The Elix Guide to Endometriosis

Dr. Jessica Ritch, MD helps to treat patients and get them back to their lives faster through behavioral modifications, physical therapy, medical treatment and surgical treatment including robotic surgery, advanced laparoscopy, hysteroscopy and vaginal procedures. She specializes in the management of benign gynecologic conditions such as abnormal bleeding, pelvic pain, fibroids, endometriosis, and polycystic ovarian syndrome (PCOS).

What Is Endometriosis? 

Endometriosis is often a painful inflammatory and hormonal condition that affects around 10% of women of reproductive age. It occurs when the glandular cells that are similar to the cells that line the Uterus — the endometrium — start growing in places outside of where they are supposed to be. When this occurs, there is an inflammatory response that can lead to issues like pain, scarring, and infertility. 

This tissue can usually be found in the pelvic cavity in places like: 

• The ovaries 
• The fallopian tubes 
• The pelvic side-wall 
• uterosacral ligaments (major ligaments in the uterus) 
• The pouch of douglas, or the space between rectum and the uterus

However, in more rare cases, endometriosis has been found in other areas throughout the body, including the upper abdomen and lungs.

What Are the Symptoms of Endometriosis? 

Endometriosis can be experienced differently by each person, but having extreme period pain (dysmenorrhea) or pain between ovulation (mid-way between periods) and leading up to menses that requires a lot of medication to be suppressed is often one of the main signs of endometriosis. This pain typically starts during the teenage years or early 20s, and will usually get progressively worse, lasting for longer and longer periods of time. Mild cramping during a menstrual cycle is normal, but if the pain is constant, happening outside the time of your period, or has spread to other areas of your body, you should seek medical advice. 

Other symptoms to look out for include: 

• Pain with intercourse 
• Pain with urination
• Bladder or bowel dysfunction 
• Excessive bleeding 
• Infertility 

How is Endometriosis Diagnosed? 

Diagnosing endometriosis can be difficult as there is not a blood test that can be taken to detect this. Occasionally a diagnosis can be made through imaging.  If there is an endometrioma type of cyst on the ovaries, then this can be picked up on an ultrasound. Some specialized MRIs can also detect different endometriosis nodules. However, typically endometriosis is diagnosed through a minimally invasive surgery called laparoscopy. 

Unfortunately, studies have shown that it can take up to 7 years on average for women to receive the appropriate diagnosis from healthcare providers.  You can speed up this process by talking with your doctor about your symptoms.  Specifically, the frequency, duration and heaviness of your periods, what your pain feels like, when it starts, and how long it lasts, and any other symptoms associated with your menses like mood changes, bloating and bowel and bladder dysfunction. If you have pain with sex or trying to insert a tampon, that will help direct your provider as well and you should make a list of everything that makes your symptoms better or worse. It is important to push back if you are not feeling supported by your doctor, and ask these tough questions to be your own best advocate to find the care you deserve.  If your doctor minimizes your symptoms or doesn’t know how to help, ask if they might know a specialist in endometriosis, or a minimally-invasive gynecologist that you could see for a consultation.

Holistic, Natural Support Options for Endometriosis

Although there is no one-size-fits-all endometriosis treatment that works consistently for everyone, there are multiple holistic options that you can ask your doctor about to find the best solution for you.

1. Pelvic Floor Physical Therapy

The inflammation, pain, and scar tissue from endo can lead to pain that spasms in the pelvic floor. Working with a specially trained pelvic floor physical therapist can help to decrease some of this scar tissue and spasms to help reduce pain in conjunction with other endometriosis treatments. 

2. Acupuncture

Data shows that acupuncture can also relieve chronic pelvic pain from endometriosis and other conditions and is a helpful addition to other endometriosis treatment strategies.

3. Herbal Supplements

Chinese herbal medicine has also been shown to reduce symptoms linked to endometriosis with fewer side effects than conventional treatment. At Elix, we use the same science to create personalized herbal blends, to help balance hormones, reduce inflammation, and decrease pain — all of which are helpful if you have endometriosis. Some of the herbs in our formulas that target these specific concerns include: 

• Safflower: Reduces inflammation, promotes blood circulation, and helps to regulate an irregular menstrual cycle.
  
• Poria: An edible mushroom that suppresses inflammation, reduces menstrual cramps, and protects nerve cells to alleviate depression and boost your mood.
  
• Cinnamon: Effectively targets pain related to inflammation, such as menstrual cramps, and activates protective proteins that help stop mutation and damage to cells.

Treatment Options for Endometriosis 

1. Minimally Invasive Surgery

Surgical options such as laparoscopic surgery are available. This should be done both for diagnosis and treatment of endometriosis.  For treatment, the endometriosis is typically excised (or removed) wherever it is safe to do so and sometimes fulgurated (or cauterized) in other areas.  The general focus should be on treatment of the disease and leaving the normal organs in place, but some women who are no longer trying to get pregnant and have tried other strategies may opt for hysterectomy or larger procedures.

2. Fertility Treatment

Endometriosis can lead to trouble conceiving, but there are a variety of options to choose from based on your personal situation. This can include stimulating your ovaries for increased egg production, in vitro fertilization (IVF) where the egg is fertilized outside of the body, and more. Women having trouble conceiving should discuss their symptoms and concern for possible endometriosis with a reproductive endocrinology and infertility specialist (REI).

3. Hormone Therapy

Supplemental hormones can be effective in reducing or eliminating the pain that comes with endometriosis. Birth control pills, patches, or rings with estrogen and progesterone can help to stabilize and suppress the natural hormonal surges in the menstrual cycle that stimulate growth of endometriosis. These can even be used continuously to skip menses and the associated symptoms. There are also progesterone-only IUDs, and hormonal injections that can be taken to decrease the growth of endometriosis. This includes progesterone-only pills, injections and IUDs or medications that affect GnRH, a hormone from your brain that stimulates the ovaries.  These hormonal treatments are not safe for everyone and can have side effects, so it’s important to talk with your doctor about what options are right for you.  

Additional Resources

For Endometriosis:
Endometriosis.org

For general information on menstrual health: 
Mayo Clinic 

For pelvic floor physical therapy: 
Women’s Health Apta
Pelvic Rehab

Elix is here to support every cycle of your journey. Take our Health Assessment and discover your personalized herbal formula to address your worst menstrual symptoms and heal from within.

This article was reviewed by Dr. Elizabeth Fine.

Dr. Elizabeth Fine is currently the Dean of Clinical Education at Emperor’s College, the #2 ranked colleges for TCM. She has been practicing Acupuncture and Herbal Medicine for over 20 years, with a specialization in women’s reproductive health.