ENDOMETRIOSIS

The Chinese and Western Medicine View and Treatment

It’s estimated that around 25% of women with pelvic pain, and 20% of women with infertility may have endometriosis [1].

Endometriosis is most prevalent in women of reproductive age, and so it can affect couples trying to get pregnant.

90.4% of Endometriosis occurs in women between the ages of 15 and 55 years [2].

WHAT IS ENDOMETRIOSIS?

There are different thoughts on what endometriosis is and I’ll share with you the common thoughts in Chinese and Western medicine.

The Western medicine view: 

Endometriosis is a western medicine disease name for a condition in which the endometrium (tissue cells that line the inside of the uterus – i.e. the uterine lining cells) is found in other locations around the body.

The lesions caused by endometriosis are called ‘endometriotic lesions’, and they can be found anywhere in the pelvic cavity including:

the ovaries, fallopian tubes, pelvic side-wall, the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and the rectal-vaginal septum.

The lesions are less commonly found on the bladder, bowel, appendix, and rectum.

Rare cases find endometriosis inside the vagina, the bladder, on the skin, and even in the lung, spine, and brain [3][4][5].

If endometriotic lesions form scarring, then this forms hardened or enlarged areas called endometriotic nodules.

Areas of endometriosis can grow large enough to also become a type of tumour, and these tumours are called ‘endometriomas’. They typically develop as cysts on the ovary, commonly known as ‘chocolate cysts’.

The Chinese medicine view:

Classical Chinese medicine (not TCM – “Traditional” Chinese Medicine) has a history of over 2500 years and is still successfully used in China today.

It’s based on understanding the root health balance of the body, so that we can detect when this balance is disturbed – ideally before any disease manifests itself.

This helps us to diagnose health issues earlier – before they present as a physical disease.

Chinese medicine describes disease on 2 key levels:

1. The Branch – the physical presentation of a disease through symptoms and its manifestation in the body – that can be seen (visual body changes or medical test results), or felt through physical symptoms such as pain or other irregularities of the body. The branch leads us to identify the root.

2. The Root – the underlying cause of the issue at a deeper level of the body. This can’t be seen directly, but instead presents itself through the branch/symptoms. Before a disease is properly formed there are tell-tale signs showing imbalance is present on this deeper level. To identify these imbalances, we use categories of symptoms that are combined into groups, known as ‘patterns.

The physical presentation of endometriosis that we can see through medical investigation and physical symptoms is viewed as the ‘branch’ of the disease in Chinese medicine.

These symptoms, and the endometriosis itself, are not the root cause of the endometriosis. This is just the presentation. There is another deeper cause.

In many situations this is where Chinese and western medicine differ.

In most cases western medicine focuses on the treatment of the disease presentation (branch), rather than the root cause. With diseases such as endometriosis, western medicine looks to alleviate the symptoms or physically remove the presentation with surgery. However, as you’ll read shortly, this only temporarily deals with the issue as most people have a recurrence of endometriosis within 1-5 years after western medicine treatment.

Chinese medicine always puts a focus on treating the root cause, but at times will also treat the branch alongside the root. This is particularly useful for cases such as endometriosis where the symptoms (branch) are so strong that they cause pain – and so the symptoms also need to be addressed to make life comfortable for the patient.

When we can identify the root cause of any health issue, we have a much greater chance of successfully treating it.

As the famous Chinese physician Lu Buwei said 2300 years ago: “Nothing is better than knowing the root cause” [6].

Understanding our health through the Chinese medicine patterns, allows us to identify the underlying ‘malfunctions’ of the body – regardless of whether a disease (such as endometriosis) has been diagnosed or not.

This is helpful:

  1. Before a western medicine diagnosis has been discovered – to allow for early detection of issues.
  2. To find the deeper root cause of an already diagnosed disease in western medicine – to allow for root treatment.
  3. To find the underlying root cause/ imbalance when western medicine diagnoses an ‘unexplained’ situation – to allow for treatment when western medicine can’t.

What is Endometriosis in Chinese Medicine?

Endometriosis is categorised as a blood circulatory disorder in the Chinese medicine system.

This is explained in China’s oldest (still existing) medical book, the Huang Di Nei Jing, written around 220BC.

In the 39th chapter of the book the causes of blood circulatory disorders are discussed, along with treatment options [7]. It identifies that when blood circulation is decreased, reversed, or interrupted, the person will experience pain – and symptoms of poor blood flow.

In Chinese medicine we call this: Blood Stagnation.

SYMPTOMS OF ENDOMETRIOSIS

Symptoms can vary widely, although many people may have no symptoms at all (asymptomatic) according western medicine. The Chinese medicine concept of Blood Stagnation presents with all the western medicine symptoms of endometriosis and a few more.

Western Medicine View:

The single most common symptom of endometriosis according to western medicine is: pelvic pain.

Pelvic pain occurs in many women with fertility issues, and up to 80% of endometriosis sufferers [8].

Pelvic pain typically includes: 

  • Painful periods
  • Backache
  • Pressure on the rectum
  • Lower abdominal discomfort
  • Severe cramps
  • Pain during or after sex

Other associated symptoms are:

  • Heavy or irregular bleeding
  • Infertility
  • Painful bowel movements
  • Fatigue
  • Blood weakness issues such as anemia
  • Blood circulation issues
  • It may also contribute to a lack of energy and depression.

Chinese Medicine View:

Blood Stagnation causes one or more of the following signs and symptoms:

  • Dark red menstrual blood
  • Clotted menstrual blood
  • Thicker consistency (often grainy, dry or pasty) menstrual blood
  • Irregular flow of menstrual blood
  • Spotting of brown or dark blood after menstruation
  • Heavy or scanty menstrual flow
  • Stabbing or cramping abdominal or lower back pain
  • Difficulty standing up or stretching the abdomen when in pain
  • Pain in the rectum
  • Fever or feeling cold
  • Dizziness or feeling light headed
  • Delayed or irregular menstruation

These symptoms are the most commonly experienced, that vary greatly in intensity and frequency.

Both forms of medicine agree that if you have never had symptoms of pain but they start to present regularly, it may be an indicator of endometriosis or at least early stages of poor blood circulation. The same is true if you have pain, but it progressively becomes more severe over multiple cycles. Please speak to your doctor for further investigation.

CAUSES OF ENDOMETRIOSIS

Western Medicine View:

The actual cause is not currently known in western medicine, and there are several ideas – but they do not fully explain the complex presentation of the disease.

The 3 key ideas are:

1. Retrograde Menstruation:

This is where the menstrual blood (containing the endometrial cells that are released during menstruation) travels up the fallopian tubes and spills out into the pelvic cavity – instead of flowing down and out of the body through the vagina, as in ‘normal’ menstruation.

If this spillage happens into the pelvic cavity, the endometrial cells can attach to other areas of the body and begin to grow. They are then affected by the changing hormone levels throughout the menstrual cycle.

The theory of endometriosis and retrograde menstruation was first proposed in 1921 by John A. Sampson [9].

Retrograde menstruation seems to be a common cause of endometriosis as it is seen in as many as 76 – 90% of women [10].

This concept does not however explain why the endometrial cells are sometimes found in other areas of the body such as the lungs, nose, spine etc. There is therefore a possibility that the vascular or lymphatic system may be involved in these other cases.

2. Metaplasia:

This is where healthy cells outside the uterus turn into endometrial cells, and then grow and develop into areas of endometriosis.

This theory is based on the understanding that different types of tissue in the pelvic area originate from the same embryonic cells. This means that they have the potential to transform into another type of cell such as endometrial cells [11].

3. Immune Factors:

This is where there may be an involvement of the immune system.

A decrease in Natural Killer Cells (NK Cells) or T-Lymphocyte activity, or other changes in the immune system, may affect the normal removal of menstrual debris or cells. This may increase the risk of developing endometriosis as the cells remain in the body and become active.

An increase in a variety of immune markers have been found in women with endometriosis [12].

Chinese Medicine View:

When the blood doesn’t flow freely through the uterus to release the uterine lining during menstruation, you will experience some degree of Blood Stagnation.

This stagnation may present as:

  • An incomplete release of the uterine lining (endometrium). 

Under normal circumstances the blood should ‘push away’ the old lining of the uterus and carry it out of the body with the act of menstruation. If the blood flow is poor or obstructed, this mechanism isn’t successful, and patches of old lining remain attached to the uterus.

  • A counter-flow of menstrual blood.

If the endometrium is released, but the downward flow is interrupted, blocked or hindered, it can cause counter-flow (retrograde) menstruation. This stops the blood from being released and causes it to stagnate outside the uterus. Symptoms will usually follow at some later stage.

Both of the above arise from weak, obstructed, or incorrectly located blood circulation.

How Endometriosis Affects Fertility?

For pregnancy to occur, an egg must be released from the ovary and fertilised.

Once released it travels through the fallopian tube, gets fertilised, and makes its way to the uterus. Once there it implants in the uterine wall to begin development.

Endometriosis can stop pregnancy happening because:

  1. The ovary may have one or more endometriomas (chocolate cysts) in it, which can interfere with ovulation and the release of an egg.
  2. Scarring or adhesions can obstruct the fallopian tubes so that the egg can’t travel down the tube to be fertilised and reach the uterus.
  3. Scarring or damage to the uterine lining, which prevents the embryo from implanting in the uterine wall.

DIAGNOSIS OF ENDOMETRIOSIS

Western medicine:

The diagnosis of endometriosis requires visual confirmation, and a laparoscopy is the gold standard for reaching a diagnosis in western medicine. Ultrasound examination is limited to detect endometriomas in the ovary.

If you are diagnosed with endometriosis you will be told which of the 4 stages you have.

Many women with mild to moderate Endometriosis can still conceive and carry a pregnancy to term.

Doctors often advise younger women with endometriosis to get pregnant early, because the condition can worsen with age in some people.

Pregnancy can at times improve the condition, due to increased blood circulation and elevated Progesterone levels.

The 4 Stages:

Stage I – (minimal): This shows superficial lesions and/or a few filmy adhesions.

Stage II – (mild): The same as stage I above but there are also some deep lesions present in the Cul-De-Sac.

Stage III – (moderate): The same as stage II above but there are also endometriomas (cysts) on the ovary along with other adhesions.

Stage IV – (severe): The same as stage III above but with large endometriomas, extensive adhesions, and infiltration of other organs such as the bladder, intestines, ureter etc.

Chinese Medicine:

Diagnosis in Chinese medicine involves a detailed assessment of your health, which determines the root (cause) and branch (symptoms) of your unique health balance.

Blood Stagnation is the general category of disease for Endometriosis, but as you’ll see below there are 6 common causes of Blood Stagnation.

The aim is to get clear on which patterns are causing your blood stagnation, to be able to target treatment at them.

The 6 causes of Blood Stagnation:

Blood Deficiency: Poor quality blood that cannot flow well because the blood is too weak and has insufficient force to circulate properly.

Qi Stagnation: Poor circulation of the Qi (energy). Qi is involved in circulating the Blood. When the Qi is stagnant it can’t perform its action of supporting Blood circulation and Blood Stagnation develops.

Cold: the element of Cold can enter the body and constrict the blood vessels, which disrupts blood flow and creates blood stagnation.

Heat: too much internal heat (due to a fever or lack of fluids over time) can disrupt blood flow because it has a ‘drying’ effect on the blood, which weakens circulation.

Dampness: an accumulation of excess fluid in the body. These fluids collect in the blood vessels, glands (incl.thyroid or pituitary), organs (incl.ovaries) and hollow structures of the body such as the fallopian tubes, uterus, stomach, intestines and more. Dampness disrupts the circulation of the Qi and Blood – both of which cause Blood Stagnation.

Over the past 22+ years I’ve seen around 98% of my clients with this issue involved in their fertility health complications. My experience also shows that Dampness plays a key role in immune disorders, that may also relate to endometriosis according to western medicine.

Obstruction of Blood Flow: This relates to actions that people take that can obstruct the flow of the menstrual blood, or alter its course.

If any of the following are carried out during menstruation, it can result in obstruction or retrograde flow of the blood:

using tampons or a MoonCup, having intercourse, doing headstands (yoga), high impact exercise, swimming in cold water, saunas or ‘heated’ forms of exercise such as Bikram Yoga.

Note: You can read more about the 6 health patterns by using the links above.

TREATMENT OPTIONS

Western Medicine

Different methods are used to address the symptoms of endometriosis as there is no known cure in western medicine.

This has resulted in medicated, surgical, or medicated and surgical combined approaches – with varying degrees of success. These approaches may help alleviate the symptoms, but they don’t treat the root cause.

A return of symptoms within 1 year is seen in 28 – 50% of people that have been treated with one or both of these methods [13].

Western Medicine Treatment:

1. Medication

There are a variety of medications that have been used with varying success. Contraceptives, Progestins (synthetic progesterone), Danazol, GnRH agonists, and aromatase inhibitors are commonly used drugs.

These medications disrupt the function of the endometrial cells and reduce their activity. This reduces their potential to create the symptoms of pain and also the further development of adhesions that causes the disease to spread.

A recurrence of symptoms is experienced in approximately 50% of patients using these medications [14].

2. Surgery

Surgery through laparoscopy is the most common choice, which aims to remove all endometrial growth. Endometriomas are treated to minimise damage to the ovary – particularly when someone is on a fertility journey.

Pregnancy rates after laparoscopic treatment of endometriomas in fertility patients, were 50% and 52% success according to 2 studies.

In another study of fertility patients with partial or complete cul-de-sac obliteration, 74% conceived after laparoscopy treatment with 38% requiring more than one laparoscopy [15].

For stage III or IV endometriosis it usually requires surgery first, followed by medicated treatment to try to reduce the recurrence. Typically 40.3% will need treatment again within 5 years [16].

For very severe cases where someone is not trying to conceive, surgery consists of a hysterectomy in many cases.

Surgery is also helpful for endometriosis associated with infertility. In contrast to medical treatment, a period of contraception is not required. This provides older infertility patients a time saving of up to six months during which time fertility may normally decrease [11].

As a general rule, a pregnancy rate of approximately 65% can be expected after surgery for endometriosis [17].

3. Ovarian Stimulation or IVF

Ovarian stimulation (with or without insemination) and IVF, are also common treatments.

These treatments are intended to increase the chances of getting pregnant and do not directly treat endometriosis. Drug treatment in either of these types of treatment cycles can increase the chances of pregnancy due to the stimulation of follicles.

Chinese Medicine Treatment for Endometriosis:

Once a clear Chinese medicine diagnosis has been established, I use The 5 Fertility Health Foundations to work on the patterns of imbalance that need treating.

Each of the following 5 Foundations are listed in order of importance for treating Endometriosis and Blood Stagnation:

  • Herbal medicine: In 100% of cases, endometriosis will require the use of herbal medicine if you want to use Chinese medicine as your treatment method.This is because Blood Stagnation patterns respond extremely well to herbal medicine treatment. The correct herbs need to be chosen for each stage of your menstrual cycle, to address your root pattern of Blood Stagnation.Please do not self-treat with herbal medicine as you may create further complications.
  • Dietary Support: This is also vital in 100% of endometriosis cases. There is absolutely no ‘one-size-fits-all’ dietary approach and what you eat needs to be adjusted to your presenting Chinese medicine health patterns. Many people with endometriosis are told to avoid red meat, but if the cause of your endometriosis is Blood Deficiency – then this advice will not support you well, as red meat is important for building good healthy red blood cells.
  • Lifestyle Support: movement and activity at the right level for your diagnosis will support the circulation of your Blood. Too much activity when your Qi or Blood are weak, will further weaken them and cause blood stagnation. Too little exercise with Qi stagnation or Dampness and it won’t be enough. The best option for now, until you’re clear on your root cause, is to do moderate daily exercise such as walking, swimming in warm water, or gentle cycling. We want to gently circulate blood – so movement is vital at least once a day.
  • Environmental Support: I’ve written and spoken extensively over the years about pollution through air, light, noise, food and chemical contact on the body through body care products. If you’re not familiar with these issues please read my other posts, as it’s a huge topic. Taking care to keep your environment as ‘clean’ from pollutants as possible is vital to your good health. The average woman uses around 168 chemicals daily, in her general care regime, creating a huge amount of contamination [18].People and relationships are also a part of your environment, and they play a key role in your health balance too. Try to keep these relationships as healthy and balanced as possible so as to avoid unnecessary stresses.
  • Mindset: This is key to all of the above, and to our general health. Chinese medicine has spoken about the 5 emotions since before the writing of the Huang Di Nei Jing that I mentioned to you above. Having a balanced and calm mind is fundamental to our good health, but can be hard in this modern time of high stress environments. Take time out for yourself daily and work to keep your mind calm and centred in the moment.

Integrating Classical Chinese Medicine and Biomedicine

Using Classical Chinese herbal medicine has shown to potentially have a better overall treatment effect than Danazol, and may also be more effective in relieving painful periods [19].

As endometriosis cannot be completely treated with Biomedicine, we can utilise some of the older treatment systems of the world, such as Classical Chinese Medicine (not TCM), that have dealt with gynecological issues for around 2500 years.

Using our modern technology and combining it with older natural methods based on clear diagnosis from both forms of medicine, is a logical way forward for medicine.

HOW I CAN HELP

For 22+ years I’ve been supporting people on their fertility journey’s, and many with endometriosis. This is a complex condition that once diagnosed needs a strong strategy to support treatment of it.

My online program offers individualised 1-2-1 support with all of the 5 Fertility Foundations listed above – to help you take control of your health and address the root cause, to help you have your baby.

If you’re interested in working with me, book a FREE 30-minute Online How to Get Pregnant Discovery Session and let’s see if I can help you too.

 

References:

[1] Eskanazi B, Warner ML (1997). “Epidemiology of Endometriosis”, Obstetrics and Gyneacology Clinics of North America.

[2] Eisenberg VH et al. (2017). “Epidemiology of Endometriosis: a large population-based data study from a healthcare provider with 2 million members” www.doi.org

[3] Cowart CL. (1992). “Extrapelvic Endometriosis”. Infertility and Reproductive Medicine Clinics of North America, Vol.3.

[4] Schenken RS (1989). “Endometriosis: Contemporary Concepts in Clinical Management. Philadelphia.

[5] Koger KE et al. (1993). “Surgical scar endometrioma”, Surgery, Gynecology & Obstetrics vol 177.

[6] [18] The Annals of Lu Buwei, 3rd Century BCE (Stanford University Press – translated by K, K and Riegel – 2000)

[7] [17] Chapter 39, Huang Di Nei Jing. Blood stagnation.

[8] Pittaway DE (1992). Infertility and Reproductive Medicine Clinics of North America, Vol.3

[9] Sampson JA (1921). Archives of Surgery, vol 3.

[10] Halme J et al (1984). Obstetrics and Gynecology.

[11] Gruenwald (1942), published in The American Journal of Obstetrics and Gynecology.

[12] Markers such as: growth factor-b (TGF-b), IL-1, tumour necrosis factor-a (TNF-a) and vascular endothelial growth factor.

[13] Yuning Wu and Celine Leonard with Dr Michael Haeberle. (2019). Female Infertility & Reproductive Gynecology.

[14] Fedele L et al. (1989). Published in The American Journal of Obstetrics and Gynecology

[15] (1986) . Journal of Reproductive Medicine vol 31.

[16] Recurrent Endometriosis Incidence, Management and Prognosis. (1983). American Journal of Obstetrics and Gynecology.

[17] Fertility and Sterility vol 31.

[18] Dr Mercola on Environmental Toxins: https://articles.mercola.com/sites/articles/archive/2015/05/13/toxic-chemicals-cosmetics.aspx#_edn7)

[19] Flower A et al. (2009). “Chinese herbal medicine for endometriosis”. Cochrane Database of Systematic Reviews, (3):CD006568

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