Endometriosis
Description
In endometriosis, the special inner lining of the uterus, the endometrium, grows outside the uterus. It has recently become recognized as one of the most common gynecological disorders.
The most common sites for endometriosis are near the uterus. The ovary is affected in 40% of the cases. Implantation often occurs on the lining of the pelvic cavity, the peritoneum, covering the uterus, Fallopian tubes, bladder, rectum or the various uterine ligaments. Less common places for endometriosis include any part of the abdomen or chest, and surgical scars, especially from episiotomy or caesarean section.
Endometriosis may be asymptomatic or severe, progressive, chronic and debilitating, depending on the extent and placement of lesions.
Endometrial tissue's cyclic growth and decay permit it to colonize and damage tissue outside the uterus.
Once tissue is established it continues to menstruate. The blood cannot escape as it normally does and provokes inflammation which ends in fibrosis. Repeated cycles of inflammation and fibrosis can produce adhesions, scar tissue, between neighboring organs, which normally glide freely past one another. The inflammatory phase causes severe menstrual cramps. Adhesions interfere with the function of pelvic organs.
Effects
Adhesions to the vagina may inhibit sexual pleasure by causing pain on intercourse. Dense fibrous rings around the rectum may result in constipation. Urination may be painful or incomplete. Endometriosis is a common cause of infertility. Inability to conceive may result from involvement of ovary, fimbria or Fallopian tube.
The pain of endometriosis may greatly disturb social relationships. A woman may lose several days of work each month, and friends, family and employers lose patience. Even today, many endometriosis patients are told their pain is psychosomatic. Often a correct diagnosis comes as a great relief, and may help in pain management.
Types
Historically, Sampson's initial 1921 monographs on endometriosis spoke of an internal and an external form of the disease. Most modern references to "endometriosis" mean "endometriosis externa". Therefore, discussion of endometriosis interna, presently more often known as adenomyosis, will be confined to this section.
In adenomyosis, endometrial tissue is found within myometrium, the uterine muscle. Often undistinguishable from leiomyoma (fibroids) except on biopsy, adenomyoma produces an enlarged, soft uterus. Symptoms include menstrual cramps, heavy menstrual bleeding and bleeding between periods. In contrast to endometriosis, it is more often found in women who have given birth, and responds poorly to oral contraceptives. Internal and external endometriosis coexist in about 20% of patients. For severe pain or bleeding, hysterectomy may be the only effective treatment. Endometriosis is a disease of women in their child-bearing years, and menopause generally cures it.
Who Is Affected
Formerly thought to affect only childless, tense, white, career-oriented women, endometriosis is now known to occur in all races and classes. Estimates of its prevalence in the population at risk range from 7-23%. The disease arises more commonly in women between the ages of 25 to 40, but as gynecologists become more aware of it, the diagnosis is on the rise among teenagers. A slight hereditary tendency has been suggested but remains unproven. Two Israeli studies ten years apart discovered the exceedingly low prevalence of 1.4%. Explanations offered for the Israeli rate include heredity, early and frequent childbirth, and the orthodox Jewish sexual practice of avoiding intercourse during menstruation.
Causes
The cause or causes of endometriosis is unknown. Two basic hypotheses have been suggested:
Spread of endometrial tissue outside the uterus during menstruation
Conversion of undifferentiated cells to endometrium under an unknown influence, probably hormonal.
Currently the former is deemed more credible, so that it will be explored in more detail.
Laparoscopy has demonstrated blood and tissue do pass into the peritoneal cavity during menstruation, not just in some women, but in nearly all who have been tested. This endometriosis may result from a larger than normal amount of retrograde flow or from greater ability of endometrium to implant and grow in some women.
Conditions which may favor tubal flow of menstrum include:
Narrowing of the uterine cervix
Retroversion or retroflexion ("tipped uterus")
Heavy menstrual cramping and heavy flow
Tampon use
Intercourse or orgasm during menstruation
A greater number of menstrual periods may increase the total amount of tubal flow (simply by multiplication)
We do not know precisely the importance of the factors in the development of endometriosis. The determinants of endometrial tissue's ability to implant outside the uterus also are unknown.
Signs & Symptoms
Long-standing menstrual cramps, worsening in severity with age
Pain on intercourse (especially before or during menstruation)
Heavy bleeding or "old blood" clots
Constipation
Inability to conceive
Tender, hard nodules attached to the uterus and adnexa, especially in the cul-de-sac
Afebril patient
Normal CBC and serum chemistry (in contrast to Pelvic Inflammatory Disease)
Pelvic organs, fixed in place and tender
Endometriosis can only be diagnosed with certainty by biopsy through laparoscopy of laparotomy. Care must be taken in bimanual examination, especially during menstruation, so as not to dislodge fragments of endometrial tissue and spread the disease.
Nutritional Supplements
Structure & Function: Women's Health
---------------------------------
General Supplements
---------------------------------
B complex*
Beta carotene*
Bioflavonoids*
CoQ10*
Iron*
Vitamin C
*Please refer to the respective topic for specific nutrient amounts.
Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Discussion:
Since dysmenorrhea has been implicated as a possible cause of endometriosis, nutritional supplements known to help menstrual cramps may be helpful to those wishing to prevent endometriosis and may alleviate symptoms of patients with early disease.
Based largely upon European sources, the Propolis Information Bureau, in England, has recommended bee propolis for this condition.
Dietary Considerations
No program of dietary recommendations has been tested in the treatment of endometriosis. However, since dysmenorrhea has been implicated in the etiology of endometriosis, a diet known to help menstrual cramps may be helpful to those wishing to prevent endometriosis and may alleviate symptoms of patients with early disease.
Homeopathic Remedy
| 1.*Apocynum androsaemifolium | 15C |
| 2.Elaps corallinus | 15C |
| 3.Magnesia phosphorica | 30C |
| 4.Tarantula hispanola | 15 - 30C |
Treatment Schedule
Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
Legend
X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.
References
Boericke, D.E., 1988. Homeopathic Materia Medica.
Coulter, C.R., 1986. Portraits of Homeopathic Medicines.
Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.
Koehler, G., 1989. Handbook of Homeopathy.
Shingale, J.N., 1992. Bedside Prescriber.
Smith, Trevor, 1989. Homeopathic Medicine.
Ullman, Dana, 1991. The One Minute (or so) Healer.
Herbal Approaches
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Herbs
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Alfalfa
Black cohosh
Dandelion
False Unicorn Root
Nettle
Vitex
Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.
Discussion:
Alfalfa is a good source of vitamin K, which helps with blood coagulation.
Black Cohosh (derived from Native American herbology) is renowned as an analgesic and emmenagogue. (Bruneton, 1982)
Dandelion is a versatile component: diaphoretic, diuretic, laxative, nutritive...
False Unicorn Root is a uterine tonic.
Nettle is a rich source of iron.
Vitex (Agnus castus) is versatile: antihypermenorrhagic (Olin, 1995), emmenagogue and hormone balancer.
References:
Bruneton, J: The use of Actaea racemosa in dysmenorrhea and ovarian irritation. Practitioner, 1982, 48:265-268.
Moerman, D: Medicinal Plants of Native America. Tech Report of University of Michigan, Ann Arbor, 1986.
Olin, B (Ed.): The Lawrence Review of Natural products. Facts & Comparisons, St. Louis, 1992-1995.
Aromatherapy - Essential Oils
| Cinnamon Essence, | Cypress Essence, |
| Geranium Essence, | Juniper Essence, |
| Terebinth Essence. |
Related Health Conditions
AbstractsReferences
Arumugam K & Yip YC: De novo formation of adhesions in endometriosis: the role of iron and free radical reactions. Fertil Steril, 1995 Jul, 64:1, 62-4.
Arumugam K & Lim JM: Menstrual characteristics associated with endometriosis. Br J Obstet Gynaecol, 1997 Aug, 104:8, 948-50.
Benson, R. Gynecology and Obstetrics. Current Medical Diagnosis and Treatment. Krupp, M. & M. Chatton, eds. Lange Medical Publications: Palo Alto, 1981. pp. 443-444.
Brett KM et al., Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample. J Womens Health, 1997 Jun, 6:3, 309-16.
Brzezinski, A., et.al. Contribution to the problem of the etiology of endometriosis. Israel M.J., 1962: 21; 5.
Davis, V. Menstrual coitus and endometriosis. M.J. of Australia, 1981: 1; 648.
Dmowski WP et al., Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility. Fertil Steril, 1997 Feb, 67:2, 238-43.
Endometriosis: New Views, New Therapies. Round-table discussion. Patient Care, Nov. 1978: 12; 19.
Eskenazi B & Warner ML: Epidemiology of endometriosis. Obstet Gynecol Clin North Am, 1997 Jun, 24:2, 235-58.
Greenblatt, R.B. Endometriosis: The Nature of the Problem. Recent Advances in Endometriosis. Greenblatt, R.B. (Ed.) Elsevier: New York, 1976.
Hill JA et al., Immunology and endometriosis. Fact, artifact, or epiphenomenon? Obstet Gynecol Clin North Am, 1997 Jun, 24:2, 291-306.
Hoeger KM & Guzick DS: Classification of endometriosis. Obstet Gynecol Clin North Am, 1997 Jun, 24:2, 347-59.
Houlihan, P.: Traditional Chinese Medicine Becoming Another Health Care Option for Canadians. Canadian Medical Association Journal, 1993;149(4):482-483.
Merril, J. Endometriosis. Obstetrics and Gynecology. Romney, S., et. al. ed. McGraw-Hill: New York, 1975. pp. 883-893.
Older, Julia. Endometriosis. Charles Scribner's Sons: New York, 1984.
Portz, D. M. et al: Oxygen Free Radicals and Pelvic Adhesion Formation: I. Blocking Oxygen Free Radical Toxicity to Prevent Adhesion Formation in an Endometriosis Model. International Journal of Fertility, 1991;36(1):39-42.
Schifrin, B.S., et. al. Teenage endometriosis. Am J. Ob. and Gynecol, 1973: 116; 973.
Sharpe-Timms KL: Basic research in endometriosis. Obstet Gynecol Clin North Am, 1997 Jun, 24:2, 269-90.
Signorello LB et al., Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol, 1997 May, 7:4, 267-741.
Venter, P.F. Endometriosis. S. Afr. M.J., 1980: 57; 897.
Vercellini P et al., Menstrual characteristics in women with and without endometriosis. Obstet Gynecol, 1997 Aug, 90:2, 264-8.
Verspyck E et al., Treatment of bowel endometriosis: a report of six cases of colorectal endometriosis and a survey of the literature. Eur J Obstet Gynecol Reprod Biol, 1997 Jan, 71:1, 81-4.
Zeyneloglu HB et al., Environmental toxins and endometriosis. Obstet Gynecol Clin North Am, 1997 Jun, 24:2, 307-29.
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