Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Endometriosis results from the transplantation of the tissue that lines the interior of the uterus to other places, such as the outside of the uterus, the ovaries, fallopian tubes, bowel, appendix, bladder, umbilicus, floor of the pelvis, internal abdominal wall, and along the ligaments that hold the uterus and other pelvic structures in place. Endometriosis is a common disorder, being found in up to 20% of women, and it is increasing in frequency.‍

Causes

‍It is believed by some that marital relations during the menstrual period may increase the risk of getting endometriosis, according to a study done at the New Jersey Medical College (Journal of Reproductive Medicine. 34(11):887890, November 1989).

During sexual excitation there is a movement of the uterus to encourage the spermatozoa to travel backward to meet the ovum, and material inside the uterus and tubes more naturally flows backward toward the ovaries than forward toward the outside. Products of menstruation (shed fragments of the inside of the uterus) may be milked up the fallopian tubes or up the lymphatics by muscular contractions, and then transplanted in other places, while these fragments are still living, thus taking root. Even sexual stimulation or thoughts can result in muscular contractions of the uterus, tubes, or vaginal structures, which encourages endometrial transplantation.

In harmony with the idea that endometriosis may be caused by sexual excitation is the fact that it is more common for the disease to occur after sexual activity begins. There has also been a great increase in the incidence of the disease in modern times, since intercourse during menstruation no longer caries the taboos of former times.

Other theories as to the cause of endometriosis include the possibility of its development in the prenatal or early childhood periods, the possibility of backward flow along the lymphatics or blood vessels, and, recently, that of fetal monitoring during labor. The fetal monitor is a device that measures the heartbeat of the unborn baby. The measurement may be done externally or internally. It is only the internal fetal monitoring that has been associated with increased incidence of endometriosis.

It has also been theorized that the development of vaginal tampons, a custom having its origin after about 1930, is the cause of the recent increase in endometriosis. Some investigators believe that the use of tampons encourages backflow of menstrual blood.

Most physicians believe that pelvic examinations done during menstrual periods should be quite gentle, any squeezing of the uterus being likely to cause the backflow of the blood, causing shed lining tissue, to go into the tubes, where living particles could take hold and grow on the ovaries or other structures. No fertility tests involving sufflation of the tubes should be performed during the menstrual period. There is no evidence that the backward bending uterus, so-called "retroversion," is associated with an increased incidence of endometriosis.

The symptoms of endometriosis have been found to be connected with the use of dairy products. In certain patients the connection is very obvious, since as soon as the person eliminates dairy products they cease having difficulties. It is certainly well worth a trial. Perhaps not all patients would be relieved, but if a patient is helped by this simple measure, it is one of the easiest to institute. Other food sensitivities may intensify pain with the period. Use the Elimination and Challenge diet to discover foods intensifying the pain.

Birth control pills stimulate endometriosis by preparing a fertile site for the transplants to grow. Since all of this class of hormone administration can be regarded as having many side effects, from weight gain to an increased incidence of cancer of the breast and uterus, it seems well to withhold the use of any kind of hormone.

‍Symptoms‍

There are no typical symptoms of the disease; but the most distinctive symptom, which can be found in the greatest number of women, is that of painful menstrual periods, the pain being felt also in the rectum, lower sacrum, and the coccyx (tailbone). Even this sign is found in only about one-third of patients. Painful menstruation may develop many years, or even decades, after the onset of menstruation.

Other symptoms of endometriosis include pain on sexual intercourse, low abdominal pain present any time of the month (but which worsens in the premenstrual and menstrual periods), backaches, pain on passing urine or bowel movements, constipation, and menstrual disturbances; the most common menstrual disturbance is that of excessive menstrual flow.

Pain with the menstrual period, infertility, and abnormal bleeding represent the commonest symptoms. Other symptoms are low back pain and pain in the lower extremities; sometimes the back pain radiates down the legs. While it is rare in black women, probably up to 30% of white women suffer from this condition at one time or other. Pregnancy improves the symptoms, although endometriosis is a common cause of infertility. The pregnancy rate in women with endometriosis is about half that of women not having endometriosis.‍

Treatment‍

Many patients require no treatment at all, as they tend to burn out endometriosis. In my opinion, it is well worth a trial to treat the symptoms of endometriosis with home remedies and allow a woman to have the opportunity to stop the symptoms on her own. Certainly surgery and hormone administration should be reserved for the severe and incapacitating case of endometriosis. One would then have to balance the side effects of the treatment against the threatened destruction of the quality of life from the symptoms of the disease.

Many women may prefer to tough it out, until the transplants burn themselves out and await the onset of menopause when endometriosis is automatically cured by the cessation of stimulation of growth by hormones. This is a good way to treat the disease in both younger and older patients, treating the pain with the remedies suggested, until the implants have burned themselves out. This may take from one to five years, but the pain tends to be worse at first and then better as time goes by.‍

Remedies‍

The application of heat by any method—hot sitz bath, fomentations, heating pad, hot water bottle, etc.—have all been reported to clear symptoms. A hot water bottle or electric heating pad over the low back for one hour at the very onset of the menstrual period can relieve pain in some women. One treatment routine includes a series of three fomentations taken each of the first three days of the menstrual period for twelve months. For some, this has resulted in complete clearing of symptoms. Hot foot baths for 30 minutes or hot sitz baths for 20-30 minutes can go far toward reducing congestion of the pelvic organs. An ice bag, or a hot water bottle, or heating pad to the low abdomen or low back, placed in the chair on the seat, may all be remarkably helpful in reducing the pain and discomfort of endometriosis. A large charcoal poultice covering the lower abdomen and pelvis at night is useful in pain relief.

A diet high in the plant steroids has seemed to help many of our patients with endometriosis. This diet should emphasize the use of the following foods (and teas):

• apples
• cherries
• olives
• plums
• wheat germ
• whole grains
• carrots
• peanuts
• soybeans
• all dried beans and peas
• yams
• bell pepper
• eggplant
• potatoes
• tomatoes
• parsley
• sage
• clover
• alfalfa leaf tea
• licorice root tea
• red raspberry leaf tea
• food yeast
• garlic
• anise seed
• coconut
• all nuts

A stretching exercise has been found of benefit by many women. It is done by measuring a line on the floor two feet from a wall. Stand with the tips of the toes on the line and heels on the floor (be sure to keep them on the floor during the entire exercise). Lean the whole body toward the wall, placing the hands at about shoulder height, until the chest touches the wall. Hold this position for ten seconds, push up straight for five seconds, and repeat three times. Turn to the side, putting the right outer edge of the foot on the line, and lean sideways toward the wall until the right hip touches the wall. Hold for ten seconds and repeat as at first. Turn with the left hip toward the wall, the left outer foot on the line, and lean into the wall touching the left hip to the wall, and continuing as for the other two exercises. These three stretching exercises should be done three times daily for three days, once a day for 30 days, and once a week for one year. Another good exercise is that of walking up and down ten flights of stairs daily.