Endometriosis is the abnormal growth of endometrial tissue similar to that which lines the interior of the uterus but in a location outside of the uterus. Endometriosis is most commonly a disease of the reproductive years, and symptoms usually go away after a woman reaches menopause.

Endometrial tissue is shed each month during menstruation. Areas of endometrial tissue found in ectopic locations are called endometrial implants. These lesions are most commonly found on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity (i.e. the peritoneum). They are less commonly found to involve the vagina, cervix, and bladder.

Rarely, endometriosis can occur outside the pelvis. Endometriosis has been reported in the liver, brain, lung, and old surgical scars. Endometrial implants, while they may become problematic, are usually benign (i.e. non-cancerous).

Stages of endometriosis

Endometriosis is classified into one of four stages

1. I-minimal,
2. II-mild,
3. III-moderate,
4. IV-severe.

Based upon the exact location, extent, and depth of the endometriosis implants as well as the presence and severity of scar tissue and the presence and size of endometrial implants in the ovaries.

Most cases of endometriosis are classified as minimal or mild, which means there are superficial implants and mild scarring. Moderate and severe endometriosis typically results in cysts and more severe scarring. The stage of endometriosis is not related to the degree of symptoms a woman experiences, but infertility is common with stage IV endometriosis.

When women get endometriosis?

Endometriosis affects women during their reproductive years. The exact prevalence of endometriosis is not known, since many women who are later identified as having the condition are asymptomatic.

Endometriosis is one of the leading causes of pelvic pain and it is responsible for many of the laparoscopic procedures and hysterectomies performed by gynecologists. Estimates suggest that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected.

While most cases of endometriosis are diagnosed in women aged 25 to 35 years, endometriosis has been reported in young girls (as young as 11 years of age). Endometriosis is rare in postmenopausal women. Studies further suggest that endometriosis is most common in taller, thin women.

Delaying pregnancy until an older age, never giving birth, early onset of menses, and late menopause all are risk factors for endometriosis. It also is likely that there are genetic factors that predispose a woman to develop endometriosis since having a first-degree relative with the condition increases the chance that a woman will develop the condition.

Causes of endometriosis

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the retrograde flow of menstrual debris through the Fallopian tubes into the pelvic and abdominal cavities. The cause of this retrograde menstruation is not clearly understood. Retrograde menstruation is not the only cause of endometriosis, as many women who have retrograde menstruation do not develop the condition.

Another possibility is that areas lining the pelvic organs possess primitive cells that can develop into other forms of tissue, such as endometrium (this process is termed coelomic metaplasia).

It is also likely the direct transfer of endometrial tissues at the time of surgery may be responsible for the endometriosis implants occasionally found in surgical scars (for example, episiotomy or Cesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most plausible explanation for the rare cases of endometriosis that are found in the brain and other organs remote from the pelvis.

Finally, there is evidence that some women with endometriosis have an altered immune response in women with endometriosis, which may affect the body’s natural ability to recognize ectopic endometrial tissue.

Symptoms and signs

Most women who have endometriosis do not have symptoms. Of those who do, the most common symptoms include:

• Pain (usually pelvic) that usually occurs just before menstruation and lessens after menstruation,
• Dyspareunia (painful sexual intercourse) and cramping during intercourse,
• Cramping or pain during bowel movements or urination,
• Infertility,
• Pain with pelvic examinations.

The intensity of the pain can vary from month to month and can vary greatly among affected individuals. Some women experience progressive worsening of symptoms, while others can have a resolution of pain without treatment.

Pelvic pain in women with endometriosis depends partly on where endometrial implants of endometriosis are located. Deeper implants and implants in areas of high nerve density are more apt to produce pain.

The implants may also release substances into the bloodstream, which are capable of eliciting pain. Pain can result when endometriotic implants incite scarring of surrounding tissues. There appears to be no relationship between the severity of pain and the amount of anatomical disease which is present.

Infertility

Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed during evaluations for infertility, implants are often found in asymptomatic individuals. The reasons for diminished fertility in many patients with endometriosis are not understood. Endometriosis may incite scar tissue formation within the pelvis. If the ovaries and Fallopian tubes are involved, the mechanical processes involved in the transfer of fertilized eggs into the tubes may be altered. Alternatively, the endometriotic lesions may produce inflammatory substances, which adversely affect ovulation, fertilization, and implantation.

Other symptoms

Other symptoms that can be related to endometriosis include:

• lower abdominal pain,
• diarrhea and/or constipation,
• low back pain,
• chronic fatigue
• irregular or heavy menstruation,
• painful urination, or hematuria (particularly during menstruation).

Rare symptoms of endometriosis include chest pain or coughing blood due to endometriosis in the lungs and headache and/or seizures due to endometriosis in the brain.

Does endometriosis increase a woman’s risk of getting cancer?

Some studies have postulated that women with endometriosis have an increased risk for the development of certain types of ovarian cancer, known as epithelial ovarian cancer (EOC). This risk is highest in women with both endometriosis and primary infertility (those who have never conceived a pregnancy). The use of combination oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly increase this risk.

The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo malignant transformation into cancer.

Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that serve to increase a woman’s risk of developing ovarian cancer.

Diagnosis

• Pelvic examination: The uterus and surrounding structures are movable as the uterus hangs freely with support of ligaments, but adhesions caused by endometriosis can cause restriction of mobility.
• Transvaginal ultrasonography: would reveal adhesions and endometriomas (trapped secretions in a cyst).
• MRI: would give more detailed information.
• Laparoscopy: is a surgical procedure that allows visualization of the abdomen thus would reveal the condition.

Allopathic treatment for endometriosis

Allopathic treatment options for infertility associated with endometriosis are varied, but most allopathic doctors believe that surgery is superior to allopathic (with drugs) treatment for endometriosis. When appropriate, assisted reproductive technology may also be used as an adjunct or an alternative to surgical therapy.

The goals of endometriosis treatment with allopathy may include symptom relief and/or enhancement of fertility.

Medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. These pain-relieving medications do not affect the endometrial implants or the progression of endometriosis. However, they do decrease prostaglandin production, and prostaglandins are well known to have a role in the causation of pain.

As the diagnosis of endometriosis can only be definitively confirmed with a biopsy, many women with complaints suspected to arise from endometriosis are treated for pain first without a firm diagnosis being established. Under such circumstances, NSAIDs are commonly used as a first-line empirical treatment of allopathic doctors; and according to allopathic theory, if they are effective in controlling the pain, no other procedures or medical treatments are needed. If they are ineffective, additional evaluation and treatment will be necessary.

Since endometriosis occurs during the reproductive years, many of the available allopathic treatments for endometriosis rely on the interruption of the normal cyclical hormone production by the ovaries. These medications include GnRH analogs, oral contraceptive pills, and progestins.

Gonadotropin-releasing hormone analogs (GnRH analogs)

In allopathy Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of endometriosis implants. These drugs suppress estrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause.

Some of annoying side effects of these drugs are a result of the lack of estrogen, and include:

• hot flashes,
• vaginal dryness,
• irregular vaginal bleeding,
• mood alterations,
• fatigue, and
• loss of bone density (osteoporosis).

Fortunately, by adding back small amounts of progesterone in pill form (similar to treatments sometimes used for symptom relief in menopause). To avoid many of the annoying side effects due to estrogen deficiency “Add back therapy” is a term that refers to the way of administering GnRH agonists along with progesterone in a way to ensure compliance by eliminating most of the side effects of GnRH therapy.

Progestins side effects

Progestins, for example, medroxyprogesterone acetate (Provera, Cycrin, Amen), norethindrone acetate, and norgestrel acetate are more potent than birth control pills and are recommended for women who do not obtain pain relief from or cannot take a birth control pill and may be helpful in women who do not respond or cannot take (for medical reasons) oral contraceptives.

Some side effects are more common for example:

• Breast tenderness,
• Bloating,
• Weight gain,
• Irregular uterine bleeding,
• Depression.

Because the absence of menstruation (amenorrhea) induced by high doses of progestins can last many months following cessation of therapy, these drugs are not recommended for women planning pregnancy immediately following cessation of therapy.

Birth control pills (oral contraceptives)

In allopathy practice, oral contraceptive pills (estrogen and progesterone in combination) are also sometimes used to treat endometriosis. The most common combination used is in the form of the oral contraceptive pill (OCP). Sometimes women who have severe menstrual pain are asked to take the OCP continuously, meaning skipping the placebo (hormonally insert) portion of the cycle. Continuous use in this manner will generally stop menstruation altogether.

Side effect – weight gain, breast tenderness, nausea, and irregular bleeding may occur.

Aromatase inhibitors

Another approach to the treatment of endometriosis has involved the administration of allopathic drugs known as aromatase inhibitors (for example, anastrozole and letrozole). These drugs act by interrupting local estrogen formation within the endometriosis implants themselves. They also inhibit estrogen production within the ovary and adipose tissue.

Research (experiments) is ongoing to evaluate the effectiveness of aromatase inhibitors in the management of endometriosis. Aromatase inhibitors can cause significant bone loss. In premenopausal women, these drugs must be taken in combination with other drugs because of the drug’s effect on the ovaries.

Other drugs to treat endometriosis and pain are:

Danazol

Danazol is a synthetic drug that creates a high androgen (male type hormone) and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. It will be effective in three months. Eighty percent of women who take this drug will have pain relief and shrinkage of endometriosis implants, but up to 75% of women develop significant side effects from the drug for example:

• Weight gain,
• Edema,
• Breast shrinkage,
• Acne,
• Oily skin,
• Hirsutism (male pattern hair growth – on face, chest/breasts, legs etc),
• Deepening of the voice (like man’s voice),
• Headache,
• Hot flashes,
• Changes in libido,
• Mood alterations.

Unfortunately, many of these side effects are irreversible. In some cases, the resolution of the side effects may take many months. Women with certain types of liver, kidney, and heart conditions should not take Danazol.

Can surgery cure endometriosis?

Allopathic doctors advise surgical treatment for endometriosis when the symptoms are severe or there has been an inadequate response to allopathic therapy. Surgery is the preferred allopathic treatment when there is an anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract. It may be classified either as conservative, in which the uterus and ovarian tissue are preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.

Conservative surgery is typically performed laparoscopically. Endometrial implants may be excised or destroyed by different sources of energy (e.g. laser, electrical current). If the disease is extensive and anatomy is distorted, laparotomy may be required.

Surgical treatments can be only effective in the reduction of pain, the recurrence rate of endometriosis following conservative surgical treatment has been estimated to be as high as 40% even more in many cases. Many allopathic doctors recommend ongoing medical therapy following surgery in an attempt to prevent symptomatic disease recurrence.

Homeopathic Treatment for Endometriosis

Endometriosis is more common in infertile women, as opposed to those who have conceived a pregnancy. However, almost all women with confirmed endometriosis can conceive without difficulty, particularly if the disease is mild or moderate if they receive Homeopathic treatment, these homeopathic medicines are almost always (87-96% cases) effective in relieves/cures pains, curing endometriosis and infertility simultaneously.

Here are some Homeopathic medicines for endometriosis:

Sepia officianalis

Sepia is a most effective Homeopathic medicine for hormone imbalance leading to PCODs with irregular periods. Along with menstrual troubles, complaints of facial hair and infertility from PCODs, flushes, tiredness/fatigue, indifferent toward life and/or family, mood swings, irritable, irritable mood appears a few days before periods, bearing down sensation (in the pelvic region, uterine/internal organs), vaginal dryness (may lead to aversion to sex) etc.

Sepia Succus

Pelvic organs relaxed. Bearing-down sensation as if everything would escape through vulva. Leucorrhea yellow, greenish; with much itching. Menses Too late and scanty, irregular; early and profuse; sharp clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Ovarian cysts. Prolapse of uterus and vagina. Morning sickness. Vagina painful, especially on coition.

Ignatia Amara

Ignatia will be prescribed where the main complaint is mood swings, emotional imbalance, depression, sadness and weeping before menses, continuous sad thoughts; still, serious melancholy, with moaning, Sadness and concentrated sorrow. Cramp-like and compressive pains in uterine region, with fits of suffocation; pressure, and lying on the back, mitigate the pain.

Itching in the genital parts, and in the penis, in the evening after lying down especially in the evening, removed by scratching, Lasciviousness, with weakness of genital power (without erections). Contraction of the penis; it becomes quite small.

Conium Maculatum

Conium is recommended as the most remarkable among Homeopathic medicines for hormone imbalance where breast pain, swelling and tenderness are the main issues arising before periods, Cramps in the uterus, with pinching or contracting, or with digging above the vulva, accompanied by tension in the abdomen, Shootings in the vagina, and sensation as of bearing down, Shooting in the labia. Breasts flabby, Inflammation of the mammae, with stitches.

Swelling of the testes, Impotence, insufficient erections, and absence of erections, Easy emission of semen, even without firm erections.

Agnus Castus

Relaxed, flaccid genitals. Aversion to sex, Itching of the genital organs. Abhorrence of sexual intercourse. Relaxation of genitals, with leucorrhea (transparent or yellow leucorrhea). Agalactia; with sadness. Sterility. Leucorrhea staining yellow; transparent. Hysterical palpitation with nosebleed. Sterility, with suppressed menses, Swelling and inflammation of the uterus.

Caladium

Despairing sadness; low-spirited, Low spirits and gloomy thoughts. Forgetfulness. Very irritable and depressed, Confused, Organs swollen (puffy), relaxed, and sweating, swelling with smarting during micturition. Itching of genitals with voluptuousness. Pruritus of vulva and vagina; with onanism (nymphomania), cramp-like pains in uterus after midnight.

Lycopodium

Nymphomania with terrible teasing desire in external organs. Itching, burning, and gnawing in vulva. Pressure towards the outside, above the vulva, and extending as far as the vagina, when stooping, Expulsion of wind from the vagina, Chronic dryness of vagina, shooting pains in labia, when lying down. Excoriation between the thighs, and at the vulva. Burning pain in vagina, during and after coition. Catamenia (too early) too profuse, and of too long duration. Catamenia suppressed readily, and for a long time, by fright.

Before menses: shivering, sadness, melancholy; bloating of the abdomen. During menses: delirium, with tears; headache; sourness in the mouth; pain in loins; swelling (edema) of feet; fainting; vomiting of sour matter; cuttings, colic; and pains in the back. Menstruation too late; lasts too long; sometimes suppression of; profuse, protracted; flow partly black, clotted, partly bright red or partly serum; with labor-like pains followed by swooning; with sadness; suppressed by fright. May find females at change of life with one side of the body greatly hypertrophied.

Metrorrhagia; at menopause; dark blood with large clots. A rumbling begins in upper abdomen and descends to lower, when a flow of blood follows, and so on successively. Leucorrhea – milky, yellowish, reddish, and corrosive. Varices on the genitals. Disposition to miscarriages. Swelling of the breasts with nodosities. Excoriation and moist scabs on nipples. Stinging in nipples. Milk in breasts without being pregnant.

Acid Phosphoricum

Helpful homeopathic medicines from hormone imbalance. Hair loss from scalp, whiskers and genitals. Disposition to weep. Weakness and fatigue are predominantly present. Restlessness and precipitation. Silent (sadness) peevishness and aversion to conversation. Complete indifference to everything; not a sonorous, delirious, or irritable condition, but simply an indifferent state of mind to all things; patient does not want anything, nor to speak, shows no interest in anything.

Oophoritis, metritis, or prolapsus from debilitating or emotional influences; amenorrhea. Very irritable uterus. Uterine ulcer, with copious, putrid, bloody discharge, itching or corroding pain, or no pain. Hepatic pains during menses, menses too early and too long; too copious; too late; dark clotted; preceded by leucorrhea, and for one or two days by griping and rumbling in abdomen. Yellowish, itching leucorrhea after menses. Distension of uterus as by gas, Itching pricking between mammae. Dysuria during pregnancy; cutting pains.

Calcarea Carb

Calcarea carbonic, a well indicated Homeopathic medicines for hormone imbalance from under-functional thyroid gland (hypothyroidism). Melancholy, dejection, and sadness. Disposition to weep, even about trifles. Vexation and lamentation, on account of old offences. Anxiety and anguish, excited by fancies, or frightful stories, Sadness, with heaviness in the limbs, shuddering and dread during the twilight, or at night, sensitivity to cold air is well marked, Excessive ill-humor and mischievous inclination, with obstinacy and a disposition to take everything in bad part. Indifference, apathy.

Catamenia premature and too copious. Sterility, with catamenia too early, and too profuse, fatigue, headache, disposition to be frightened, colic, and shivering.

During the catamenia, congestion in the head, with internal heat, or cuttings in the abdomen, and cramp-like flank pain, vertigo, headache. Suppressed menstruation, with full habit. Miscarriage. Voluptuous sensation in the genital parts, with emission. Itching or pressing in the vagina. Shootings in the orifice of the matrix, and pressive pain in the vagina. Prolapsus uteri, with pressure on the parts. Itching in the womb. Inflammation and swelling of the womb, with redness, purulent discharge, and burning pain.

Varices in the labia majora. Leucorrhea before the catamenia, Leucorrhea, with burning itching, or else like milk, flowing by fits, and during the emission of urine. Inflammatory swelling of the mammae and of the nipples. Swelling of the glands of the breast, breasts painful and tender before menses.

Iodum

Iodum, a Homeopathic medicine for hormone imbalance from a hyperactive thyroid gland (hyperthyroidism). Major weight loss in spite of eating well, losing flesh. Heated sensation in body. Restlessness, nervousness and anxiety, Lachrymose disposition and mental dejection. Melancholy hypochondriasis, sadness, heartache, and anxiety.

Shuns persons, anxious apprehensions, restless agitation (with inclination to move about), which will neither permit the patient to remain seated, nor to sleep. Irresistible impulse to run; feels she will fall if she walks. Cross, irascible, peevish. Sudden maniacal impulses; to murder. Excessive mental excitement, with great susceptibility. Illusions of moral feeling. Loquacity and immoderate gaiety.

Hormonal imbalance. Catamenia at one time too late, at another too early. Menses premature, violent and copious. Metrorrhagia. Weakness, palpitation of the heart, and many sufferings, before, during, and after the catamenia. Atrophy of ovaries and breasts, with sterility. Pain (dull, pressing, wedge-like) commencing in right ovary passing down broad ligament to uterus. Great sensitiveness of right ovarian region during or after menses. Inflammation of right ovary with an itching eruption on head and hands following application of Iodine to os uteri.

Chronic oophoritis with thick, yellow, burning leucorrhea, worse after eating. Pain in lower abdomen, pain ovarian region. Induration and swelling (tumors, cancer?) of the uterus. Uterine hemorrhage renewed after every stool. Leucorrhea, corroding the limbs and the linen; acrid; profuse; worse at time of menses.

Flaccidity and atrophy of the breasts. Mammary hyperesthesia. Heaviness of breasts. Acute pain and soreness in breasts with metritis. Bluish red nodosities in breasts; dry, black points at tips.

Natrum Muriaticum

Depressed, nervous and irritable nature suffering from thyroid hormone imbalance. Weight loss, emaciation. Weakness, tachycardia and bradycardia. Natrum Mur is equally effective in regulating the menstrual cycle disturbed by thyroid hormone imbalance in women.

Pressure and general bearing down towards genital organs every morning; has to sit down to prevent prolapsus. Prolapsus uteri with aching in loins worse when lying on back; cutting in urethra after micturition. Catamenia premature and profuse; or retarded and scanty. Sterility, with too early and too profuse menstruation. Prolonged catamenia, suppression of catamenia.

Difficulty in appearance of first menses, sadness, cramps in abdomen. Spitting blood at menstrual nisus; bloody saliva. Itching in genital organs. Repugnance to coition. Coition – painful from dryness of vagina; burning smarting during; in anemic women with dry mouth and dry skin. Leucorrhea, with headache, disposition to diarrhea, colic, and mucous evacuations. Acrid (greenish) leucorrhea (increased discharge when walking), with yellow color of face. Abundant discharge of transparent, whitish, and thick mucus from vagina.

Uvulitis with falling off of hair. Itching of external parts with falling off of hair. Pimples on mons veneris. Stitches beneath nipples, breasts sensitive to slightest touch.

Baryta Carbonica

Yes, it’s possible to prevent development of endometriosis if periodical visit a Homeopathic doctor or treat Homeopathically when diagnosed.

Does diet affect endometriosis?

Yes, data is well-established that shows that dietary modifications – that is artificial sweeteners, non-organic fruits and vegetables, caned/processes food, food colors, white sugar, processed cocking oils, broiler chicken, pork, fast food, processed (pasteurized) milk, margarines etc will soon develop symptoms of endometriosis in any woman. ♀ 

PS: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS) ; senior research officer Dnepropetrovsk state medical academy Ukraine; is a leading Homeopathic physician practicing in Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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