of endometriosis vary from woman to woman but dysmenorrhea (painful periods), dyspareunia (painful intercourse), and dysuria (painful urination) are the most frequently reported symptoms. Around 70% of women with endometriosis experience severe pelvic pain and/or painful periods, whereas others are asymptomatic. In many women the recurring pain can impact their general physical, mental, and social wellbeing.
In the early stages of the disease one or two mild symptoms may be felt for the first day or two of the menstrual period but as the condition continues to develop, symptoms may get worse for more days of the month. The type of symptoms and their severity tend to be related to the location of the misplaced endometrial tissue rather than how much misplaced tissue there is.
This helps explain why some women experience no symptoms. In fact around 30% of women with endometriosis only discover they have it because they have not been able to fall pregnant, or because endometriosis is found during an operation for another reason.
How is it diagnosed?
There are several tests that may indicate and assist in the diagnosis of endometriosis:
- Clinical examination – a pelvic examination by a specialist can reveal localised tenderness or nodules in the vagina that are suggestive of endometriosis,
- Blood test – an elevated protein CA-125 can be helpful in diagnosing the disease, however, it is less reliable as an indicator in the early stages,
- Ultrasound – the ability to diagnose deep infiltrating endometriosis with trans-vaginal ultrasound has improved dramatically in the last 5 years. Ultrasound can now detect deep infiltrating endometriosis with a high degree of accuracy. It is a useful pre-operative diagnostic tool,
- Laparoscopy – laparoscopy is the definitive method of diagnosing all forms of endometriosis. It is during this surgery that a biopsy of tissue that is thought to contain endometriosis is removed and sent to a pathologist to confirm the diagnosis.
The medication options include painkillers and hormone therapy. Painkillers only relieve the symptoms, whereas hormone-based treatments aim to slow down the growth of endometrial implants. These hormone therapy treatments include progestins, oral contraceptives and gonadotropin releasing hormone agonists. Meanwhile surgical interventions aim to remove visible areas of endometriosis via laparoscopic surgery.
Laparoscopic surgery can often relieve the terrible pain and heavy bleeding many women experience, however, the endometrial cells soon return and the process begins again.
What is the treatment in Chinese medicine?
In China, the treatment of endometriosis using Chinese herbal medicine (CHM) is routine, and considerable research into the role of CHM in alleviating pain, preventing relapses, and promoting fertility has taken place. Our team uses acupuncture, CHM, nutritional supplements, and diet therapy to treat the symptoms of endometriosis and reduce the growth of endometrial lesions.
We reduce fatigue, emotional distress and anxiety, endometrial lesions, pain, heavy bleeding, and irregular bleeding associated with endometriosis and hormonal imbalance.
We assess your general health and wellbeing using the insights of Traditional Chinese Medicine theories on ‘patterns of disharmony’, to prevent the reoccurrence of the disease. There is good evidence to support the use of acupuncture to treat endometriosis.
A 2012 Cochrane Review found that post surgical administration of CHM may have comparable or better overall treatment effect than hormone therapy alone, but with fewer side effects.
References
- A, Khachikyan. I, Stratton. P, (2010) Invasive and non-invasive methods for the diagnosis of endometriosis. Clinical Obstetric Gynecology 52(2): 413-419.
- P, Vigano. P, Somigliana. E, Fedele. L, (2014) Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology 10(5): 261-75.
- Z, Lian. F, (2015) Traditional Chinese Medical herbs staged therapy in infertile women with endometriosis: a clinical study. International Journal of Clinical and Experimental Medicine 8(8) 14085-14089.
- A, Liu. JP, Lewith. G, Little. P, Li. Q, (2012) Chinese herbal medicine for endometriosis. Cochrane Database System Review, 2012 May 16(5).
- Brown. J, Farquhar. C, Endometriosis: an overview of Cochrane Reviews. Cochrane Database System Review 2014 March 10