Endometriosis is a condition where the lining of the uterus grows in abnormal places, usually in the pelvis. It's often linked to retrograde menstruation (when menstrual blood flows backward) but other factors like surgeries or cellular differentiation might also contribute. Endometriosis can be very painful and negatively impact a patient's quality of life. Integrative practitioners are crucial in helping patients manage this condition and find appropriate treatment options.
What is Endometriosis?
Endometriosis is a chronic condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and discomfort. Endometriosis can affect various parts of the body, including the fallopian tubes, ligaments, pelvic cavity lining, ovaries, the uterus's outer surface, and the space between the uterus and rectum or bladder.
Endometriosis can affect women of all ages, starting as early as their first period and continuing until menopause. It's a common condition, affecting approximately 5-10% of women and adolescents who can have children.
The precise cause of endometriosis remains elusive, but several factors are thought to play a role.
Retrograde Menstruation: This occurs when menstrual blood flows backward through the fallopian tubes, potentially implanting endometrial tissue in the pelvic cavity.
Genetic Predisposition: Family history can increase the risk of developing endometriosis, suggesting a genetic component.
Immune System Imbalance: The immune system may regulate the growth and behavior of endometrial tissue.
What are the Symptoms of Endometriosis?
The main symptoms of endometriosis include:
Pelvic pain that worsens during menstrual periods
Cramps that begin before and extend after a menstrual period
Lower back or abdominal pain
Pain with intercourse
Pain with bowel movements or urination
Heavy or irregular menstrual periods
Infertility
An Integrative Approach to Endometriosis
There are adverse effects associated with the current conventional means of treating endometriosis. This is problematic because these adverse effects limit their long-term use, and conventional therapies tend to need to be taken long-term since symptoms usually return after cessation of these therapies. Therefore, as practitioners, it is in our and our patients’ best interest for us to familiarize ourselves with integrative therapies that have more tolerable side effect profiles. This includes nutritional therapies and botanical products.
In my clinical experience, plant-based diets tend to be highly beneficial in the treatment of endometriosis.[2] This is likely because plant-based foods contain anti-inflammatory components that modulate immunological and inflammatory body processes.[3] Furthermore, research demonstrates that the ratio of the omega-3 fatty acid eicosapentaenoic acid (EPA) to the omega-6 fatty acid arachadonic acid (AA) is a relevant factor in indicating the severity of disease in endometriosis.[4]
Although plant-based foods contain comparatively low amounts of EPA, they also contain virtually no pre-formed AA. Animal-based foods, on the other hand, are much higher in pre-formed AA, with grain-fed meat having, on average, an up to five times higher omega-6 to omega-3 ratio than grass-fed meats.[5] Therefore, I typically recommend completely plant-based diets for my patients with endometriosis, and I have seen stellar results with this dietary intervention alone. If compliance is difficult for this dietary intervention, I recommend a mostly plant-based diet with some fish. If that is also too difficult, I recommend that they at least choose grass-fed meats over grain-fed meats.
How to Use Integrative Medicine to Support Patients Taking Conventional Medicine for Endometriosis
In cases where the severity of our patients’ condition requires conventional therapies, we can still provide integrative support. For example, research demonstrates that oral contraceptive pills deplete various nutrients, including vitamins B2, B6, B9 (folate), B12, C, and E, and the minerals magnesium, selenium, and zinc.[6] We can make recommendations to replenish these nutrients using oral supplementation, or we can assist our patients by recommending and administering intravenous nutrient therapy to restore these nutrients.
[To find out more about integrating intravenous nutrient therapy into your practice, visit IV Nutritional Therapy Training for Healthcare Professionals.]
Furthermore, research demonstrates that pycnogenol, a natural nuclear factor-kappa B inhibitor, enhances the efficacy of oral contraceptives in the treatment of endometriosis.[7] Individuals who took pycnogenol along with oral contraceptive pills reported significantly greater decreases in pain scores compared to individuals on oral contraceptives alone.
Resveratrol is another natural constituent that may help potentiate the effects of oral contraception in the treatment of endometriosis. Research concluded “the addition of 30 mg of resveratrol to the contraceptive regimen resulted in a significant reduction in pain scores, with 82% of patients reporting complete resolution of dysmenorrhea and pelvic pain after 2 months of use.”[8]
What is the Functional Approach to Endometriosis?
The functional approach to endometriosis emphasizes addressing root causes and tailoring treatment to the individual. Key components include:
Comprehensive testing to identify hormonal imbalances, inflammation, gut issues, and nutrient deficiencies.
Personalized dietary changes, focusing on an anti-inflammatory diet.
Targeted supplements like omega-3s, turmeric, magnesium, and antioxidants.
Optimizing gut health through probiotics and prebiotics.
Regular physical activity, including yoga and walking.
Stress management techniques such as yoga, meditation, and deep breathing.
Prioritizing quality sleep for hormonal balance and recovery.
Emotional and psychological support through counseling or support groups.
Integrative therapies like acupuncture to alleviate pain and improve hormonal balance.
IV Therapy for Endometriosis
No specific intravenous (IV) therapy is commonly used to treat endometriosis. While some alternative practitioners may offer IV infusions of vitamins or minerals to manage symptoms, the effectiveness and safety of these treatments are not well-established. It is essential to consult a qualified healthcare provider to determine the best treatment plan based on individual needs.
The incidence and symptomatology of endometriosis
Endometriosis is a common women’s health problem. In fact, it’s estimated that 10% of the female population in America will be affected by endometriosis during their reproductive years, with an incidence of 2-4%.[1] The condition is a very common cause of chronic pelvic pain. Aside from chronic pelvic pain, common symptoms of endometriosis include dyspareunia, infertility, and menstrual irregularities such as dysmenorrhea, menorrhagia, and metrorrhagia, also referred to as intermenstrual bleeding.
Treatments for Endometriosis
Non-Surgical Treatments:
Pain medications (NSAIDs)
Hormonal therapies (oral contraceptives, progestins, GnRH agonists/antagonists, aromatase inhibitors)
Surgical Treatments:
Laparoscopy to remove endometrial tissue
Laparotomy for extensive endometriosis
Hysterectomy as a last resort
Fertility Treatments:
Laparoscopic surgery to improve chances of conception
Assisted reproductive technologies like IUI and IVF
Conventional Treatment for Endometriosis
The most common treatment options for endometriosis include:
Over-the-counter non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen
Hormonal contraceptives, including oral contraceptive pills, patches, and vaginal rings to help control estrogen levels and prevent abnormal thickening of the uterine lining
Gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of luteinizing hormone and follicular stimulating hormone in order to decrease estrogen levels and prevent menstruation
Progestin intrauterine devices, implants, injections, or pills to prevent menstruation and the growth of ectopic endometrial tissue thereby reduce the associated pain and symptoms in this population
Aromatase inhibitors to reduce estrogen levels and prevent build-up of the endometrium and the pain and symptoms associated therewith
Surgery to remove ectopic endometrial tissue while preserving the uterus and ovaries. This type of surgery is known as conservative surgery. In some cases, hysterectomy with oophorectomy is still performed; however, medicine is moving away from this approach because of associated symptoms.
What are the 4 Stages of Endometriosis?
The condition is classified into 4 stages based on the extent of tissue growth and adhesion formation:
Stage 1: Minimal - Isolated implants with no significant adhesions.
Stage 2: Mild - Superficial implants on the peritoneum and ovaries, with no significant adhesions.
Stage 3: Moderate - Multiple implants, both superficial and deeply invasive, with adhesions around the tubes and ovaries.
Stage 4: Severe - Multiple superficial and deep implants, large ovarian endometriomas, and dense adhesions.
Conclusion
In conclusion, endometriosis is a fairly common reproductive health concern. Conventional therapies are able to control pain and other associated symptoms for many patients; however, they are associated with unwanted side effects in many cases and symptoms often return with cessation of the therapy. As integrative practitioners, we can make dietary recommendations to address endometriosis-related concerns and use our integrative approach to support our patients who are using conventional therapies.
Related Blog Post: IV Therapy During Pregnancy
References
Fourquet, J., Sinaii, N., Stratton, P., Khayel, F., Alvarez-Garriga, C., Bayona, M., Ballweg, M. L., & Flores, I. (2015). Characteristics of women with endometriosis from the USA and Puerto Rico. Journal of endometriosis and pelvic pain disorders, 7(4), 129–135. https://doi.org/10.5301/je.5000224
Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. https://doi.org/10.2174/1567201816666181227112421
Watzl, B. (2008). Anti-inflammatory effects of plant-based foods and of their constituents. Int J Vitam Nutr Res. 78(6),293-298. doi: 10.1024/0300-9831.78.6.293
Khanaki, K., Nouri, M., Ardekani, A. M., Ghassemzadeh, A., Shahnazi, V., Sadeghi, M. R., Darabi, M., Mehdizadeh, A., Dolatkhah, H., Saremi, A., Imani, A. R., & Rahimipour, A. (2012). Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids. Iranian biomedical journal, 16(1), 38–43. https://doi.org/10.6091/ibj.1025.2012
Beezhold, B. L., & Johnston, C. S. (2012). Restriction of meat, fish, and poultry in omnivores improves mood: a pilot randomized controlled trial. Nutrition journal, 11, 9. https://doi.org/10.1186/1475-2891-11-9
Palmery, Maura & Saraceno, A & Vaiarelli, Alberto & Carlomagno, Gianfranco. (2013). Oral contraceptives and changes in nutritional requirements. European review for medical and pharmacological sciences. 17. 1804-13.
Maia, H., Jr, Haddad, C., & Casoy, J. (2013). Combining oral contraceptives with a natural nuclear factor-kappa B inhibitor for the treatment of endometriosis-related pain. International journal of women's health, 6, 35–39. https://doi.org/10.2147/IJWH.S55210
Maia, H., Jr, Haddad, C., Pinheiro, N., & Casoy, J. (2012). Advantages of the association of resveratrol with oral contraceptives for management of endometriosis-related pain. International journal of women's health, 4, 543–549. https://doi.org/10.2147/IJWH.S36825