Endometriosis

When a woman’s endometrial tissue is found in the body, outside of its normal location in the uterus, it is termed endometriosis. Endometriosis can have many symptoms including dysmenorrhea (i.e. painful menstruation), menstrual bleeding irregularities, pelvic pain, abdominal pain or back pain among other symptoms. However the chief symptoms are cyclic pain in the lower abdomen, lumps in the pelvic cavity and infertility. Endometriosis is classified according to its severity (mild, moderate, severe). The classification does not seem to directly determine its impact on fertility.

Rogue endometrial tissue is usually found on the ovary or lower regions of the pelvis but can be found outside the pelvis and in rare incidence at locations including the lung, arm or kidneys. This misplaced tissue responds to the fluctuating estrogen and progesterone levels in the woman’s hormonal cycle including bleeding at the time of menstruation. The blood may then trigger an immune response resulting in inflammation and also eventually cause scar tissue to form. The inflammation and scar tissue are thought to be responsible for the common symptom of severe cyclic pain.

Endometriosis is very common, with estimates of as many as 1 in 5 reproductive age women have some degree of misplaced endometrial tissue with 30 – 40% of those women being infertile. According to modern medicine, endometriosis is one of the most common causes of infertility. The pain associated with the disease is not predictably present in all cases. The procedure to confirm a diagnosis is laparoscopy or surgery, however, MRI or ultrasound imaging are often used as a less invasive first investigation.

The most popular theory of how the endometrial tissue appears outside the uterus is menstrual debris flows backward into the pelvis in “retrograde menstruation”. Other theories suggest other cells in the body change into endometrial cells.

Treatment

Endometriosis has no cure in modern medicine and is usually treated with NSAID’s to relieve pain, drugs to control/minimize menstruation or surgical removal of the tissue.

Research on treatment using Traditional Chinese Medicine plus our own clinical results have shown significant success using Acupuncture and Chinese Herbal Formulas. The condition is recalcitrant and one should expect treatments of at least 3 months.

Study 1

Chinese herbal formulas have been tested against common Western medical treatments for endometriosis with some exciting results. One such study, conducted at Osaka City University Medical School in Japan, measured immune factors in the blood of a group of women diagnosed with endometriosis. The women were found to have elevated serum levels of anti-endometrial Immunoglobulin-M (IgM) antibody titers, indicating an immune response to the endometrial tissue. One group of these women received treatment with leuproride acetate (Lupron) to suppress hormonal production. A second group received the herbal formula Gui Zhi Fu Ling Wan, which historically has been used in China to treat bleeding during pregnancy due to Blood stasis in the womb and to prevent miscarriage. In more recent times, it has been used in the treatment of immunologic and inflammatory conditions of the uterus, including dysmenorrhea, uterine fibroids, ovarian cysts, chronic pelvic inflammatory disease, inflammation of the fallopian tubes and endometriosis.

At the conclusion of the study, the Lupron-treated group had lowered levels of estradiol but no change in the IgM antibody titer. The group treated with herbs had no changes in estradiol levels, but the levels of IgM antibody titer were decreased and the patients remained symptom-free for months. It would appear that the herbal formula was able to reduce the body’s immune response to the endometriosis—a hopeful sign when it comes to restoring a woman’s fertility.

Study 2

Studies done in China treated women with severe menstrual pain. The authors stated that the primary disease mechanism related to dysmenorrhea is blood stasis—the same pattern that often creates endometriosis. A group of 125 women were diagnosed using the principles of traditional Chinese medicine and categorized into four groups depending on the patterns they were exhibiting, as follows:

Group 1: Qi stagnation with Blood stasis
Group 2: Qi stagnation, Blood stasis and cold
Group 3: Qi stagnation, Blood stasis and heat
Group 4: Qi stagnation, Blood stasis and vacuity

The study began by comparing serum levels of various prostaglandins’, a contributing factor in menstrual cramps, in the bloodstreams of all three groups. Then, the women were given either Eastern or Western medical treatment. The women treated with Eastern methods received the herbal formula Jia Wei Mo Jie Tang, whose intended purpose is to invigorate the blood, transform stasis, and move the qi. From a Western medical point of view, the formula achieves its effect by regulating serum prostaglandins. The herbs were taken as a decoction and administered twice a day beginning two weeks before the anticipated start of the period. The other group was given the Western medicine indomethacin, a non-steroidal anti-inflammatory analgesic. In both groups, treatment was administered for three months. In the Jia Wei Mo Jie Tang group, 80.4 percent of women experienced relief from their menstrual pain, compared to 73.3 percent for the indomethacin group. Further, Jia Wei Mo Jie Tang seemed to help balance the reproductive cycle, as indicated by markedly lower levels of a negative type of estrogen. The herbal decoction also increased the content of late phase progesterone secreted by the corpus luteum, which is essential to creating a proper climate for implantation. Indomethacin, on the other hand, had no marked effect on either estrogen or progesterone.

It is clear that Chinese herbal medicines can play an important role in balancing the complex interrelated factors contributing both to the treatment of endometriosis and the promotion of a normal reproductive cycle. But what is most important is to uncover the pattern of imbalance that is the root cause of an individual patient’s problem.

Study 3

From 1988 – 1994 the authors of this study treated 38 cases of endometriosis with a modified version of the formula Di Dang Tang in a study reported in Yunnan Journal of Chinese Medicine (1994). The patients ranged in age between 28-46 years old. The symptoms were severe lower abdominal pain with menstruation, dry lips, sweating and damp exterior, and blood clots in menstrual blood and subsiding of pain after clots appeared in menstrual blood. An ultrasound examination diagnosed that there was endometriosis in all cases.

Over the course of treatment (which lasted 12-72 days), 26 of the 38 women were cured, meaning the symptoms had disappeared and the follow-up ultrasound was normal. Five of the women had some improvement and the remaining 7 had no result.

Study 4

In one study reported in the Sichuan Journal of Traditional Chinese Medicine (1993) 40 cases of endometriosis were treated with a modified version of ‘Boost the Qi and Transform Stasis Formula’. The patients included in this study were between the ages of 24 and 48 years old and had endometriosis between 1 and 18 years. The endometriosis was diagnosed by a gynecological examination and laproscopic exploration.

Of this group 25 were infertile and 31 had had previous gynecological surgical procedures. In regards to symptoms, 37 patients experienced intense menstrual pain, 12 had pain with intercourse, 28 had pelvic pain and 18 experienced a heavy distended feeling in the anus.

After a course of treatment, 33 of the 40 women had obvious reduction in endometrial nodules and disappearance of any symptoms and 7 of these women became pregnant afterwards. Four women had a reduction of symptoms and nodules and 3 women had no change.

Study 5

Between 1992 and 1994 one study treated 89 cases of endometriosis treated with a modified Tao He Cheng Qi Tang formula. Patients were between 23 and 46 years old and had endometriosis from 3 months to 11 years. All 89 women were diagnosed using the standards set at the 3rd Chinese National Integrated Chinese-Western Medicine Gynecology Conference. These criteria included lower abdominal pain and pathological lumps and nodulations in the pelvic cavity in addition to one of the following five symptoms: purple tongue; choppy or bound regularly irregular pulse; fixed pain worse with pressure; blood vessel abnormalities and/or subdermal static macules.

Of the 89 patients, 77 had dysmenorrhea, 24 had pain with intercourse, 39 had pelvic pain, 42 had a heavy distended feeling in the anus, 44 had chocolate ovarian cysts and 30 cases had pelvic nodulations.

After 2 to 6 menstrual cycles of treatment, 31 women experienced complete disappearance of symptoms, 37 had marked reduction of symptoms, 16 had some effect and 5 cases experienced no change. The blood of 36 women was examined before and after treatment, and all 36 showed improvements in red blood cell agglutination, blood sedimentation, and blood serum viscosity. In 41 women prostaglandin levels were measured and were notably higher then normal value before treatment and all were reduced after treatment.