March is endometriosis awareness month, so it’s time for me to talk Endo. Endometriosis New Zealand estimates at least 120,000 girls and women in New Zealand are living with Endometriosis – so it’s important we are all more aware of this condition and how it affects women.
First of all, let’s talk about what Endometriosis is and how it presents, then consider what we can do about it.
The endometrium is the lining of the uterus, and endometriosis means that tissue like the endometrium is found outside of the uterus. Often this is in other parts of the pelvis, such as peritoneum, ovaries or intestines, but it can also be in the muscles of the uterus or sometimes outside the pelvic region as well. This can be intensely painful, start prior to the period, and also be painful during sex, and while urinating or defecating. Bleeding can be heavy, and there may be spotting or bleeding between the periods. It can also be very tiring, cause other gastrointestinal issues, and also infertility or difficulty conceiving.
Retrograde menstruation is one theory about how the lesions end up in other parts of the pelvis, and this is when during menstruation instead of the blood just going down through the cervix and leaving the body through the vagina, some flows upwards through the fallopian tubes, and out into the pelvic cavity. While this is normal and can happen in all women, cells or superficial lesions from retrograde menstruation should be cleaned up by the immune system, but this doesn’t happen in endometriosis.
There are other things we need to be aware of as well. Oestrogen stimulates endometriosis lesions, and the lesions have fewer progesterone receptors to normal endometrial tissue. Endometriosis lesions also have more nerve tissue than normal endometrium, and can have a high iron concentration in the tissue (even if they are anaemic), and low oxygen.
There are particular genetic changes that make you more likely to get endometriosis, including exposure to environmental toxins like dioxins even as far back as your grandmother, and low androgens in utero, which can also be due to environmental toxins. Girls and women who are more at risk of endo also have genetic polymorphisms associated with autoimmune diseases, and can have a nickel allergy.
Endometriosis is considered to be an inflammatory disease, but Lara Briden, naturopathic doctor, talks about it as a disease of immune dysfunction. A recent theory with some merit, is that bacterial endotoxins are responsible for a cascade that leads to endometriosis. This may be from dysbiosis of the normal bacterial balance of the vagina, or from ‘leaky gut’ which is often seen with irritable bowel syndrome or SIBO in endometriosis.
What can we do about this?
Conventional treatment of endometriosis include:
*Hormonal treatment – either with a progetogen only contraceptive or a combined oral contraceptive if contraception is required, or an alternative progestogen orally in higher doses. A progestogen implant or intrauterine device can also be used. Later options include gonadotrophin-releasing hormone analogues like goserelin to lower the oestrogen levels, but these do have more adverse effects and are usually used when other measures are not enough.
*Pain relief – usually Non-steroidal antiinflammatory drugs (NSAIDs) like Naproxen, and/or Paracetamol.
*Surgery – firstly laparoscopic to remove all visible lesions. While this can improve or just retain fertility, it does have a higher rate of recurrence. If this is ineffective, or there is no desire to conceive, radical surgeries including hysterectomy or removing fallopian tubes or ovaries may be recommended.
Integrative and naturopathic options include:
*Diet and lifestyle – addressing the gut, particularly if there is IBS or SIBO, but also the increased permeability. With an autoimmune genotype it can be useful to avoid gluten (particularly if you have a coeliac gene), and A1 dairy. Remove inflammatory foods – like high sugar, and seed oils. If nickel is an issue, a low-nickel diet, reducing wheat and dairy and some canned foods like tomatoes is useful. A Naturopath or holistic Nutritionist could help you with an individualised plan here.
*Antibiotics have been shown to reduce the size of lesions (further supporting the idea of a bacterial cause). Conventional doctors may not be willing to prescribe on this basis, but there are a number of antimicrobial naturopathic options, including berberine, oregano and lactobacillus GG. Please talk to a Naturopath for more support here!
*Targeted supplements to support the immune system, including zinc, retinol, selenium, N-acetyl cysteine (NAC), vitamin D, curcurmin and resveratrol. These can work in various ways, including reducing the macrophage activation, supporting detox pathways, supporting the body to clean up by programming cell death for unhealthy cells in the lesions, and reducing the formation of nerves and blood supply to those areas. Again, see a Naturopath for help!
*Pelvic floor therapy – with a specialised physio to address any dysfunction, given that in some cases lesions are related to pelvic floor problems.
*Stress and trauma support, including considering the vagus nerve and the amygdala in the brain. The vagus nerve regulates everything from your immune system and digestion to your breathing, heart rate and mood. The amygdala is the part of your brain involved with emotional processing, and the effect of emotions like anger and fear if not dealt with have an effect on the whole body. There are a wide variety of ways to deal with these, whether it is somatic processing, support with herbs and supplements from a naturopath or medical processing, energy healing or something else – find an option that works for you.
Now let’s consider homeopathy:
With homeopathy we are always looking for a remedy that matches the symptoms and experience that you have. Below are remedies that are listed strongly in my repertory for endometriosis, although the information about them is lacking. I have only included short snapshots of these remedies, and while they are listed clinically for endometriosis, the picture is lacking for some of them. However homeopathy matches symptoms not conditions, and there are many other remedies that will be able to help – a Homeopath can help you find the right one(s).
Onchorynchus tschawythscha is the pacific salmon, and has a big female hormonal picture. There are periods that are too frequent, cramping pain that feels better for bending forward, and pain in the left ovary.
Hirudo medicinalis is the leech. I could not find any homeopathic indications, but leech therapy can be used for endometriosis and leeches are used in Korean and Chinese medicine “toxic animal based medicinal materials”.
Crotalus Cascavella is the Brazilian rattlesnake, and has periods with heavy flow for two days, then bleeding that comes on and off. Blood is dark, and offensive. There is severe pains at the beginning of the period, which comes with pain that extends down the thighs. There can also be tenderness around the ovaries.
Peganum harmala is wild rue, a herb that has use as a uterine stimulant, and is also antimicrobial. Homeopathically while it is listed for endometriosis there are not a lot of associated symptoms, instead it can have suppressed periods. However there can be sharp, cutting abdominal pains, and a weak perineum which does fit with endometriosis.
Other remedies to consider include some polychrests that have a big female hormonal picture, such as Pulsatilla, Sepia and Lachesis.
I have one last remedy to include, not from my homoepathic literature, but from research.
Oestrogen- a Brazilian placebo controlled study gave women oestrogen in 12c, 18c, or 24c twice daily for 24 weeks, and found that the oestrogen was significantly more effective than placebo for reducing symptoms.
Photo by Polina Zimmerman.