Abundant Spring | Endometriosis and Chinese Medicine

Endometriosis

Endometriosis and Chinese Medicine
By Lee Hullender, MS, LAc

Intro
The menstrual period is dreaded for its discomfort, inconvenience, incalculability, and if one is trying to conceive, its message of failure. The experience can vary widely among women and is often bemoaned. For some, the period is a mere nuisance and bears very little impact. For others, the period is spent medicated, in the fetal position. One reason for an extremely painful period may be endometriosis.

In America today, it is estimated that approximately 5.5 million women (2 to 10 percent) have it. This number may be a gross underestimation for a couple of reasons. First, some women do not experience any symptoms and therefore never seek treatment. No definitive diagnosis is ever made. Second, the best way to diagnose endometriosis is through laproscopy, something not every woman can or will have to ensure proper diagnosis. A complicated and somewhat vexing condition, it is one of the top three causes of infertility, accounting for 30 to 40 percent of all cases.

Endometriosis defined
Endometriosis is often defined simply as the presence of endometrial (or uterine) tissue in abnormal locations outside the uterus. The tissue is ordinarily expelled from the body through menstruation. In the case of endometriosis, this tissue travels outside the uterus and implants itself. It can take the form of a cyst as the endometrial cells proliferate and act as though they are still in the uterus. Just as they would in the uterus, these cells respond to hormonal fluctuations during the menstrual cycle by thickening, enlarging and bleeding just as it does in the uterus. There is no way for this blood to leave the body, so it stagnates at the site forming more tissue or lesions. The lesion can inflame and may adhere to surrounding tissues leading to adhesions. If the lesion is situated in close proximity to any nerve endings, these endometriosis sites can create pain. At the same time, the immune system may detect the abnormal placement of these endometrial cells and initiate an inflammatory reaction to protect the rest of the body from the perceived ‘invader.’ When the immune system is unable to eradicate the misplaced tissue, it can react to all endometrial tissue, creating a toxic environment for an implanting embryo.

In general, endometriosis is thought to be a very painful disease. This is not always the case. One can have a very serious case of endometriosis, meaning having multiple, large adhesions and not experience any pain. It is also interesting to note the amount of endometriosis one has is not always equal to the amount of pain one experiences. Despite the severity or extensiveness of their endometriosis, some women experience very little to no pain at all. Other women may experience severe pain and have very little endometriosis. The severity of endometriosis is classified as mild, moderate and severe. Mild endometriosis often involves small, flat patches. Moderate endometriosis can be classified by the appearance of chocolate cysts. Severe cases generally have adhesions or a vast area covered with endometriosis. General symptoms of endometriosis are as follows (but not limited to):

Severe to disabling menstrual pain
Chronic pelvic pain
Pain with intercourse
Infertility
Pain that gradually worsens
Heavy menstrual bleeding
Spotting before and after menses
Bowel pain
Intestinal pain
GI upset

An interesting observation by Chinese medicine practitioners is the state of the menstrual blood in a woman who is diagnosed with or suspected as having endometriosis. The menstrual flow in these women can be significantly darker in color and thicker. Sometimes described as silty, oxidized, clotted, or sediment-like, the blood is full of chemical debris from an immune system that has been waging a battle against it.

Endometriosis causes
At present, the exact cause of endometriosis is unknown. One theory suggests the menstrual blood is not fully discharged through the vagina. Instead, it flows backward or ‘retrograde’ through the fallopian tubes, onto the ovaries and into the peritoneum. This flow carries endometrial cells and tissue, which adhere to surrounding tissues. Reasons for this retrograde flow may be the use of tampons, an extremely narrow cervical opening, or a maligned uterus such as retroflexed or anteverted. Another theory questions if endometrial cells are transported to various parts of the body via the lymph system. Yet another theory suggests a genetic component to endometriosis and questions whether some women pre-disposed to it or if there is a physical change of normal cells into endometrial cells. Finally, dioxin/PCB exposure may be a cause because it has been shown to increase the instances of endometriosis in several studies.¹

Whatever the reason(s) may be for its development, endometriosis can be challenging for doctor and patient, especially when one’s fertile potential is in question. Surgery to remove lesions and medication to manage pain or adjust hormones are often recommended in western medicine. These approaches can significantly impair one’s fertility as surgery can result in removing ovarian tissue, the uterus, and/or potentially creating other scar tissue that can block the fallopian tubes or starve the ovaries of vital blood flow. Inhibiting the natural hormonal fluctuation in a menstrual cycle will undoubtedly inhibit ovulation as well – leaving little opportunity for procreation. Additionally, surgical removal of endometriosis does not ensure it will not return – even if the removal involves a hysterectomy.

Chinese medicine offers some help
Because endometriosis can present itself in many ways, it requires a flexible treatment strategy. This is one of the many strengths of Chinese medicine. For some women, the primary complaint is pain. For others, the complaint focuses on an extremely heavy and irregular menstrual flow. For others still, the only complaint is infertility. Rather than treat each person the same way because they all have been diagnosed with endometriosis, each person will be treated according to their constitution. An astute practitioner will acknowledge these variances and treat based on the current presentation, adjusting the treatment as improvements are made.

In simplest terms, Chinese medicine describes endometriosis as static Blood and Qi. In an ideal situation, the Blood and Qi would move freely in the body. The menstrual period would arrive without any premenstrual symptoms, free of pain. The blood would be fresh red and free of clots. It would flow at a moderate pace for four to five days, and taper to a gentle stop. When the Blood and Qi are static or blocked, the period can change dramatically. This blockage causes pain in varying levels, distension, and overall discomfort due to the conglomeration of endometrial tissue into cysts, lesions, or adhesions or in other words, stasis. It can also cause irregular blood flow, unusually heavy blood flow, intermittent blood flow (stops and starts again), spotting before and after the period, and thick, dark, clotted blood. Additionally, the Chinese category of damp-heat, excess heat, excess cold, or blood deficiency can explain how endometriosis presents symptomatically.

To address the complexity of endometriosis, treatment should include several aspects: acupuncture, Chinese herbs, diet and lifestyle.

Acupuncture is an excellent part of any endometriosis treatment plan as it has been shown in several studies to relieve pain. ^2,3,4 While the exact mechanism is still unknown, blood serum levels after acupuncture show increased levels of -endorphins leading to decreased pain perception and blood vessel dilation. These two aspects help to free the blockage, encouraging the menstrual cycle to normalize and helping to mute an overactive immune system.

Chinese herbs are especially useful in treating endometriosis. Over a 20-year period, 900 women were treated in complex herb formula studies. Only 12% of them failed to respond to the herbal therapy.⁵ Herbal formulas are customized based on symptom presentation and constitution and are exceptionally effective at treating endometriosis. Often, a woman can see improvement in the first month, with significant improvement in three to six months, depending on the severity.

Other considerations
When considering diet, there are several supplements I suggest that are appropriate for everyone, regardless of how her endometriosis presents.

Supplement your diet with a natural, high potency, multi-dose vitamin and mineral complex with folic acid and B vitamins. Splitting dosage throughout the day is best. Avoid ‘one-a-day’ vitamins for two reasons: they are often made with poor quality ingredients, and they are not readily absorbed. Big box store brand vitamins, major drugstore chain vitamins, and most grocery store brand vitamins are of exceptionally poor quality. Look for vitamin labels that clearly state what version of each vitamin and mineral is in them. For example, is the Vitamin A in the form of retinyl palmitate or beta-carotene? Retinyl palmitate in high doses can lead to toxicity and should not be taken by women who are attempting to conceive as it has been linked to fetal abnormalities. Beta-carotene, on the other hand is safe at any dose, acts as an antioxidant and will not affect pregnancy. I often recommend Thorne or Usana. Pharmax or Metagenics are also good brands.
Essential Fatty Acids or EFAs are especially important when dealing with endometriosis as they are multi-functional. First, EFAs work like aspirin in that they block the archadonic acid cycle and prevent prostaglandins from being made. This is important because prostaglandins clot blood when the immune system tells it to do so. Second, they help with hormone balance through modulating the HDL and LDL cholesterol levels. Estrogen influences endometriosis with every menstrual cycle. EFAs help to ensure the building blocks of hormones such as estrogen are in proper balance. Third, EFAs are excellent for neuromuscular health. Good sources of essential fatty acids are fish, and fish oil, eggs, soy products, raw nuts and seeds, dark green and winter vegetables like broccoli, cauliflower, beets, carrots, kale, collards, cabbage, turnips, rutabaga and brussel sprouts.⁶ Ensure your fish oil is third-party tested for PCBs, Lead and Mercury. It should say this on the bottle.
Antioxidants are imperative in helping to quiet a hyperactive immune system. They battle oxidation, which creates that dark, sediment-filled menstrual blood. Bioflavoinoids like pycnogenol, a superantioxidant derived from pine bark, grapeseed, red wide or bilberry include OPC superoxidants, which contain oligomeroproanthocyanidins, caffeic and ferulic acid.⁶ These substances have demonstrated anti-inflammatory and antispastic effects and are helpful in muting immune responses. Additionally supplement your diet with B vitamins and antioxidants like beta-carotene, selenium in the form of selenomethionine, and zinc picolinate.
Probiotics are also of great importance when dealing with a hormone-dependent disease. Read the label to ensure it contains active cultures like lactobacillus acidophilus and bifidus. They help the intestines to eliminate excess estrogens and prevent their reabsorption. Ensure your bottle is refrigerated and each capsule contains 5 to 8 billion live cultures per pill.
Consider adopting a diet free of dairy, wheat, red meat and low in sugar. Also consider a whole food, organic diet free from pesticides and hormones. This is recommended because all of these have been shown to trigger immune responses and oxidative stress. Avoiding them entirely will help to mute a hyperactive immune system that has been sent into overload by endometriosis.
Avoid trans-fatty acids like the plague! These are one of the most detrimental additives in food today, as they significantly increase oxidative stress in the body. If there is anything that says hydrogenated on the food label, put it back on the shelf.
Foods especially good for resolving Blood stasis include kelp, hawthorne berry, vinegar, lemons, limes, onions, Irish moss and bladder wrack (the last two are seaweeds).⁵

Avoid coffee, both caffeinated and decaffeinated, as the volatile oils increase oxidation via an increase in stress hormones.

There are also things you can do in your daily life to help manage endometriosis. Again, these are beneficial for everyone, regardless of the severity or presentation. Here are some basic lifestyle recommendations:

Mayan abdominal massage is an excellent option to help align the uterus and break up tissue adhesions and provide relief.
Say no to tampons and switch to natural cotton maxi-pads for two reasons. First, they are often bleached with chorine, a dioxin. Second, they may increase retrograde menstrual flow by blocking the regular expulsion of menstrual blood.
Avoid intercourse during menstruation for the same reason listed above.
Apply warm castor oil to the lower abdomen and cover with plastic wrap two to three times per day during the premenstrual and menstrual period. (If you are actively trying to conceive, only use during menstruation.)
Regular, moderate exercises help improve circulation and ease symptoms. However, inversion techniques and abdominal core work during menstruation, especially if you have endometriosis, should be avoided.

Conclusion
An endometriosis diagnosis is rich with negative connotation and its implications of pain and infertility. It does not have to spell defeat or a lifelong battle with pain. Acting proactively to manage it naturally through diet, lifestyle and the addition of acupuncture and Chinese herbs to your treatment plan, endometriosis can absolutely be addressed naturally and effectively.

Rier S, Foster W. Environmental toxins and Endometriosis. Tox Sci. 2002; 70:161-170
Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002 Oct; 81(10):943-948.
Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. BMJ. 2004 Mar 27;328(7442):744. Epub 2004 Mar 15.
Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J.strong> Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004 Mar;83(3):246-50.
Dharmananda, S. Chinese Herbal Therapy for Endometriosis. 2002. http://www.itmonline.org/journal/arts/endometriosis.htm
Lewis R. The Infertility Cure. Little, Brown. 2004. 216-222.

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Lee Hullender, MS, LAc, Dipl. OM, is an acupuncturist and herbalist in Bellevue, WA. She practices out of her own Bellevue clinic, Abundant Spring Fertility Acupuncture, and a fertility clinic, Northwest Center for Reproductive Sciences, Kirkland, WA. Her entire practice focuses on treating male and female fertility issues. She resides in Seattle with her husband and dog.