Endometriosis is the deposition of endometrial tissue at abnormal sites in the body (usually in the pelvic area) instead of where it should normally be positioned which is as the lining of the womb. How does the endometrium function normally?
The endometrium lines the womb (a.k.a. the uterus). In the normal course of events the endometrium goes through a process of build-up and then shedding (this shedding is called the menstrual ‘period’ or monthly ‘bleed’) during the course of a woman’s monthly cycle.The endometrium is the hormonally-sensitive innermost layer of the uterus or womb. During the monthly menstrual period the endometrium is shed from the uterine cavity and discharges through the neck of the womb (the cervix) into the vagina and eventually to the outside. This is the monthly ‘period’ which all females experience during the child-bearing years.
What happens differently in endometriosis?
Endometriosis involves the deposition of endometrial tissue at sites other than the lining of the womb. As a result hormonally-active tissue which continues to bleed on a monthly basis may end up deposited around the pelvis, fallopian tubes, ovaries, rectum and the intestinal area.
Consequently every month this abnormally-situated menstrual tissue becomes built up and then, at period-time, bleeds and sheds blood and cells but because the tissue may be in the pelvis or abdomen rather than in the uterus problems arise.
In endometriosis there is no route of escape and so ‘old’ blood and cells become deposited around the pelvis and this may cause congestion and pelvic, intestinal and rectal pain, period pain, fertility problems etc.
The blood becomes deposited around the pelvis and may adhere to the ovaries and fallopian tubes potentially causing pelvic adhesions and the innocent-sounding but potentially very troublesome ‘chocolate-cyst ovaries’. Endometrial tissue may also be found in the area surrounding the rectum causing severe rectal pain.
Problems experienced by women with endometriosis range widely but pelvic pain including vaginal pain, anal pain, painful periods, fertility issues and pre-menstrual syndrome probably top the list.
For some patients it is constant or semi-constant pelvic pain which leads to gynaecological investigation and an eventual diagnosis of endometriosis. The pain may be severe enough to be described as ‘knife-like’ in the rectal or vaginal area. For other patients the pain is not the predominant feature and the endometriosis may be discovered as part of the investigation of infertility.
Endometriosis- an integrative approach
It is in the nature of how I practice that I tend to become involved in the care of a patient usually when the ‘purely conventional’ approach has not worked or when an individual patient is suffering substantial side effects from conventional medication. Patients suffering from endometriosis are no exception to this rule and many women, not totally unexpectedly in my opinion, are reluctant to take hormonal treatments with the potential for masculinising effects.
Frequently patients with endometriosis patients also have other significant health problems and frequently, in my experience, also suffer from ongoing tiredness all of which need to be addressed in an integrative approach. Frequently ‘irritable bowel syndrome’ is also present and, is in my opinion, highly significant and the bowel problems also need to be addressed in detail. Detailed digestive and stool analysis performed by sending samples to an excellent laboratory in the United States frequently contributes much useful information which benefits both the endometriosis, the irritable bowel and, last but not least, the overall sense of energy and well-being .
I will usually investigate hormone status and pay careful attention to the level of progesterone during the second part of the menstrual cycle.
I also usually do a fairly complete nutritional assessment. Fortunately for my London patients the Biolab Medical Unit which is a world-class nutritional medicine laboratory facility is just a ten-minute walk from Harley Street. Happily, though, for Dublin patients the Blackrock Clinic will usually take blood samples and courier them to Biolabs in London, but unfortunately some Biolab investigations are only feasible to perform in-house.
Some patients with endometriosis have, in my experience, low-intensity ongoing bowel infections (please see sections on low-grade bowel infections and irritable bowel syndrome) and these need to be considered in any endometriosis patient. Liver detoxification may be sluggish (please see section on Sluggish Liver Detoxification ), there may occasionally be subtle underactivity of the thyroid gland (please see page on Hypothyroidism and Underactive Thyroid) or there also may be problems with maintaining blood sugar balance with patients experiencing the overwhelming need to eat very frequently or else they find themselves ‘fading’ which also needs to be attended to.
Success rates with endometriosis
I have treated a small group of patients with endometriosis but have been very pleased with the results achieved thus far (August 2002). Happily the integrative approach with its broad emphasis: on a the nutritional aspects of this disorder alongside some acupuncture, hormonal rebalancing and homoeopathy has consistently given excellent results for patients both in terms of relief of pain and also the non-specific fatigue, bowel problems and the other symptoms associated with endometriosis.
I also feel it is always important to state that while I have been extremely pleased with the results of my treatment of endometriosis patients so far if one is honest one can never guarantee future results.
Stay in touch with you GP and gynaecologist
As a matter of ordinary medical common sense: it is very important for patients to remain under the care of and be advised by their general practitioner and gynaecologist and continue to have routine preventive gynaecological and general medical care.