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ENDOMETRIOSIS
By John G. Connor, M.Ac., L.Ac.
April, 2000
· Barbara and I are always looking for ways we can help those suffering from endometriosis. The craniosacral acupuncture and hara visceral work is very helpful in getting things moving energetically and in terms of improved fluid exchange, improved delivery of nutrients and removal of metabolic waste products in the affected areas. The visceral mobilization work is especially useful in releasing those restrictions which are due to adhesions. When indicated we also use herbs, supplements, diet and lifestyle recommendations in our treatment program. We hope the following article gives you a better understanding of endometriosis and how we treat it.
· Endometriosis is defined as the occurrence of pseudocysts in response to endometrial tissue that is in the pelvic cavity other than as part of the endometrium. This tissue adheres to various pelvic organs, responds to the hormones of the menstrual cycle and sloughs tissue and blood, as does the endometrium.
· Symptoms 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.
· Endometriosis sometimes vanishes with a pregnancy or disappears for a while afterward only to return later, and it fades with menopause. Estrogen replacement therapy can cause endometrial hyperplasia and stimulation of endometrial cysts, but combined therapies with progesterone and its derivatives avoid this problem.
· The exact cause of endometriosis is not known, but the classic theory is that endometriosis results when menstrual blood and tissue go backwards up the fallopian tubes and become seeds of implants in the pelvic cavity.
· A second theory is that pelvic tissues spontaneously convert to endometrial tissue possibly due to irritation or hormonal activity from environmental toxins such as dioxin, which can have estrogen-like activity. Evidence for higher concentrations of dioxin in women with endometriosis is beginning to surface.
· A third theory is that it is congenital and arises from embryonic female genital tissue that never made it to the inside of the uterus during development. This theory helps explain why endometriosis can run in families and why some girls have severe pelvic pain from endometriosis as soon as they start their periods.
· A fourth theory suggests that autoimmune processes are involved that may include autoimmune responses aimed at hormones and/or at components of the cysts.
· Some experts feel that the endometrial lesions secrete some kind of chemical that results in bleeding from the surrounding capillaries in the peritoneum. Over time, this monthly bleeding into the pelvic cavity is believed to be the cause of painful cysts and adhesions that tend to flare up under certain circumstances.
· Patients with endometriosis have been found to have high levels of immunoglobulins IgG and IgM that cause the destruction of the body’s own tissue, as seen in autoimmune conditions. Natural killer cell activity has also been found to be suppressed in the peritoneal fluid of women with severe endometriosis, which decreases the immune defense against the growth of tissue.
· Endometriosis symptoms are exacerbated by an excess of series 2 eicosanoids, such as prostaglandin F2 alpha (the same hormone associated with menstrual cramps), and a lack of series 1 eicosanoids, which help the body by preventing inflammation, opening up blood vessels, helping move fluid thorough the body and helping improve nerve and immune function. Prostaglandins of the 1 and 3 series are generally viewed as “good” prostaglandins, while prostaglandins of the 2 series are viewed as bad. Prostaglandins of the 1 and 3 series prevent platelet aggregation, improve blood flow and reduce inflammation, while prostaglandins of the 2 series lead to hardening of the arteries, heart disease and strokes.
· Endometriosis is an estrogen-sensitive disease and symptoms are increased by estrogen. Substances that have been shown to have estrogenic effects in the body include polychlorinated biphenyls (PCBs), weed killers, substances that line cans, plastics, detergents, and household cleaners. Since the liver is involved in breaking down 80-90 percent of the hormones in the body, it follows that optimal liver function can be of benefit in treatment.
Possible traditional Chinese medicine diagnoses of endometriosis include:
- Stagnant Liver Qi and Blood Stagnation
- Accumulation of Cold causing Blood Stagnation
- Heat Congestion with Blood Stagnation
- Qi and Blood Deficiency with Blood Stagnation
The diagnosis that most closely matches the symptoms of endometriosis is Qi and Blood Stagnation. According to some studies, both problems need to be addressed, but at the root of it all is Kidney Qi Deficiency.
· Chinese Herbal Formulas There are several Chinese herbal formulas which could be very useful depending on the specific traditional Chinese medical presentations of each case.
· Carrots, kale, broccoli, brussel sprouts, cabbage, cauliflower, beets, artichokes, lemons, dandelion greens, watercress, burdock root, onions, garlic and leeks contain compounds that enhance liver function, thereby preventing the buildup of toxins and metabolites that produce cell damage.
· Flaxseeds or flaxseed oil is an excellent source of omega-3 and omega-6 fatty acids. Flaxseed oil has been found to be beneficial in the treatment of PMS, inflammatory conditions and improving overall vitality. It is also beneficial in treating heart disease, cancer, diabetes, arthritis, asthma, allergies, water retention and skin conditions. Omega-3 fatty acids are the precursors of the good prostaglandin 3 series.
· Soybean oil, light sesame oil, walnut oil, hazelnut oil, macadamia nut oil and peanut oil are good sources of quality omega-6 fatty acids.
· Cod, mackerel, sardines and salmon are good sources of omega-3 fatty acids.
· Cruciferous vegetables, kale, collar greens, broccoli, cabbage and turnip greens modulate estrogen levels.
· Dark green leafy vegetables, cold-pressed vegetable oils, legumes, nuts, seeds, whole grains, brown rice, eggs, kelp, desiccated liver, milk, oatmeal, soybeans, sweet potatoes, watercress, wheat, wheat germ, flaxseed and don quai contain vitamin E. Vitamin E helps to correct abnormal progesterone/estradiol ratios in patients with mammary dysplasia (increased growth of cells). Since parallels have been found between abnormal tumor growth in cancer and abnormal growth of lesions in endometriosis, vitamin E supplementation may be advantageous in cases of endometriosis. Also, studies on the use of vitamin E with primary dysmenorrhea show benefit perhaps through the inhibition of the arachidonic lipid pathway, thereby preventing the release of chemicals that would normally cause edema, inflammation and smooth muscle contraction.
· Carrots, sweet potatoes, collard greens, cantaloupe, squash, apricots, fresh pumpkin, kale, spinach, mangos, papayas and yams contain beta-carotene, which helps enhance immunity. In addition, beta-carotene was shown to be protective against early stages of tumor growth.
· Citrus fruits, acerola cherries, sprouted alfalfa seeds, black currants, guava, papaya, tomatoes, cantaloupe, strawberries, kiwi fruit, broccoli, green peppers, brussel sprouts, cabbage cauliflower, kale and peas contain vitamin C, which has been shown to decrease autoimmune progression and fatigue. Vitamin C also enhances immunity and decreases capillary fragility and tumor growth, all of which are involved at various levels in women with endometriosis.
· Soy foods, tofu, tempeh, and miso may also help.
· Turmeric seasoning protects against environmental carcinogens, decreases inflammation and increases bile secretion.
· Ginger helps with liver detoxification.
· Milk thistle helps with liver function.
· Fiber helps restore the balance of friendly bacteria in the large intestine, which can crowd out the unfriendly bacteria responsible for increasing estrogen reabsorption.
· Sugar is known to increase estrogen levels in men; presumably the effect is similar in women. Sugar also weakens the Spleen and, therefore, the healthy creation of Qi and Blood. It also tends to create Dampness, which hinders the Spleen function even more.
· Caffeine and other substances containing methylxanthines tend to inhibit the action of cAMP and cGMP phos-phodiesterase, which yields a marked elevation of these levels in endometrial tissue. These increased levels of cyclic nucleotides tend to have a marked effect on the protein-kinase activity and, as a result, lead to the overproduction of cellular material and cystic fluid.
· Coffee is very bad for any woman with Stagnant Liver Qi. Although it disperses Stagnant Qi, it wastes the Blood and Yin. Coffee gives a sense of energy and get-up-and-go by freeing up stuck Qi. But in the process, it also liberates stored jing, or essence in the Kidneys and, therefore, is deleterious to the health overall. Although caffeinated coffee has an even worse effect that decaf, it is not the caffeine alone that is the offending substance. There are many volatile oils in coffee that, as a whole, cause the problem.
· Alcohol use depletes stores of B vitamins in the liver and also has estrogenic effects on the body. Alcohol is dampening and also hot, therefore, it tends to not only create Dampness, but Damp Heat.
· Alcohol, cortisol and margarine inhibit the conversion of essential fatty acids to eicosanoid hormones that are needed for the optimal health of the female body.
· Meat and dairy foods are high in pro-inflammatory arachidonic acid. The EPA estimates that 90 percent of human dioxin exposure is through food, primarily meat and dairy products.
· Red meat, dairy products and alcohol may contain growth hormones, exogenous estrogens and xenobiotics.
· Sugar, saturated fats and oils tend to lower the pain threshold.
· Margarine is hydrogenated vegetable oil with high (40%) trans fatty acid content. Studies have shown that individuals who have developed heart disease and cancer have had diets high in trans fatty acids. The term “hydrogenated” signifies trans fatty acids in the food. Trans fatty acids, among other things, lower good HDL cholesterol, negatively affect the immune system and potentiate free radical formation.
· Avoid becoming angry, afraid or excessively emotional. Avoiding emotional excess helps to maintain an even, free flow of Qi and Blood.
· Avoid becoming fatigued just prior to and during menstruation. Fatigue can lead to Qi and Blood Deficiency and Blood Stasis.
· Avoid eating cold foods prior to or during periods, as cold depresses the digestion, thus hindering the production of Qi and Blood. Cold also constricts the flow of Qi and Blood.
· Avoid sex during your periods. Sex during periods can reverse the flow of Qi and Blood from down and out to up and in and definitely cause Blood Stasis.
· Reduce the stress (i.e., stagnant Qi) in your life, and cultivate, daily, 20-minute sessions of deep relaxation, via meditation, yoga or tai chi.
· Engage in moderate 20-minute physical exercise sessions every other day. This activity helps to increase the production of Qi and Blood thereby helping to clear away stagnation of Liver Qi and Blood Stasis. It will also improve one’s digestion, elimination, appetite, mood, energy and sleep.
· Practice good food combining, while following a diet similar to the macrobiotic diet.
· Drug therapy for endometriosis is often unsatisfactory. Most of the current drug therapy is aimed at altering the hormones. Surgical removal or aspiration of the endometrial cysts usually provides only temporary benefits and may cause secondary problems including persistent abdominal pain due to adhesions.
· Traditional Chinese medical treatments have been reported to be highly successful.
· Christiane Northrup says that natural progesterone often works very well to relieve endometriosis symptoms. She recommends 2% progesterone cream, one-quarter to one-half teaspoon on the skin twice a day. Natural progesterone helps counteract endometriosis by decreasing the effects of estrogen on the endometrial lesions. Natural progesterone is free from side effects. Use it on days 10-28 of each cycle.
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Balch, James F., M.D., Balch, Phyllis A., C.N.C., Prescription for Nutritional Healing Garden City Park: Avery Publish Group, 1997
Dharmananda, Subhuti, Ph.D., Treatment of Endometriosis with Chinese Medicine Portland: Institute for Traditional Medicine (undated article)
Flaws, Bob, Endometriosis, Infertility and Traditional Chinese Medicine Boulder: Blue Poppy Press, Inc., 1989
Hudson, Tori, N.D., Women’s Encyclopedia of Natural Medicine Los Angeles: Keats Publishing, 1999
Northrup, Christiane, M.D., Women’s Bodies, Women’s Wisdom New York: Bantam Books, 1998
Strehl, Frank E., DC, Effective Conservative Treatment of Endometriosis The Internist, March 1998
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Copyright © 2005 John G. Connor