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Endometriosis

 

Endometriosis Introduction

:endometriosis.gif Endometriosis is a gynecological condition defined by endometrial (lining of the Uterus) tissues being located outside the Uterus, usually in the abdominal and pelvic cavities. These misplaced cells are the result of menstruation, and are thought to be caused by the continual change in the hormonal patterns of menstruating females.

Instead of the usual expulsion of these cells during menstruation, they actually continue their monthly cycles elsewhere in the body. This is where problems arise, as these cells attach themselves to other organs, primarily located in the lower abdomen. The most common sites for ectopic endometrium are in the abdomen and pelvis; however, other sites such as large bowel, ureters, surgical scars, and pericardium have also been observed. It remains a mystery as to what actually causes endometriosis. Several theories have been proposed, but all lack substantiation. The most popular of these theories is Retrograde (or Reflux) menstruation. This theory suggests that menstrual fluid flows back into the fallopian tubes, spilling into the peritoneal cavity and causing these usually expelled cells to implant themselves on surrounding tissues. Other commonly proposed theories of endometriosis development include:

  • Abnormal immune system functioning,
  • Congenital malformations,
  • Transportation of endometrial cells through lymphatic system, and
  • Exposure to certain environmental toxins (i.e. polychlorinated biphenyls, or PCBs, and dioxin)

Diagnosis of Endometriosis is usually made based on clinical presentation, as well as by direct observations via pelvic laparoscopy. Laboratory tests are also available. These tests are considered useful for tracking the progress of Endometriosis, however are only useful after a definitive diagnosis has been made; they are not considered an adequate screen in and of themselves. [1, 2]

Endometriosis Symptoms

Interestingly, one-third of all women suffering from endometriosis exhibit no clinical symptoms. Typical symptoms of Endometriosis include a capacitating pain of the pelvic cavity, lower back, and uterus. Pain, prior to or during menses (Dysmenorrhea), as well as pain with vaginal intercourse (Dyspareunea), are also common symptoms. It is important to note that pain associated with intercourse is considered highly suggestive of Endometriosis. Depending on where Endometrial lesions are located, there can also be pain during defecation, supra pubic pain during urination, and possible acute abdominal pain. [4, 5] Pelvic masses may also be present.

Endometriosis Statistics

  • Endometriosis appears to have a hereditary pattern of prevalence. There is an estimated 8.1% chance that a mother of an Endometriosis patient may also be affected by the disease, and that her sister has a 5.8% chance of also having Endometriosis.
  • Affects approximately 10 - 20 percent of women and girls of childbearing age - some 5 1/2 million females.
  • Endometriosis accounts for 30 % of all infertile women in the U.S.
  • Caffeine consumption has been associated with an increased incidence of Endometriosis. Seven grams of caffeine relates to a 1.6 X increase in the developmental risk of Endometriosis. [3]

Endometriosis Treatment

Treatments options, routinely selected for Endometriosis, are considered dependant upon the extent the disease. Relatively mild Endometriosis is usually not treated. Instead, physicians may suggest using over-the-counter pain relievers or prostaglandin inhibitors (e.g. ibruprofen, naproxen, acetaminophen) for the management of pain. In some cases, typically when patients wish to become pregnant, hormonal agents such as birth control pills may be utilized. For women who are not seeking a pregnancy and have received a definitive diagnosis, various hormonal suppression therapies are used to end ovulation. These may include:

  • Androgens: male sex hormones, like Danazol
  • GnRH agonists: gonadotropin-releasing hormone agonists, which block pituitary gland hormones that normally stimulate ovarian cycles
  • Synthetic progestins
  • Combination Therapies: ex: estrogen taken in combination with an Oral contraceptive

Hormone treatment is successful in nearly 80 - 90 percent of patients with smaller endometrial implants. However, this form of treatment is often questioned because of the many safety issues concerning male hormones being used in women, as well as other adverse side effects (e.g. loss of bone mineral density); all of which are of increasing concern when using this particular treatment protocol. In the severest cases of Endometriosis, ‘conservative’ surgery is recommended to remove the diseased tissue. The surgical excision or cauterization of endometrial lesion(s) is done via laparoscopy or laparotomy. Laraoscopy treatments are considered feasible when the surgeon can see pelvic structures clearly through a laparoscope. Newer techniques, such as laser vaporization are also currently being employed, and provide substantial reductions in patient recovery times. [6]

-Other Standard Approaches in Endometriosis Treatment -

Nutritional: Dietary: Physical:
Vitamins Avoiding specific food and environmental toxins Movement / Exercise
Minerals Consumption of more immune-stimulating foods Increased Muscle Tone
Amino Acid / Proteins Consumption of foods containing natural plant sterols (phytosterols) Increased Aerobic Capacity
Essential Fatty Acids Breathing Techniques
Antioxidants Postural Adjustments
Nutrient and Herbal Supplements
Enzymes
Homeopathic Remedies

Supplements helpful for Endometriosis

Vitamins and Minerals:

Vitamin C

Vitamin C is a well known antioxidant vitamin that is found primarily in fruits and vegetables. Humans are among the few mammals that are unable to produce their own vitamin C and must obtain it from various dietary sources. High doses of vitamin C have been shown to improve autoimmunity s well as to decrease the inflammatory reactions. [8, 9]

Beta Carotene

Beta Carotene is in the same class of compounds as vitamin A. Approximately one third of the beta carotene in the diet is converted into Vitamin A. Oral supplementation with beta-carotene has been shown to increase the number of T4 immune cells that can help to prevent and lessen autoimmune reactions. There is also evidence that various carotenoid compounds, including beta-carotene, are capable of inhibiting some tumor formation. Additionally, NK cell numbers and activity have been observed to be increased in response to beta-carotene supplementation, possibly resulting from the anti carcinogenic effects of carotenoids. [10, 11, 12]

Vitamin E

Vitamin E is another antioxidant nutrient that is important for the proper function of many body systems including the immune system. Vitamin E can also modify ratios of Progesterone to estradiol towards a more normal ratio. This is significant as many gynecological conditions, including Endometriosis, which are associated with a progesterone to estradiol ratio that is too low. Dysmenorrhea is the most common symptom of Endometriosis, and is often the indicator that brings women to see their physician. Vitamin E is an effective way to help diminish the symptoms of Dysmenorrhea by regulating estrogen metabolism and certain inflammatory processes. [13, 14]

Selenium

Selenium is a mineral that is involved in a number of detoxification and antioxidant reactions. Selenium is also important for proper function of the immune system. Selenium has demonstrated an ability to enhance both B and T cell function and proliferation. A greater immune response has been observed in subjects that have been treated with Selenium than in controls. Selenium also stimulates a greater cell mediated response to malignant cells and may reduce tumor formation. When taken with Vitamin E, selenium has also been shown to positively impact immune response. In addition, this mineral is critical for fatty acid metabolism. Due to the fact that Endometriosis involves cells developing ectopically, it suggested that this type of support for the immune system is beneficial. [15, 16, 17]

Other Nutritional and Dietary Supplements:

Essential Fatty Acids

Essential Fatty Acids (EFAs) are a class of compounds that are found in various natural sources, such as flax seed, borage seed, hemp seed, and cold water fish body oils. Other fatty acids that are present in diet are regularly acquired form terrestrial animal sources, like beef, poultry, etc. The fatty acids that are acquired from animal sources tend to lead to the formation of pro-inflammatory compounds in the body (Prostaglandins), while EFAs lead to the formation of less inflammatory compounds. Due to the inflammatory nature of Endometriosis, it is thought that limiting inflammatory conditions in the body would be of benefit in this condition. [18]

Lipotropics

Lipotropics are compounds that function as cofactors in the Liver’s role of detoxification. Normally hormones are metabolized in the liver into less active forms and are then eliminated from the body. It is possible that an imbalance of hormonal levels can contribute to the pathogenesis and progression of Endometriosis. Supplementation with lipotropic compounds will ensure that the liver has the materials it needs to do its job of hormonal elimination. [19] Lipotropic combinations often times include the amino acids methionine, choline, and inositol, which facilitate the transportation of fats out of the liver. Specific herbs, such as milk thistle, dandelion, turmeric, boldo, are also added to lipotropic formulas. These herbs are known to stimulate gallbladder function, increase secretions of bile, and cleanse the body; characteristics deemed beneficial for improving the symptoms associated with Endometriosis.

Black Cohosh Root

Black Cohosh Root contains many active constituents, including the isoflavone most beneficial to women, formononetin. Formononetin, along with other compounds found within the root, actually bind to estrogen receptors of the uterus. This may prove especially relevant for women suffering from Endometriosis. Certain phyto-estrogens block estrogen from binding at uterine receptor sites, thereby lessening the overall symptoms of the condition. In fact, several studies have reported that Black Cohosh has positive menopausal and post-menopausal effects, which may be extremely beneficial for women suffering from Endometriosis. [20, 21]

Saw Palmetto / Saw Palmetto Extract

Saw Palmetto is a traditional treatment for supporting prostate health in men. However, recent study has revealed that it can actually block the action of the sex hormone, Follicle Stimulating Hormone (FSH). This finding may prove significant in women suffering from Endometriosis, as FSH has been shown to increase endometrial tissue in study. Dietary supplementation with Saw Palmetto-containing products may work to reverse or eliminate this effect.

Chasteberry and Dong Quai

Chasteberry (also commonly referred to Vitex) and Dong Quai are herbs that are traditionally combined together to assist in the balancing of hormones in Endometriosis sufferers. For treatment, these herbs are taken daily and are recommended to be administered over the duration of a three to six month period. . The balancing of hormones remains integral in Endometriosis, as certain hormones may actually work to promote the spreading of endometrial tissue and result in increases of endometrial pain. Some nutritionist also suggest using wild yam in addition to this synergistic combination to provide a reduction in possible cramping and to also soothe the uterus. [22]

References

[1] Hudson, Women’s Encyclopedia of Natural Medicine (Los Angeles: Keats Publishing, 1999), 79-88.

[2] Beers and Berkow, The Merck Manual (Whitehouse NJ: Merck laboratories, 1999), 1956-59.

[3] Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. 1993 Jun 15;137(12):1353-60.

[4] Hudson, Women’s Encyclopedia of Natural Medicine (Los Angeles: Keats Publishing, 1999), 79-88.

[5] Beers and Berkow, The Merck Manual (Whitehouse NJ: Merck laboratories, 1999), 1956-59.

[6] Beers and Berkow, The Merck Manual (Whitehouse NJ: Merck laboratories, 1999), 1956-59.

[7] Hudson, Women’s Encyclopedia of Natural Medicine (Los Angeles: Keats Publishing, 1999), 79-88.

[8] Bergman M, Salman H, Djaldetti M, Fish L, Punsky I, Bessler H. In vitro immune response of human peripheral blood cells to vitamins C and E. J Nutr Biochem. 2004 Jan;15(1):45-50.

[9] Leibovitz B, Siegel BV. Ascorbic acid and the immune response. Adv Exp Med Biol. 1981;135:1-25.

[10] Alexander M, Newmark H, Miller RG. Oral beta-carotene can increase the number of OKT4+ cells in human blood. Immunol Lett. 1985;9(4):221-4.

[11] Gerster H. Anticarcinogenic effect of common carotenoids. Int J Vitam Nutr Res. 1993;63(2):93-121.

[12] Watson RR, Prabhala RH, Plezia PM, Alberts DS. Effect of beta-carotene on lymphocyte subpopulations in elderly humans: evidence for a dose-response relationship. Am J Clin Nutr. 1991 Jan;53(1):90-4.

[13] London RS, Sundaram GS, Schultz M, Nair PP, Goldstein PJ. Endocrine parameters and alpha-tocopherol therapy of patients with mammary dysplasia. Cancer Res. 1981 Sep;41(9 Pt 2):3811-3.

[14] Ziaei S, Faghihzadeh S, Sohrabvand F, Lamyian M, Emamgholy T. A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG. 2001 Nov;108(11):1181-3.

[15] Hawkes WC, Kelley DS, Taylor PC.The effects of dietary selenium on the immune system in healthy men. Biol Trace Elem Res. 2001 Sep;81(3):189-213.

[16] Kiremidjian-Schumacher L, Roy M, Wishe HI, Cohen MW, Stotzky G. Regulation of cellular immune responses by selenium. Biol Trace Elem Res. 1992 Apr-Jun;33:23-35.

[17] Broome CS, McArdle F, Kyle JA, Andrews F, Lowe NM, Hart CA, Arthur JR, Jackson MJ. An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status. Am J Clin Nutr. 2004 Jul;80(1):154-62.

  

[18] Moncada S, Salmon JA. Leukocytes and tissue injury: the use of eicosapentaenoic acid in the control of white cell activation. Wien Klin Wochenschr. 1986 Feb 21;98(4):104-6.

[19] Pizzorno and Murray, Encyclopedia of Natural Medicine (Roseville CA: Prima Health, 1998) Pages.

[20] Jarry H, et al. The Endocrine Effects of Constituents of Cimicifuga racemosa. 2. In Vitro Binding of Constituents to Estrogen Receptors. Planta Med. Aug1985;4:316-19.

[21] Lieberman S. A Review of the Effectiveness of Cimicifuga racemosa (black cohosh) for the Symptoms of Menopause. J Womens Health. Jun1998;7(5):525-29.

[22] Hirata JD, et al. Does Dong quai Have Estrogenic Effects in Postmenopausal Women? A Double-blind, Placebo-controlled Trial. Fertil Steril. 1997;68(6):981-86.