What is the medical definition of endometriosis?
Endometriosis is the occurrence of pseudocysts in response to endometrial tissue that is in the pelvic cavity in areas of the body other than the endometrium.
What causes it?
When hormones are not regulated, the layer of tissue that normally gets sloughed off during menses does not get sloughed off, and adheres to various pelvic organs.
What are the symptoms?
Degrees of pain and discomfort vary in women, some cases being quite severe and others only mild. The severity usually corresponds with the organs affected, which can be fallopian tubes, ovaries, rectum, bladder and even sites outside of the pelvic cavity in very severe cases. Because the blood and displaced cells have no place to go, the result is that layers of connective tissue develop in response to the confined fluid, and the resulting cysts can grow to considerable size. They are considered pseudocysts because they do not have an epithelial lining.
The main symptoms that arise include increased menstrual bleeding, severe menstrual pain, pain on having intercourse, general pelvic pain (possibly due to adhesions), and changes in bowel conditions with menstruation (due to cysts adhered to the intestine; there can even be rectal bleeding).
How is it diagnosed?
Endometriosis is suggested by such symptoms, but it is confirmed only by laparoscopy, which is the insertion of a small viewing tube into the abdomen. The endometrial cysts usually appear dark blue to brown (called “chocolate cysts” because of their color), or they may appear as lesions.
What are the treatment options, both western and eastern?
Conventional (western) treatment is drug therapy, which is often unsatisfactory. Most of the current drug therapy is aimed at altering the hormones (Sai Kong et al., 2014), for example, by giving the testosterone derivatives danazol or methyltestosterone, giving progesterone and related progestogens, or using Buserelin, Goserelin, Lupron or other Gn-RH antagonists (that cause ovarian inhibition). One can also use analgesics that block prostaglandins to relieve the severe dysmenorrhea. An emerging area of research in the use of aromatase inhibitors is underway as these have been studied and shown to target estradiol and slow secretion of this form of estrogen (Nothnick, 2011). Research shows that positive results were obtained for the first 3-6 months of treatment, however, after this period of time women found that their pelvic pain returned and that they also suffered side effects including weight gain, joint pain, spotting and migraines.
Surgical removal or aspiration of endometrial cysts usually provides only temporary benefits and may cause secondary problems, including persistent abdominal pain due to adhesions. Therefore, alternative treatments are of interest to those who suffer from endometriosis. Chinese medical treatments have been reported to be highly successful and patients overwhelmingly prefer this non-invasive form of therapy that does not cause side effects.
Acupuncture and herbal medicines (eastern) treatment not only address the symptoms of endometriosis, such as dysmenorrhea and pelvic pain, but can actually get to the underlying cause of the problem as well. Acupuncture can promote blood circulation to the pelvis, reduce pain, and adjust hyper-or hypo-hormonal feedback to the brain.
Blood stasis, a condition where small vessels are not capable of carrying normal blood flow, is believed to be the cause of severe pain, especially lower abdominal pain, and it is believed responsible for many cases of excessive menstrual bleeding and infertility. The underlying causes of the blood stasis, in turn, are mainly the syndromes of qi stagnation (restricted circulation caused by emotional distress) and coldness (impaired metabolism and circulation), sometimes described as kidney yang deficiency. Therefore, when applying the ideas of traditional Chinese medicine, endometriosis will usually be treated by acupuncture and herbs that vitalize blood circulation as the primary therapy.
Oftentimes herbs and acupuncture are staged such that a course of treatment will allow the body to adjust to each step of repairing and restoring healthy endometrium. Initially points to promote blood circulation and ease pain are used in conjunction with points that release channels detected as “locked” or “slack.” For example, Spleen 6, located above the inner ankle bone, intersects all three yin channels (Liver, Spleen & Kidney) and is able to invigorate circulation to the pelvic area (Acupuncture and herbs…, 2017). This point might be combined with Gall Bladder 29, located on the lower abdomen, with the function of releasing swelling in the pelvic area.
Acupuncture is a science and an art. Detecting the layer of energy that is weakest is definitely part of successfully freeing flow of blood and lymph. For example, a person with immune system weakness (gets colds easily, has chronic cough or allergies) will need more work towards improving this level of energy (wei qi, or immune level) before any progress can be made on deeper (organ level) changes. A treatment plan is typically provided at the initial appointment to prescribe estimated number of treatments, whether herbs will be employed, and any nutritional or dietary modifications that will assist treatment goals.
Herbal treatments are often as important, and sometimes more so than acupuncture, and in my own clinical experience, both strategies are required to achieve the best outcome. A separate post on herbal treatments for endometriosis will be posted soon.
REFERENCES
Acupuncture and herbs ameliorate endometriosis. (2017). Retrieved from https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1800-acupuncture-and-herbs-ameliorate-endometriosis
Nothnick, W.B. (2011). The emerging use of aromatase inhibitors for endometriosis treatment. Reproductive Biology & Endocrinology, 9 (Article 87). https://doi.org/10.1186/1477-7827-9-87
Sai Kong, Yue-Hui Zhang, Chen-Fang Liu, Ilene Tsui, Ying Guo, Bei-Bei Ai & Feng-Juan Han. (2014). Complementary and alternative medicine for endometriosis: A review of utilization and mechanism”, Evidence-Based Complementary and Alternative Medicine, Article ID 146383, https://doi.org/10.1155/2014/146383
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