Understanding Endometriosis: Symptoms, Diagnosis, and Holistic Treatment Options

Endometriosis

Endometriosis is a chronic, systemic, and complex disease in which endometrial-like cells, similar to those in the uterine lining, grow outside the uterus where they are not supposed to. This abnormal growth triggers an inflammatory response, with the most common symptom being pain. On average, it takes between 7 to 12 years from the onset of symptoms to receive a proper diagnosis. A 2012 survey from France found that "63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease." Some of the primary symptoms include pelvic pain, pain during intercourse, painful periods (especially with pain radiating to the lower back or abdomen), infertility, pain with bowel movements or urination, and other menstrual issues such as spotting and heavy bleeding. While these statistics are from 2012, and hopefully have improved since, they illustrate the complexity of diagnosing endometriosis.

The intensity of the pain can vary, ranging from mild discomfort to severe, debilitating pain. Symptoms may also appear unexpectedly later in life as the disease progresses. Pain can occur outside of the menstrual cycle and may be experienced in areas of the body not typically associated with gynecological conditions, such as the sacrum, legs, rectum, diaphragm, abdomen, and ribs. Although rare, endometrial lesions have even been found in the nose. These cells respond to the hormonal cycle just like the uterine lining; however, since they have nowhere to be expelled, they progressively thicken, impacting surrounding anatomy. This can cause organs to adhere to each other, leading to pain as the affected areas develop a stronger nerve supply.

The connection between endometriosis and autoimmunity is still being studied, but research suggests that having endometriosis increases the risk of autoimmune conditions. The inflammatory nature of the disease appears to disrupt immune system balance, leading the body to mistakenly identify misplaced endometrial tissue as foreign and attempt to destroy it, causing further inflammation and lesion formation.

Studies indicate that endometriosis increases the risk of conditions such as Hashimoto’s disease, celiac disease, Sjogren’s syndrome, multiple sclerosis, eczema, rheumatoid arthritis, and systemic lupus erythematosus. A study from Denmark found that women with endometriosis have a greater risk of developing 28 autoimmune diseases (Shigesi et al., 2019). There is also a strong familial component—women with a first-degree relative (mother, sister, or daughter) diagnosed with endometriosis are 7 to 10 times more likely to develop the condition themselves.

A Complex Condition Requires a Comprehensive Approach

When considering treatment, it can be helpful to view the body as being in a "hot" and inflamed state, requiring therapies to "cool" it down. This approach can help slow inflammatory processes and optimize therapeutic outcomes, especially if advanced surgery is needed. A multimodal approach is ideal. Relying solely on surgical removal of lesions is often insufficient, as they can recur. The entire physiological terrain needs to change to prevent further progression.

Which Multimodal Therapies Are Beneficial?

A broad range of therapies can help manage endometriosis. These include:

• Pelvic floor therapy to address muscle spasms and dysfunction contributing to pain.

• Physical therapy to support optimal movement through techniques such as stretching, mobilization, manipulation, and massage targeting joints, fascia, nerves, and muscles.

• Nutritional support to reduce inflammation and identify dietary triggers.

• Mindfulness, talk therapy, and stress reduction to calm the central nervous system.

• Acupuncture, especially when combined with Traditional Chinese Medicine herbal formulas, to reduce inflammation, modulate pain signals, and improve circulation.

• Naturopathic adjunctive therapies, including hydrotherapy to enhance circulation and oxygenation, herbal medicine, and targeted nutraceuticals.

• Blood testing to identify nutritional deficiencies or metabolic imbalances that impact immune health, inflammation, and hormonal regulation.

• Gut health optimization, as endometriosis can alter the microbiota, requiring interventions to address dysbiosis.

• Hormonal balance support, particularly for estrogen metabolism, as high estrogen levels are consistently linked to endometriosis.

• Reducing environmental triggers, such as dioxins, BPA, phthalates, pesticides, and flame retardants, which mimic estrogen and disrupt hormonal balance.

• Advanced supportive tools, including red light therapy, low-level laser therapy, pulsed electromagnetic field (PEMF) therapy, transcutaneous electrical nerve stimulation (TENS), electroacupuncture, and hyperbaric oxygen therapy (HBOT) to reduce inflammation, modulate pain, improve tissue oxygenation, and stimulate regeneration.

  
  

Scientific Evidence Supporting These Therapies

TENS Therapy A TENS unit is a small, battery-powered device that delivers mild electrical currents through electrodes placed on the skin. It relieves pain by stimulating nerves and blocking pain signals from reaching the brain.

A comprehensive review (Li et al., 2023) assessing the effectiveness of various complementary therapies for endometriosis found that a TENS unit, typically set at 50-120 Hz, effectively reduces pelvic pain. Patients reported a pain reduction of 2-4 points on a 0-10 scale and decreased reliance on pain medication. A Norwegian study of 21 women found that TENS significantly reduced average pain scores from 6.73 to 5.18, with 33% of participants stopping medication altogether. Long-term follow-up showed that 67% continued using the TENS unit for pain management 6-8 months later (Schiøtz et al., 2007).

Acupuncture A randomized controlled feasibility study found that 19 participants with laparoscopy-confirmed endometriosis who received 16 acupuncture treatments over 8 weeks experienced significant pain reductions and improved quality of life (Armour et al., 2021). A 2019 retrospective survey found that 44.3% of patients (58 out of 574) considered acupuncture to be effective for endometriosis (Schwartz et al., 2019).

Complementary Home Remedies The same survey found that nearly half of women with endometriosis used additional analgesics, topical heat, or rest, while about a quarter used homeopathy, phytotherapy, or acupuncture/TCM, with reported effectiveness ranging from 41.4% to 80.3%. Additionally, 25% of participants used massage or physical therapies, with 69.2% rating them as beneficial (Schwartz et al., 2019).

Final Thoughts

Complementary and alternative medicine offers a favorable safety profile but may require trial and error to determine the most effective approach for each individual. At IVY Integrative, we provide a range of supportive services that integrate beautifully to establish foundations for health and improve quality of life. Not all therapies may be necessary, but I highly recommend prioritizing nutrition, mindfulness, and pelvic floor physical therapy.

While these therapies are not curative, they can be profoundly helpful. If further diagnostics and treatment, such as laparoscopic surgery, are required, these integrative approaches can prepare the body for optimal recovery. If considering surgery, I strongly recommend consulting an endometriosis excision specialist for the best outcomes. Here is a directory of specialists: Endometriosis Excision Specialist Directory.

At IVY Integrative, you can work with one practitioner or build your own team of holistic practitioners! Reach your optimum health in-person or online. Check out our Get Started page to learn how to work with us!

Author: Dr. Yelena Okhotin ND, LAc 

References:

1. Armour M, Cave AE, Schabrun SM, et al. Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: A randomized controlled feasibility study. J Altern Complement Med. 2021;27(10):841–849.

2. Li, L., Lou, K., Chu, A., O'Brien, E., Molina, A., & Riley, K. (2023). Complementary therapy for endometriosis related pelvic pain. Journal of Endometriosis and Pelvic Pain Disorders, 15, 34 - 43. https://doi.org/10.1177/22840265231159704.

3. Quibel A, Puscasiu L, Marpeau L, Roman H. Les médecins traitants devant le défi du dépistage et de la prise en charge de l'endométriose : résultats d'une enquête [General practitioners and the challenge of endometriosis screening and care: results of a survey]. Gynecol Obstet Fertil. 2013 Jun;41(6):372-80. French. doi: 10.1016/j.gyobfe.2012.02.024. Epub 2012 Apr 20. PMID: 22521982.

4. Schiøtz HA, Jettestad M, Al-Heeti D. Treatment of dysmenorrhoea with a new TENS device (OVA). J Obstet Gynaecol. 2007;27(7):726–728.

5. Schwartz ASK, Gross E, Geraedts K, et al. The use of home remedies and complementary health approaches in endometriosis. Reprod Biomed Online. 2019;38(2):260–271.

6. Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014. PMID: 31260048; PMCID: PMC6601386.

   
   

Disclaimer:

This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.