Endometriosis

Endometriosis is a disease where the tissue that lines the uterus (endometrial tissue) is found outside of the uterus. The tissue attaches itself on other organs and can spread over a larger area over time. It acts just like the tissue inside the uterus during the monthly menstrual cycle. Endometrial implants, as this tissue is called, may be found anywhere in the body, but are mostly found in the pelvic region.(1) Often, these implants are seen on the outside of the ovaries, the fallopian tubes, or the uterus.

The exact cause of endometriosis is unknown, but it occurs almost exclusively in menstruating women. It is rarely seen in women before puberty or after menopause, or in women who are not having monthly periods. One theory that explains how these cells get outside of the uterus is called the transport theory. The transport theory says that endometrial tissue moves to and attaches itself in the abdomen and other areas of the body by something called "retrograde menstruation." This means that the lining of the uterus that is shed at the end of the monthly cycle flows upwards instead of draining out of the body normally. The transport theory also says that the tissue may spread by going through the blood vessel circulation or the lymph nodes.(2)

When the implants act along with the menstrual cycle, it often leads to inflammation in the areas around the implants. These cycles of bleeding and inflammation cause scar and fiber-like tissue to form in the abdomen. The organs may even become attached to each other.(3) Endometriomas are blood filled cysts that range in size from those that are so small that they can only be seen with a microscope to 10 centimeters (about 4 inches). They are often found on the ovaries. These cysts are commonly called "chocolate cysts" because of their dark brown color. Small swellings may form on the muscular tissue around the uterus. Women with endometriosis are often infertile.(4)

The number of women who have endometriosis is unknown. Women with endometriosis may have an increased risk for other diseases such as chronic fatigue syndrome, fibromyalgia, and hypothyroidism among other disorders.(5) This disease can be present without major symptoms, and diagnosis is only possible through looking at the lesions during a surgery called laparoscopy, where a lighted tube is inserted into the abdomen or other affected area. The number of women 15 to 44 years of age with endometriosis is estimated to be between 10 and 20 percent.(6)

Laparoscopic surgery provides a way to place the disease diagnosis into a specific stage, which helps the health care practitioner select an appropriate treatment for the patient. The stages are minimal (Stage I), mild (Stage II), moderate (Stage III), and severe (Stage IV). These stages are based on the location and size of the endometrial lesions, and the presence and extent of adhesions, fibrous structures by which parts abnormally stick together.(7)

Endometriosis Research Center, 2002.

• An estimated 77 million women worldwide have endometriosis.

• At least 5.5 million women in North America alone have endometriosis.
• About 35 percent to 50 percent of women with endometriosis are infertile, making it one of the top three causes for female infertility.
• Current estimates place the number of women with endometriosis between 2 percent and 10 percent of women of reproductive age. But, it's important to note that these are only estimates, and that such statistics can vary widely.

Other organ systems can be affected by endometriosis. If the intestines are involved, symptoms may also include painful bowel movements, diarrhea, constipation, or other upsets of bowel habits during menstrual periods. Rectal bleeding may also be present. If the bladder or urinary tract is involved, symptoms may include blood in the urine, an increased feeling of the need to urinate, or painful urination during menstrual periods. Lower back pain may also occur during periods. If the lungs are involved, blood may be seen in sputum that may be coughed up during a menstrual period.

• Pelvic pain
• Pain during menstruation
• Abnormal or heavy menstrual flow
• Difficulty becoming pregnant
• Pain during bowel movements
• Pain during urination
• Rectal bleeding
• Blood in the urine

Patients choosing hormone therapy use estrogen-progestin combinations (birth control pills) to cause a state of false pregnancy. When these pills are taken continuously, amenorrhea (no menstrual periods) results. The combination products used are generally given on a continuous basis for six to nine months.

Another option of hormone therapy is progestin therapy alone. Medroxyprogesterone may be taken either by mouth or by injection to stop ovulation (release of eggs from the ovaries). The most common dose is 10mg by mouth three times daily for three months. Usually, pelvic pain and tenderness begin to disappear within a few days of starting therapy. Also, medroxyprogesterone acetate injection can be given into the muscle in doses of 100mg every two weeks for eight weeks, followed by 200mg every month for four months. (9)

A drug called danacrine can also be used. This stops the release of specific hormones from the pituitary gland in the brain and is generally given in doses of 400 to 800mg per day for a period of six to nine months.

The drug nafarelin can be used for pelvic pain and implant shrinkage in endometriosis. The dose is usually 200mcg every 12 hours administered into the nose as a nasal spray. It works to stop the release of a specific hormone from the hypothalamus, a part of the brain.

Apis mellifica
Typical Dosage: 6X or 6C, 30X or 30C
Burning; Stinging pains; Ovaritis (predominately right-sided)

Belladonna
Typical Dosage: 6X or 6C, 30X or 30C
Abdomen swollen and sensitive to touch; Stitching pain

Kali iodatum
Typical Dosage: 6X or 6C, 30X or 30C
Pressure in the uterus when walking; Griping pain in abdomen

Lachesis mutus
Typical Dosage: 6C
Left-sided ovarian pain; Cannot bear pressure

Acupuncture-Moxibustion Therapy

Ni et al. treated 54 cases of pain associated with endometriosis with acupuncture and moxibustion. The treatment consisted three parts: 1) body acupuncture: acupuncture was applied on Zhong Ji (CV 3), Guan Yuan (CV 4), Qi Hai (CV 6), and San Yin Jiao (SP 6), with the needles maneuvered by the uniform reinforcing-reducing method and retained for 20 minutes; 2) auriculo-acupuncture: one or two days prior to the onset of the menstrual period, auricular needles were embedded at otopoints related to the ovary, sympathetic nerves, and endocrine (alternatively, otopoint sticking therapy with vaccaria seeds could be used in lieu of needle embedment); and 3) moxibustion: moxibustion with moxa sticks was performed for 10-15 minutes at any one or two of the following points: Yin Bai (SP1), Yin Ling Quan (SP9), and Di Ji (SP8). Moxibustion was performed only on the patients treated with body acupuncture for lower abdominal pain. One course of treatment consisted of two sessions of body acupuncture and one session of auriculo-acupuncture. The results: after 1-3 courses of treatment, 4 cases were resolved, 29 cases were greatly improved, another 1 case improved slightly, and the remaining 4 cases did not respond to the treatment, with the total effectiveness rate of 92.6%.(31)