Endometriosis is a condition where cells similar to those that make up the lining of the uterus grow in places where they have no business showing up - like the ovaries, bowel and bladder, and even the muscular tissue of vagina. Like their relatives in the uterus, these rogue upstarts (called implants) respond to the hormonal cues of the menstrual cycle, first getting thicker and then breaking down to "bleed." But unlike the endometrial lining of the uterus, the implants have nowhere to flow and as a result may form into painful scar tissue or fluid-filled lesions - ouch!
Pelvic pain (sometimes severe!) at the time of menstruation and/or ovulation is the most common symptom of endometriosis, and secondary symptoms may include abnormally heavy periods and infertility. If you are under the care of a physician for endometriosis, treatment can include birth control pills, other hormonal medications and in advanced cases, laparoscopy to remove scar tissue and implants.
Endometriosis is challenging under any circumstances, but managing endometriosis while you're trying to conceive adds an entirely new level of complexity. Obviously, when you're trying to conceive, using birth control pills and hormone treatment becomes trickier. Nevertheless, don't despair. Your OB or Reproductive Endocrinologist will counsel you on how best to treat your endometriosis in preparation for ART (Assisted Reproductive Technology). In addition, the following holistic practices can help you manage pain and stress, as well as support your reproductive system in preparation for a successful pregnancy.
1. Eat an anti-inflammatory/gut-friendly diet
The pain associated with endometriosis is thought to be in part due to inflammation caused by higher levels of "bad prostaglandins." Prostaglandins are chemical messengers produced in every cell in the body. These chemicals have some beneficial effects (enhance immune function, increase blood flow, block inflammation) and some problematic effects (promote inflammation, decrease blood flow, contract muscles and produce pain). Unfortunately, research shows that women with endometriosis produce higher than normal levels of the second guys, pro-inflammatory prostaglandins (1), as well as higher levels of oxidative stress (click here to read more about oxidative stress and fertility) (2).
Certain foods can increase levels of inflammation in the body. For that reason, women with endometriosis can benefit from limiting pro-inflammatory foods like red meat, omega-6 oils and refined sugars. Other foods, including healthy oils and anti-oxidant rich fruits and vegetables can help reduce inflammation. Promoting good digestion is also key. Endometrial implants can occur in the gut and pelvic pain is often exacerbated by poor digestion. At Pulling Down the Moon we recommend that women with endometriosis adopt an ultra-healing diet like our ART Recovery/Prep Program. This eating program is designed to decrease dietary sources of inflammation and promote gut health.
2. Stress Reduction
Interestingly, studies show that women with endometriosis suffer from depression at a higher rate than their fertile counterparts. (2). In addition, levels of the stress hormone cortisol are higher in the follicular fluid of women with endometriosis vs. fertile women (3). Since stress and depression have been shown to negatively impact a woman's ability to conceive, relaxation training and finding emotional support can play an important of healing endometriosis. (4) Taking a yoga class, joining a support group or learning basic relaxation techniques are all good strategies for women with endometriosis.
3. Acupuncture/Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) treats endometriosis in much the same way that it treats any disorder - as a symptom of underlying imbalance that can be treated with acupuncture, herbal therapy and lifestyle changes. While no specific studies exist looking at endometriosis, TCM and fertility, there is a growing body of evidence that TCM can help with the pain and dysmenorrheal that many women with endo experience (5). In addition, it is well established that TCM helps treat stress and depression.
Many women don't realize the potential healing benefit of massage for endometriosis. Studies have shown that mechanical manipulation (stretching and pulling) on body tissue can release and potentially break down scar tissue (7). Touch therapy also helps to elevate mood and reduce stress and release tight musculature that contributes to pelvic pain. A fertility massage like our FEM protocol session "Enhance the Blood" that focuses on deep work in the pelvis and improving blood and fluid flow in lower abdomen can be extremely beneficial for women with endometriosis - even when not trying to conceive.
The take-home message here is if you're struggling with endometriosis, you can still feel very optimistic about your odds of conceiving. A combination of excellent medical care and lifestyle changes can drastically impact your symptoms and put parenthood in your sights. For more information or for help building your holistic self-care strategy, contact Pulling Down the Moon at 312-321-0004 (Chicago) or 301-610-7755 (Shady Grove, MD) for a complimentary Patient Advocate session or visit our website at www.pullingdownthemoon.com.
- Lee J. Selective blockade of prostaglandin E2 receptor EP2 and EP4 signaling inhibits proliferation of human endometriotic epithelial cells and stromal cells through distinct cell cycle arrest. Fertil Steril. 2010 Mar 5. [Epub ahead of print].
- Ngo C. Reactive oxygen species controls endometriosis progression. Am J Pathol. 2009 Jul;175(1):225-34. Epub 2009 Jun 4.
- Danielle L. Depression: an emotional obstacle to seeking medical advice for infertility. FertileSteril. 2010 Jan 2. [Epub ahead of print]
- Oehmke F. Impact of endometriosis on quality of life: a pilot study. Gynecol Endocrinol. 2009 Nov;25(11):722-5.
- Volgsten H. Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment. Acta Obstet Gynecol Scand. 2010;89(1):27-34
- Wayne P. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008 Oct;21(5):247-57.
- Langevin H. Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo. Am J Physiol Cell Physiol. 2005 Mar;288(3):C747-56. Epub 2004 Oct 20