Endometriosis

Endometriosis is an abnormal gynaecological condition in which the endometrium (the lining of the uterus) is found in areas outside the uterus. Endometriosis may lead to infertility in some women.

Endometriosis can be present in menstruating women from the early age of puberty to menopause. Normally the endometrial tissue in the uterus is stimulated by the change in hormone levels during the monthly cycle. This tissue grows and thickens and then breaks down and bleeds. This bleeding is normal menstruation. Sometimes this endometrial tissue moves outside the uterus. It can move to the ovaries, to the surface of other organs in the pelvic region and can even be found in areas other than the abdomen, although this is rare.

One of the possible causes of Endometriosis is the retrograde (backwards) menstruation theory. Endometrial cells, which are proteins, flow backwards outside the uterus into the pelvic cavity. These cells are then carried by the lymphatic system to other locations in the body. During menstruation, this same tissue bleeds due to the normal hormonal changes. This blood cannot escape from the body and discharges onto the surface of various nearby organs. This can cause inflammation, scarring, and sometimes adhesions.

As time passes, the affected endometrial tissue can enlarge in size and form cysts. These in turn can break during the monthly cycle due to the pressure from the blood within. The pain can be intense.

The disease affects about 10% of all women of reproductive age and about 50% of women with infertility. The risk of developing Endometriosis increases if a woman has first-degree relatives in her family with the condition. The average age of women with this ailment is 30 years. Endometriosis can only be diagnosed by laparoscopy, which can be performed under local or general anaesthetic.

Some women who are suffering from Endometriosis have no symptoms at all while others have obvious symptoms including dysmenorrhoea (painful periods), pelvic pain, pain during intercourse, ovarian cysts, and bowel problems.
Endometriosis is one of the main causes of infertility in women. Many women can outgrow mild Endometriosis. The incidence of this ailment seems to lessen in some women after pregnancy.

TREATMENT OPTIONS
As with all conditions your Doctor should be consulted to diagnose and treat this condition.
For women who do not wish to become pregnant, the first choice of therapy is the combined oral contraceptive pill, taking only the active tablets with no breaks. The Pill is very effective in reducing symptoms and can be used long-term, although the same health risks associated with the Pill still apply, such as nausea, thromboembolism, weight gain and depression.
For women who are trying to fall pregnant, non-steroidal anti-inflammatories may offer some relief, although gastrointestinal side effects are common. Generally, surgical treatment is recommended. A laparoscopy is performed under general anaesthetic, allowing division of adhesions and laser, diathermy, drainage and/or excision of endometriomas (tissue/blood deposits). This can be done as a day patient. However, there is no guarantee that symptoms or fertility will improve and recurrence of the disease is common.
The only permanent cure for Endometriosis is total hysterectomy, including removal of both ovaries. Women who have completed their family or who have long-term infertility may choose this option.

DIET HINTS
• The diet should consist of low fat, high fibre and low sugar foods. Include lots of fruit, vegetables and wholegrain cereals. Keep processed and refined foods to a minimum. An acidic system may promote the inflammatory pain of Endometriosis. Fruits and vegetables help to alkalise the body, while meats and sugar may promote a more acidic environment in the body.
• A high intake of fruits and vegetables have a protective effect against Endometriosis, whereas the intake of red meat and ham appears to increase the risk, according to the results of a recent clinical study. This study found that there was a 40 percent reduction in the risk of developing Endometriosis in women with a higher consumption of green vegetables and fresh fruit. For those women with a higher consumption of beef, other red meat and ham, there was an increase in the risk of developing Endometriosis of approximately 80 to 100 percent.
• Increase intake of fish and cold pressed vegetable oils as they contain Omega 3 and Omega 6 essential fatty acids. These fatty acids are thought to have an anti-inflammatory effect. Include food, which is high in essential fatty acids e.g., nuts, seeds, linseeds and linseed oil.
• It is important to have smaller meals frequently and to eat all food as fresh as possible. Vegetables should only be cooked lightly as this will help keep the vitamin content high. Avoid 'fast foods' as they may contain excess salt and food enhancers.
Drink filtered water as often as you can. Tea, coffee and alcohol should be avoided.

VITAMINS/MINERALS/HERBS
Nutritional supplements should only be used if the dietary vitamin intake is inadequate. Recommended supplements include:
• Omega-3 Fatty acids may prevent the production of hormones, which cause inflammation and stimulate growth of endometrial tissue. These can be obtained from flaxseed oil, fish oil, evening primrose oil or borage oil.
• Vitex agnus-castus can increase progesterone secretion, which can balance the oestrogen/progesterone ratio. Vitex agnus-castus is especially useful if short periods occur.
• Wild yam may relax muscles and reduce inflammation and provide relief to symptoms of endometriosis.
• Dong quai can reduce the pain of endometriosis. Dong quai works well in combination with vitex to restore the hormonal imbalances that can cause the often severe pain of this disorder. When taken together, the herbs can also relax the uterine muscle.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Take capsules or tablets for the pain. Ask your Pharmacist for the best brand for you.
3. Use a hot water bottle on the stomach if there are cramps as this may ease the pain.
4. Have sufficient rest.
5. Reduce caffeine drinks, including strong coffee, tea, cola and chocolate. These products contain methylxanthines, which are known to stimulate overproduction of cellular products, such as fibrous tissue and cyst fluid.
6. Consider some supplements if the diet is inadequate. Evening Primrose Oil capsules are suggested as they may help with hormonal problems. Ask your Pharmacist about the suitable dose of Evening Primrose Oil in the management of Endometriosis.