What is endometriosis?

Endometriosis is a condition in which endometrial tissue (ie the cells lining the interior of the uterus) grows in other parts of the pelvic cavity, outside the uterus. The endometriosis can be found on the muscle of the uterus, the ovaries, bowels, vagina, bladder and appendix. The endometrial tissue responds to oestregen and progesterone, and may bleed during menstruation. The blood will have no outlet for escape, leading to inflammation, and resulting in scar tissue, adhesions and cysts. Endometriosis is usually characterized by painful periods (women with endometriosis have higher levels of prostaglandins, one of the triggers of menstural pain), often with dark menstrual blood and clotting. There may be palpable masses in the abdomen, pelvic pain or pain during intercourse.

 Endometriosis is classified according to its severity – mild (small, flat patches of endometrial tissue growing outside the uterine lining), moderate (larger, often somewhat raised implants), or severe (imflammation and scarring caused by the unabsorbed blood can creat bands of fibrous scar tissue – adhesions –  that binds pelvic organs together).  However, the severity of the endometriosis does not necessarily bear any relation to the degree of infertility that it may cause.

Endometriosis can impair natural fertility for a variety of reasons. It can physically obstruct ovulation and the transportation of the egg along the tube. The presence of endometrial tissue also activates immune cells (macrophages), which attack sperm cells and release substances (cytokines) that are toxic to sperm and embryo. Some forms of endometriosis secrete mucus, which can coat the fimbriae or the ovary, preventing the transport of the egg to the tube. Endometriosis can also be associated with ovulatory disturbance, leading to unruptured follicles and/or low progesterone levels in the luteal phase, which results in an insubstantial endometrial lining.

 What causes endometriosis?

Modern science does not understand what causes endometriosis, although several theories are currently being investigated.  One theory is that endometriosis is caused by retrograde menstruation.  When a woman is supposed to menstruate, the blood should be discharged through the cervix.  However, sometimes it can seep back up through the fallopian tubes and flow into the abdominal cavity.  Endometrial cells in the menstrual blood can then attach to sites in the abdominal cavity outside the uterus.  Anatomical abnormalities such as a retroverted uterus or an unusually small cervical opening may cause the menstrual blood to flow up into other areas of the pelvis, but many women are known to have retrograde menstruation, but have no signs of endometriosis.  Some researchers believe that endometrial cells are transported through the blood and lymph systems to different sites of the body, and others still believe that embryonic cells outside the uterus are transformed into endometrial cells by some unknown stimulus.

Treatment of endometriosis with Western medicine

Endometrial tissue can be surgically removed, and conception after such surgical intervention is about 50% after 2-3 years. Surgery presents a risk of scar tissue being created, so it is kept to a minimum. It is also difficult to remove all the tissue, and some small lesions may be left that still produce secretions that interfere with normal fertility. Hormonal medication can also be used to stop the menstrual cycle for 3-9 months in order to suppress the endometrial tissue, as, like fibroids, endometriosis is oestregen-dependent.

Diagnosis and treatment of endometriosis with acupuncture and Chinese herbal medicine

In Chinese medical terms, endometriosis is largely due to Blood Stagnation in the Uterus. However, this is only the outward manifestation of the disease, and the Chinese medical practitioner works to establish the underlying cause of the congealed blood. For example, this may be Kidney Yang Deficiency, and Damp Stagnation. As the deficient Kidney Yang fails to transform the fluids, Dampness accumulates. This in turn obstructs the flow of Qi and Blood, resulting in Blood Stagnation. There may also be some element of Liver Qi Stagnation (causing further Blood Stagnation, as Qi is the driving force that moves the Blood), or Cold, or Spleen Qi Deficiency. The practitioner makes her diagnosis according to the presenting signs and symptoms, and treats accordingly.

The treatment principle will also vary according to whether the endometriosis is in the form of superficial, pale, non-pigmented lesions (which do not bleed, but seem to be more implicated in infertility), deeper, brown lesions, which bleed and tend to cause more pain, whether it takes the form of cysts, nodules or masses. The type of endometriosis has to be established in order to give the best possible treatment.

If the patient is wanting to conceive and the endometriosis is extensive and bulky and it is causing pain, the patient should be referred for surgery, though strong blood-regulating herbs should be administered until one week before surgery. After surgery Chinese medical treatment should be resumed to promote fertility, if required.

If the patient is wanting to conceive and the endometriosis is extensive and bulky, but not painful, and it is causing distortion of tubes and ovaries, the patient should be referred straight for surgery, before Chinese medical treatment is undertaken to enhance fertility, if required.

If the patient is wanting to conceive and the endometriosis is made up of small brown lesions and it is causing pain and reduced fertility, Chinese medical treatment should be administered, combining herbs to move the Blood, with Kidney Yang tonics, to resolve the endometriosis and promote fertility.

If the patient is wanting to conceive and the endometriosis is made up of small pink lesions which are thought to be affecting fertility, Chinese medical treatment should be administered, particularly using Kidney Yang tonics to promote fertility.

Studies in China confirm that the treatment of endometriosis with Chinese herbal medicine and acupuncture can substantially diminish the pain, as well as the size of the ectopic mass of cysts. Research shows that Chinese herbal medicine improves microcirculation in the lower abdomen, as well as modulating the immunological disturbances associated with endometriosis, so alleviating pain and enhancing reproductive function.

Case history:

Jane, 33, had been suffering from endometriosis for 10 years. She had also had 2 ovarian cysts. She had undergone surgery 3 times to remove the endometriosis, but it kept coming back. She had also had hormone treatment. Her periods were so painful, that she took the pill so that she would only have a period once every 3 months. The pain lasted for 10 days and was stabbing and very severe. Jane was diagnosed with Kidney Yang Deficiency and DampCold and Blood Stagnation in the Uterus. She started a course of acupuncture and herbal treatment, and agreed to stop taking the pill. A month after starting treatment, her period was significantly less painful, and they improved with each cycle. After 4 months her pain was minimal. Her energy had also improved, as had her digestion, her headaches and her backache.

See research into the treatment of endometriosis with Chinese herbal medicine.