Causes

The exact cause of the condition remains a mystery, though several theories exist as to why it happens. These are some possible explanations.

RETROGRADE MENSTRUATION. Blood flows backward instead of downward through the cervix and out of the body. It is thought to go out the fallopian tubes and into the pelvic and abdominal cavity. Once it is there, cells from the exiting blood implant themselves outside the uterus onto other tissues.

LYMPHATIC CHANNELS. Cells of the endometrium lining pass through lymphatic channels or migrate via blood and then implant themselves outside the uterine cavity.

GENETIC PREDISPOSITION. Certain families are predisposed to the condition.

IMMUNOLOGIC DISORDER. The immune system is deficient in some way, causing tissue to proliferate in abnormal areas. The idea is that through some type of immune deficiency, hormonal and chemical influences cause endometrial tissue to become activated at different times in the cycle.

CHILDBEARING. Childbearing in combination with methods of contraception may be responsible.

Symptoms

About 70 percent of women with endometriosis have severe, chronic symptoms. Endometriosis can produce slight or severe pain, ranging from mild cramps to agony and dysfunction. Endometrial implants produce chemicals, including prostaglandins, which cause the uterus to contract, resulting in cramping. Pain also results from swelling, inflammation, and scarring of affected tissues. It is usually cyclical and most commonly occurs just before menstruation. Some women have pain during sexual intercourse any time in the month.

Where and to what degree pain is felt depend on the location of the endometrial tissue and the degree to which it has spread outside the uterus. Some women have pain during urination as a result of implants on the bladder. Some have pain during bowel movements because of colon and rectal implants. There can be ovarian pain or pain radiating to the back or buttocks or down the legs. Upon a manual gynecological examination, there may be pelvic pain.

Internal bleeding may occur as well as nose bleeding or bleeding from another orifice at certain times of the month. Any cyclic bleeding is suspect for endometriosis. Other symptoms that sometimes appear include aggravated premenstrual syndrome (PMS), bladder infections, fatigue, and lower back pain. Endometriosis may result in infertility when it interferes with ovarian function.

Diagnosis

Endometriosis can be suspected in the presence of one or more of the symptoms listed above, but the only real way to confirm a diagnosis is with a surgical procedure known as a laparoscopy, which allows the doctor to actually see and biopsy tissue. Sonograms and magnetic resonance imaging (MRI) scans may be helpful, but they are not definitive in making the diagnosis.

The proper diagnosis is important, notes Dr. Anthony Aurigemma, because while endometriosis is considered benign, it can become malignant.

Conventional Therapy

Treatment usually consists of medical prescriptions for pain control and reduction of endometrial growth. Antiprostaglandin medicines such as indomethacin, ibuprofen, and naproxen are often given to reduce pain.

Another popular pharmaceutical, danazol, is also used for this purpose, but in some women it does not provide total or lasting relief. Studies show that danazol has a good effect after surgery to remove adhesions. After some of the adhesions have been removed, it may help an infertile woman become pregnant. A side effect of the drug is that it may increase cholesterol, especially the low-density lipoprotein (LDL) variety, which is implicated in accelerated arteriosclerosis. The adverse effects of all these drugs can include weight gain, edema, decreased or increased breast size, acne, excess hair growth on the face and perhaps even in a developing fetus, and deepening of the voice.

Hormones are sometimes given to fool the body into believing it is pregnant, since pregnancy seems to retard or prevent the development of endometriosis. This method appears to have some benefit, but the side effects include depression, painful breasts, nausea, weight gain, bloating, swelling, and migraine headaches. Since the side effects can be fairly severe, this is not a popular method.

Newer drugs, called gonadotropin-releasing hormone compounds, are sometimes given by injection. These agents suppress pituitary gland release of the female hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH), causing what is called a clinical pseudomenopause. They help reduce pain in many women and decrease the size and volume of endometrial tissue after surgery.

Through the advanced surgical technique of female reconstructive surgery (FRS) developed by Dr. Vicki Hufnagel, the uterus and ovaries can be repositioned, thus reducing the deep pelvic pain that is associated with endometriosis.

Alternative Therapies

PAIN RELIEF “When I started looking at nutrition for the endocrine system,” Mills says, “I came across A lot of research which suggests that if you are deficient in various nutrients, it may affect the way your body deals with pain. These nutrients would be the essential fatty acids, such as evening primrose oil, fish oil, linseed oil, safflower oil, and vitamins C, E, and K. All these are important in the body’s control of pain. The B vitamins, particularly B₁, seem to be important in building up the endorphins, which are the body’s natural painkillers. Also, there is an amino acid called DLPA, which is DL-phenylalanine, which seems to help in dulling pain. Also, there are zinc, selenium, and magnesium.”

If you are deficient in many of these nutrients, your body may not be able to cope well with pain. Mills says, “If we look at, say, magnesium, we see that it is very important in allowing muscles to relax. Calcium and magnesium balance one another. Calcium causes muscles to contract, and magnesium allows them to relax. Seeing that the uterus is one of the largest muscles in the body, it would be quite important to make sure you are getting enough magnesium-rich foods, such as green leafy vegetables, nuts, and seeds. The same is true of B vitamins. There are lots of those in vegetables and fruits. That’s also where you’ll get vitamin C. Zinc will be found in nuts and seeds. Selenium would be in seafood.”

DIGESTION AND THE REPRODUCTIVE SYSTEM “Once I have a patient who has a major endometriosis problem,” Mills says, “the first thing I look at is her digestion. If she doesn’t get the nutrients from food or any supplements she takes, nothing will work. So, you have to heal the digestion first. If she has constipation or diarrhea or heartburn indigestion, I will give her digestive enzymes, acidophilus, and possibly slippery elm. Then, once we’ve got that healed, you can try a digestive supplement, such as a multivitamin, and some magnesium, zinc, and vitamin C.

“You have to analyze what is wrong with each individual person and tailor the treatment specifically to her needs. Generally, for endometriosis, I try to ensure that the woman is taking evening primrose and fish oil. The supplements also must be wheat-, yeast, sugar-, and dairy-free. By taking magnesium, zinc, the probiotics, and the digestive enzymes, you are working through the body system from different angles to try to relieve the pain while supporting the endocrine and immune systems.”

NATUROPATHY Dr. Tori Hudson, a naturopath from Portland, Oregon, believes there is most support for the immunological weakness theory of endometriosis because women with this condition have altered immune cells and fewer T lymphocytes. By improving immune function with supplements, diet, and botanicals, she claims to help many patients: “I’ve seen women with severe pelvic pain who were scheduled for surgery one month from the date I saw them. My treatment helped them recover completely without the surgery.” She adds that most, but not all, women respond to her protocol, which is designed to stimulate a maximal immune response. The basic program consists of the following.

Antioxidants
Vitamin C: to bowel tolerance, up to 10,000 mg
Beta carotene: 150,000 to 200,000 IU
Selenium: 400 mcg
Vitamin E: 800 to 1200 IU

Changes in the diet are made to further stimulate the immune system. This is accomplished by lowering fat; adding whole grains, vegetables, and fruits; and eliminating immune system inhibitors such as coffee, sugar, alcohol, and high-fat foods. Foods such as cheese and meat have high amounts of estrogen and are omitted, because estrogen aggravates the disease. A mostly vegetarian diet is best for lowering estrogen and stimulating the immune system.

Two botanical formulas are included. One contains chaste tree berry, dandelion root, motherwort, and prickly ash in equal amounts. A half teaspoon is taken three times daily. The other formula contains small doses of toxic herbs that must be carefully prescribed by a naturopathic physician.

In addition, Dr. Hudson sometimes prescribes natural progesterone made from wild yam. The wild yam extract is converted in the laboratory to natural progesterone.

OTHER NUTRITIONAL RECOMMENDATIONS Dr. Susan M. Lark, a physician who is the author of The Women’s Health Companion: Self-Help Nutrition Guide & Cookbook, recommends vitamins, herbs, and minerals that will decrease estrogen stimulation of the endometrial cells.

VITAMIN A. In the form of beta carotene, a maximum daily dose of 5,000 units to help decrease the excess menstrual bleeding that may occur with endometriosis.

VITAMIN B COMPLEX. 50 to100 milligrams with an additional dose of up to 300 milligrams daily of vitamin B6. These vitamins help the liver convert excess estrogen into less stimulating forms.

VITAMIN C. 1000 to 4000 milligrams of bioflavonoids daily. Vitamin C not only regulates estrogen levels but reduces cramps and bleeding by strengthening capillaries. You can get bioflavonoids by eating citrus fruits (including the inner peel), berries, the skins of grapes, alfalfa, buckwheat, and soybeans and taking 800 milligrams a day of vitamin C as a supplement.

VITAMIN E. 400 to 2,000 units a day. If you have high blood pressure, begin with 100 units and work up to the higher levels gradually. Vitamin E helps even out the effects of high levels of estrogen.

ESSENTIAL FATTY ACIDS. Essential fatty acids (EFAs), including linoleic and linolenic acids, are the source for the manufacture of prostaglandins, which prevent cramping of muscles and blood vessels. Good sources of EFAs are raw seeds, especially flax seed, nuts, salmon, mackerel, and trout. They can also be taken as dietary supplements.

HERBS. 100 milligrams per day maximum dose of fennel, anise, blessed thistle, black cohosh, and false unicorn root works to restore hormonal balance. You can also use white willow bark and meadowsweet to reduce pain, fever, cramps, and inflammation of the endometrial implants. Be sure to follow the directions on the label, since these herbs can cause an upset stomach and diarrhea.

ASIAN MEDICINE Dr. Roger Hirsch, a naturopathic doctor in California who specializes in Asian medicine, says that the Chinese diagnose endometriosis by looking at the way the blood flows in the body, specifically in the pelvic cavity. This is determined by the appearance of the root of the tongue, which represents the pelvic cavity. “If a woman has endometriosis, there will be raised bumps and papillae in the back of the tongue and perhaps a greasy yellow coating,” Dr. Hirsch says. “If you look at the back of your tongue in the mirror and see raised bumps that are red and fiery, especially during the time of menstruation, you may well have endometriosis.”

HELLERWORK Hellerwork is a bodywork technique derived from Rolfing. Both modalities use deep tissue work to improve body structure, but Hellerwork is different in that it is not painful. Certified Hellerwork practitioner Sarah Suatoni gives an overview of the process: “There are three components to Hellerwork. There is a hands-on part, which feels much like a massage; a movement educational aspect; and a mind-body dialogue aspect.

“In the hands-on process, we analyze the body much as a chiropractor would, looking at the posture, or the structure, as we call it, to determine which parts of the body are out of balance. We look to see which myofascial tissue connections are creating this misalignment. Then we work with our hands to release it.

“The second part of the work is movement education, in which we do very simple everyday movements. We look at how a person sits or stands. In the case of computer programmers, we look at how they sit at the computer and use their arms. We look at whatever it is that may be contributing to the dysfunction in the body, and then we begin to look at how we can have the person move in a way that will not create the same problem.

“Last but certainly not least is mind-body dialogue. We work under the belief that our emotional patterns, memories, and attitudes are reflected in our bodies. In the same way one needs to look at a movement pattern in order to shift some sort of physical dysfunction, one needs to look at emotional patterns or beliefs in order to shift those as well.

“This work is a process where people come in for 11 sessions. Once a week for an hour and a half is ideal, although other time frames are possible. Each session touches upon a different part of the body and different aspects of the being.”

Suatoni tells how she began using Hellerwork to treat endometriosis and similar chronic conditions: “I met Dr. David Kauffman, a urologist, who determined that women with interstitial cystitis had severe spasm of the pelvic muscles. He has since started working with patients with endometriosis, vulvodynia, vestibulitis, and a number of other conditions that show the same symptoms of severe spasm or contraction. Dr. Kauffman was using biofeedback and felt that he needed someone who did hands-on work to accompany the biofeedback treatments. That’s how I began.

“Although this process deals with mind-body relationships, this does not imply that these diseases are imaginary. Some women have been told for years that their disease is all in their head, when there are all kinds of physical evidence for the disease. Rather, the disease is the result of a set of relationships between the mind and body. Hellerwork and other forms of bodywork help because they are process-oriented and look at relationships. Once women start understanding these relationships, they find that they have a whole lot of power to overcome disease and regain health.”

HOMEOPATHY Homeopathy is another holistic therapy that addresses underlying emotional causes. Dr. Aurigemma has been treating his patients homeopathically for 10 years and claims that the therapy is completely safe and highly effective. “There is no doubt in my mind that something actually happens and that it helps people,” he says. “I utilize the remedies because I see them work. What spurs me on is the continuous improvement of most of the patients I see.”

Patient Story

One woman came to see me who was on prescription narcotic medication for the pain. The medicine gave her no relief, and she was at the point of wanting a hysterectomy to get relief from the pain. I put this woman on a natural hygienic regimen for a couple of weeks. First she fasted for 5 days. Then she followed up with a nutritional plan.

Let me briefly describe a typical hygienic regimen. The patient has a breakfast consisting of a vegetable juice or a vegetable and fruit juice combination, a blended salad, a piece of fruit, perhaps some hot cereal, and a couple of soft-boiled egg yolks. Lunch is a vegetable juice or vegetable and fruit juice combination, a blended salad, a cup or a little more than that, a piece of fruit, and then some raw nuts or unsalted raw-milk cheese. For the evening meal the patient starts with juice again, blended salad, tossed salad, and steamed vegetables such as string beans, broccoli, or escarole. Then she goes on with the main course, which includes a steamed potato or yam, natural brown rice or another whole grain, and a legume. I also might supplement the meal with egg or cheese, depending on the protein needs of the woman. Of course, there are variations for individual patients.

After following this general plan, this patient was pain-free at the end of a month. That was 10 years ago. Right now she is pregnant with her second child, whereas before she was infertile. Natural hygiene has tremendous implications for endometriosis. There is absolutely no reason why a woman should have pain or be infertile because of such a simple condition.

From my perusal of the literature I can see that endometriosis is plainly a condition of liver toxicity, where the liver is failing to completely break down the estrogen hormones that the body is manufacturing. These breakdown products wreak havoc in the form of endometrial tissue in the pelvic cavity.

—Dr. Anthony Penepent