Endometriosis

Chronic pain and bloating in a woman’s abdomen may point to an abnormality of the endometrial tissue. According to research or other evidence, the following self-care steps may provide some relief:

Ease the soreness with C and E
Lessen the pain by taking a daily combination of 1,000 mg of vitamin C and 1,200 IU of vitamin E

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full endometriosis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Endometriosis is a progressive and chronic condition in which endometrial tissue (the inner lining of the uterus that is shed each month during menses) is found outside of the uterus and implanted within the pelvic cavity.

Endometriosis is believed to affect as many as 10% of all women in the United States and is the third leading cause of gynecologic hospitalisation and a leading cause of hysterectomy.¹ Although many theories exist, the cause of endometriosis is unclear. However, there does appear to be a genetic link—women who have a mother or sister with endometriosis are more likely to develop this condition.

Product ratings for endometriosis

Science Ratings	Nutritional Supplements	Herbs
	Vitamin C and vitamin E (in combination)
	Fish oil	Agnus castus
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Women with endometriosis may have symptoms including pain before and during menstrual periods, pain with sexual intercourse, abdominal bloating, pain during urination or bowel movements, pelvic tenderness, premenstrual spotting, abnormally heavy or long menstrual periods, rectal bleeding during menstrual periods, and an inability to become pregnant.

Medical options

Over the counter drugs for inflamation, such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and naproxen (Aleve®), might be beneficial.

Prescription drug treatment focuses on controlling inflammation and reducing oestrogen and progesterone blood levels. Prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®), naproxen (Anaprox®, Naprosyn®), indomethacin (Indocin®), ketoprofen (Orudis®), and diclofenac (Voltaren®), help control inflamation. Oral birth control pills (Ortho-Novum®, Mircette®, Loestrin®, Triphasil®), antiestrogens such as danocrine (Danazol®), progestins including progesterone (Prometrium®) and medroxyprogesterone (Provera®), and gonadotropin-releasing hormones, such as leuprolide (Lupron®) and goserelin (Zoladex®), are prescribed to affect hormone levels.

Surgical treatments, such as removal of the endometrial areas, ovaries, or uterus may also be recommended.

Dietary changes that may be helpful

There has been no research investigating the effect of any specific diet in women with endometriosis. Preliminary research suggests that women who consume more than 5 grams of caffeine per month (about 1.5 cups of coffee a day) are more likely to have endometriosis.² No study has investigated whether avoiding caffeine improves the symptoms of endometriosis.

Lifestyle changes that may be helpful

Preliminary studies suggest that women who exercise two to four hours per week have less risk of developing endometriosis.³ ⁴ However, the benefit seems to be limited to those women who participate in vigorous exercise, such as jogging or other activities that raise the heart rate. Whether exercise will reduce the symptoms of existing endometriosis is unknown.

Vitamins that may be helpful

In a study of women with pelvic pain presumed to be due to endometriosis, supplementation with vitamin E (1,200 IU per day) and vitamin C (1,000 mg per day) for two months resulted in an improvement of pain in 43% of women, whereas none of the women receiving a placebo reported pain relief.⁵

Animal research suggests that fish oils may reduce the severity of endometriosis,⁶ ⁷ and fish oils have been shown to improve symptoms of dysmenorrhoea (painful menstruation),⁸ which may be caused by endometriosis. Therefore, while no specific research has been done on the effects of fish oils in women with endometriosis, some health practitioners recommend several grams of fish oil per day for this condition.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Agnus castus is recommended either alone or in combination with other herbs, such as dandelion root, prickly ash, and motherwort, by some doctors to treat the symptoms of endometriosis.⁹ ¹⁰ Although agnus castus affects hormones that in turn affect the severity of endometriosis,¹¹ and it may be effective for premenstrual syndrome,¹² no research has tested the effect of agnus castus supplementation on women with endometriosis. Similarly, no other botanical medicines have been scientifically researched for treating this disease.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

According to preliminary reports, regular meetings with other endometriosis sufferers may help women with endometriosis learn about the disease and cope better with the many psychological and emotional issues that often accompany this condition.¹³ One preliminary study found that women who had the opportunity to speak with other women with endometriosis, as well as to meet with their physician, had a higher satisfaction with their overall care.¹⁴

Acupuncture has been reported anecdotally to help control the pain associated with some cases of endometriosis,¹⁵ but no controlled studies have confirmed this claim. One small, preliminary study found that auricular acupuncture (acupuncture of the ear) was as effective as hormone therapy in treating infertility due to endometriosis.¹⁶

References
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1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997;24:235–58 [review].

2. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol 1993;137:1353–60.

3. Cramer DW, Wilson E, Stillman RJ, et al. The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA 1986;255:1904–8.

4. Signorello LB, Harlow BL, Cramer DW, et al. Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol 1997;7:267–74.

5. Johnson K. Antioxidant therapy quickly improves endometriosis pain. Fam Pract News 2004(March 15):75 [News report].

6. Yano Y. Effect of dietary supplementation with eicosapentaenoic acid on surgically induced endometriosis in the rabbit. Nippon Sanka Fujinka Gakkai Zasshi 1992 Mar;44(3):282–8 [in Japanese].

7. Covens AL, Christopher P, Casper RF. The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertil Steril 1988;49:698–703.

8. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol 1996;174:1335–8.

9. Batchelder HJ, Hudson T, Lewin A, et al. Therapeutic approaches to endometriosis. The Protocol Journal of Botanical Medicine 1996;Spring:25–60.

10. Hudson T. Women’s Encyclopedia of Natural Medicine. Los Angeles: Keats Publishing, 1999:79–88.

11. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res 1993;25:253–5.

12. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual tension syndrome with Vitex agnus-castus. Controlled, double-blind study versus pyridoxine. Phytomedicine 1997;4:183–9.

13. Whitney ML. Importance of lay organizations for coping with endometriosis. J Reprod Med 1998;43(3 Suppl):331–4.

14. Wingfield MB, Wood C, Henderson LS, Wood RM. Treatment of endometriosis involving a self-help group positively affects patients’ perception of care. J Psychosom Obstet Gynaecol 1997;18:255–8.

15. Maciocia, G. Obstetrics and Gynecology in Chinese Medicine. New York: Churchill Livingstone, 1998:691–733.

16. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171–81.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.