ENDOMETRIOSIS AND FERTILITY: An Integrated approach
What is Endometriosis?
Endometriosis is a common gynaecologic disorder that can result in pelvic pain and infertility. Normally during your menstrual period you shed your uterine lining through the cervix and vagina. With endometriosis some of this lining actually goes up the fallopian tubes and is deposited in the pelvis in a process called "retrograde menstruation". Instead of your body absorbing this retrograde lining, it implants in the pelvis or on the ovaries. These implants can become inflamed and bleed with every menstrual period Overtime this may result in scarring of your reproductive organs and problems with fertility.
What are the symptoms?
About 40% of women with endometriosis report no symptoms at all until they experience infertility. Women who do have symptoms can have painful periods, abnormal menstrual bleeding, painful intercourse or bladder and bowel symptoms.
What is the cause of endometriosis?
There are several risk factors for developing endometriosis including being taller and thinner but these are relatively weak associations – endometriosis can basically occur in any woman of reproductive age. There is a genetic effect (i.e. it can run in families) but again, this association is not that strong
In Chinese medicine endometriosis is known by its symptoms and called “menstrual movement pain.” It is often attributed to Kidney Deficiency with Blood stasis if there are symptoms such as dark clotted menstrual blood and stabbing pelvic pain. Blood stagnation may trigger auto immune responses. In the case of endometriosis, the immune system perceives the misplaced endometrial material as an invader and produces inflammation.
According to Chinese medicine the real issue with blood stasis is that the body’s ability to reabsorb or keep blood flowing is impaired. If you think of a bruise --where blood leaks in to the tissue at the site of the injury- that excess blood is gradually metabolized or broken down and reabsorbs as the body heals itself. In the case endometriosis, your body is unable to reabsorb the blood and instead creates inflammation that results in scars and adhesions.
How does endometriosis interfere with fertility?
There are two ways in which endometriosis can interfere with fertility.
1. The first is if the scarring and endometriosis is severe enough to distort the woman's anatomy. An example of this occurs when the fallopian tubes are blocked because of endometriosis and there is no place for the egg and sperm to meet.
2. The second is that the deposits, even if they do not cause scarring or distend the anatomy, may release chemicals that irritate or are "hostile" to the egg, the process of fertilization or the process of implantation. There is also an association between endometriosis and ovulatory dysfunction or luteal phase defect.
How do you diagnose endometriosis?
Endometriosis is classified as mild, moderate or severe based on how much of the disease is present and how much damage (scarring) it has done. Your gynaecologist will make a diagnosis of endometriosis based on:
Your symptoms and a gynaecologic examination. .
Ultrasound examination: An ultrasound examination shows the position of your reproductive organs: If they appear distorted or an abnormal position your doctor may suspect endometriosis.
Laparoscopy: A laparoscopy involves putting a small camera through the belly-button and visually examining the pelvis and taking biopsies of suspected areas of endometriosis. Mild endometriosis can look like blood blisters or "freckles" on the pelvic structures (such as the uterus and ovaries) or it can look white and very subtle—that is why performing a biopsy is important to make sure the pathologist agrees with the diagnosis.
From a Chinese medical perspective, it is always important to look at the individual pattern diagnosis. Your practitioner will do a thorough evaluation of physical and emotional signs and symptoms as well as analyzing your diet and lifestyle and checking your tongue and pulse.
How do you treat endometriosis?
Western and Chinese medicine have a different approach. Western medicine can be very effective at treating symptoms of endometriosis, removing scar tissue and repairing structural problems. While Chinese medicine cannot treat endometriosis surgically, it can help resolve the underlying condition by promoting the healthy flow of blood, balancing hormones and reducing inflammation. In cases where surgery is necessary, Chinese Medicine can help minimize the effect of surgery and speed post-operative healing.
We encourage women who have abnormal bleeding, painful menses, and pain with intercourse to visit their gynaecologist for a complete medical assessment. If the endometriosis is mild then Chinese medicine is a safe and effective approach on its own. However, if the endometriosis is severe then a combination of Chinese and western treatment may be the most beneficial.
Mild endometriosis
If you have mild or moderate endometriosis your MD may prescribe birth control drugs to suppress the female hormones affecting the endometriosis. This therapy may reduce the endometriosis, but it also prevents conception. As well the endometriosis tends to reappear once you stop using the medication.
With mild or moderate endometriosis, Chinese medicine provides an alternative to drug therapy. While this treatment approach takes longer than Western treatment, the benefit is that it addresses the imbalance causing the endometriosis and may in fact enhance your fertility.
We recommend a minimum four month treatment protocol. Your practitioner will develop a personalized treatment program based on your particular pattern that includes:
Anti-inflammatory diet therapy free of dairy, wheat and most animal products
Flaxseed or fish oil
Bioflavonoid like pycnogenol that helpful in calming the immune system.
Chinese herbs
Acupuncture.
The treatment is designed to reduce inflammation, enhance the body's ability to absorb the endometrial tissue, promote your own healing capacity and optimize your fertility. After four months you should notice a reduction in pelvic pain, improved menstrual regularity and flow. Chinese medicine has been shown to support the body's ability to absorb retrograde blood thus both preventing endometrial implants from forming and even reversing some forms of endometriosis.
Severe endometriosis
Women who have severe endometriosis (with significant pelvic anatomy distortion) seeking treatment for infertility have two options in western treatment:
1. The first is surgery to remove the endometriosis and repair the damage to the reproductive organs. The effectiveness of this strategy depends on whether a somewhat normal anatomy can actually be restored. The decision to embark on this type of surgery should be made with your gynaecologist.
2. The second option is in vitro fertilization (IVF). IVF is a method by which a woman is given fertility medications to produce a large number of eggs, have these eggs removed from her body and fertilize these eggs in the laboratory setting. The created embryos are then returned to the woman's uterus. IVF does not require that you have a normal anatomy or open fallopian tubes.
Chinese medicine can provide a powerful adjunct to surgery and IVF. Acupuncture, herbal therapy and diet helps reduce inflammation, enhances post surgical recovery and improves you body's ability to absorb the endometrial tissue. By reducing inflammation and treating the imbalance associated with the chemicals that are hostile to the egg and sperm, Chinese treatment optimizes the uterine environment for implantation. This typically requires four to six months of preconception care before an IVF.
Whether you have mild or severe endometriosis, Chinese medicine can help reduce symptoms, regulate your menstrual period, balance your hormones and make your body more receptive to conception and implantation. Most women with endometriosis can conceive a pregnancy either naturally or with advanced therapies including IVF. Check out more at our Blog
References
Article Endometriosis and fertility by Dr Jason Hitakari
Giovani's Gynecology book (TCM)
Jane Lyttleton's infertility book (TCM)
Bob Flaws Infertility book
Jane Lyttletons infertility course
Links
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