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.