Endometriosis

Endometriosis is an abnormal gynaecological condition in which
the endometrium (the lining of the uterus) is found in areas
outside the uterus. Endometriosis may lead to infertility in some
women.

Endometriosis can be present in menstruating women from the
early age of puberty to menopause. Normally the endometrial tissue
in the uterus is stimulated by the change in hormone levels during
the monthly cycle. This tissue grows and thickens and then breaks
down and bleeds. This bleeding is normal menstruation. Sometimes
this endometrial tissue moves outside the uterus. It can move to
the ovaries, to the surface of other organs in the pelvic region
and can even be found in areas other than the abdomen, although
this is rare. 

One of the possible causes of Endometriosis is the retrograde
(backwards) menstruation theory. Endometrial cells, which are
proteins, flow backwards outside the uterus into the pelvic cavity.
These cells are then carried by the lymphatic system to other
locations in the body. During menstruation, this same tissue bleeds
due to the normal hormonal changes. This blood cannot escape from
the body and discharges onto the surface of various nearby organs.
This can cause inflammation, scarring, and sometimes
adhesions.

As time passes, the affected endometrial tissue can enlarge in
size and form cysts. These in turn can break during the monthly
cycle due to the pressure from the blood within. The pain can be
intense.

The disease affects about 10% of all women of reproductive age and
about 50% of women with infertility. The risk of developing
Endometriosis increases if a woman has first degree relatives in
her family with the conition. The average age of women with this
ailment is 30 years. Endometriosis can only be diagnosed by
laparoscopy,which can be performed under local or general
anaesthetic. 

Some women who are suffering from Endometriosis have no symptoms
at all while others have obvious symptoms including dysmenorrhoea
(painful periods), pelvic pain, pain during intercourse, ovarian
cysts, and bowel problems. 

Endometriosis is one of the main causes of infertility in
women. Many women can outgrow mild Endometriosis. The incidence of
this ailment seems to lessen in some women after pregnancy.

TREATMENT OPTIONS

As with all conditions your Doctor should be consulted to
diagnose and treat this condition. 

For women who do not wish to become pregnant, the first choice
of therapy is the combined oral contraceptive pill, taking only the
active tablets with no breaks. The Pill is very effective in
reducing symptoms and can be used long-term, although the same
health risks associated with the Pill still apply, such as nausea,
thromboembolism, weight gain and depression.

For women who are trying to fall pregnant, non-steroidal
anti-inflammatories may offer some relief, although
gastrointestinal side effects are common. Generally, surgical
treatment is recommended. A laparoscopy is performed under general
anaesthetic, allowing division of adhesions and laser, diathermy,
drainage and/or excision of endometriomas (tissue/blood deposits).
This can be done as a day patient. However, there is no guarantee
that symptoms or fertility will improve and recurrence of the
disease is common.

The only permanent cure for Endometriosis is total
hysterectomy, including removal of both ovaries. Women who have
completed their family or who have long-term infertility may choose
this option.

DIET HINTS

• The diet should consist of low fat, high fibre and low sugar
  foods. Include lots of fruit, vegetables and wholegrain cereals.
  Keep processed and refined foods to a minimum. An acidic system may
  promote the inflammatory pain of Endometriosis. Fruits and
  vegetables help to alkalise the body, while meats and sugar may
  promote a more acidic environment in the body.
• A high intake of fruits and vegetables have a protective effect
  against Endometriosis, whereas the intake of red meat and ham
  appears to increase the risk, according to the results of a recent
  clinical study. This study found that there was a 40 percent
  reduction in the risk of developing Endometriosis in women with a
  higher consumption of green vegetables and fresh fruit. For those
  women with a higher consumption of beef, other red meat and ham,
  there was an increase in the risk of developing Endometriosis of
  approximately 80 to 100 percent.
• Increase intake of fish and cold pressed vegetable oils as they
  contain Omega 3 and Omega 6 essential fatty acids. These fatty
  acids are thought to have an anti-inflammatory effect. Include food
  which is high in essential fatty acids e.g., nuts, seeds, linseeds
  and linseed oil. 
• It is important to have smaller meals frequently and to eat all
  food as fresh as possible. Vegetables should only be cooked lightly
  as this will help keep the vitamin content high. Avoid ‘fast foods’
  as they may contain excess salt and food enhancers.

Drink filtered water as often as you can. Tea, coffee and
alcohol should be avoided.

VITAMINS/MINERALS/HERBS

Nutritional supplements should only be used if the dietary
vitamin intake is inadequate. Recommended supplements
include:

• Omega-3 Fatty acids may prevent the production of hormones
  which cause inflammation and stimulate growth of endometrial
  tissue. These can be obtained from flaxseed oil, fish oil, evening
  primrose oil or borage oil.
• Vitex agnus-castus can increase progresterone secretion which
  can balance the oestrogen/progesterone ratio. Vitex agnus-castus is
  especially useful if short periods occur.
• Wild yam may relax muscles and reduce inflammation and provide
  relief to symptoms of endometriosis.
• Dong quai can reduce the pain of endometriosis. Dong quai works
  well in combination with vitex to restore the hormonal imbalances
  that can cause the often severe pain of this disorder. When taken
  together, the herbs can also relax the uterine muscle.

 

Ask your Pharmacist for advice.

1. Follow the Diet Hints.
2. Take capsules or tablets for the pain. Ask your Pharmacist for
   the best brand for you.
3. Use a hot water bottle on the stomach if there are cramps as
   this may ease the pain.
4. Have sufficient rest.
5. Reduce caffeine drinks, including strong coffee, tea, cola and
   chocolate. These products contains methylxanthines which are known
   to stimulate overproduction of cellular products, such as fibrous
   tissue and cyst fluid. 
6. Consider some supplements if the diet is inadequate. Evening
   Primrose Oil capsules are suggested as they may help with hormonal
   problems. Ask your Pharmacist about the suitable dose of Evening
   Primrose Oil in the management of Endometriosis.