Endometriosis, The Most Frequent Comorbidities in Women and Their Treatment Options

By Kristen Burris, L.Ac, M.S.T.O.M. Licensed Acupuncturist and Master Herbalist in Traditional Chinese Herbal Medicine Women’s Health Expert in Infertility and Menopause

Women diagnosed with endometriosis are typically defined by the presence of viable extra-uterine endometrial glands and stroma where the tissue that normally lines the uterus, the endometrium, grows outside of the uterus and metastasizes to various pelvic organs. . These growths can bleed cyclically, bleed intermittently or even grow.  They can also be quite aggressive, purporting characteristics that are invasive, destructive,  and can attach themselves to other organs and areas of the body embodying a metastatic nature. Many women with endometriosis also find they suffer from pelvic inflammatory disease, debilitating pain, chronic pain, and even infertility.  In some cases endometriosis can progress to malignant tumors but this is a small percentage. 

There are different stages of endometriosis including stage one-four. 

Stage One- Endometriosis is considered minimal: there are small endometrial patches or plaques, inflammation mild adhesions

Stage Two Endometriosis is mild: Stage one in addition there may also be many endometrial patches, possible scarring and adhesions between the uterus and the rectum. Often women will exhibit painful bowel movements during their menstrual cycle but this is not true in every case.

Stage Three Includes Stage one and two and additionally adhesions involve the ovaries.

Stage Four Includes Stage one, two, three and there are large amounts of implanted endometrial patches that may cause scarring, nodules and adhesions attach to other organs including the bladder and bowels often changing the overall shape and distortion of pelvic organs. 

Nationwide, population-based studies,  showed that women with endometriosis  have more of an overall tendency of being obese and  in addition had a higher rate of diabetes mellitus. A study also found that a higher proportion of women with endometriosis had pelvic inflammatory disease (76.0% vs. 38.4%, endometriosis vs. controls, p < 0.0001), infertility (10.2% vs. 2.0%, p < 0.0001), cardiovascular diseases (4.9% vs. 3.5%, p < 0.0001), chronic liver disease (2.2% vs. 1.5%, p = 0.0002), and rheumatic disease (4.0% vs. 2.4%, p < 0.0001). 4

A recent study showed that women with endometriosis had a higher risk of  suffering from irritable bowel syndrome (IBS)  with a hazard ratio (HR) of 1.79 and 95% confidence interval (CI) of 1.55–2.07 (p < 0.001). 12   The increased risk of irritable bowel syndrome could persist over 5 years. Wu and colleagues 12 tried to explain the association between endometriosis and irritable bowel syndrome, and raised the hypothesis that both diseases might share similar risk and pathogenic factors, such as visceral hypersensitivity,  similar inflammatory processes in the  peritoneal cavity  and gastrointestinal mucosa, and mast cell activation.

According to recent research acupuncture addresses endometriosis by invigorating blood circulation and alleviating pain. According to Traditional Chinese diagnosis there are many different physiological and hormonal imbalances that cause an imbalance of patterns to arise. 

The Traditional Chinese Medical patterns women have with endometriosis:

  • SPLEEN YANG DEFICIENCY

  • SPLEEN AND STOMACH DEFICIENCY COLD

  • COLD STAGNATION IN THE LIVER CHANNEL

  • LIVER AND GALL BLADDER DAMP-HEAT

  • LIVER AND SPLEEN DEFICIENCY WITH BLOOD STAGNATION DUE TO DAMPNESS

  • KIDNEY YIN DEFICIENCY WITH EMPTY FIRE RISING LEADING TO BLOOD STAGNATION 

  • KIDNEY YANG DEFICIENCY WITH WATER FLOODING

  • KIDNEY YANG DEFICIENCY WITH BLOOD STAGNATION 

  • QI DEFICIENCY WITH BLOOD STAGNATION 

  • QI STAGNATION LEADS TO BLOOD STAGNATION 

  • QI AND BLOOD STAGNATION

  • QI AND BLOOD DEFICIENCY WITH BLOOD STAGNATION

  • BLOOD DEFICIENCY WITH BLOOD STAGNATION 

  • BLOOD STAGNATION 

  • BLOOD STAGNATION DUE TO COLD 

  • BLOOD STAGNATION DUE TO COLD-DAMPNESS 

  • COLD AND BLOOD STAGNATION IN THE CHANNELS

  • BLOOD STAGNATION DUE TO HEAT 

  • YANG DEFICIENCY WITH COLD STAGNATION

  • COLD ACCUMULATION IN THE UTERUS

  • POSTPARTUM COLD AND BLOOD STAGNATION

  • DEFICIENCY COLD OF THE CHONG AND REN CHANNELS * Source AmericanDragon.com 

As your provider it is our job to differentiate how, why and the best way to address your endometriosis. Most patients see an improvement after 3 full menstrual cycles and can either use our telemedicine services to address their endometriosis with herbal medicine or through in-person one on one visits to address their medical conditions with both acupuncture and herbal medicine. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659600/

References

1. Dizereza GS, Barber DL, Hodgen GD. Endometriosis: role of ovarian steroids in initiation, maintenance, and suppression. Fertil Steril. 1980; 33 (6): 649–653. . [PubMed] [Google Scholar]

2. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005; 20 (10): 2698–704. doi: 10.1093/humrep/dei135 . [PubMed] [Google Scholar]

3. Ferrero S, Esposito F, Abbamonte LH, Anserini P, Remorgida V, Ragni N. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005; 83 (3): 573–9. doi: 10.1016/j.fertnstert.2004.07.973 . [PubMed] [Google Scholar]

4. Amer S. Endometriosis. Obstet Gynecol Reprod Med. 2008; 18 (5): 126–33. [Google Scholar]

5. Brawn J, Morotti M, Zondervan KT, Becker CM, Vincent K. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014; 20 (5): 737–747. doi: 10.1093/humupd/dmu025 [PMC free article] [PubMed] [Google Scholar]

6. Eisermann J, Gast MJ, Pineda J, Odem RR, Collins JL. Tumor necrosis factor in peritoneal fluid of women undergoing laparoscopic surgery. Fertil Steril. 1988; 50 (4): 573–579. [PubMed] [Google Scholar]

7. Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod. 2003; 18 (9): 1922–1927. [PubMed] [Google Scholar]

8. Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol. 2004; 190 (4): 1020–1024. doi: 10.1016/j.ajog.2003.10.698 [PubMed] [Google Scholar]

9. Wieser F, Cohen M, Gaeddert A, Yu J, Burks-Wicks C, Berga SL, et al. Evolution of medical treatment for endometriosis: back to the roots? Hum Reprod Update. 2007; 13 (5): 487–99. doi: 10.1093/humupd/dmm015 [PubMed] [Google Scholar]

10. Andersson S, Lundeberg T. Acupuncture–from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses. 1995; 45 (3): 271–281. [PubMed] [Google Scholar]

11. Hui KK, Liu J, Marina O, Napadow V, Haselgrove C, Kwong KK, et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005; 27 (3): 479–96. doi: 10.1016/j.neuroimage.2005.04.037 [PubMed] [Google Scholar]

12. Chen S, Wang S, Rong P, Wang J, Qiao L, Feng X, et al. Acupuncture for visceral pain: neural substrates and potential mechanisms. Evid Based Complement Alternat Med. 2014; 2014: 609594 doi: 10.1155/2014/609594 [PMC free article] [PubMed] [Google Scholar]

13. Jacobs I. Screening for ovarian cancer by CA-125 measurement. Lancet 1988; 16 (8590):889. [PubMed] [Google Scholar]

14. Barbieri RL, Niloff JM, Bast RC Jr., Scaetzl E, Kistner RW, Knapp RC. Elevated serum concentrations of CA-125 in patients with advanced endometriosis. Fertil Steril 1986; 45 (5): 630–4. [PubMed] [Google Scholar]

15. Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis. Obstet Gynecol. 2002; 99: 375–380. [PubMed] [Google Scholar]

16. Amaral VF, Ferriani RA, Sá MF, Nogueira AA, Rosa e Silva JC, Rosa e Silva AC, et al. Positive correlation between serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis. Sao Paulo Med J. 2006; 124: 223–227. [PubMed] [Google Scholar]

17. Sun YZ, Chen HL. [Controlled study on Shu-Mu point combination for treatment of endometriosis]. Zhongguo Zhen Jiu. 2006; 26 (12): 863–865. Chinese. [PubMed] [Google Scholar]

18. Xiang DF, Sun QZ, Liang XF. [Effect of abdominal acupuncture on pain of pelvic cavity in patients with endometriosis]. Zhongguo Zhen Jiu. 2011; 31 (2): 113–116. Chinese. [PubMed] [Google Scholar]

19. Chen GX. [Clinical study on the treatment of endometriosis dysmenorrhea with catgut implantation at acupoints]. Doctoral Dissertation, Guangzhou University of Chinese Medicine. 2014: 16–20.

20. Zhang XX, Li W. [Efficacy on endometriosis treated with electroacupuncture]. Zhongguo Zhen Jiu. 2015; 35 (4): 323–326. Chinese. [PubMed] [Google Scholar]

21. Miller JD. Quantification of endometriosis-associated pain and quality of life during the stimulatory phase of gonadotrophin-releasing hormone agonist therapy: A double-blind, randomized, placebo-controlled trial. Am J Obstet Gynecol. 2000; 182 (6): 1483–1488. doi: 10.1067/mob.2000.106846 [PubMed] [Google Scholar]

22. Wang M, Yu Z, Qian Z. [The diagnosis and treatment standards for the treatment of Combine traditional Chinese and western medicine on Endometriosis]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1991; 11 (6): 376–379. Chinese. [Google Scholar]

23. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration, 2011. http://www.cochrane-handbook.org. Accessed July 17, 2015. [Google Scholar]

24. Xu T, Hui L, Juan YL, Min SG, Hua WT. Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-analysis. Altern Ther Health Med. 2014; 20 (4): 33–42. [PubMed] [Google Scholar]

25. Wayne PM, Kerr CE, Schnyer RN, Legedza AT, Savetsky-German J, Shields Monica H et al. 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; 21 (5): 247–257. doi: 10.1016/j.jpag.2007.07.008 [PMC free article] [PubMed] [Google Scholar]

26. Wu JX, Qian XP, Long YF, Chen F. [The clinical observation of acupuncture combining with Shugan Xiaozheng Decocionin treating endometriosis dysmenorrhea]. J Emerg Tradit Chin Med. 2013; (11): 1947–1948. Chinese. [Google Scholar]

27. Chen M, Zhang H, Li J, Dong GR. [Clinical observation on acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis]. Zhongguo Zhen Jiu. 2010; 30 (9): 725–728. Chinese. [PubMed] [Google Scholar]

28. Chen QX. The clinical study on treatment of endometriosis-related chronic pelvic pain using Traditional Chinese medicine. Doctoral Dissertation, Guangzhou University of Chinese Medicine. 2015: 16–20.

29. Gao CY. The clinical observation of dysmenorrhea treated by acupuncture and moxibustion combining with blood-letting puncture based on the theory of collateral disease. M Sc. Thesis, Heilongjiang University of Chinese Medicine. 2015: 16–26.

30. Tian LY, Cheng ZX, Cheng XM, Nie T. [Clinical observation of modified gexia zhuoyu decocion combine with Ren and Du meridian acupoint selection in treating endometriosis]. Clin J Trad Chin Med. 2016; (5): 670–672. Chinese. [Google Scholar]

31. Yan H, Huang X, Deng G. Observation on therapeutic effect of acupuncture and moxibustion on disorders of myometrial gland. Zhong Guo Zhen Jiu [Chinese Acupuncture and Moxibustion] 2008; 28 (8): 579–81. [PubMed] [Google Scholar]

32. Vercellini P, Crosignani PG, Abbiati A, Somiglinana E, Vigano P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Human Reproduction Update 2009; 15 (2): 177–88. doi: 10.1093/humupd/dmn062 [PubMed] [Google Scholar]

33. Liu YX, Cao YX, Wang RY, MA XW, Fei L. Clinical observation on the use of herbal moxibustion with properties of warming and soothing functions for 76 cases of endometriosis. Xin Zhong Yi [New Chinese Medicine] 2003; 35 (5): 55. [Google Scholar]

34. Liu YY, Ai Z, Xi YF, Lin F. Clinical observation on different acupuncture methods for endometriosis. Hu Bei Zhong Yi Za Zhi [Hu Bei Journal of Traditional Chinese Medicine] 2009; 31(7): 53. [Google Scholar]

35. Jin YB, Sun ZL, Jin HF. Randomised controlled study on ear-electroacupuncture treatment of endometriosis induced dysmenorrhoea. Acupuncture Research 2009; 26 (3): 188–92. [PubMed] [Google Scholar]

36. Zhen R, Hong W. Clinical observation of the use of acupuncture with warming needle method for 38 cases of endometriosis. Yi Xue Li Lun Yu Shi Jian [Journal of Medical Theory & Practice] 2009; 22 (5): 571–2. [Google Scholar]

37. Lund I, Lundeberg T. Is acupuncture effective in the treatment of pain in endometriosis?. J Pain Res. 2016. March 24; 9: 157–65. doi: 10.2147/JPR.S55580 [PMC free article] [PubMed] [Google Scholar]

38. Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis. Cochrane Database Syst Rev. 2011. September 7; (9): CD007864 doi: 10.1002/14651858.CD007864.pub2 [PubMed] [Google Scholar]

39. Staud R, Price DD. Mechanisms of acupuncture analgesia for clinical and experimental pain. Expert Rev Neurother. 2006; 6 (5): 661–667. doi: 10.1586/14737175.6.5.661 [PubMed] [Google Scholar]

40. Torres-Rosas R, Yehia G, Peña G, Mishra P, del Rocio Thompson-Bonilla M, Moreno-Eutimio MA, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med. 2014; 20 (3): 291–295. doi: 10.1038/nm.3479 [PMC free article] [PubMed] [Google Scholar]

41. Kaludjerovic J, Ward WE. The interplay between estrogen and fetal adrenal cortex. J Nutr Metab. 2012; 2012: 837901 doi: 10.1155/2012/837901 [PMC free article] [PubMed] [Google Scholar]

42. Ma J, Yun-guang H, Zhang DH. Effects of acupuncture on bone metabolism and serum estradiol level in ovariectomy-induced osteoporosis rats. Zhen Ci Yan Jiu. 2008; 33 (4): 235–239. [PubMed] [Google Scholar]

43. Scheerer C, Bauer P, Chiantera V, Sehouli J, Kaufmann A, Mechsner S. Characterization of endometriosis-associated immune cell infiltrates (EMaICI). Arch Gynecol Obstet. 2016. September; 294 (3): 657–664. doi: 10.1007/s00404-016-4142-6 [PubMed] [Google Scholar]

44. Ahn SH, Khalaj K, Young SL, Lessey BA, Koti M, Tayade C. Immune-inflammation gene signatures in endometriosis patients. Fertil Steril. 2016. November; 106 (6): 1420–1431. e7. doi: 10.1016/j.fertnstert.2016.07.005 [PMC free article] [PubMed] [Google Scholar]

45. Johnston MF, Ortiz Sánchez E, Vujanovic NL, Li W. Acupuncture may stimulate anticancer immunity via activation of natural killer cells. Evid Based Complement Alternat Med. 2011; 2011: 481625 doi: 10.1093/ecam/nep236 [PMC free article] [PubMed] [Google Scholar]

Kristen Burrisablation, heavy periods, hysterectomy, OBGYN, uterus, hormone therapy, bio-identical hormones