Endometriosis occurs when endometrial cells, the cells that make up the lining of the uterus, travel outside the uterus to other parts of the body. Even though these cells no longer reside within the uterus, they are still stimulated by a woman's reproductive hormones and shed blood during menstruation each month. Blood from these cells causes deposits to accumulate and form scar tissue, which can be painful. Endometriosis affects 10% of American women of childbearing age and up to 90% of women with infertility. It is one of the main causes of infertility in women.
- Pelvic pain, especially during menstruation
- Heavy or irregular menstruation
- Pain during sexual intercourse
- Infertility or miscarriage
- Pain with bladder or bowel function, or intestinal pain
- Chronic low back pain
- Diarrhea, constipation, nausea, or bloating that worsens during menstruation
- Abnormal functioning of the immune system
- Retrograde (or reflux) menstruation, in which some menstrual blood flows backward through the fallopian tubes
- Genetic or heredity factors (Some studies put the risk of endometriosis as 10-fold higher among women who have a first degree relative with endometriosis, but at least one study has found the risk to be closer to 2 times as high. In this study, women who had a close relative with endometriosis had double the chance of developing the condition, compared to patients with no family history.)
- Some studies suggest that being overweight during late childhood is associated with the development of endometriosis
- Nonsteroidal anti-inflammatory drugs (such as ibuprofen)
- Oral contraceptives
- Hormone-suppressing drugs (which stop ovulation)
- Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may test for food sensitivities.
- Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell pepper).
- Avoid refined foods, such as white breads, pastas, and sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives, such as monosodium glutamate (MSG).
- Drink 6 to 8 glasses of filtered water daily.
- Omega-3 fatty acids, such as fish oil, to help reduce inflammation and improve immunity. Talk to a health care provider before taking omega-3 fatty acid supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).
- A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Vitamin C, as an antioxidant and for immune support.
- Alpha-lipoic acid, for antioxidant support.
- L-carnitine, for muscular support. Carnitine may interact with certain medications, including acenocoumarol (Sintrom), thyroid hormone, and blood-thinning medications, such as warfarin (Coumadin), aspirin, and others.
- Probiotic supplement (containing Lactobacillus acidophilus), when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully. People who are severely immune compromised, or who are taking immune suppressive drugs, should speak to their physicians before taking probiotic supplements.
- Calcium d-glucarate, can help rid the body of toxins and may help the body get rid of excess estrogen. If you are taking birth control pills or hormonal medication, talk to your physician before taking Calcium d-glucarate as this supplement may interfere with hormonal and many other medications.
- Diindolylmethane (DIM), to help the body metabolize estrogen into the most beneficial form and not into harmful forms. If you are taking birth control pills or any kind of hormonal medicine, talk to your doctor before taking DIM as this supplement may interfere with hormonal medications and many other medications.
- Coenzyme Q10 (CoQ10), for antioxidant and immune support. CoQ10 may interfere with blood-thinning medications by making the blood more prone to clot.
- Chasteberry (Vitex agnus cactus) standardized extract, for hormonal support. Chasteberry is usually taken long term (12 to 18 months) for maximum effectiveness. Consult a physician for long-term use. It can potentially interfere with certain medications, including hormonal, antipsychotic, Parkinson disease, and other medications. Talk to your doctor.
- Evening primrose oil (Oenothera biennis) standardized extract, as a source of gamma linolenic acid (GLA), for symptoms of hormonal imbalance and stress. You should not take evening primrose oil if you are taking antipsychotic medications, medications that may increase bleeding, or if you have a history of seizures.
- Bromelain (Ananus comosus) standardized extract, for pain and inflammation. May increase the effect of blood thinning medications, such as warfarin (Coumadin); speak with your physician. Bromelain can also interact with other medications, including certain antibiotics.
- Turmeric (Curcuma longa) standardized extract, for inflammation. May increase the effect of blood-thinning medications, such as warfarin (Coumadin); speak with your physician. Turmeric can make gallbladder problems, such as gallstones, worse.
- Belladonna. For menstruation with sensation of heaviness and heat.
- Calcarea phosphoricum. For excessive periods with backache.
- Chamomilla. For heavy menses with dark clotted blood and pains.
- Cimicifuga racemosa. For unbearable pain radiating from hip to hip.
- Contrast sitz baths. You will need two basins in which you can comfortably sit. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this 3 times to complete one set. Do 1 to 2 sets per day, 3 to 4 days per week.
- Castor oil pack. Apply oil to a soft, clean cloth, place on your abdomen, and cover with plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. Use for 3 consecutive days. Never use castor oil internally.
- Transcutaneous Electrical Nerve Stimulation (TENS). Preliminary studies suggest that TENS may help reduce pain and improve quality of life for women with deep endometriosis.
Signs and Symptoms
Many women with endometriosis have no symptoms, and they often do not find out they have it until they have problems trying to conceive. The most common symptoms include the following:
What Causes It?
The cause is unknown, but theories include:
What to Expect at Your Doctor's Office
A physical examination may include gentle pushing on your abdomen and a pelvic exam. Your doctor may order an ultrasound, Magnetic Resonance Imaging (MRI) or other tests to help determine whether or not you have endometriosis. Definitive diagnosis is made with laparoscopy, a surgical procedure that inserts a fiber-optic rod and camera into the abdomen through a small incision in the belly button.
There is no cure for endometriosis. Treatments are designed to relieve symptoms.
The following drugs can relieve the symptoms of endometriosis:
Laparoscopic laser techniques help shrink lesions and may improve fertility. Doctors typically only recommend total hysterectomy (removal of the uterus and ovaries) when necessary, however, this approach does not guarantee an end to symptoms. Doctors sometimes use surgical procedures in combination with long-term medicine. Studies suggest medication combined with surgical therapy offers an advantage over surgery alone.
Complementary and Alternative Therapies
In addition to diet, herbs, and supplements, exercise may help prevent endometriosis. It is unknown whether exercise will help an existing condition. Since hormones like estrogen affect endometriosis, many treatments are designed to reduce estrogen levels in the body. If you are pregnant, or thinking of becoming pregnant, do not use any complementary and alternative therapies unless directed to do so by your physician.Nutrition and Supplements
These nutritional tips may help reduce symptoms:
Nutritional deficiencies may be addressed with the following supplements:
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to choose the safest, most effective herbal therapies before starting any treatment. Many of the following herbs have hormonal activity and may therefore interfere with hormonal medications. Always tell your doctor about any herbs you may be taking. Never use herbs if you are pregnant unless directed to do so by your physician. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Traditional Chinese Medicine (TCM) is often used as an alternative and/or complementary treatment for endometriosis. Herbs often prescribed include corydalis, cnidium, bupleurum, dong quai, and perilla, sometimes accompanied by acupuncture. Because doses vary, you should talk to a licensed provider of TCM.Natural Hormone Replacement
A qualified natural medicine provider may prescribe natural hormone creams, such as progesterone, to balance excess estrogen levels. This should only be done under the care of a licensed doctor skilled in the use of natural hormones. Keep all of your doctors informed whenever you use hormones of any kind.Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you.
Some of the most common remedies are listed below. A common dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.
DO NOT perform these therapies during menstrual flow:
Acupuncture may help reduce pain and balance hormone levels. Preliminary studies show that acupuncture is effective in reducing pain related to endometriosis. More studies are needed.Massage
Therapeutic massage may help resolve pelvic congestion.
Endometriosis often resolves temporarily during pregnancy and lessons after menopause -- although not always. Recent evidence suggests that women who have endometriosis are at greater risk of developing ovarian cancer.
Allen C, Hopewell S, Prentice A. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2005;(4):CD004753.
Anger DL, Foster WG. The link between environmental toxicant exposure and endometriosis. Front Biosci. 2008;13:1578-93.
Bope & Kellerman. Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders; 2013.
Doyle JO, Missmer SA, Laufer MR. The Effect of Combined Surgical-Medical Intervention on the Progression of Endometriosis in an Adolescent and Young Adult Population. Journal of Pediatric and Adolescent Gynecology. 2009;(22)4.
Kocakoc E, Bhatt S, Dogra VS. Endometriosis. Ultrasound Clinics - Volume 3, Issue 3. Philadelphia, PA: Elsevier Saunders; 2008.
Ferri F. Ferri's Clinical Advisor 2010. 1st ed. Philadelphia, PA: Elsevier Mosby; 2009.
Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet--what is the evidence? Eur J Obstet Gynecol Reprod Biol. 2007;132(2):140-7.
Flower A, Lewith GT, Little P. A feasibility study exploring the role of Chinese herbal medicine in the treatment of endometriosis. J Altern Complement Med. 2011;17(8):691-9.
Flower A, Liu JP, Chen S, et al. Chinee herbal medicine for endometriosis. [Review]. Cochrane Database Syst Rev. 2009;(3):CD006568.
Greene R, Stratton P, Cleary SD, et al. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91(1):32-9.
Hamdan M, Omar SZ, Dunselman G, et al. Influence of endometriosis on assisted reproductive technology outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2015;125(1):79-88.
Heilier JF, Donnez J, Lison D. Organochlorines and endometriosis: A mini-review. Chemosphere. 2007; [Epub ahead of print].
Jacobson TZ. Potential cures for endometriosis. Ann N Y Acad Sci. 2011;1221:70-4.
Jarrell J, Brant R, Leung W, et al. Women's Pain Experience Predicts Future Surgery for Pain Associated With Endometriosis. J Obstet Gynaecol Can. 2007;29(12):988-91.
Jiang H, Shen Y, Wang XG. Current progress of Chinese medicinal treatment of endometriosis. [Review]. Chin J Integr Med. 2010;16(3):283-8.
Kaatz J, Solari-Twadell PA, Cameron J, et al. Coping with endometriosis. J Obstet Gynecol Neonatal Nurs. 2010;39(2):220-5; quiz 225-6.
Kvaskoff M, Mu F, Terry KL, et al. Endometriosis: a high-risk population for major chronic diseases? Human Reprod Update. 2015;21(4):500-16.
Lambrinoudaki IV, Augoulea A, Christodoulakos GE, et al. Measurable serum markers of oxidative stress response in women with endometriosis. Fertil Steril. 2009;91(1):46-50.
Leong FC. Complementary and alternative medications for chronic pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):503-10.
Meissner K, Böhling B, Schweizer-Arau A. Long-term effects of traditional Chinese medicine and hypnotherapy in patients with severe endometriosis - a retrospective evaluation. Forsch Komplementmed. 2010;17(6):314-20.
Mira TA, Giraldo PC, Yela DA, et al. Effectiveness of complementary pain treatment for women with deep endometriosis through transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2015;194:1-6.
Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25(6):1528-35.
Moen MH, Rees M, Brincat M, et al. EMAS position statement: Managing the menopause in women with a past history of endometriosis. Maturitas. 2010;67(1):94-7.
Nagle CM, Bell TA, Purdie DM, et al. Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis. Hum Reprod. 2009;24(6):1501-6.
Netsu S, Konno R, Odagiri K, et al. Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis. Fertil Steril. 2007; [Epub ahead of print].
Nezhat F, Datta MS, Hanson V, et al. The relationship of endometriosis and ovarian malignancy: a review. Fertil Steril. 2008;90(5):1559-70.
Parazzini F, Vigano P, Candiani M, et al. Diet and endometriosis risk: a literature review. Reprod Biomed Online. 2013;26(4):323-36.
Rodgers AK, Falcone T. Treatment strategies for endometriosis. Expert Opin Pharmacother. 2008;9(2):243-55.
Rubi-Klein K, Kucera-Sliutz E, Nissel H, et al. Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial. Eur J Obstet Gynecol Reprod Biol. 2010;153(1):90-3.
Schrager S, Falleroni J, Edgoose J. Evaluation and Treatment of Endometriosis. American Family Physician. 2013;87(2).
Shakiba K, Bena JF, McGill KM, et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008:111(6):1285-92.
Tsuchiya M, Miura T, Hanaoka T, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology. 2007;18(3):402-8.
Valiani M, Ghasemi N, Bahadoran P, et al. The effects of massage therapy on dysmenorrhea caused by endometriosis. Iran J Nurs Midwifery Res. 2010;15(4):167-71.
Xie J, Kvaskoff M, Li Y, et al. Severe teenage acne and risk of endometriosis. Hum Reprod. 20141;29(11):2592-9.
Zhou J, Qu F. Treating gynaecological disorders with traditional Chinese medicine: a review. [Review]. Afr J Tradit Complement Altern Med. 2009;6(4):494-517.
Review Date: 4/1/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.