Women are often led to believe that experiencing severe pain during menstruation is normal: this belief has been ingrained in our society for generations. In this blog, we look to challenge that notion and shine a light on a silent issue that many women face – endometriosis. In this condition, patches of endometrial tissue – which normally only occurs in the lining of the uterus (endometrium) – appear outside the uterus, leading to pain, inflammation and other complications.
Endometriosis isn't a rare condition: it affects approximately 6 to 10% of all women. For those struggling with infertility, this percentage rises to between 25 and 50%, and for women dealing with chronic pelvic pain, it soars to between 75 and 80% (Liu, 2022). Despite its prevalence, endometriosis often goes undiagnosed and misunderstood, leading to unnecessary suffering. Early detection is crucial to manage the effects of the condition and mitigate the risk of complications.
Herbal medicine can be a great source of holistic support for individuals with endometriosis, alongside any medical and pharmacological care required. Certain herbs, nutritional interventions and lifestyle changes can help alleviate symptoms and improve both your quality of life and your fertility outcomes.
In this blog, we will:
- Take a look at the fundamentals of endometriosis
- Summarise current medical and pharmacological treatments for women with endometriosis
- Explore herbal medicine approaches that may help provide holistic care to endometriosis
What is endometriosis?
First recognised in the late 1920s, endometriosis is a complex, chronic disorder. It happens when the tissue usually found lining the inside of the uterus (endometrium) grows outside of it, often on other parts of the pelvis, which can lead to various complications.
Before we delve into the world of endometriosis, we must first take a journey through the female reproductive system. This intricate system, complete with its rhythms and cycles, lays the groundwork for the occurrence of endometriosis. Understanding the biology of the female reproductive system can provide valuable context as we dive into the nature of endometriosis.
The female reproductive system includes two ovaries, two fallopian tubes, the uterus, and the vagina. Each month, in response to hormonal cues, the uterus develops a thick lining (the endometrium, as mentioned before) in preparation for a possible pregnancy. If fertilisation does not occur, this lining is shed through menstruation.
Endometriosis happens when tissue similar to this uterine lining grows outside the uterus, often in places like the ovaries, fallopian tubes, and pelvic tissue. Despite being outside the uterus, this displaced tissue behaves like the endometrium – thickening, breaking down, and bleeding with each menstrual cycle. But because this tissue has no way to exit the body, it becomes trapped, leading to inflammation, pain, and potentially fertility issues.
The growth and development of endometriotic lesions are stimulated by the hormone oestrogen. Oestrogen is one of the primary hormones regulating a woman's menstrual cycle. It helps prepare the endometrium, the inner lining of the uterus, for possible pregnancy by triggering its growth and thickening. Endometrial-like tissue outside of the uterus occuring in endometriosis also responds to oestrogen fluctuations. Moreover, endometriotic lesions themselves can produce oestrogen, creating a local excess of the hormone that stimulates further growth of the lesions. This process contributes to a self-perpetuating cycle of growth and inflammation. Some research also suggests that women with endometriosis may have alterations in the way their bodies regulate levels of oestrogen and progesterone in the body and metabolise them, which can result in higher levels of oestrogen in the pelvic cavity (Marquardt et al., 2019). This may contribute to the onset and progression of the disease.
What are the main symptoms and risks of endometriosis?
Symptoms of endometriosis can vary significantly, from very painful periods and discomfort during sexual intercourse to issues with bowel movements and urination. It can also impair fertility (Liu, 2022). It's also worth noting that some women might not experience any noticeable symptoms, making diagnosis even more challenging.
Endometriosis can lead to the formation of endometriomas, or cystic lesions on the ovaries, which are typically filled with dark brown endometrial fluid (Hoyle & Puckett, 2022). Endometriomas indicate a more severe stage of endometriosis. They often lead to chronic pain and infertility, and may require surgery. Another possible complication is the creation of scar tissue where the misplaced endometrial tissue and its bleeding may irritate nearby tissues – sometimes as bands of fibrous tissue (called adhesions) between structures in the abdomen. These adhesions can interfere with the functioning of the organs – for example, the large intestine, the bladder and the ovaries.
However challenging, a good diagnosis of endometriosis is essential to managing the symptoms and preventing the potential long-term health issues that can be associated with endometriosis, including chronic pain, infertility, and an increased risk of ovarian cancer and autoimmune disorders (Tanbo & Fedorcsak, 2017; Králíčková et al., 2020; Shigesi et al., 2019).
How is endometriosis diagnosed?
The risk of endometriosis can be evaluated through ultrasounds or magnetic resonance imaging (MRI), to check for the presence of endometrial tissue outside of the uterus. However, the condition is usually diagnosed through a more invasive procedure: laparoscopy, whereby a doctor examines the abdominal cavity with a thin viewing tube (a laparoscope). During the procedure, it is possible for the doctor to take one or more samples of some of the tissues identified to examine them under a microscope and determine whether they really are endometrial tissue.
Endometriosis can be classified as stage I (minimal), stage II (mild), stage III (moderate) or stage IV (severe), based on the mount of misplaced tissue, its location, whether it is on the surface or deep within an organ, and the presence and number of endometriomas and adhesions.
How is endometriosis addressed?
Addressing endometriosis requires a comprehensive approach, considering not only hormonal imbalances but also the associated inflammatory and immune dysfunctions.
The diagnosis and understanding of endometriosis is far from straightforward; yet, there are definite pathological mechanisms that provide a blueprint for effectively supporting women dealing with this condition. Endometriosis is not just a gynaecological disorder, but a systemic condition that has multifaceted implications for a woman's overall health that need to be addressed and managed in order to limit the serious long-term negative health consequences. Herbal support can play a key role in this, alongside any medical and pharmacological treatments – which we will look at in the next section. We will then more closely investigate how herbal medicine approaches can complement these traditional treatments to provide a more holistic care pathway for endometriosis sufferers, to help them manage their symptoms and improve their quality of life.
Current medical treatments for women with endometriosis
As of today, there is no definitive cure for endometriosis, but several conventional medical and pharmacological treatments are often used to help manage symptoms, slow the progression of the disease, and improve quality of life.
Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are often prescribed to support pain management. Although they can help reduce pain and inflammation, they do not slow down the disease progression, and they present a series of side effects. As we will see in the following section, herbal approaches may provide a helpful alternative for pain and inflammation management.
Hormone-based medications can be prescribed to endometriosis sufferers to reduce the body's oestrogen levels, because oestrogen fuels the growth of endometriosis. These medications can also help manage symptoms like heavy bleeding and pelvic pain. Several hormonal therapies are available, including birth control pills, patches, vaginal rings, progesterone intrauterine devices (IUDs), gonadotropin-releasing hormone (GnRH) agonists, and progestin therapy. Each of these has different mechanisms of action and side effects, and effectiveness, and the choice will depend on the woman's unique circumstances, including the severity of her symptoms, her age, and her desire to have children in the future. These also present significant side effects that must be carefully considered.
In severe cases, when hormonal therapy is not effective or when endometriosis is causing fertility issues, surgery may be an option. Laparoscopic surgery is a minimally invasive procedure that allows the doctor to remove or destroy endometriosis tissues. For women who do not wish to preserve fertility or in extreme cases, a hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries) can be considered, but these are generally last resort treatments due to their irreversible nature and potential side effects.
Natural health approaches to supporting endometriosis management
As mentioned before, modern medicine offers several options to manage endometriosis, such as hormonal therapies and surgery. However, these can have significant side effects, and many women seek out complementary approaches to provide a more holistic care path. This is where herbal medicine comes in.
Herbal medicine taps into the natural healing properties of a range of plants and plant extracts. These remedies have been used for centuries in traditional medicine systems and are increasingly thoroughly studied in scientific research today. Many herbs can provide gentle, holistic relief for a variety of symptoms associated with endometriosis. Remember, endometriosis is a complex condition, and managing it often requires a multi-faceted approach. While it's crucial to work with a medical herbalist and/or other healthcare practitioners to develop a treatment plan that suits your individual needs, and while herbal medicine may not always be a replacement for traditional medical treatments, it can play a supportive role in managing endometriosis.
Can Herbal Medicine Support Endometriosis?
Certain herbs can help offer holistic support to endometriosis sufferers, addressing various aspects of the condition. Whether it's about managing hormone levels, reducing pain, controlling heavy bleeding, preventing scarring or promoting relaxation, these herbs can provide a holistic approach to dealing with endometriosis. It's important, though, to always consult with a medical herbalist before starting any new herbal treatment to ensure it's safe and right for you.
- Painkilling herbs: To ease pelvic pain and inflammation, herbs such as cramp bark (Viburnum opulus), pasque flower (Anemone pulsatilla) or ginger (Zingiber officinalis) can help.
- To ease excessive pelvic bleeding, lady’s mantle (Alchemilla vulgaris), shepherd’s purse (Capsella bursa-pastoris), raspberry leaf (Rubus idaeus), or yarrow (Achillea millefolium) can be indicated.
- Preventing scarring: Certain herbs such as gotu kola (Centella asiatica) can also play a role in preventing scarring.
- Promoting relaxation: To promote calm, relaxation and restful sleep, a range of herbs can also be of help, including lavender (Lavandula angustifolia), lemon balm (Melissa officinalis), or rose (Rosa damascena).
Many of these herbs are included in our Menstrual support and Female vitality ranges, but as mentioned before, it is very important to consult a medical herbalist if you have endometriosis, or if you suspect you may have it, so that they can help devise a bespoke approach for you.
Dietary and lifestyle considerations:
There are a series of dietary and lifestyle considerations that can support endometriosis management,,,
- Eat a wide range of organic fruit and vegetables, to avoid pesticides, herbicides and fungicides, which may contain oestrogen-mimicking compounds (also known as xeno-oestrogens) that bind to oestrogen receptors and contribute to the imbalances seen in endometriosis.
- Eat more flax seeds, sunflower seeds, pumpkin seeds and sesame seeds – natural sources of enterodiol and enterolactone, which have been found to have weak estrogenic and antiestrogenic properties. This means that they can mimic the effects of oestrogen in some tissues, while blocking or reducing oestrogen's effects in others.
- Increase intake of omega 3 essential fatty acids: fatty fish, chia seeds, flaxseeds (or flaxseed oil), hemp seeds – to help dampen inflammation.
- Regularly eat organic soy-based products: Soy is rich in isoflavones, which can also bind to oestrogen receptors, but their affinity is weaker than that of the body's own oestrogen. As a result, isoflavones can act as selective oestrogen modulators, reducing the overall estrogenic activity in the body. This may help counterbalance the effects of excessive oestrogen that could fuel the growth of endometrial tissue in endometriosis.
- Reduce intake of saturated animal fat: Eating saturated animal fat can affect the bacteria in our colon. These bacteria produce an enzyme called beta-glucuronidase (Brinkman et al., 2010), which has a role in breaking down certain forms of oestrogen in our body. When this happens, more oestrogen gets reabsorbed into the bloodstream, which could be a reason why a diet high in fat is linked to conditions like endometriosis (Wei et al., 2023), but also breast cancer, heavy menstrual periods and fibroids.
- Use natural, chemical-free cosmetics, skin care and cleaning products – also to avoid those xeno-oestrogens.
- Exercise regularly, for many good reasons, one of them being that lack of physical activity increases the level of circulating oestrogens.
- Stress management techniques: Chronic stress can contribute to hormonal imbalance and inflammation, which can worsen endometriosis symptoms. Techniques such as mindfulness, yoga, meditation, or other relaxation practices can help manage stress and its impacts.
- Avoid smoking, as smoking can lead to more inflammation and can alter the metabolism of oestrogen.
Herbal medicine consultations for endometriosis support
To sum up, it's crucial to remember that every woman's experience with endometriosis is unique, and what works for one person might not work for another. While there's no definitive cure for the condition, there are many ways to manage it and enhance quality of life – including support from a range of herbal remedies, lifestyle and diet changes. If you or someone you love is struggling with severe menstrual pain or has been diagnosed with endometriosis, consider speaking with one of our medical herbalists to explore some natural health approaches to managing the condition.
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Wei, Y., Tan, H., Yang, R., Yang, F., Liu, D., Huang, B., OuYang, L., Lei, S., Wang, Z., Jiang, S., Cai, H., Xie, X., Yao, S., & Liang, Y. (2023, May 12). Gut dysbiosis-derived β-glucuronidase promotes the development of endometriosis. Fertility and Sterility. Advance online publication. https://doi.org/10.1016/j.fertnstert.2023.03.032