Best Treatments for Endometriosis

What is the best treatment for Endometriosis?

Treatment for endometriosis falls into three broad categories

    1. Medical treatment with medications such as pain relief and hormonal therapy to suppress estrogen production
    2. Surgical to remove endometriosis. However surgery is unable to remove the microscopic endometriosis and this is why endometriosis is likely to proliferate and grow again.
    3. Complementary treatments such as dietary adjustments, counselling, herbal medicine, physical therapy and acupuncture.

Receiving the right treatment will depend on your symptoms, your genetic profile, the severity of the condition and whether you are trying to become pregnant or maintain your ability to have children.

Diet and lifestyle

As endometriosis is an estrogen driven inflammatory condition it is imperative to make diet and lifestyle changes to minimise exposure to environmental and plant based estrogens along with assisting estrogen metabolism and reducing inflammation.

Treatment should be individualised to achieve the best response however some guidelines to assist in the management of endometriosis:

  • Avoid food intolerances and allergens that may exacerbate inflammation. Food intolerance testing is ideal to discover what foods you are reacting too.
  • Avoid foods that are estrogenic such as soy based products.
  • Know your genetic profile and expression of genes such as MTHFR, COMT and PEMT to establish underlying genetic reasons for estrogen issues, immune response and antioxidant production. This will also enable a tailored dietary, lifestyle and supplement protocol for you to assist with estrogen metabolism.
  • Avoid toxins that may mimic estrogens in the body such as dioxins, pesticides and polychlorinated biphenyls (PCB’s).
  • Assist estrogen metabolism with cruciferous vegetables such as broccoli, brussel sprouts and cauliflower. These vegetables are a rich source of sulfur containing compounds known as glucosinolates. When chewed they generate indole-3-carbinol.
  • Ensure good gut and liver health to assist with estrogen and toxin metabolism.
  • Moderate to intense frequent exercise has shown to reduce the size of endometrial lesions in some studies.
  • Stress less as stress may contribute to the development and severity of endometriosis through dysregulation of the hypothalamic-pituitary axis and promoting release of inflammatory markers

Chinese Medicine Approach and Endometriosis

Traditional Chinese medicine alongside conventional medicine utilises a number of different approaches and techniques to treat the symptoms of endometriosis using diet therapy, manual techniques, acupuncture and Chinese herbal medicine. To date research has shown some promising results however more research is required in this area.

Acupuncture has shown to reduce pain and serum markers associated with endometriosis, according the authors of a systematic review. The results showed that acupuncture yielded better reductions in pain associated with dysmenorrhoea, and led to a better reduction in peripheral blood CA-125 (a marker for endometriosis) when compared with control interventions [9].

Whilst a recent research article showed that Acupuncture increase’s the release of endorphins, the body’s own ‘feel-good’ chemicals, which play an important role in the regulation of physical and emotional stress responses associated with pain and digestive issues. [10-11].

Endometriosis the future

The complex nature of endometriosis and misconceptions around menstruation and infertility have led to delayed diagnosis and many hit-and-miss treatments. Myths continue to surround the endometrial phenomena such as ‘surgery will cure my endometriosis whilst medical/surgical classifications continue to evolve as consensus on classification is debated. Meanwhile many women continue to suffer.

It is time for women to take control educate and empower themselves to address the underlying reasons for endometriosis. Finding this can seem overwhelming and can take time. For some it is a matter of months some years. But remember every small step towards change is better than staying where you are.

If you would like to take the first step contact us or book an appointment on line

 

References
1 Pinkert TC, Catlow CE, Straus R. Endometriosis of the urinary bladder in a man with prostatic carcinoma. Cancer. 1979;43:1562–7.
2. Fukunaga M. Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma. Pathol Res Pract. 2012;208:59–61.
3. Simsek G, Bulus H, Tas A, Koklu S, Yilmaz SB, Coskun A. An unusual cause of inguinal hernia in a male patient: Endometriosis. Gut Liver. 2012;6:284–5.
4. Schenken, R, Barbieri, R, Eckler, K 2019, Endometriosis: Pathogenesis, clinical features, and diagnosis, Up to date 2019.
5.Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril 2006; 86:298.
6. Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986; 67:335.
7. Lasmar, Ricardo Bassil, Lasmar, Bernardo Portugal, & Pillar, Claudia. (2012). Diagram to map the locations of endometriosis. International Journal of Gynecology & Obstetrics, 118(1), 42-46
8. Sourial, Tempest, Hapangama 2014, Theories on the pathogeneses of endometriosis International journal of reproductive medicine 2014.
9. Xu, Wenli, Li, Ahao, Bu, Song 2017, Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis, PLoS One. 2017.

Understanding Endometriosis

Say no to ENDO……

It is estimated that 176 million women worldwide are affected with Endometriosis, a debilitating condition that can play havoc with mood, hormones, libido, pain, energy levels and infertility.

On average it can take 12 years from the onset of symptoms to a definitive diagnosis and then even longer to address and treat the underlying causes.

This in turn may lead to the condition worsening as endometrial like cells proliferate, invade and implant elsewhere in the body.

What is Endometriosis?

Endometriosis is an estrogen- dependent, benign, inflammatory disease where endometrial like tissue grows outside of the uterine cavity. The peak prevalence of endometriosis occurs in women 25-35 years of age. However the disease has been reported in younger girls whom have not commenced menstruation, postmenopausal women and even men [1-4].

Where is Endometriosis found?

Histological reports have found endometrial lesions in the following areas of the body

• Reproductive organs
• Gastrointestinal region
• breasts
• Kidney & adrenal glands
• Urinary tract
• Spinal column
• peripheral and central nervous system
• Chest cavity (lungs and around the heart)
• Prostate [5-6]

Symptoms of endometriosis?

The symptoms of endometriosis are different for everyone, the pattern of your pain can often indicate the location of your endometriosis and thus help with treatment options. Although some women have no or minimal symptoms it is still important to have the correct diagnosis to best support your hormones.

1. Pain
2. Infertility
3. Bowel issues such as IBS
4. Bladder problems such as recurring UTI’s
5. Heavy menstrual bleeding
6. Endometrioma (ovarian mass)
7. Chronic fatigue symptoms
8. Emotional disturbances

What Causes Endometriosis?

The cause of endometriosis remains uncertain but appears to be multifactorial. A number of theories have been postulated for further research such as the Sampson theory, Coelomic Metaplasia theory, embryonic rest theory and lymphovascular metastasis theory. Other causes may include one or more of the following [4,7,8].

1. Genetic Factors
2. Immune dysfunction
3. Hormonal imbalance
4. Abnormal endocrine signalling
5. Imbalanced cell proliferation
6. Sampson theory of retrograde menstruation
7. Lymphatic dissemination
8. Infectious or environmental triggers
9. Oxidative stress
10. Inflammation
11. Alterations in the gut microbiota
12. Liver damage
13. Long term hormonal therapy

How is endometriosis diagnosed?

The only way to be 100% certain of the diagnosis is to have a laparoscopy. This is a surgical procedure where a thin telescope is placed into your belly button to allow your gynaecologist to see inside and assess the organs of your pelvis and abdomen whilst taking a biopsy (tissue sample) for diagnosis.

As the cause of endometriosis is multifactorial the treatment approach should be the same to address all facets of the disease and its many causes. Over the years working both in the medical and complementary medicine worlds an integrative approach with the commitment to make the necessary changes and adjustments is required to achieve the best outcome.

Want to learn more or find out how we may be able to assist with symptoms associated with endometriosis contact us or book online.

 

 

References:
1 Pinkert TC, Catlow CE, Straus R. Endometriosis of the urinary bladder in a man with prostatic carcinoma. Cancer. 1979;43:1562–7.

2. Fukunaga M. Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma. Pathol Res Pract. 2012;208:59–61.

3. Simsek G, Bulus H, Tas A, Koklu S, Yilmaz SB, Coskun A. An unusual cause of inguinal hernia in a male patient: Endometriosis. Gut Liver. 2012;6:284–5.

4. Schenken, R, Barbieri, R, Eckler, K 2019, Endometriosis: Pathogenesis, clinical features, and diagnosis, Up to date 2019.

5.Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril 2006; 86:298.

6. Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986; 67:335.

7. Lasmar, Ricardo Bassil, Lasmar, Bernardo Portugal, & Pillar, Claudia. (2012). Diagram to map the locations of endometriosis. International Journal of Gynecology & Obstetrics, 118(1), 42-46.

8. Sourial, Tempest, Hapangama 2014, Theories on the pathogeneses of endometriosis International journal of reproductive medicine 2014.

9. Xu, Wenli, Li, Ahao, Bu, Song 2017, Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis, PLoS One. 2017.

Pain and Acupuncture

What is Pain?

Pain is often complex and debilitating affecting jobs, relationships, mental and emotional wellbeing, sleep, ability to exercise and overall health. Managing ongoing chronic pain often involves taking a multidisciplinary approach. Here we provide a guide on the types of pain and some simple ways you can manage pain.

How is Pain Classified?

Pain is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage (1)

Pain can be classified in a number of different ways with some of them overlapping such as

  • Physiological pain due to nociceptive, neuropathic and/or inflammatory response
  • Mild, moderate or severe
  • Acute, Chronic or acute on chronic
  • Type of tissue involved  such as skin, muscles, viscera, joints, tendons, bones
  • Syndromes or disease such as endometriosis, fibromyalgia, cancer, migraine etc.

Pain the signs and symptoms

  • Stinging
  • Burning
  • Ache
  • Sore
  • Stiffness
  • Throbbing
  • Anxiety
  • Depression
  • Moodiness
  • Sleep problems
  • Fatigue and weakness
  • High blood pressure
  • sweating
  • change in skin and body temperature
  • inflammation
  • joint deformity
  • change in body posture

How Pain is assessed?

Physical examination is only one aspect of pain assessment. Self-reports are the most reliable indicators of pain and no one tool should be used as an absolute measure of an individual’s experience. There are, however, various assessment tools such as the visual analogue scale, abbey pain scale for people whom are unable to verbalise and the Wong-Baker faces tool (often used in children over three years of age (2)

 

The Wong baker faces scale

 

 

 

 

 

 

How many Australians suffer with Pain?

  • In 2007-2008 approximately 67% or 11.1 million people in Australia aged 15 years and over reported experiencing bodily pain. (3)
  • More Australian adults experienced chronic pain in 2007–08 than in 1995. Rates of overall body pain has increased from 57% to 68%, whilst severe/very severe pain increased from 7% to 10%. (3)
  • The average cost of chronic pain is estimated at $34 billion dollars
  • Arthritis and back problems are the most common reason people drop out of the work force
  • More than 700,000 women suffer from crippling symptoms of pelvic pain and conditions such as endometriosis including severe period pain at a cost of $6 billion per year in Australia (3)

Common Pain conditions we treat?

  • Back pain
  • Shoulder pain
  • Hip pain
  • Headache
  • Migraine
  • Plantar fasciitis
  • Knee pain
  • Fibromyalgia
  • Arthritic pain
  • Sciatica
  • Digestive Pain
  • Pelvic Girdle pain in pregnancy
  • Symphysis pubis dysfunction
  • Painful Periods
  • Endometriosis

Treatment Options for Pain?

Alongside conventional treatment there are also a number of complementary treatment options to consider for managing pain such as diet, relaxation and acupuncture.

Diet

A well balanced diet with plenty of fresh fruit and vegetables is important for general health and wellbeing. However for pain it is important to take a more targeted individualised approach to efficiently manage inflammation. Here is what some recent research provides to efficiently manage inflammation

  1. Support Gut Health with the correct prebiotic and probiotic’s to modulate immune function, support digestion and reduce intestinal hyperpermeabiilty (leaky gut) as it is noted as a contributor to inflammation. One reason is due to the passage of lipopolysaccharides (LPS). LPS are endotoxins (present on the cell wall of gram-negative bacteria) that may elicit an immune/inflammatory response. Consuming soaked then cooked legumes, fruits, and vegetables such as chicory and Jerusalem artichoke are good sources of prebiotic fibres (4)
  1. Proteolytic enzymes, such as bromelain, papain and trypsin assist in the breakdown of numerous inflammatory by-products such as bradykinin, making them useful in addressing the symptoms of inflammation and injury. Proteolytic enzymes can be used for swelling, pain, redness and recovery during intense training and exercise. It is important to ensure you are taking the correct enzymes for your condition, dosing correctly and taking at the correct time for pain management.  (5,6)
  1. Anti-inflammatory diets inclusive of foods such as fish for their omega-3 fatty acid content and herbs such as curcumin/turmeric. Research has shown that curcumin blocks inflammatory cytokines and enzymes, including cyclooxygenase-2 (COX-2), the target that the pharmaceutical medication Celebrex targets, without the side effects (7). However turmeric contains only 2-6% of curcumin so check the standardised amount of curcumin.
  1. Magnesium reduces pain and is necessary to breakdown substance P (a compound responsible for the sensation of pain) (9). Foods containing magnesium include legumes, nuts and seeds, green leafy vegetables such as kale and spinach.

Relaxation techniques to manage pain:

Relaxing your muscles and mind are important in managing pain this may include actives such as mindfulness, meditation, listening to music, gardening, gentle exercise, massage and acupuncture.

A recent research article showed that Acupuncture increase’s the release of endorphins, (11) he body’s own ‘feel-good’ chemicals, which play  an important role in the regulation of physical and emotional stress responses such as pain, heart rate, blood pressure and digestive function. (12, 13, 14, 15).

Acupuncture for Pain

There is substantial clinical evidence to support acupuncture for the relief of both acute and chronic pain according to a number of systematic reviews and randomised controlled trials (16,17,18,19,20,21).

In china and other countries acupuncture for pain relief is provided daily as part of the medical system to ease the symptoms of conditions such as:

  • Osteoarthritis and rheumatoid arthritis
  • low back pain
  • fibromyalgia
  • sciatica
  • Migraine
  • Painful periods

If you feel this information may help a friend or you would like more information about acupuncture, diet therapy and additional pain management strategies please Contact us or you can make an appointment on line BOOK online.

 

 

References:

  1. Pain, IASP terminology. International Association for the Study of Pain 2018, https:// www.iasp-pain.org/terminology?navItemNumber=576#Pain
  2. Garra G, Singer AJ, Taira BR, et al. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Acad Emerg Med 2010;17(1):50-54.
  3. ABS, National Health Survey, Characteristics of bodily pain in Australia, 2007–2008 http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4841.0Chapter12011
  4. Rodes L, Khan A, Paul A, et al. Effect of probiotics lactobacillus and bifidobacterium on gut-derived lipopolysaccharides and inflammatory cytokines: an in vitro study using a human colonic microbiota model. J Microbiol Biotechnol 2013;23(4):518-526. 3
  5. Bucci LR. Nutrition applied to injury rehabilitation and sports medicine, CRC Press, Inc, Florida: 1995.
  6. Bromelain monograph. Altern Med Rev 1998;3(4):302-305
  7. Arthritis Foundation 2018
  8. Weglicki WB, Chmielinska JJ, Tejero-Taldo I, et al. Neutral endopeptidase inhibition enhances substance P mediated inflammation due to hypomagnesemia. Magnes Res 2009;22(3):167S-173S
  9. Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013 Nov 15;38(24):2124-38.
  10. Manyanga T, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014;14:312.
  11. Da Silva AN. Acupuncture for migraine prevention. Headache. 2015 Mar;55(3):470-3.
  12. Qin 2015 (SR & MA of 11 RCTs; 10 acupuncture vs medications; 1 acupuncture vs sham): Acupuncture may be superior to drugs and may enhance the effect of drugs for patients with sciatica; low quality evidenc
  13. Xiang, A., Cheng, K., Shen, X., Xu, P., & Liu, S, 2017, The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM2017, 383719
  14. Liu T, Yu JN, Cao BY, Peng YY, Chen YP, Zhang L. 2017, Acupuncture for Primary Dysmenorrhea: A Meta-analysis of Randomized Controlled Trials. Altern Ther Health Med. 2017 Nov 7