An Integrative Approach to Managing Endometriosis

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By Mary Sabo, L.Ac, DACM

Endometriosis is a condition where endometrial cells that normally grow inside the uterus grow elsewhere in the body. It affects about 10% of women and can range in symptoms from extremely painful periods, severe PMS, painful intercourse, painful urination or bowel movements to absolutely no symptoms at all. Many women do not realize they have endometriosis until it interferes with their fertility. While it can be a confusing condition to diagnose and treat, there are many ways to manage symptoms and improve fertility using both Western and Chinese medicine techniques. Recent studies have also shown promising results when integrating the two.

Endometrial cells are sensitive to hormone fluctuations and are responsible for building the uterine lining, which grows and sheds each menstrual cycle. While these cells are part of our own bodies, when they grow outside the uterus where they shouldn’t grow (often on the bladder, fallopian tubes, ovaries, intestines, outer uterine wall, or peritoneum), the body can treat them as if they are invaders and will launch immune and inflammatory responses. This reaction can potentially interfere with egg quality, ovarian health, uterine receptivity and therefore, fertility. The confusing thing about endometriosis is that many women with the condition are able to conceive and carry to term easily. Because of that, women are not screened for it in initial fertility testing and it is often only considered once a woman has undergone In Vitro Fertilization (IVF) with multiple failed embryo transfers or miscarriages. 

While endometriosis can be difficult to detect and diagnose, some testing is possible.  Endometrial cysts can be seen on ovaries in an ultrasound. MRIs can reveal lesions in the abdomen, most commonly in advanced cases. Exploratory laparoscopic surgery is the gold standard for diagnosis and treatment to remove obvious lesions inside the abdomen, but microscopic lesions can be left behind, as well as scar tissue. An endometrial biopsy can assess inflammatory markers that reflect a high likelihood of endometriosis or inflammation in the uterus. Treatments to decrease endometrial growth such as Lupron after laparoscopic surgery or in the months leading up to a frozen embryo transfer cycle from an IVF may help decrease inflammation and immune activity, improving implantation and pregnancy rates.

Acupuncture and customized Chinese herbs, along with following an anti-inflammatory diet, have been shown in studies to help decrease the size of lesions, improve fertility, and reduce associated symptoms of endometriosis[1]. I also find some supplements helpful in my clinical practice, including N-Acetyl Cystein (NAC) and pycnogenol[2]. Because patients with endometriosis can have different underlying diagnoses in Chinese medicine theory, it is wise to work with an experienced practitioner who can prescribe an appropriate custom blend of herbs as well as dietary and lifestyle changes. Acupuncture can be helpful in reducing inflammation and regulating the immune system while patients are preparing or undergoing IVF and are in treatment or recovery for endometriosis.

Whether you are trying to manage endometriosis symptoms, trying to conceive naturally, or are undergoing fertility treatments such as IVF, working with an experienced acupuncturist can be a helpful addition for managing endometriosis.

 

[1] Sai Kong, 1 Yue-Hui Zhang, 2 , 3 Chen-Fang Liu, 1 Ilene Tsui, 4 Ying Guo, 1 Bei-Bei Ai, 1 and  Feng-Juan Han 2 ,*The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evid Based Complement Alternat Med. 2014; 2014: 146383

 

[2] Maria Grazia Porpora, 1 Roberto Brunelli, 1 Graziella Costa, 2 Ludovica Imperiale, 1 Ewa K. Krasnowska, 2 Thomas Lundeberg, 3 Italo Nofroni, 4 Maria Grazia Piccioni, 1 Eugenia Pittaluga, 2 Adele Ticino, 1 and  Tiziana Parasassi 2 ,*. A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evid Based Complement Alternat Med. 2013; 2013: 240702. 

 

 

 

This Ancient Philosophy on Miscarriage Makes So Much Sense

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This blog by Mary Sabo, L.Ac DACM was originally published on the national blog MindBodyGreen.  For the full article, click here!

The elation that comes with a positive pregnancy test when trying to conceive is often euphoric followed closely by the joyful excitement that surrounds planning for a new baby. But for women who have experienced a miscarriage, this news often comes with a whisper of doubt and fear of another potential loss. According to the American Pregnancy Association, around 25 percent of pregnancies result in a miscarriage. With this high rate—one in four—one would suspect women are miscarrying everywhere, and it would be more normalized, but most couples suffer in silence, and it is not uncommon for women to feel shame on top of the grief that goes along with it.

There is no protocol for dealing with a miscarriage. 

There are no guidelines for grieving this loss. And in our culture, most women think of pregnancy as something they created and therefore a miscarriage is something they "created" and then "lost." It can elicit philosophical questions like "Is something wrong with me?" "Why me?" "Am I being punished?" "What did I do wrong?" "Can I carry to term?" These questions, along with hormones dropping and trying to renormalize, can create quite a bit of emotional suffering. 

While I was getting my degree in Chinese medicine, we learned of a different belief system regarding miscarriage that was rooted in the ancient Buddhist philosophy. They believed that the souls of our potential children hang out with the parents and wait for the right moment to "jump in" and activate a pregnancy. This was their explanation for the spark of life and why some cycles work and some don’t. If something goes wrong with the "vessel" or physical form of the fetus once a pregnancy is established, the soul jumps out and waits for another opportunity. I find this way of thinking as a much kinder one that can offer some relief to women grieving a miscarriage, especially if she is open to other religious or philosophical systems. 

The majority of miscarriages cannot be controlled or prevented.

We now know that the majority of miscarriages are due to genetic abnormalities in the embryo, meaning the fate of that fetus was determined at fertilization and would never become a healthy baby. A much smaller percentage of miscarriages can be prevented if a problem is detected with blood clotting in the mother or occasionally an immune disorder. Infections in the uterus, hormone imbalances, uterine abnormalities, and tubal disorders can also play a role and be treated. But the majority of miscarriages cannot be controlled or prevented. Many women blame themselves, creating unnecessary suffering, and it is my hope that with more awareness about miscarriage, this self-blame and suffering will be reduced.

Miscarriage is so common that most OB/GYNs won’t do any additional testing until a woman has had two or three of them. However, by that point, the emotional roller coaster for the potential parents can be quite intense, resulting in stresses on a physical and psychological level. Patients often come to me for acupuncture and Chinese herbs, both of which can offer emotional support but may also help correct some of the mild abnormalities that are associated with miscarriage, such as hormone imbalances and mild clotting or immune issues. If a woman has already had several miscarriages, I prefer to work collaboratively with a miscarriage specialist physician, supporting my patient with acupuncture, herbs (if appropriate and approved by her doctor), and dietary advice, while she undergoes testing and treatments directed by her doctor. In some cases, artificial reproductive technologies like in vitro fertilization (IVF) with embryo biopsy can be quite helpful in controlling the quality of the chromosomal makeup of the embryos that make it to the uterus. When combined with acupuncture, IVF results can be even better.

Click here to read the rest of the article on MindBodyGreen.

Here's How to Talk to Someone Struggling with Infertility

By Mary Sabo, L.Ac DACM

Struggling to conceive can sometimes be the toughest challenge a couple goes through. Having the right support from friends and family can make a difference in quality of life during the journey. The following blog was written by Mary for the national blog MindBodyGreen.  For the full article, click here.

 

Couples struggling to conceive can experience levels of stress and anxiety as extreme as patients undergoing cancer treatments. The process reminds us that we don't have absolute control over our bodies or our fertility. It is frustrating, to say the least, and can be excruciatingly painful the more time goes on. The experience can be tough for friends and family members, too, who may not understand the intensity of this journey. According to resolve.org, one in eight couples will struggle to get pregnant, so there is a good chance someone in a couple's life may know how difficult it can be, but for those who don't have an experienced friend, co-worker, or family member, it can make this process even harder. Below are some tips that may help you create a more supportive interaction with your loved ones who are struggling to get pregnant:

1. Don't assume what worked for you, your friend, your sister, your mother, a celebrity or anyone else will work for them.

Each fertility case is different, and there are many reasons a couple may struggle to conceive. What worked for one person will not work for everyone. Unless your friend asks, try not to give advice or assume you know the reason she's not conceiving unless she asks.

2. Her infertility is not a result of her stressing about her fertility, so please stop telling her to relax.

While intense long-term stress can create hormonal changes that can contribute to infertility, it is typically not the cause. A couple does not usually start out stressing about their fertility, so implying that they are causing it with their anxiety will likely make them feel worse. This is a process that cannot be controlled yet even with the most advanced technology, so assuming a woman can control her fertility in any way, including by just not caring anymore, is reinforcing her stress. Relaxing may improve her quality of life, but reminding her about how unrelaxed she is will probably not help her get pregnant.

Read the rest of the article here!