Endometriosis affects approximately 10% of reproductive aged women, and is found in 20-50% of women with infertility or chronic pelvic pain. This painful female reproductive condition is characterised by the presence of endometrial tissue which normally lines the uterus, outside the uterus. Occurring most commonly in the pelvic region, endometrial implants may be found on the ovaries, fallopian tubes, vagina, cervix, Pouch of Douglas, uterosacral ligaments or in the rectovaginal septum. Endometriosis may also occur in distant sites, such as the pleura, lungs, diaphragm, kidney, spleen, gallbladder, nasal mucosa, spinal canal, stomach, and breast. This condition is most often associated with pelvic pain and infertility but may also be found in fertile and asymptomatic women.
The common symptoms of endometriosis include the following:
- Premenstrual syndrome and/or painful periods (the most common symptom)
- Pelvic pain – especially painful sexual intercourse, pain on urination, pain on passing bowel motions
- Joint and muscle aches
- Fatigue and lethargy
Endometriosis is strongly associated with infertility. It is considered that up to 50% of infertile women have endometriosis, and 30-40% of endometriosis sufferers are infertile. The condition may contribute to reproductive failure in various ways, including:
- Poor egg development, as endometrial lesions on the ovaries may interfere with ovulation
- Scar tissue and adhesions may block the fallopian tubes or interfere with movement of the egg into uterus
- Immune signalling – there is an association between endometriosis and autoimmune diseases and recurrent immune-mediated miscarriage
The pain of endometriosis is induced by recurrent, cyclic micro-bleeding of extra-uterine endometrial tissue. This cyclic activation of tissue is oestrogen-dependent and inflammatory, leading to the development of lesions and cysts which form, filling with blood. These are known as “chocolate cysts”. These cysts may rupture and cause severe pain at any time during the month. The severity of pain is related to an inflammatory process, rather than the size, location and extent of endometrial implants – explaining why some women with few microscopic lesions experience debilitating pain, whilst others with widespread endometrial implants may be asymptomatic. Chronic inflammation also contributes to the formation of scar tissue and adhesions between lesions and organs causing restrictive pain. Most commonly, pelvic pain is experienced at the onset of menstruation, although it may occur at ovulation, after menstruation or throughout the month.
Fundamentally, endometriosis is an oestrogen-dependent, immune-mediated, inflammatory condition that is believed to start with refluxed endometrium entering the pelvic cavity, as a result of retrograde menstruation. It is estimated that retrograde menstruation occurs in up to 90% of all women, although only about 10-15% of these women will develop endometriosis. The question then, is why do some women develop endometriosis while others do not?
It appears all of the alterations in inflammatory and immune processes play an important role in the persistence and progression of endometriosis and contribute to the development of infertility and pelvic pain.
From a Naturopathic perspective there are a number of functions which need support in a female who is suffering from endometriosis. There is involvement of the immune system, heavy and painful periods, possible issues with liver detoxification and hormone balance, inflammation, muscle spasm and cramping, and diet. All of these aspects would be considered by our Naturopaths at Nurtura Health in supporting you in your mission to regain and restore healthy endometrial tissue and relief from symptoms.
Watch this space for future posts on other conditions in more detail!Disclaimer: The advice on this website is of a general nature only and Nurtura Health expressly disclaims all liability arising out of the improper use of the information provided. Nurtura Health actively discourages any self-diagnosis or self-medication. Please consult your health practitioner regarding these important health issues. All rights reserved.