Endometriosis is a common yet poorly understood disease. It can strike women of any ocioeconomic class, age, or race. It is estimated that between 10 and 20 percent of American women of childbearing age have endometriosis. While some women with endometriosis may have severe pelvic pain, others who have the condition have no symptoms. Nothing about endometriosis is simple, and there are no absolute cures. The disease can affect a woman’s whole existence-her ability to work, her ability to reproduce, and her relationships with her mate, her child, and every one around her.
What Is Endometriosis?
The name endometriosis comes from the word “endometrium,” the tissue that lines the inside of the uterus. If a woman is not pregnant this tissue builds up and is shed each month. It is discharged as menstrual flow at the end of each cycle. In endometriosis, tissue that looks and acts like endometrial tissue is found outside the uterus, usually inside the abdominal cavity.
Endometrial tissue residing outside the uterus responds to the menstrual cycle in a way that is similar to the way endometrium usually responds in the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed.
However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced tissue has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around the area of endometriosis. These endometrial tissue sites may develop into what are called “lesions,” “implants,” “nodules,” or “growths.”
Endometriosis is most often found in the ovaries, on the fallopian tubes, and the ligaments supporting the uterus, in the internal area between the vagina and rectum, on the outer surface of the uterus, and on the lining of the pelvic cavity. Infrequently, endometrial growths are found on the intestines or in the rectum, on the bladder, vagina, cervix, and vulva (external genitals), or in abdominal surgery scars. Very rarely, endometrial growths have been found outside the abdomen, in the thigh, arm, or lung. Physicians may use stages to describe the severity of endometriosis. Endometrial implants that are small and not widespread are considered minimal or mild endometriosis. Moderate endometriosis means that larger implants or more extensive scar tissue is present. Severe endometriosis is used to describe large implants and extensive scar tissue.
What Are The Symptoms?
Most commonly, the symptoms of endometriosis start years after menstrual periods begin. Over the years, the symptoms tend to gradually increase as the endometriosis areas increase in size. After menopause, the abnormal implants shrink away and the symptoms subside. The most common symptom is pain, especially excessive menstrual cramps (dysmenorrhea) which may be felt in the abdomen or lower back or pain during or after sexual activity (dyspareunia). Infertility occurs in about 30 to 40 percent of women with endometriosis. Rarely, the irritation caused by endometrial implants may progress into infection or abscesses causing pain independent of the menstrual cycle. Endometrial patches may also be tender to touch or pressure, and intestinal pain may also result from endometrial patches on the walls of the colon or intestine.
The amount of pain is not always related to the severity of the disease-some women with severe endometriosis have no pain; while others with just a few small growths have incapacitating pain. Endometrial cancer is very rarely associated with endometriosis, occurring in less than 1 percent of women who have the disease. When it does occur, it is usually found in more advanced patches of endometriosis in older women and the long-term outlook in these unusual cases is reasonably good.
How Is Endometriosis Related To Fertility Problems?
Severe endometriosis with extensive scarring and organ damage may affect fertility. It is considered one of the three major causes of female infertility. However, unsuspected or mild endometriosis is a common finding among infertile women and how this type of endometriosis affects fertility is still not clear. While the pregnancy rates for patients with endometriosis remain lower than those of the general population, most patients with endometriosis do not experience fertility problems.
How Is Endometriosis Diagnosed?
Diagnosis of endometriosis begins with a gynecologist evaluating the patient’s medical history. A complete physical exam, including a pelvic examination, is also necessary. However, diagnosis of endometriosis is only complete when proven by a laparoscopy, a minor surgical procedure in which a laparoscope (a tube with a light in it) is inserted into a small incision in the abdomen. The laparoscope is moved around the abdomen, which has been distended with carbon dioxide gas to make the organs easier to see. The surgeon can then check the condition of the abdominal organs and see the endometrial implants.
The laparoscopy will show the locations, extent, and size of the growths and will help the patient and her doctor make better-informed decisions about treatment. Endometriosis is a long-standing disease that often develops slowly.
What Is The Treatment?
While the treatment for endometriosis has varied over the years, doctors now agree that if the symptoms are mild, no further treatment other than medication for pain may be needed. For those patients with mild or minimal endometriosis who wish to become pregnant, doctors are advising that, depending on the age of the patient and the amount of pain associated with the disease, the best course of action is to have a trial period of unprotected intercourse for 6 months to 1 year. If pregnancy does not occur within that time, then further treatment may be needed.
For patients not seeking a pregnancy where treatment specific for the management of endometriosis is required and a definitive diagnosis of endometriosis by laparoscopy has been made, a physician may suggest hormone suppression treatment. Since this therapy shuts off ovulation, women being treated for endometriosis will not get pregnant during such therapy, although some may elect to become pregnant shortly after therapy is stopped.
Hormone treatment is most effective when the implants are small. The doctor may prescribe a weak synthetic male hormone called Danazol, a synthetic progestin alone, or a combination of estrogen and progestin such as oral contraceptives.
Danazol has become a more common treatment choice than either progestin or the birth control pill. Disease symptoms are improved for 80 to 90 percent of the patients taking Danazol, and the size and the extent of implants are also reduced. While side effects with Danazol treatment are not uncommon (e.g., acne, hot flashes, or fluid retention), most of them are relatively mild and stop when treatment is stopped. Overall, pregnancy rates following this therapy depend on the severity of the disease. However, some recent studies have shown that with mild to minimal endometriosis, Danazol alone does not improve pregnancy rates.
Another type of hormone treatment is a synthetic pituitary hormone blocker called gonadotropin-releasing hormone agonist, or GnRH agonist. This treatment stops ovarian hormone production by blocking pituitary gland hormones that normally stimulate ovarian cycles.
These hormones are currently being tested using different methods of administration. One such treatment involves a drug that is administered as a nasal spray twice daily for 6 months and works by suppressing production of estrogen, which controls the growth of the endometrial tissue. Other treatments being developed in this category include daily or monthly hormone injections. One concern is the loss of bone mineral which occurs with this type of hormone therapy. This may limit the duration and frequency of this type of treatment.
Conservative surgery attempts to remove the diseased tissue without risking damage to healthy surrounding tissue. This surgery is called laparotomy and is performed in a hospital under anesthesia. Pregnancy rates are highest during the first year after surgery, as recurrences of endometriosis are fairly common. The specifics of the surgery should be discussed with a doctor.
Some patients may need more radical surgery to correct the damage caused by untreated endometriosis. Hysterectomy and removal of the ovaries may be the only treatment possible if the ovaries are badly damaged. In some cases, hysterectomy alone without the removal of the ovaries may be reasonable.
New surgical treatments are being developed that further utilize the laparoscope instead of full abdominal surgery. During routine laparoscopy, the surgeon can cauterize small areas of endometriosis. Other evolving techniques include using a laser during laparoscopy to vaporize abnormal tissue. This involves a shorter recovery time. Laparoscopy treatment is possible, however, only if the surgeon can see pelvic structures clearly through the laparoscope. These newer techniques should be performed by surgeons specializing in such delicate procedures. Although these techniques are promising, more study is needed to determine if they yield results comparable to conventional surgical management.
Diet and Lifestyle
Avoid caffeine, sugar, alcohol, and acid-forming foods (red meat, dairy products, heated or treated oils, and excess carbohydrates, especially refined products).
Try a short juice fast to clear out the body, and follow up with cultured foods such as miso or tempeh, unless you have a food allergy to soy products. After cleansing the body, plenty of fresh greens, fresh fruits in season, and a reasonable quantity of whole grains provide strength. Include changes to stabilize hypoglycemia (low blood sugar), such as eating smaller meals. As always, eating little or no animal fat decreases harmful excess estrogen.
The following food items are especially good:
Soybean (Glycine max) and Other Beans
Soybeans are high in estrogen-like plant compounds, genistein and daidzein. These prevent your body from taking up the more harmful forms of estrogen circulating in your blood. These phytoestrogens take the place of the bad estrogen, binding to the cell’s estrogen receptor sites and prevent more harmful estrogens from binding to these receptors. They also protect the body from pollutants that chemically mimic estrogen.
Bean sprouts supply more genistein (the more active of the two phytoestrogens) than soybeans. As beans germinate, their genistein content increases. If the sprouts have fungi, the genistein content may increase as much as hundred-fold!
Pinto beans, yellow split beans, black turtle beans, lima beans, anasazi beans, red kidney beans, red lentils, black eyed peas, mung beans, adzuki beans and fava beans are other sources of these important phytoestrogens.
If you have endometriosis, eat as much edible beans as possible as often as possible. Eat salds made of bean sprouts. Take bean soups, baked beans, and Mexican foods rich in beans such as burritos.
Flax (linum Usitatissimum)
Flaxseed contains generous amounts of compounds called lignans, that is believed to help control endometrial cancer.
Flaxseed might be particularly helpful for anyone who is not a vegetarian, Vegetarians have high blood and urine levels of lignans. Consuming meat suppresses lignans substantially. Flaxseed helps to supplement this deficit.
Peanut (Arachis hypogaea)
Peanuts contain many of the healthful substances as soybeans and other beans. Many people prefer the taste of peanuts over soybeans.
The papery red membrane surrounding spanish peanuts is a source for oligomeric procyanidins (OPCs), substances that may help control hormone dependent cancers and possibly endometriosis.
Alfalfa (Medicago sativa)
Alfalfa sprouts contain phytoestrogens. Use them liberally on salads. Eating them also reduces the risk of contracting cancer. (Do not consume alfalfa if you or your family has a history of lupus.)
Evening Primrose Oil (Oenothera biennis)
EPO contain gamma-linolenic acid (GLA) and tryptophan, substances that promote good health in women.
folic acid – 150 micrograms
liquid potassium: taken in recommended doses – 3 times a day
vitamin E: 8-1 0 milligrams alpha-TE (alpha tocopherol equivalent) – may use 200-600 IU (up to 1,200 IU maximum)
calcium and magnesium – 800/400 milligrams
vitamin A – 800 RE (retinol equivalent); may use 5,000 IU (up to 50,000 IU for four months or less)
vitamin D – 10 RE; may use 400 IU (up to 1,000 IU maximum)
vitamin C – 300 milligrams (up to 1 0 grams)
GLA – Gamma-Linolenic Acid – eight 500 milligram capsules per day for six to ten weeks, if women can afford this dose (most effective)