What Is Endometriosis?
The
name endometriosis comes from the word "endometrium," the tissue
that lines the inside of the uterus. If a woman is not pregnant this
tissue builds up and is shed each month. It is discharged as menstrual
flow at the end of each cycle. In endometriosis, tissue that looks and
acts like endometrial tissue is found outside the uterus, usually inside
the abdominal cavity.
Endometrial tissue residing outside the uterus responds to the menstrual cycle in a way that is similar to the way endometrium usually responds in the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed.
However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced tissue has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around the area of endometriosis. These endometrial tissue sites may develop into what are called "lesions," "implants," "nodules," or "growths."
Endometriosis is most often found in the
ovaries, on the fallopian tubes, and the ligaments supporting the uterus,
in the internal area between the vagina and rectum, on the outer surface
of the uterus, and on the lining of the pelvic cavity. Infrequently,
endometrial growths are found on the intestines or in the rectum, on the
bladder, vagina, cervix, and vulva (external genitals), or in abdominal
surgery scars. Very rarely, endometrial growths have been found outside
the abdomen, in the thigh, arm, or lung. Physicians may use stages
to describe the severity of endometriosis. Endometrial implants that are
small and not widespread are considered minimal or mild endometriosis.
Moderate endometriosis means that larger implants or more extensive scar
tissue is present. Severe endometriosis is used to describe large implants
and extensive scar tissue.
What Are The Symptoms?
Most commonly, the symptoms of endometriosis start years after menstrual
periods begin. Over the years, the symptoms tend to gradually increase as
the endometriosis areas increase in size. After menopause, the abnormal
implants shrink away and the symptoms subside. The most common
symptom is pain, especially excessive menstrual cramps (dysmenorrhea)
which may be felt in the abdomen or lower back or pain during or after
sexual activity (dyspareunia). Infertility occurs in about 30 to 40
percent of women with endometriosis. Rarely, the irritation caused by
endometrial implants may progress into infection or abscesses causing pain
independent of the menstrual cycle. Endometrial patches may also be tender
to touch or pressure, and intestinal pain may also result from endometrial
patches on the walls of the colon or intestine.
The amount of pain is not always related to
the severity of the disease-some women with severe endometriosis have no
pain; while others with just a few small growths have incapacitating pain.
Endometrial cancer is very rarely associated with endometriosis, occurring
in less than 1 percent of women who have the disease. When it does occur,
it is usually found in more advanced patches of endometriosis in older
women and the long-term outlook in these unusual cases is reasonably good.
How Is Endometriosis Related To Fertility Problems?
Severe endometriosis with extensive scarring and organ damage may affect
fertility. It is considered one of the three major causes of female
infertility. However, unsuspected or mild endometriosis is a common
finding among infertile women and how this type of endometriosis affects
fertility is still not clear. While the pregnancy rates for patients with
endometriosis remain lower than those of the general population, most
patients with endometriosis do not experience fertility problems.
What Is The Cause Of Endometriosis?
The cause of endometriosis is still unknown. One theory is that during
menstruation some of the menstrual tissue backs up through the fallopian
tubes into the abdomen, where it implants and grows. Another theory
suggests that endometriosis may be a genetic process or that certain
families may have predisposing factors to endometriosis. In the latter
view, endometriosis is seen as the tissue development process gone awry.
Whatever the cause of endometriosis, its
progression is influenced by various stimulating factors such as hormones
or growth factors. In this regard, investigators are studying the role of
the immune system in activating cells that may secrete factors which, in
turn, stimulate endometriosis.
In addition to these new hypotheses, investigators are continuing to look
into previous theories that endometriosis is a disease influenced by
delayed childbearing. Since the hormones made by the placenta during
pregnancy prevent ovulation, the progress of endometriosis is slowed or
stopped during pregnancy and the total number of lifetime cycles is
reduced for a woman who had multiple pregnancies.
How Is Endometriosis Diagnosed?
Diagnosis of endometriosis begins with a gynecologist evaluating the
patient's medical history. A complete physical exam, including a pelvic
examination, is also necessary. However, diagnosis of endometriosis is
only complete when proven by a laparoscopy, a minor surgical procedure in
which a laparoscope (a tube with a light in it) is inserted into a small
incision in the abdomen. The laparoscope is moved around the abdomen,
which has been distended with carbon dioxide gas to make the organs easier
to see. The surgeon can then check the condition of the abdominal organs
and see the endometrial implants.
The laparoscopy will show the locations, extent, and size of the growths and will help the patient and her doctor make better-informed decisions about treatment. Endometriosis is a long-standing disease that often develops slowly.
What Is The Treatment?
While the treatment for endometriosis has varied over the years, doctors
now agree that if the symptoms are mild, no further treatment other than
medication for pain may be needed. For those patients with mild or minimal
endometriosis who wish to become pregnant, doctors are advising that,
depending on the age of the patient and the amount of pain associated with
the disease, the best course of action is to have a trial period of
unprotected intercourse for 6 months to 1 year. If pregnancy does not
occur within that time, then further treatment may be needed.
For patients not seeking a pregnancy where treatment specific for the
management of endometriosis is required and a definitive diagnosis of
endometriosis by laparoscopy has been made, a physician may suggest
hormone suppression treatment. Since this therapy shuts off ovulation,
women being treated for endometriosis will not get pregnant during such
therapy, although some may elect to become pregnant shortly after therapy
is stopped.
Hormone treatment is most effective when the implants are small. The
doctor may prescribe a weak synthetic male hormone called Danazol, a
synthetic progestin alone, or a combination of estrogen and progestin such
as oral contraceptives.
Danazol has become a more common treatment choice than either progestin or
the birth control pill. Disease symptoms are improved for 80 to 90 percent
of the patients taking Danazol, and the size and the extent of implants
are also reduced. While side effects with Danazol treatment are not
uncommon (e.g., acne, hot flashes, or fluid retention), most of them are
relatively mild and stop when treatment is stopped. Overall, pregnancy
rates following this therapy depend on the severity of the disease.
However, some recent studies have shown that with mild to minimal
endometriosis, Danazol alone does not improve pregnancy rates.
It is important to remember that Danazol
treatment is unsafe if there is any chance that a woman is pregnant. A
fetus accidentally exposed to this drug may develop abnormally. For this
same reason, although pregnancy is not likely while a woman is taking this
drug, careful use of a barrier birth control method such as a diaphragm or
condom is essential during this treatment.
Another type of hormone treatment is a synthetic pituitary hormone blocker
called gonadotropin-releasing hormone agonist, or GnRH agonist. This
treatment stops ovarian hormone production by blocking pituitary gland
hormones that normally stimulate ovarian cycles.
These hormones are currently being tested using different methods of administration. One such treatment involves a drug that is administered as a nasal spray twice daily for 6 months and works by suppressing production of estrogen, which controls the growth of the endometrial tissue. Other treatments being developed in this category include daily or monthly hormone injections. One concern is the loss of bone mineral which occurs with this type of hormone therapy. This may limit the duration and frequency of this type of treatment.
While pregnancy rates for women with fertility problems resulting from endometriosis are fairly good with no therapy and with only a trial waiting period, there may be women who need more aggressive treatment. Those women who are older and who feel the need to become pregnant more quickly or those women who have severe physical changes due to the disease, may consider surgical treatment. Also, women who are not interested in pregnancy, but who have severe, debilitating pain, may also consider surgery.
Conservative surgery attempts to remove the diseased tissue without risking damage to healthy surrounding tissue. This surgery is called laparotomy and is performed in a hospital under anesthesia. Pregnancy rates are highest during the first year after surgery, as recurrences of endometriosis are fairly common. The specifics of the surgery should be discussed with a doctor.
Some patients may need more radical surgery to correct the damage caused by untreated endometriosis. Hysterectomy and removal of the ovaries may be the only treatment possible if the ovaries are badly damaged. In some cases, hysterectomy alone without the removal of the ovaries may be reasonable.
New surgical treatments are being developed that further utilize the laparoscope instead of full abdominal surgery. During routine laparoscopy, the surgeon can cauterize small areas of endometriosis. Other evolving techniques include using a laser during laparoscopy to vaporize abnormal tissue. This involves a shorter recovery time. Laparoscopy treatment is possible, however, only if the surgeon can see pelvic structures clearly through the laparoscope. These newer techniques should be performed by surgeons specializing in such delicate procedures. Although these techniques are promising, more study is needed to determine if they yield results comparable to conventional surgical management.
Natural Treatments:
Supplement the diet with vitamin C, vitamin B-6, folic acid, calcium, magnesium, essential fatty acids such linoleic acid, and evening primrose oil.
Avoid caffeine, sugar, alcohol, and acid-forming foods (red meat, dairy products, heated or treated oils, and excess carbohydrates, especially refined products).
Try a short juice fast to clear out the body, and follow up with cultured foods such as miso or tempeh, unless you have a food allergy to soy products. After cleansing the body, plenty of fresh greens, fresh fruits in season, and a reasonable quantity of whole grains provide strength. Include changes to stabilize hypoglycemia (low blood sugar), such as eating smaller meals. As always, eating little or no animal fat decreases harmful excess estrogen.
The following food items are especially good:
Soybean (Glycine max) and Other Beans:
Soybeans are high in estrogen-like plant compounds, genistein and daidzein. These prevent your body from taking up the more harmful forms of estrogen circulating in your blood. These phytoestrogens take the place of the bad estrogen, binding to the cell's estrogen receptor sites and prevent more harmful estrogens from binding to these receptors. They also protect the body from pollutants that chemically mimic estrogen.
Bean sprouts supply more genistein (the more active of the two phytoestrogens) than soybeans. As beans germinate, their genistein content increases. If the sprouts have fungi, the genistein content may increase as much as hundred-fold!
Pinto beans, yellow split beans, black turtle beans, lima beans, anasazi beans, red kidney beans, red lentils, black eyed peas, mung beans, adzuki beans and fava beans are other sources of these important phytoestrogens.
If you have endometriosis, eat as much edible beans as possible as often as possible. Eat salds made of bean sprouts. Take bean soups, baked beans, and Mexican foods rich in beans such as burritos.
Flax (linum Usitatissimum)
Flaxseed contains generous amounts of compounds called lignans, that is believed to help control endometrial cancer.
Flaxseed might be particularly helpful for anyone who is not a vegetarian, Vegetarians have high blood and urine levels of lignans. Consuming meat suppresses lignans substantially. Flaxseed helps to supplement this deficit.
Peanut (Arachis hypogaea)
Peanuts contain many of the healthful substances as soybeans and other beans. Many people prefer the taste of peanuts over soybeans.
The papery red membrane surrounding spanish peanuts is a source for oligomeric procyanidins (OPCs), substances that may help control hormone dependent cancers and possibly endometriosis.
Alfalfa (Medicago sativa):
Alfalfa sprouts contain phytoestrogens. Use them liberally on salads. Eating them also reduces the risk of contracting cancer. (Do not consume alfalfa if you or your family has a history of lupus.)
Evening Primrose Oil (Oenothera biennis):
EPO contain gamma-linolenic acid (GLA) and tryptophan, substances that promote good health in women.
- 150 microgramsliquid potassium: taken in recommended doses - 3 times a day
vitamin E: 8-1 0 milligrams alpha-TE (alpha tocopherol equivalent)
- may use 200-600 IU (up to 1,200 IU maximum)magnesium - 400 milligrams
- 800 milligrams - 800 RE (retinol equivalent); may use 5,000 IU (up to 50,000 IU for four months or less) - 10 RE; may use 400 IU (up to 1,000 IU maximum) - 300 milligrams (up to 1 0 grams)GLA - Gamma-Linolenic Acid - eight 500 milligram capsules per day for six to ten weeks, if women can afford this dose (most effective)