The endometrium is a layer of renewable tissue that lines your uterus. During each menstrual cycle, this layer thickens in response to hormonal stimulation as it prepares for implantation of a fertilized egg. If fertilization does not occur, the endometrium is shed and the cycle begins again. Just like the endometrium within your uterine cavity, endometrial implants in other areas of the body cycle in response to monthly hormonal fluctuations. As endometrial implants thicken, bleed, and shrink again, they can trigger inflammation and pain.
Your ovaries, fallopian tubes and the cul-de-sac behind your uterus are the most common sites for endometrial implants to occur, but they can appear nearly anywhere in a woman’s body. Endometriosis can scar surrounding tissues and disrupt the function of nearby organs. Chronic pelvic, abdominal, back and thigh pain, irregular periods, pain during intercourse and infertility are common in women who have endometriosis.
The number of endometrial implants in your pelvis, abdomen or other body regions does not necessarily correlate with the severity of your symptoms. Some women with extensive endometriosis have minimal discomfort, while others with very few implants suffer from severe, intractable pain and infertility.
Medical Treatment for Endometriosis
Women who are diagnosed with endometriosis may find their therapeutic options limited. Conventional treatments for this condition include drugs that suppress ovarian function and reduce endometrial growth (oral or injectable contraceptives, hormone-secreting IUDs [Mirena], Danazol, or Lupron), ablative surgery to remove individual endometrial implants and reduce scarring and, in severe or stubborn cases, hysterectomy. Pain control with nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, sulindac, nabumetone, etc.), acetaminophen (Tylenol) or narcotic painkillers is usually of mild to moderate benefit.
Recent studies suggest that endometriosis may be driven by autoimmunity in a significant percentage of women. This discovery may one day lead to new therapies aimed at modulating the immune response in a select group of patients. However, since it isn’t yet clear whether endometriosis is the cause or the effect of immune hyperactivity, and since immunomodulation carries its own burden of side effects, it may be some time before these treatments are available.
Given the paucity of effective treatment modalities – and acknowledging that the most effective treatments can temporarily or permanently impair fertility – it’s little wonder many women simply opt for the best pain medication they can find and hope for the best.
Alternative Therapies for Endometriosis
Alternative and complementary remedies for endometriosis are aimed at alleviating pain, reducing the influence of hormones on endometrial implants and balancing your immune system. In general, alternative therapies are less effective than conventional medical treatment for reducing pain, and none has been shown to improve fertility.
A great deal of controversy surrounds the use and effectiveness of plant-based estrogens, particularly in women who have a history of breast, ovarian, or uterine cancer. However, some evidence indicates that phytoestrogens exert a selective effect on estrogen receptors and may even be of benefit in patients with estrogen-dependent cancers.
Phytoestrogens, which are plant-based compounds that resemble estrogen, bind to estrogen receptors in the human body. However, phytoestrogens aren’t as potent as the estrogens your body produces. Therefore, in situations where less estrogen stimulation is desirable – endometriosis, for example – phytoestrogens may reduce your symptoms by occupying estrogen receptors and preventing your own estrogen from exerting its full effects. Conversely, when your own estrogen levels are low (e.g., menopause), phytoestrogens bind to receptors that would not otherwise be occupied and exert a weak estrogenic effect.
Sources of phytoestrogens include (in no particular order):
- Soy or tofu
- Burdock root
- Dried beans
- Sweet potatoes
- Red clover
- Mung beans
- Alfalfa sprouts
- Wild yam
Estradiol is the most potent form of estrogen in your body. Conversion of estradiol to weaker forms, such as estriol, occurs naturally in your liver. Like phytoestrogens, estriol binds to estrogen receptors but exerts a weaker effect than estradiol.
Indole-3-carbinol, a compound found in cruciferous vegetables like broccoli, cauliflower and cabbage, hastens the conversion of estradiol to estriol. Thus, a diet that is high in indoles – or an indole supplement – may reduce the symptoms of endometriosis. As an added benefit, indoles appear to decrease your risk for certain malignancies, such as colon cancer.
Inflammation is the driving force behind the pain and scarring that characterize endometriosis. Interrupting the inflammatory process requires a multi-factorial approach that includes proper diet, sufficient rest, stress reduction and anti-inflammatory herbs.
Some key measures to consider:
- Avoid refined or processed foods; limit sugar, alcohol and caffeine.
- Eat foods that are rich in alpha- and gamma-linolenic acids, which help regulate the levels of inflammatory prostaglandins in your body. These healthy fatty acids can be found in evening primrose oil, black currant seed oil, flaxseed oil, and borage oil.
- Maintain an adequate intake of antioxidant vitamins C (500 – 1000 mg daily) and E (400 – 800 IU daily) through diet or supplementation.
Consider these anti-inflammatory herbs:
- Devil’s claw
- White willow bark
- Licorice root
Other Important Measures
Women who exercise several hours weekly appear to have a lower risk for developing endometriosis, and their symptoms are less severe if they already have it. This may be due to lower levels of circulating estrogens in active women.
Cut out non-organic red meat and dairy products, which can be sources of additional estrogen.
Avoid sugars, refined carbohydrates and processed meats, which can aggravate inflammation in your tissues.
Consider using a progesterone cream. Progesterone generally opposes the actions of estrogen, and it may reduce the pain arising from endometrial implants in women with severe disease.
Many women with endometriosis don’t want to submit to surgery – either laparoscopic ablation or hysterectomy – and they prefer to avoid medications that reduce their fertility or cause serious side effects. For these women, alternative approaches to dealing with this troublesome condition are certainly worth a try.
- AR Mounsey, A Wilgus, DC Slawson. Diagnosis and Management of Endometriosis. Am Fam Phys. 2006;74(4):594-600
- R Gajbhiye, et al. Multiple endometrial antigens are targeted in autoimmune endometriosis. Reproductive Biomed Online. 2008;16(6):817-24
- Life Extension Foundation’s Disease Prevention and Treatment, 4th Edition: Endometriosis. Life Extension Media 2003:1245-6