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.

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:

• 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

The cause is unknown, but theories include:

• 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
• Stress

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.

Drug Therapies

The following drugs can relieve the symptoms of endometriosis:

• Nonsteroidal anti-inflammatory drugs (such as ibuprofen)
• Oral contraceptives
• Hormone-suppressing drugs (which stop ovulation)

Surgical Procedures

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:

• 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.

Nutritional deficiencies may be addressed with the following supplements:

• 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.

Herbs

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.

• 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.

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.

• 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.

Physical Medicine

DO NOT perform these therapies during menstrual flow:

• 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.

Acupuncture

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.

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