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Endometriosis

The ectopic occurrence of endometrial tissue is a common problem which has no known etiology but a higher occurrence is seen in women who defer pregnancy until later in life. Fiberoptic laparoscopic techniques allow a direct look at the problematic tissue. Endometriosis is a painful, devastating disease in which small islets of endometrial tissue somehow migrate into the muscular wall of the uterus, out along the Fallopian tubes, and even to the surface of the ovaries and the pelvic contents, including the nearby colon. When observed at surgery, these small islets appear as tiny chocolate-colored blobs scattered here and there, some so small as to be nearly invisible to the unaided eye. Being endometrial tissue, they respond to the monthly surges of estrogen and progesterone exactly like the endometrium within the uterus, i.e., they swell with blood during the month and then bleed at menses time, causing considerable pain starting shortly before menstruation and not subsiding until after menstruation. The small drops of blood trapped in the tissue in which the endometrial islets are embedded become chocolate-colored over time. When confined to the muscular wall of the uterus, the condition is called adenomyosis and can cause significant pain with menstruation, otherwise known as dysmenorrhea. The cause of this disorder is presently unknown. There is no mechanism known by which endometrial tissue could migrate throughout the pelvis as some cancers are able to. The hypothesis that scattered islets of endometrial tissue persist from embryonal time likewise is unproved. Further, the disorder appears to be of modern origin; it is difficult to imagine that such a painful disorder could have existed a century or two ago without some medical comment of it being made. Some have hypothesized that it has something to do with the long time (and the many menses) between menarche and the first pregnancy. Until this century, women in the Northern hemisphere typically experienced only two or three years of menstruation before becoming pregnant, menarche being at about age 16 and first pregnancies at about age 18 or 19. Now, menarche is common at age 12 and pregnancy is often delayed until after the mid-20’s. It has been calculated that the number of menses between menarche and first pregnancy was typically less than 30, whereas now it customarily exceeds 150. The outward migration of endometrial cells may somehow result from such a long run of menstrual cycling in sexually active women without the hormonal “rest” of pregnancy. Further study is obviously needed. Medical treatment of this disorder has included low-dose synthetic estrogen (to suppress endogenous estrogens), high-dose synthetic progestins taken daily or as long-acting IM injections of synthetic progestins (to suppress menses), and analgesics, including codeine and narcotics, for pain. The results are generally unsuccessful. Surgical treatment attempts to resect all visible endometrial lesions is also rarely successful. Almost invariably, it becomes necessary to ablate (remove or destroy) both ovaries, tubes, and the uterus, regardless of the patient’s age. When confined to the uterus (adenomyosis), hysterectomy is usually recommended. Natural progesterone offers a more benign alternative since sufficient serum progesterone inhibits FSH and LH.


Naturopathic Approach to Endometriosis

A naturopathic approach to treating someone with endometriosis would start with ordering a complete hormone panel to evaluating the balance of the hormones. Most often women with endometriosis are estrogen dominant and see fantastic results with an estrogen detoxification program. Also frequently I see low progesterone, mostly as a result of insulin resistance. Therefore a low glycemic anti-inflammatory meal plan is implemented and at times either bio-identical progesterone or Chaste berry is prescribed to bring progesterone levels back into normal range. Proteolytic enzymes may be used to help with the destruction and re-absorption of the excess tissue. Quite often castor oil packs can offer relief at the most symptomatic times.

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