Endometriosis Awareness Month
Sandra Sapio, Acupuncturist and Naturopath
March is Endometriosis Awareness Month and takes place across the globe. The aim is to bring awareness to a condition which can be extremely debilitating for women both physically and emotionally.
In the 15 years of practice, I have seen and supported hundreds of women who have struggled with varying degrees of diagnosed Endometriosis. Some discovering endometriosis through their fertility journey while others have had the condition from their late teens or early twenties. Many have searched for natural treatment methods for pain management to support them alongside western medical approaches.
With so much information available, there’s always so many questions and concerned still raised about Endometriosis. Topics covered in my blog include:
- What is Endometriosis
- Four stages of Endometriosis
- What causes Endometriosis
- Endometriosis Symptoms
- Treatment of Endometriosis
- Endometriosis Prognosis
- Endometriosis & Fertility
As a qualified Acupuncturist and Naturopath, my treatments are complementary and I will always recommend patients seek the advice of their GP and an endometriosis specialised gynaecologist, if there is ever any concerns or common endometriosis symptoms warranting further investigation.
What is Endometriosis
Endometriosis is a gynaecological disorder that affects on average 1 in every 10 women during reproductive years from the time you start having periods (puberty) to the time your ovaries shut down (menopause). Endometriosis is an oestrogen dependant condition in which tissue that typically forms in the lining of your uterus also starts growing outside of your uterine cavity. The more common organs and structures impacted by endometrial tissue include, ovaries, bowel, bladder and the lining of the pelvis. Endometriomas are a localised form of endometriosis in which cyst like formations form around the ovaries. With each menstrual bleed surrounding tissue can become irritated and cause significant pain, although pain is not always limited to menstrual bleeding alone and can occur throughout the cycle. In some severe cases scar tissue and adhesions can form (abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other).
Four stages of Endometriosis
Endometriosis can often be noted as mild, moderate or severe and with Laparoscopic surgical classification for the various stages, it can be also graded I-IV (1-4). It is important to note that the extent of endometriosis is not always related to the symptoms experienced. In the US it is estimated that a quatre of the women diagnosed with endometriosis had no major presenting symptoms. The following four stages of endometriosis are commonly known worldwide amongst medical professionals.
- Mild – Grade I (1) – Endometriosis appears as small patches or surface lesions scattered around the pelvic cavity.
- Moderate – Grade I (1) or II (2) – Endometriosis appears in a larger widespread area of tissue and can also infiltrate tissue. This stage of endometriosis can often be found on the ovaries, uterosacral ligaments and Pouch of Douglas (long and narrow structure between the uterus and the rectum). Scarring and adhesions may also be present.
- Severe – Grade IV (4) This stage of endometriosis affects most of the pelvic organs and is often found to be in women exhibiting many of the symptoms associated with endometriosis. Severe endometriosis is often with distortion of the anatomy (ovaries adhered to uterus or bowel) and scar tissue/adhesions that can be found throughout the pelvic region.
What causes Endometriosis
Although the exact cause of endometriosis is unknown, some of the more common explanations can include:
- Retrograde menstruation – In which the lining meant for the uterus is displaced or flows to areas other than the uterus.
- Hormone imbalance – Hormones such as estrogen may transform specific cells into endometrial like during puberty.
- Genetic factors – Women with a mother or sister with endometriosis may be more likely to get it.
- Surgical scars – From surgeries such as a Caesarean (C-section) or hysterectomy
- Immune Factors – Alterations in your immune system’s natural ability to recognise the presence of endometrial tissue in abnormal locations and eliminate it.
- Pelvic pain – cramping may begin before and extend several days into a menstrual period
- Ovulation pain – Pain on or around the time of ovulation.
- Painful intercourse – Pain during or after sexual intercourse.
- Pain with bowel movements – Pain may be intensified during menstruation.
- Excessive menstrual bleeding – Heavy periods and prolonged periods can be experienced.
- Irregular bleeding – Spotting that can occur up to 5 days before menstruation starts, Mid cycle spotting or bleeding with ovulation. Prolonged spotting or bleeding post menstruation.
- Generalised pain – Pain when you urinate, Pain in your pelvic region, lower back or legs.
- Bladder issues – Having trouble holding on when you have a full bladder or having to go frequently.
- Infertility – Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
- Other signs and symptoms – Fatigue, diarrhea, constipation, bloating, nausea, especially during menstrual periods.
See your doctor if you have signs and symptoms that may indicate endometriosis.
Treatment of Endometriosis
Effective medical treatments, such as hormones and excision surgery, are available and include
- Medical treatments (medications) – Often prescribed by a gynaecologist specialising in endometriosis.
- Surgical treatments (laparoscopic surgery) – Gynaecologist will have different credentials relating to the different levels of Laparoscopic surgeries they have been trained in. Severe endometriosis often requires excision from a Gynaecologist with Level 6 procedures encompassing the highest level of complexity and are domain specific.
- Complementary support treatments – (physical) physiotherapy, acupuncture, complementary medicine.
- Complementary support treatments – (emotional) psychology, acupuncture, complementary medicine.
Natural treatment methods for supporting Endometriosis
There are many natural treatment options that along with the treatment provided by your Gynaecologist may also support you in the treatment of endometriosis both physically and emotionally.
Naturopath & Nutritionist Advice
Diet & Natural Supplementation
A naturopath can recommend certain natural supplements and herbs to help support the many symptoms associated with endometriosis, some of which can include natural anti-inflammatories. Most natural anti-inflammatories prescribed by a qualified practitioner have been reviewed or had studies published to show their efficacy in treating many symptoms associated with inflammatory conditions. Naturopaths having qualifications in nutrition or Nutritionists themselves may also able to work through diet modifications to help support your condition. Suggestions such as avoiding inflammatory foods and increasing natural anti-inflammatory and Alkaline foods that may help reduce inflammation and symptoms.
Acupuncture and Chinese Herbs
Acupuncture treatment may decrease the severity of endometriosis symptoms for most patients and may help emotionally with stress and anxiety associated with the pain. The treatment effects of Acupuncture are cumulative, so longer term treatment is associated with greater improvement. Traditional Chinese medicine philosophy and theory considers endometriosis to be associated with impaired blood circulation and flow (retrograde theory), or blood stasis. Acupuncture treatment focuses on improving blood circulation, and its profusion and effect to the uterus, lower abdomen, and entire body.
Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used.
Chinese Herbal Medicine
There have been some reviews into the effectiveness of Chinese herbal medicine in alleviating endometriosis‐related pain and infertility. Further research, with larger numbers of participants, is required to substantiate these results and to explore the role of Chinese herbal as a stand‐alone medical option or as a post‐surgical adjuvant in the treatment of endometriosis.
There is no known single cure for Endometriosis, and it can be a condition impacting women throughout their entire reproductive years, especially those with severe endometriosis. Some women report only needing one laparoscopic surgery and through medical treatment and significant diet and lifestyle modifications have not experienced major pain or symptoms thereafter. For any woman diagnosed with endometriosis, it’s always important to research and explore the best pain management treatment options which work for you.
Endometriosis and Fertility
Medical and Complementary treatment options are also important for women wanting to conceive, especially those needing further assistance with IVF. There is often a big misconception that if you have endometriosis you will automatically have difficulties conceiving, even in severe cases of endometriosis, natural conception is still possible. It is estimated that medically of all women diagnosed with Endometriosis only 1 in 3 will have issues conceiving. For that 1 in 3 having difficulty (there’s always hope) A fertility specialist can offer treatment options to help with natural conception. IVF and similar techniques can also be an option for women with endometriosis, with positive outcomes. Either way, natural treatment options can be supportive to both the natural conception process and IVF.
If a multifaceted approach to your health care is what your after, then find one of the many medical professionals who support a patient’s choice to use complementary therapies alongside western medicine interventions, that will not impact but may enhance the treatment outcomes.
They say it takes a village to raise a child!……. How wonderful it would be to work together to form a village of health professionals for women needing support on their way to becoming a mothers.
Trials and Reviews:
- Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659600/
- Chinese herbal medicine for endometriosis https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006568.pub3/full