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Endometriosis is a disorder where the tissue that makes up the endometrium (the lining of the womb) grows outside the uterus.
Endometriosis is a disorder where the tissue that makes up the endometrium (the lining of the womb) grows outside the uterus. Endometriosis affects around 10% of women in United States, it is usually found in the lower abdomen, or pelvis, but can appear anywhere in the body. Endometrial cells may appear on the ovaries, fallopian tubes, bowel, bladder, peritoneal tissue, ligaments, or other structures in the abdominal cavity. Displaced endometrial tissue responds to cyclic hormonal changes, proliferating and shedding outside of the uterus; the bleeding is accompanied by inflammation caused by irritation of local tissue, such as the peritoneum. Recurrent inflammation can cause scarring and adhesions that can cause pain and dysfunction of other affected sites.
The exact causes of Endometriosis remain unknown, it is a complex condition with multifactorial origins which includes the immune system dysfunction, genetic predisposition and epigenetic factors all play a role in endometriosis. Possible co-related factors include: early menarche (< age 12), short cycles (less the 26 days), menstrual bleeding lasting longer than 7 days, IUD use, D&C history, fewer than two pregnancies. There is a higher chance of endometriosis in patients who suffer from dysmenorrhea or chronic pelvic pain.
A number of studies have demonstrated the familial clustering of endometriosis and that first-degree relatives of affected women are 5 to 7 times more likely to have surgically confirmed disease. Altercation in estrogen detoxification enzyme (cytochrome P450 enzymes CYP1A1, CYP1A2, and CYP1B1) causes an increase in circulating estrogen in the body which feeds the endometrial tissues.
Alterations in both cell-mediated and humoral immunity contribute to the pathogenesis of endometriosis, with a heightened inflammatory response within the peritoneal microenvironment., chronic inflammation contributes to enhanced lesion formation and chronic inflammation then leads to continued abnormal tissue proliferation.
Environmental exposures appear to play a role in the development of EM via endocrine and immunologic disruption.
• Dioxins, POPs, and PCBs: A tremendous amount of literature has focused on the relationship between dioxins and endometriosis. Three of seven studies that focused on dioxins or dioxin-like compounds and endometriosis have observed significantly higher concentrations in women with endometriosis than in those without the condition. An equivocal body of evidence has emerged regarding the relation between lipophilic persistent organochlorine pollutants (POPs) and endometriosis. Human endometrium is a known site for estrogen, and many POPs or their metabolites have been detected there. Studies that focused on polychlorinated biphenyls (PCBs) observed similar findings.
The gut, through the influence of the microbiome, also influences levels of circulating estrogens. The metabolism of estrogen mainly occurs in the liver. The liver can produce sex hormone binding globulin, and the combination of sex hormone binding globulin and estrogen can lead to loss of estrogen biological activity. The gut microbiota can secrete β-glucuronidase and β-glucosidase, and these products can promote the degradation of estrogen, thus increasing the reabsorption of free estrogen, and improving the level of estrogen in the circulation. Analysis of the microbiome shows that multiple bacterial genera in the gut microbiota can produce β-glucuronidase, including Bacteroid, Bifidobacterium, Escherichia coli and Lactobacillus . Patients with endometrioses notably have a significantly higher of the Escherichia coli content in their gut, which contributes to higher free estrogen.
Patients with endomitosis have a higher number of gram negative bacteria in their gut such as E.Coli which can trigger an inflammatory response leading to pain, tissue remodeling, fibrosis, adhesion formation and infertility.
In Chinese Medicine, endometriosis is a complex disorder with both excess and deficiency pattern. The excess pattern of endometriosis includes qi and blood stasis with stasis of heat or cold and underlying deficiencies of kid yin and yang, spleen qi deficiency, blood deficiency. Studies have shown that Acupuncture is effective in treating pain associated with endometriosis with results lasting up to 24 weeks after cessation of treatments. Chinese Herbal Medicine is very effective in treating endometriosis by reducing inflammation, improving blood circulation, addressing the gut microbiome and immunity using Chinese herbs. The TCM herbalist will make appropriate differential diagnosis for the patient specific pattern of endometriosis and prescribe appropriate Herbal formula along with dietary and life style recommendations.
According to multiple studies the most common Chinese herbal formula used in Endometriosis with good results are: