Endometriosis

What is Endometriosis?

Endometriosis is a chronic, progressive condition characterized by the presence of endometrial tissue outside the uterus, most commonly on the ovaries, fallopian tubes, or rectum.

What are the Symptoms?

The most common symptoms are pain with menses, pain with intercourse, and infertility. Some women may also experience rectal pain or pain with defecation.

How common is endometriosis?

Endometriosis is thought to affect 5-10% of women, although the true prevalence of the disease is unknown because surgery is required to make a definitive diagnosis. It is most common in women aged 24-40, although some women experience symptoms when they first start menstruating. Also, some women may have no pain, and only find out they have it when they are worked up for infertility. Typically, symptoms resolve once a woman goes through menopause, because estrogen and progesterone levels drop off significantly.

What causes endometriosis?

The true cause of endometriosis is still unknown, however, the most widely accepted theory involves the backwards flow of menses. Since most, if not all, women have some back-flow of menstrual fluid, the question still remains why implantation of the tissue outside the uterus is able to occur in some women and not others. There is some evidence that immune alterations may contribute to the persistence of these implants, in addition to the resultant infertility that many women experience. Some women with endometriosis have been found to have lower levels of circulating natural killer cells (cells responsible for keeping tumor and other abnormal cells in check). In addition, some women with endometriosis have higher levels of auto-antibodies, suggesting a connection between autoimmune disease and endometriosis, although this has been poorly studied. Hormonal imbalances, particularly high estrogen levels, have also been found in many women with endometriosis.

What are the risk factors?

Heredity is the main risk factor for getting endometriosis. The likelihood of a mother to also have endometriosis is 8.1% and a sister 5.8%. In addition, increased or unbalanced estrogen levels, shorter menstrual cycles (less time between periods), lack of exercise from an early age, and the use of IUD's have also been found to be risk factors.

Why does endometriosis cause infertility?

Again, we don't have all the answers yet. The most likely reasons are lesions or adhesions that disrupt the flow of egg/sperm through the reproductive tract, immune dysfunction and hormonal imbalances. When the immune system is on high alert or is not functioning properly, women often experience difficulty getting pregnant or may experience frequent miscarriages, because the body views either the sperm or the resultant fetus as “foreign” and will attack it. If hormone levels are unbalanced, achieving or maintaining a pregnancy can be difficult.

Why is the pain cyclical?

The endometrial implants found outside the uterus are very similar to the tissue that normally lines the uterus. It thickens and bleeds in response to monthly rises in estrogen.

How is endometriosis diagnosed?

The only way to definitively diagnose endometriosis is by laparoscopic surgery and biopsy of the tissue. However, endometriosis is often suspected and treated based on presenting symptoms (pelvic pain and back pain associated with menstruating, pain with intercourse, and infertility) and personal and family history. A physical exam can often reveal tenderness of the pelvis on bimanual exam, a fixed or retroverted uterus, or enlarged or tender ovaries. Ultrasound may pick up lesions on the ovaries, but is often not very useful to detect smaller lesions in other locations. There may also be other tests or exams done to rule out other possible causes of pelvic pain or infertility.

How is endometriosis treated?

Conventional treatment options include medications that suppress your natural hormone production and ovulation, such as birth control pills. These are fairly effective at reducing the pain associated with menstruation, however symptoms usually return once going off them, and this is not a viable option for women trying to get pregnant. Surgical treatment is the preferred option for women with infertility and appears to provide better long-term pain relief than medical treatment. However, it is more invasive and expensive and will not treat any underlying hormonal or immune imbalances, so over time the lesions often grow back. Surgery can also produce scarring or adhesions in the pelvis, which can contribute to further pain and infertility.

Are there any natural treatments for endometriosis?

Yes! The goal of treatment is to balance hormones and support the immune system in order to relieve symptoms and improve fertility, NATURALLY.

Dr. Cavalier's holistic approach to treating endometriosis

Dr. Cavalier provides a truly holistic and individualized treatment plan based on your specific symptoms. She combines homeopathy, nutrition and lifestyle adjustments to stimulate your body to heal itself and find its natural rhythm and balance. The treatment protocols not only provide symptom relief, but treat the underlying cause of your imbalance and increase fertility.

Homeopathy

Homeopathy is the key to successful treatment of endometriosis. Dr. Cavalier has found it to be the most important part of the treatment plan. While nutrition and lifestyle changes remove obstacles to cure and supply the raw materials the body needs, homeopathy provides the stimulus for the healing to take place. It involves matching a patient's unique symptoms to a remedy that causes the same symptoms in a healthy person. It works by stimulating your body to heal the underlying imbalance that caused the endometriosis, thereby healing the lesions, alleviating symptoms, and restoring fertility. It is the safest, most effective treatment, especially when combined with the right balance of nutritional and lifestyle changes. Endometriosis has many causes and presents differently in every woman, which makes this individualized treatment approach so effective.

Nutritional Approaches to Balancing Hormones

Most often, endometriosis exists in an environment of estrogen dominance, either relative (meaning progesterone is lower than it should be) or overt (meaning estrogen is higher than it should be). Either way, the goal is to decrease circulating estrogens and increase progesterone, particularly in the second half of the cycle. There are several nutritional interventions that can help to reduce circulating estrogens by improving how your body makes and eliminates it. Here's a little biochemistry lesson for those who like that sort of thing...

Estrogen is metabolized by the liver and eliminated from the body through the digestive tract and the urine. The liver makes estrogen water soluble, and thereby able to excrete it in the urine, by adding a hydroxy molecule (OH) either at the 2 or 16 location. The 2-OH is a much healthier version of estrogen. The 16-OH is more potent, and is associated with a higher risk of cancer in estrogen-sensitive tissues, such as the breast, ovaries or uterus. Higher amounts of 16-OH estrogen are also associated with a greater risk of endometriosis, endometrial hyperplasia, uterine fibroids, painful menses, and fibrocystic breasts. There is a urine test that can check your ratio of 2-OH vs. 16-OH estrogens to see if this may be a cause of your symptoms. Cruciferous vegetables (broccoli, cauliflower, cabbage, brussel sprouts) contain high amounts Indole-3-carbinol (I3C) and DIM which help the liver make more 2-OH estrogens as opposed to 16-OH. DIM has also been shown to increase progesterone production in the second half of the cycle. Increasing these foods or supplementing with DIM can help to restore the proper 2:16 ratio.

Estrogen is also excreted through the digestive tract. The liver adds a molecule of glucuronic acid to estrogen, making it inactive and too bulky to be reabsorbed. However, certain unfriendly bacteria in the intestines secrete an enzyme that can remove the glucuronic acid from the estrogen. Estrogen can then be reabsorbed into the bloodstream and contribute to a state of estrogen dominance. It will also have to go back to the liver to be processed again, which can put a strain on the liver and detract from its other necessary functions. Eating foods high in beneficial bacteria, such as yogurt or kefir, are important both for healthy digestion and proper estrogen metabolism. High amounts of fiber in the diet will also help move the bowels more efficiently and carry excess bile and estrogen out of the body.

There are several other hormones that are intricately involved in sex hormone production and release, such as thyroid, insulin, and adrenal hormones like cortisol. It can be very helpful to check the levels of these hormones in women who have additional symptoms, such as weight gain, fatigue, depression or insomnia. Excess body fat (particularly around the middle) can be both a cause and an effect of hormone imbalances. It can be indicative of low thyroid function or insulin resistance, and can also perpetuate imbalances in estrogen to progesterone ratios, because abdominal fat is able to convert other steroid hormones to estrogen (thereby increasing estrogen dominance). By correcting these other hormone imbalances and keeping the blood sugar stable, it is much easier to then balance estrogen and progesterone. Diet plays a major role, not only in providing us with the necessary nutrients for hormone production, but also in changing the way the body metabolizes and stores fats and sugars. Sticking to a whole foods diet and avoiding highly refined carbohydrates and sugars is the best way to lower and stabilize blood sugar and reduce abdominal fat. In addition to making dietary changes, it is often useful to add in a few key nutrients, specific to your needs, to assist the body in restoring and maintaining balance. Reducing belly fat and lowering blood sugar has the added benefit of reducing the risk of cardiovascular disease and diabetes.

Avoid environmental sources of estrogen

In addition to processing our endogenous or natural estrogens, we are also exposed to “xenoestrogens” in our environment. These are chemicals that have estrogen-like effects in our body, and they are often far more potent than the estrogen the body makes. They are found in pesticides/herbicides, plastics, meat grown with added hormones and soaps/shampoos/detergents that contain parabens. They are often fat-soluble, so they accumulate in the environment and in the body over time, adding to an environment of estrogen dominance. Some pesticides/herbicides (particularly those containing dioxins) are designed to disrupt the reproductive cycles of unwanted pests, and there is evidence that these substances are also affecting the reproduction of other animals, such as birds. As they accumulate in the environment and our bodies, they are reaching levels that could also be interfering with the reproductive health of humans.

Support immune system

In addition to balancing hormones, it can also be important to look at immune function. As mentioned above, autoimmunity and variations in particular immune cells can play a role in endometriosis and infertility. There are tests that can be run to check immune function and look for the presence of auto-antibodies. I have found this to be particularly useful in women who are having trouble getting pregnant or have other symptoms that could be related to an autoimmune disease. Again, there are nutrients and herbs that can either stimulate or settle down the immune system, depending on what is desired, however, I have found Homeopathy to be the most effective treatment for immune dysfunction.

Exercise

Exercise has been shown to reduce circulating estrogen levels and increase endorphins (natural pain-relieving substances). Regular exercise also increases circulation and immune function, and of course is an integral part of any weight loss program.

Castor Oil Packs

Castor oil when used topically can help reduce pain and inflammation by increasing circulation to the area. By increasing circulation, you are helping to bring nutrients and white blood cells to the area and increasing waste removal. This can be done as needed for pain, but I find it works better if done 3x/week, at least until symptoms begin to subside.

Instructions: 1. Pour castor oil (and a few drops of lavender essential oil if desired) onto flannel wool cloth (most health food stores carry all of these) 2. Put cloth over abdomen and cover with a towel to keep clothing clean. 3. Put a heating pad or hot water bottle over top 4. Relax with feet up for 30-60 mins.