During your menstrual cycle, estrogen production increases and causes your uterine lining to thicken to prepare for egg implantation. If the egg isn’t fertilized and doesn’t implant, the lining sheds to prepare your body for the next month’s cycle.
For someone who has endometriosis, tissue similar to the uterine lining begins to grow outside of the uterus, usually around the ovaries, bowel, and tissues in the pelvic cavity. This is called an endometrial implant. Though this tissue can grow outside the pelvis, it’s extremely rare.
The same hormones that control the growth and shedding of your uterine lining cause the endometrial implant to develop, thicken, and break down. However, unlike the endometrium, which is eliminated via the cervix and vagina, the endometrial implant has nowhere to go and gradually builds up in the pelvic cavity.
This trapped tissue can lead to:
Scar tissue development
Adhesion, where the tissue binds together the organs in your pelvis
What are the symptoms of endometriosis?
Endometriosis symptoms vary from mild to debilitating, but the severity of your symptoms doesn’t indicate the stage of the disease. You may have a mild case of endometriosis but experience intense pain, while others might have a very serious form but have minimal discomfort.
Though pain in the pelvis is the most common symptom, some of the other signs of endometriosis include:
Heavy menstrual bleeding or spotting between periods
Lower abdominal pain before and during menstruation
Abdominal cramping up to two weeks before menstruation
Lower back pain
Bowel movements or urination that cause discomfort in the pelvis
Persistent bloating and nausea
Some individuals may not have any symptoms, so it’s crucial to have regular pelvic exams to find out whether you have the condition. Untreated endometriosis can have serious health risks, including infertility and a higher risk of developing some cancers.
Endometriosis and PCOS share similar symptoms, such as heavy menstrual bleeding, pelvic pain, and infertility. But they are different diseases that require different treatments. A person may also have both conditions at the same time.
What are the risk factors for endometriosis?
The exact cause of endometriosis is still unknown, and it is often misdiagnosed as irritable bowel syndrome (IBS) because the two have overlapping symptoms. Currently, research suggests several possibilities, such as:
This happens when menstrual blood containing endometrial cells flows back up the fallopian tubes into the pelvis instead of being eliminated by the body. These endometrial cells then stick to the pelvic wall and grow and bleed with every menstrual cycle.
Peritoneal cell transformation
Immune factors and hormones change the cells lining your inner abdomen (peritoneal cells) into cells that mimic endometrial cells.
Certain immune disorders can make it hard for the body to recognize and eliminate endometrial-like cell tissue growing outside the uterus.
However, studies suggest that some individuals are at a higher risk of developing endometriosis. Risk factors include:
Never giving birth
Starting your period at an early age, typically between 8 and 10 years old
Starting menopause after 55
Short menstrual cycles that last less than 27 days
Heavy menstrual bleeding that lasts more than 7 days
Higher than average estrogen levels
A family history of endometriosis
A low body mass index (BMI)
Additional reproductive disorders
How is endometriosis diagnosed?
Diagnosing endometriosis can be challenging because symptoms vary from person to person. Diagnosis usually involves a multifaceted approach, including:
During an exam, your healthcare provider presses your pelvis to feel for abnormalities, including cysts on your reproductive organs or scar tissue around your uterus. Typically, they can only feel endometrial implant tissue if you are in the advanced endometriosis stages.
An ultrasound can’t diagnose endometriosis, but studies prove its effectiveness at helping your provider determine if cysts are present that indicate endometriosis, especially if you are in the earlier stages.
In an ultrasound, high-frequency sound waves cast by the transducer (the wand) create images of your internal organs. Both a traditional ultrasound and a transvaginal ultrasound (when the transducer is inserted into the vagina) are effective at finding endometrial cysts.
In an MRI, high-frequency sound waves are sent through the body to create images. Like an ultrasound, these images can’t definitively diagnose endometriosis, but they’re helpful for identifying endometrial cysts.
MRIs are particularly helpful when preparing for laparoscopy because healthcare providers can use them to plan the procedure.
At first, it can be difficult to determine if you have endometriosis. While you may be experiencing endometriosis pain, you may not have enough tissue formed to create a cyst that healthcare providers can see on imaging.
In this case, your provider may prescribe medication. While you are on the medication, your symptoms may disappear, but they will return when you stop taking it. Usually, providers will prescribe hormonal birth control or gonadotropin-releasing hormone agonists (GnRH) to lower estrogen levels and minimize menstrual pain.
In this surgical procedure, your provider makes a tiny incision near your navel while you are under general anesthesia. They may be able to diagnose you just by looking at the size, shape, and color of your cysts, but they will often take a sample to biopsy.
Some infertility due to endometriosis is temporary. Surgery to remove the damaged tissue and using fertility drugs can help. Healthcare providers encourage women with endometriosis to have children earlier because the damage builds over time.
What Western treatments are available for endometriosis?
There are several Western treatments for endometriosis. Often, your provider begins with the least invasive option and scales up as needed to treat your symptoms.
If possible, your provider will start you with a regimen of over-the-counter painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) — naproxen sodium (Aleve) or ibuprofen (Advil and Motrin). Often, these are not strong enough to treat the pain, so your provider may combine pain medication with hormone therapy.
Hormone therapy and contraceptives
Because endometriosis involves fluctuating hormones, regulating hormones can help slow the progression of the disease. This treatment is only appropriate for women who are not attempting to become pregnant. Common hormone therapies include:
Hormonal contraception (such as the pill or patch)
Gonadotropin-releasing hormone (GnRH) agonists and antagonists
Progestin (a synthetic form of progesterone, a natural steroid produced by the ovaries
Aromatase inhibitors (a medication that decreases estrogen)
Danazol (synthetic testosterone)
If you have endometriosis and are struggling with infertility or experiencing severe pain, your provider might recommend conservative surgery.
The surgeon uses laparoscopic surgery to remove the endometrial growths without damaging your reproductive organs. The growth is removed by burning it with a laser or by cutting away the damaged tissue.
However, this surgery doesn’t prevent new growths from forming, so if you aren’t planning to become pregnant, your provider may prescribe hormone therapy to slow the return of growths and treat pain.
Hysterectomy and oophorectomy
These surgeries were once thought to be the only treatment for endometriosis, but they are now used only in extreme cases. In a hysterectomy, the uterus is removed. In some cases, the ovaries are also removed in a surgery called an oophorectomy.
A hysterectomy can alleviate heavy cramping and bleeding, but it’s not a good option for people under 35 because it makes pregnancy impossible.
In some cases, providers may recommend an oophorectomy, which can be done on its own or in conjunction with a hysterectomy. However, the removal of your ovaries will cause instant menopause. Early menopause is linked to long-term health conditions like cardiovascular problems, metabolic issues, osteoporosis, and in some cases, early death.
What treatments for endometriosis are in the pipeline?
Several medications are in development or have been recently released for treating endometriosis.
Proellex is an oral selective progesterone receptor modulator, currently in phase 2 clinical trials. It’s mostly prescribed for premenopausal women. Proellex works to inactivate, or atrophy, endometrial tissue development. Recent research suggested that participants experienced mildly increased liver enzyme levels, so researchers are investigating other ways to administer the drug.
Resveratrol is a natural compound made from grape skins that may cause cell death in endometrial tissue by suppressing a protein called survivin. It’s not yet ready for clinical trials, but preliminary research on animals shows promising results.
Can you use acupuncture for endometriosis?
Acupuncture involves placing thin needles into a person’s skin at specific intervals to stimulate blood flow, release endorphins, and minimize inflammation.
When it’s combined with other traditional treatments for endometriosis, it can help minimize pain. A recent review of medical studies suggests acupuncture for endometriosis alleviates pain for patients better than other commonly prescribed complementary therapies.
The first round of acupuncture for menstrual cramps usually lasts six to eight weeks and includes biweekly visits. After the initial treatment, the frequency of visits is reduced. It often takes about three to six months to see results.
Can you use homeopathy for endometriosis?
Homeopathy for endometriosis has been shown to alleviate pain and mood-related symptoms in patients. But there’s not a lot of high-quality research about homeopathy, so we recommend using caution and speaking to your doctor before beginning a homeopathic regimen.
Other complementary therapies and alternative therapies for endometriosis
Several herbal extracts have also proven successful as holistic remedies for menstrual cramps. Frequently used herbal extracts include tripterygium wilfordii polyglycoside (Twp), puerarin, turmeric, resveratrol, and green tea epigallocatechin-3-gallate (EGCG).
There is not a lot of research into the effectiveness of pelvic floor therapy (also called pelvic physical therapy) for endometriosis, but studies like this one have found it helpful for chronic pain sufferers.
What’s more, there is plenty of anecdotal evidence that pelvic floor therapy works for some people. Here’s why:
It can help other causes of pelvic pain that may not be endometriosis-related.
It can strengthen your pelvic muscles and reduce cramping.
It can make sex less painful.
It can help reduce bloating.
It can give you a sense of control over your pain.
If you’re interested in trying pelvic floor therapy, we can help you find a physical therapist or physiotherapist.
Originating in ancient China, moxibustion treatment involves burning powdered herbs at acupuncture points to stimulate them without needles. Practitioners usually use moxibustion combined with acupuncture.
Chinese herbal enemas involve delivering herbal medicine through the rectum to allow it to absorb fully into the intestinal mucus. This treatment allows the medicine to be absorbed directly into the bloodstream without deterioration due to stomach acid. This makes it gentler on the body, as it bypasses potential liver damage.
Research finds certain CHEs to have a similar effect on reducing endometriosis lesions as Danazol, a common Western medication, but without the drug’s adverse side effects.
This procedure involves applying nonionizing radiation and ultra high-frequency electromagnetic waves to the lower abdomen for about 30 minutes. It promotes the absorption of menstrual blood to limit the growth of endometrial cysts and increases the effectiveness of other Chinese herbal medicine.
In one study, microwave physiotherapy combined with oral Chinese medicine showed a 94.4% success rate. However, there’s not yet a lot of research on the technique, and providers use this modality mostly for severe cases because it can cause miscarriage and interact with metal implants.
Living with endometriosis
Endometriosis is often difficult to diagnose and treat, which can take a toll on your mental health and overall lifestyle. These tips can help you manage the disease.
Get educated, and don’t be afraid to advocate for yourself
Talk to your primary caregiver about symptoms you are experiencing, and don’t be put off when they claim your symptoms are normal. Getting a second opinion allows you to explore all your treatment options.
Many treatments for endometriosis, especially hormonal therapies and contraceptives, require you to take your meds regularly. Symptoms will return if you don’t take them as instructed.
Change your diet
Studies have indicated that a diet high in fatty acids has anti-inflammatory effects, so add foods like fish and walnuts into your diet. Vegetables, fruits, and whole grains are also helpful to alleviate endometriosis inflammation.
Be as active as possible
Researchers believe that exercise can reduce the amount of estrogen in your body, which can help balance your hormones. It also releases endorphins, which can help relieve pain.
Join a support group or consider therapy
Endometriosis is linked with depression and anxiety due to pain and potential infertility. Talking with other people with the same experience can help. Organizations like the Endometriosis Association offer support options for people living with endometriosis.
Sound Cycle can help
Due to its complexity, endometriosis often requires complementary treatment options, but choosing the right complementary practitioner may feel challenging. Let us be your ally on your way to better holistic health. Follow our blog for more information on complementary and alternative therapies, and visit our provider directory to find a practitioner near you.