Integrative Treatment for Endometriosis
Endometriosis is a disease where endometrial-like tissue is found outside the uterus causing adhesions around the surrounding viscera (organs) & tissues. This tissue has actually been found attached to all the organs within the body, so it is not just a reproductive organ problem.
10-15% of women have endometriosis and it can take on average 7 years for a true diagnosis. It is diagnosed by laproscopic surgery, however many women will be considered to have endometriosis by symptoms alone.
The current gold standard of care for endometriosis treatment is excision surgery. However, this does not eliminate the pain and other secondary symptoms for everyone. And for even some, it recurs again.
That is why treating endometriosis takes an integrative approach.
First let’s look at the most common symptoms of endometriosis. For many it begins with cyclical pain that can turn constant. Common symptoms include: painful periods, deep pain with sex (especially in specific positions), painful bowel movements, rectal bleeding, painful ovulation, pain after/before orgasm, fatigue, constipation or IBS, and infertility.
Many of these symptoms are caused by the adhesions deforming the organs and constricting the blood/lymph flow, nerves and musculature. However, part of the confusion and difficulty with endometriosis symptoms are that the severity of the adhesions does not always match the severity of the symptoms or pain. Which is why taking the whole person into account may improve the symptoms more than surgery alone.
Even though traditional medicine does not understand why endometriosis occurs, there are factors shown to increase risk such as genetic predisposition, lifestyle, diet, circulation. By addressing these factors as well as the protective measures used by the body when it adapted to the chronic exposure to pain, there is a higher chance of long term success.
What does integrative treatment look like for endometriosis?
Integrative treatment takes a team approach, working with multiple practitioners from varying backgrounds. This should include at a minimum your Surgeon, a Dietician, and a Pelvic PT. You may also choose to work with a Naturopathic Doctor or Functional Medicine Doc who specialize in women’s health, an Acupuncturist, an herbalist, Chinese Medicine, or a Peristeam Hydrotherapist.
How these different specialties address the common risk factors & side effects of endometriosis
Genetic Predisposition
Women are 6-9% higher risk of developing endometriosis when their mother or aunt also has endometriosis. Unfortunately, the genetic factor that causes endometriosis in these individuals is unknown. What is speculated is how environmental exposures to certain toxins triggers the genetic predisposition. Think of it this way, “our genetics load the gun, the environmental factors pull the trigger” also known as epigenetics.
Working with a provider(s) who understands how lifestyle and diet can impact genetic expression can make a difference, especially if you want to avoid surgery.
Lifestyle
There are lifestyle factors in our control and outside of our control that can impact endometriosis. These are our habits and choices related to sleep, exercise, product use, stress levels and diet.
Since endometriosis is an estrogen-dominent disease, meaning that higher levels of a certain type of estrogen called estrodial, trigger flares. Certain lifestyle choices can either increase estrogen production or help balance the higher levels of estrogen.
For example, it has also been found that phthalates, the most widely used chemical in cleaning and personal care products, has been linked to insulin resistance. Insulin resistance actually increases free range estrogen, thus potentially increasing your risk of endometriosis especially if genetically predisposed.
This same insulin resistance that can increase estrogen process can happen with chronic systemic inflammation from sleep deprivation, chronic stress, auto-immune diseases, thyroid issues and gut dysbiosis. So addressing lifestyle factors that impact chronic inflammation may also reduce endometriosis symptoms.
Check out these blogs for some ideas.
6 Strategies for Better Sleep to Improve Reproductive Health
Stress, Your Thoracic Spine and Reproductive Health
The Gut-Fertility Link (even if you are not trying to conceive, this gives some information for help)
Diet
Your diet can impact many factors related to endometriosis, including inflammation, gut dysbiosis, insulin resistance and hormone balance (estrogen). There have been a few studies indicating a link between higher levels of Omega 3 reducing the risk of endometriosis and higher levels of trans fat intake with increased risk of endometriosis.
Either way, an individualized approach is recommended. However, there are over arching themes that become clear when considering diet and endometriosis such as foods that are anti-inflammatory, good-bacteria promoting, and sugar balancing.
You can learn more about pelvic floor friendly foods, which takes these benefits into consideration by reading my blog, Foods for Pelvic Floor Health.
Beyond the types of foods that are beneficial, you may also want to consider what the foods you consume are exposed to.
For example, a study found that women with higher levels of a pesticide called HCH were more likely to be diagnosed with endometriosis. Being able to reduce your exposure to this type of pesticide by avoiding or limiting foods sprayed with pesticides, especially if you have a genetic predisposition, may reduce your chances of developing endometriosis.
As important as diet is, your body needs to be able to process and transport the nutrients to and the byproducts from your tissues. Requiring good circulation.
Circulation
In Chinese Medicine endometriosis is considered a blood stagnation disease or disruption in natural hemodynamics. Studies have shown that using modalities that improve blood circulation, there is a reduction in endometriosis symptoms. Different modalities include acupuncture, Chinese medicine, vaginal steaming, and body work.
Acupuncture and Chinese medicine are focused on improving the energy flow through the body by removing “blocks.” Vaginal steaming and body work also promote improved energy flow through physical tissue change or manipulation. There are mixed view points on if these modalities actually cure endometriosis, however, if the symptoms are eliminated, the individual has more choices beyond surgery to maintain relief.
How does vaginal steaming and body work help to improve circulation. They both influence the adhesions, scar tissue, and muscle tension. The water molecules in steam are highly permeable which can penetrate the tough, restricted tissues to soften, thin and even break them apart. Body work such as visceral mobilization, myofascial release and Mayan abdominal massage can target the restricted tissues manually.
However, even once the adhesions or restrictions are softened or eliminated, the protective measures that your body adapted to guard against the pain may still be present.
Protective Measures
This is when your body tries to mitigate the pain by guarding, compensating or adapting habits. For many this leads to tight, tense muscles and altered postures and movement patterns. Fear of pain also plays a role in protective measures, by forming anticipatory patterns even when pain is not present.
Learning how to lengthen and move your body again without these protective measures is key to long term success. You can do this through corrective exercise that focus on progressing lengthening through the front of your body. Then gradually move to more complex forms of exercise that support the new muscle lengths as well as improve circulation, reduce inflammation, balance hormones and blood sugar.
As you can see there is a lot of overlap between each category.
Pelvic physical therapy is just one way to address factors from all categories, especially circulation and protective measures. So if you want to learn more about how pelvic PT may be able to help you and you live in New Hampshire or Maine I invite you to set up a consult call with me.