Endometriosis is a disease in which endometrial tissue (normally only found in the endometrial lining inside the uterus) grows outside the uterus and implants most commonly on adjacent pelvic organs such as the ovaries, fallopian tubes, bowel, pelvic ligaments, uterus, rectum, bladder, and less commonly on the liver and lungs. This misplaced tissue develops into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Normal menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from abnormal endometrial growths has no way of leaving the body. The result is internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation, which can all cause pain, scar tissue formation, adhesions, bowel problems, and infertility.
It is thought that scar tissue and adhesions may obstruct or distort the shape of the fallopian tubes and prevent the ovaries from releasing eggs. Endometriosis may also affect fertility by causing hormonal irregularities, a higher rate of early miscarriage, and immune system malfunctions. The immune system can react to the pain and inflammation of endometrial adhesions by attempting to keep the body safe from this perceived threatening tissue by preventing any foreign tissue (including embryos) to implant into the endometrium until the reaction is calmed down. While the cause of endometriosis is still unknown, many theories exist including retrograde menstruation, genetic predisposition, abnormal tissue development, or malfunction of the immune system. Common symptoms include:
- Severe menstrual cramps
- Pelvic pain not during your period
- Backache during your period
- Painful intercourse
- Painful bowel movements
- Heavy, dark, or clotted menstrual blood
- Menstrual diarrhea
- Painful and frequent urination
- Difficulty conceiving
Chinese medicine views endometriosis as a problem of blood stasis, or blood not moving. Stagnant blood coagulates and cannot be moved through blood vessels due to blocked or insufficient energy in the pathways of the body. Blocked or insufficient energy may be due to emotional trauma, severe stress, constitutional weakness, surgical history, and/or exposure to cold, either cold temperatures or regular consumption of cold foods, especially during menstruation. Signs of blood stasis include stabbing pain that is fixed in one place, frequent or heavy bleeding, dark (brownish) menstrual blood, and bleeding with dark clots. Endometriosis, fibroids, and ovarian cysts are all examples of blood stasis in women.
From a Chinese Medicine perspective there are two main types of endometriosis which can be called ‘strong endo’ and ‘weak endo’. What is interesting is that these two types are often quite distinct even under laparoscopy.
The strong endometriosis type is the classic endo picture: extensive active lesions all over the pelvis, severe pain which can last all month, heavy clotted periods and numerous attendant symptoms. These patients usually respond well to surgery at first, but may regress quite quickly even with hormone treatment. These are the patients for whom the strong blood stagnation removing type of herbal endometriosis treatment works best.
The weak endometriosis type is the one that drives surgeons mad. These patients may have severe symptoms, intense pain and debility, but the laparoscopy finds only mild scattered endo, certainly not what they would expect to match the symptoms! Even more annoying from their point of view is that these types of patients frequently feel much worse after surgery, instead of feeling better. From a Chinese medicine point of view, all of these phenomena are easily explained: a weak patient, one with ‘blood deficiency’, will have a weak blood flow that easily becomes blocked and stagnated. They also have fewer reserves to handle the pain and debility. Typically their periods will be scanty and brown coloured, they will be tired most of the digestion will be also impaired, so that insufficient blood can be produced. The treatment approach for the weak endometriosis is quite different; these women respond better to treatment than enhances the flow of blood and strengthens the digestion.