Endometriosis - Know Your Options

Endometriosis. The bloody and extremely painful condition you’ve been diagnosed with or are still seeking answers for. The conflicting advice, medical opinions, and treatment options. Where do you go from here? First let’s clarify what endometriosis is and what you can do for yourself.

The inner lining of your uterus is called the endometrium. This inner lining sheds every month in the form of your period due to the changes in your hormones. For those with endometriosis, the endometrium is found not only in their uterus but can be in their bowels, on the bladder, rectum, abdominal cavity, and even in the lungs. Since this lining sheds and bleeds, the blood has nowhere to go if not from the uterus and results in inflammation throughout and scar tissue locally known as “adhesions”. For some patients with endometriosis, this results in excruciating pain, infertility, gastrointestinal issues, and even pain with intercourse depending on the location of the adhesions and inflammation. For others, they have little pain but impaired fertility or isolated irritable bowel issues. It looks different for each person suffering from endometriosis.

John Hopkins Medicine lists the following most common symptoms for those with endometriosis:

• Painful menstrual cramps that may go into the abdomen (stomach) or lower back

• Pain during or after sex

• Diarrhea or constipation during a menstrual period (many of my patients have had severe diarrhea prior to their menstrual cycle)

• Fatigue or low energy

• Heavy or irregular periods

• Pain with urination or bowel movements during a menstrual period

• Spotting or bleeding between menstrual periods

So much misinformation has been spread regarding endometriosis. Clinically speaking, many OBGYNs and primary care physicians are uncomfortable treating endometriosis as they have not been taught in school and residency how to proceed with helping patients with this condition while others only know of a hysterectomy as a viable option. But, for many patients, it's not a viable option as many still want their uterus and others have had the hysterectomy but still have horrible pain. The reason for this is because the adhesions are still present in other places in the body and not just on the now removed uterus.

At this point in time, medically speaking, there is no evidence based known cause for endometriosis. Several theories exist that have strong clinical evidence which are based on estrogen dominance, environmental toxins that contribute to this estrogen dominance, and overall inflammation. There are also autoimmune factors to consider with endometriosis.

However, this information is sorely lacking with the rising percentage of people with endometriosis. Currently 10-15% of the population is diagnosed with endometriosis and this is not even considering those who are suffering without a proper diagnosis. The New York Times did a report on how many patients suffer with their menstrual cycle without being taken seriously or properly diagnosed by their physicians: https://archive.nytimes.com/well.blogs.nytimes.com/2015/03/30/endometriosis-is-often-ignored-in-teenage-girls/?_r=0

So how do you diagnose endometriosis? The gold standard is through biopsy alone, usually done through a laparoscopic exploration. The only gold standard medically at this time for pain reduction and hopeful improvements in fertility is an excision surgery for the adhesions which is only done by a handful of expert OBGYNs in the country.

What if you don’t want surgery? What if you still have pain after the surgery?

Unfortunately, I have seen several patients post hysterectomy and post adhesion removal who STILL have pain. This is because there still may be leftover scar tissue which still sheds even though they aren’t getting a period every month and the overall inflammation still has not been addressed.

Aviva Romm MD and Yale medical school professor comments on the following regarding surgery for endometriosis:

“While removal of endometrial tissue via a laparoscopy can relieve symptoms for as a long as 2 years, the symptoms do eventually return in most cases, and the procedure itself increases the likelihood of forming scar tissue. Hysterectomy is sometimes recommended, but this is not an option for women who want to become pregnant, and it's important to recognize that this is one of the most over performed unnecessary surgeries in the US – including its use for endometriosis. While it is sometimes helpful when all else fails or if symptoms are unbearable, it is major abdominal surgery – and a major cash cow for doctors and hospitals – so get more than one opinion if you're not sure you want this done!”

The other option is to treat the ROOT cause which is the aim of functional medicine. Dr. Romm, as listed above, trains clinicians in how to help patient’s with endometriosis using functional medicine. I am blessed to have trained under her and now treat patients with the following protocol.

This usually entails the following for patients working with their functional or integrative physician…

1. LOWER INFLAMMATION through an anti-inflammatory diet

2. TREAT THE PAIN without NSAIDS or strong opioids through ginger root, valerian root, cramp bark, and white willow bark (usually done in combination with specific doses prescribed by your practitioner)

3. ADD ANTIOXIDANTS such as NAC which is backed up by powerful research and shown to help not only with pain reduction but improve fertility. In a 2013 study of 92 women in Italy, 47 took NAC and 42 took a placebo. Of those who took 600 mg of NAC three times a day, three consecutive days each week for three months, 24 patients canceled their scheduled laparoscopy due to a decrease or disappearance of endometriosis, improved pain reduction or because they had gotten pregnant! Fourteen of the women in the NAC group had decreased ovarian cysts, while 8 had a complete disappearance; 21 had pain reduction and 1 became pregnant. In the other group, only 1 patient canceled surgery. A total of 8 women got pregnant in the NAC group, while 6 did in the placebo-only group.

4. REMOVE TOXINS such as synthetic estrogens, fragrances, parabens, phthalates, and other endocrine (meaning hormone) disrupting substances.

5. BALANCE HORMONES through bio identical hormones, lab testing, and diet and/or supplements.

Bottom line, know your options, seek care from a functional or integrative medicine provider trained in endometriosis, and know that surgery is not a long term option although it can definitely improve quality of time short term.

Dr. Sarah Rutherford is a licensed chiropractor and primary care physician focusing on functional medicine. Her specialty focuses on menstrual related issues such as endometriosis, adenomyosis, PCOS, infertility, autoimmune disorders, and thyroid and diabetes which all have common connections and root causes. Her approach is a three tiered system consisting of dietary, lifestyle, and supplement and nutraceutical modifications to achieve optimal health.