By Dr. Loretta Lanphier, ND, CN, HHP, CH

What is Endometriosis?

Endometriosis is a progressive disorder mainly of the female reproductive system that is the result of abnormal growth of tissues that normally line the uterus. These tissues are called endometrium, and endometriosis is the result of endometrium forming outside of the uterus. This takes place most often on the fallopian tubes, ovaries, lining of the pelvis, or behind the uterus, but on rare occasions these tissues may form outside of the pelvic region.

During a normal menstrual cycle, the lining of the uterus is stimulated by hormones to thicken in preparation for a potential pregnancy. If you do not become pregnant, the hormone levels drop back down to normal, and the excess tissue from the uterus lining is shed and causes the bleeding associated with menses. This is naturally expelled from the body through the vagina. However, when endometrium forms outside of the uterus, the monthly hormonal cycles trigger the same response, but the blood has no pathway to leave the body. Instead it accumulates on surrounding tissues, causing swelling and irritation. Eventually this can lead to the formation of cysts and resulting scar tissue and adhesions (abnormal tissues that bind organs together) in the affected areas. When found outside the uterus, endometrial tissue, or implants as they are called, are most commonly found in the pelvic region, but they have occasionally been know to form in such locations as the kidneys, lungs, and arms of some women. These implants initially start as small bumps on the surface of organs and connecting ligaments, and are sometimes referred to as “powder burns” because of their appearance. In the ovarian area, cysts may form as the endometriosis progresses. These are called endometriomas, and typically range in size from a pea to a grapefruit. The adhesions, cysts, and scar tissue can cause pain for many endometriosis patients.

Just how common is endometriosis? Well, statistics tell us that this condition affects about 7% of United States females who are of childbearing age. Most sufferers are in the 25-40 age bracket.  It is also found in teen girls at times, but never before the onset of menstruation. In years past, endometriosis was nicknamed the “career women’s disease” because it was thought to be a function of delayed childbearing. This was an incorrect oversimplification, but it does appear that pregnancy can slow down the progress of endometriosis in many women, probably due to related hormonal changes. Cases of endometriosis are classified from minimal to severe based on the number of implants and the amount of scarring, cysts, and adhesions present. Oddly enough, the amount of pain victims feel is often not related to the severity of their endometriosis. Some women with mild cases have a lot of pain, and vice-versa.

What Are the Symptoms of Endometriosis?

Endometriosis is a progressive disease. The severity of symptoms varies greatly from patient to patient. Some of the most common signs of endometriosis include:

  • Menstrual Pain (dysmenorrhea):  Some cramping during menstruation is normal for many women, but those with endometriosis often report excessive pain that worsens over time. This pain and cramping is often found in the lower abdomen and lower back, and typically begins one or two days before menses, and carries through the entire period. Some patients experience increased pain during bowel movements and urination, and also during intercourse.
  • Heavy Bleeding (menorrhagia):  Excessive amounts of bleeding during a period, irregular bleeding, or spotting between periods (menometrorrhagia) are also typical of endometriosis.
  • Infertility:  The build up of excess tissue and adhesions in the area of the fallopian tubes is thought to contribute to the high rate of infertility found in women with endometriosis. The condition may also make it more difficult for the ovaries to effectively release eggs. In some studies, a higher than normal number of miscarriages has been linked to endometriosis as well.  Many times endometriosis is first discovered in a woman who seeks treatment for infertility.
  • Endometriosis is often misdiagnosed as some other conditions that have similar symptoms. Some common conditions that may mimic endometriosis include:

v      Pelvic Inflammatory Disease (PID)

v      Ovarian Cysts

v      Irritable Bowel Syndrome (IBS):  This syndrome exhibits diarrhea, constipation, and abdominal cramping. IBS may coexist with endometriosis, making the diagnosis even more difficult.

What Causes Endometriosis?

Despite many years of study, the exact cause of endometriosis remains unknown for certain. There are several pet theories though. These include:

  • Implantation Theory:  This theory is related to a reversal in the menstrual flow that is thought to back up through the fallopian tubes and  “plant” discarded endometrial cells into cavities of the body resulting in endometrial implants. As unorthodox as this may appear at first glance, the implantation theory has been around since the 1920’s, and there is considerable evidence to support it. One problem with this line of thought is that while between 70-90% of women experience reversed menstrual flow, most of them never come down with endometriosis. Reverse menstrual flow is thought to be more common in endometriosis patients though, than in the rest of the population.
  • Vascular-Lymphatic Theory:  This is a hypothesis whereby the bloodstream and lymphatic system are responsible for distributing endometrial cells throughout the body.
  • Coelomic Metaplasia Theory states that remnants of cells that were involved with development of a woman’s reproductive system while in the womb are somehow involved with spreading endometrial cells within the body. Some researchers believe that genetic or environmental factors in adult life may cause these cells to produce endometrial implants.
  • Induction Theory places the blame for endometriosis on an unknown substance found in the body that triggers the cells lining the uterus to morph into endometrial cells.
  • Heredity:  Family history definitely plays a role.  A woman’s risk for developing endometriosis increases seven-fold if her mother or sisters have the condition.
  • Immune System Dysfunction:  Some of the most current research is focusing on immune system involvement. If a woman’s immune system is not up to par, it may not be able to prevent the growth of endometrial tissues. This may explain why so many women who experience reversed menstrual flow do not develop endometriosis.
  • Dioxin Exposure:  Environmental factors have long been suspected as possible triggers of endometriosis. There is some research that points to a chemical found in herbicides called dioxin or (TCCD).
  • Other causes for endometriosis may be infections that have previously damaged the lining of the uterus, and on rare occasions, medical conditions that impede with normal elimination of menstrual flow from the body.

What Complications Can Occur From Endometriosis?

Infertility is the most common complication of endometriosis. It is estimated that between one third and one half of all women who have a hard time getting pregnant have endometriosis. Many women with the disease are able to eventually bear children, but it can often take longer for them to get pregnant. Once a patient does become pregnant, symptoms usually disappear due to hormonal changes. Since endometriosis usually gets progressively worse over time, it is often recommended that these women do not put off childbearing. The longer one has endometriosis, the more it typically affects her ability to conceive.

Cancer does sometimes form in endometrial implants, but the risk of it is no greater than for other tissues of the body. Endometriosis is not thought to increase your risk for ovarian or uterine cancer.

How is Endometriosis Diagnosed?

A thorough pelvic exam from a trusted health practitioner can be very helpful in identifying endometriosis. Sometimes implants can be felt, but often they cannot be discovered during an exam. A procedure called a laparoscopy is often recommended if implants are suspected. This is an invasive form of minor surgery whereby a small scope equipped with a light source and a camera is inserted through a small incision in the abdomen. This can be helpful and appropriate, but as with any surgery, even “minor,” there are risks involved. A second or even third opinion is always a good idea.

Sometimes ultra sound may be used to locate and analyze endometrial implants. Be especially careful if a computed tomography scan (CT scan) is suggested. I would avoid these if possible, as they expose you to a very high amount of radiation (about 5 times that of an ordinary x-ray).

What Treatments Are Available for  Endometriosis?

Allopathic treatment options typically include medications for pain, surgery, and hormonal therapies.  The surgical options include removal of implants using lasers administered through a laparoscope, and even the extreme choice of a hysterectomy to remove such organs as the uterus, ovaries, and fallopian tubes. This is not recommended due the resulting loss of the ability to ever bear children, and to the inherent risks of such major surgery. A hysterectomy abnormally forces the body into premature menopause, and the hormonal side effects can be quite severe and unmanageable for many women.

Traditional hormone therapies are also very dangerous and unpredictable. Sometimes oral contraceptives are used to trick the body into thinking you are pregnant. While this may relieve the pain for some patients, the overall effects on the body are not good. Some practitioners even prescribe synthetic male hormones such as danazol or gestrinone to prevent menstruation or shrink implants. These drugs have many dangerous side effects, and even may cause some women to develop male characteristics. I highly discourage the use of any synthetic hormone replacement therapy.

A generally healthy and active lifestyle can go a long way towards relieving and preventing endometriosis. Studies have shown that young girls who engage in aerobic exercise have a lower incidence of endometriosis. Diet also plays a role. Many sufferers of endometriosis have found that eating whole, nutritious foods, and avoiding a diet that is high in fat, sugar, and sodium has helped them to better manage their symptoms. Supplementation with vitamin B-complex and minerals such as calcium, magnesium, and selenium is also recommended.  Warm baths and heating pads are excellent methods for relaxing pelvic muscles and relieving pain. Chiropractic care is also beneficial for many patients. As with all health concerns, find out what works best for you and your body. No one knows you better than yourself, so it really pays to be proactive when it comes to your own health care issues.

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