Endometriosis

Endometriosis is a progressive and chronic condition in which endometrial tissue (the inner lining of the uterus that is shed each month during menses) is found outside of the uterus and implanted within the pelvic cavity. Endometriosis is believed to affect as many as 10% of all women in the United States and is the third leading cause of gynecologic hospitalization and a leading cause of hysterectomy.1 Although many theories exist, the cause of endometriosis is unclear. However, there does appear to be a genetic link—women who have a mother or sister with endometriosis are more likely to develop this condition.

Checklist for Endometriosis

Rating Nutritional Supplements Herbs
1Star Fish oil Vitex
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of endometriosis? Women with endometriosis may have symptoms including pain before and during menstrual periods, pain with sexual intercourse, abdominal bloating, pain during urination or bowel movements, pelvic tenderness, premenstrual spotting, abnormally heavy or long menstrual periods, rectal bleeding during menstrual periods, and an inability to become pregnant.

How is it treated? Conventional treatment consists of medications to control inflammation (e.g., non-steroidal anti-inflammatory drugs) and to reduce the levels of estrogen and progesterone hormones (e.g., birth control pills, antiestrogens [Danazol®], progestins, and gonadotropin-releasing hormone [Leuprolide®, Nafarelin®]). Surgical treatments, such as removal of endometrial areas, ovaries, or uterus may also be recommended.

Dietary changes that may be helpful: There has been no research investigating the effect of any specific diet in women with endometriosis. Preliminary research suggests that women who consume more than 5 grams of caffeine per month (about 1.5 cups of coffee a day) are more likely to have endometriosis.2 No study has investigated whether avoiding caffeine improves the symptoms of endometriosis.

Lifestyle changes that may be helpful: Preliminary studies suggest that women who exercise two to four hours per week have less risk of developing endometriosis.3 4 However, the benefit seems to be limited to those women who participate in vigorous exercise, such as jogging or other activities that raise the heart rate. Whether exercise will reduce the symptoms of existing endometriosis is unknown.

Nutritional supplements that may be helpful: There have been no human studies examining the effect of specific nutrients on endometriosis. Animal research suggests that fish oils may reduce the severity of endometriosis,5 6 and fish oils have been shown to improve symptoms of dysmenorrhea (painful menstruation),7 which may be caused by endometriosis. Therefore, while no specific research has been done on the effects of fish oils in women with endometriosis, some health practitioners recommend several grams of fish oil per day for this condition.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Vitex is recommended either alone or in combination with other herbs, such as dandelion root, prickly ash, and motherwort, by some doctors to treat the symptoms of endometriosis.8 9 Although vitex affects hormones that in turn affect the severity of endometriosis,10 and it may be effective for premenstrual syndrome,11 no research has tested the effect of vitex supplementation on women with endometriosis. Similarly, no other botanical medicines have been scientifically researched for treating this disease.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: According to preliminary reports, regular meetings with other endometriosis sufferers may help women with endometriosis learn about the disease and cope better with the many psychological and emotional issues that often accompany this condition.12 One preliminary study found that women who had the opportunity to speak with other women with endometriosis, as well as to meet with their physician, had a higher satisfaction with their overall care.13

Acupuncture has been reported anecdotally to help control the pain associated with some cases of endometriosis,14 but no controlled studies have confirmed this claim. One small, preliminary study found that auricular acupuncture (acupuncture of the ear) was as effective as hormone therapy in treating infertility due to endometriosis.15

References:

1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997;24:235–58 [review].

2. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol 1993;137:1353–60.

3. Cramer DW, Wilson E, Stillman RJ, et al. The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA 1986;255:1904–8.

4. Signorello LB, Harlow BL, Cramer DW, et al. Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol 1997;7:267–74.

5. Yano Y. Effect of dietary supplementation with eicosapentaenoic acid on surgically induced endometriosis in the rabbit. Nippon Sanka Fujinka Gakkai Zasshi 1992 Mar;44(3):282–8 [in Japanese].

6. Covens AL, Christopher P, Casper RF. The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertil Steril 1988;49:698–703.

7. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol 1996;174:1335–8.

8. Batchelder HJ, Hudson T, Lewin A, et al. Therapeutic approaches to endometriosis. The Protocol Journal of Botanical Medicine 1996;Spring:25–60.

9. Hudson T. Women’s Encyclopedia of Natural Medicine. Los Angeles: Keats Publishing, 1999:79–88.

10. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res 1993;25:253–5.

11. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual tension syndrome with Vitex agnus-castus. Controlled, double-blind study versus pyridoxine. Phytomedicine 1997;4:183–9.

12. Whitney ML. Importance of lay organizations for coping with endometriosis. J Reprod Med 1998;43(3 Suppl):331–4.

13. Wingfield MB, Wood C, Henderson LS, Wood RM. Treatment of endometriosis involving a self-help group positively affects patients’ perception of care. J Psychosom Obstet Gynaecol 1997;18:255–8.

14. Maciocia, G. Obstetrics and Gynecology in Chinese Medicine. New York: Churchill Livingstone, 1998:691–733.

15. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171–81.