Endometriosis

EAM Patterns

Kiiko Matsumoto Acupuncture

Acupuncture Points

🌿 Chinese Herbal Formulas (Comprehensive List)

Endometriosis According to Western Medicine

Endometriosis is the abnormal growth of endometrial-like tissue outside the endometrium. When endometrial cells are found in areas outside of the uterus, the diagnosis of endometriosis is made. A definitive endometriosis diagnosis is a surgical diagnosis, typically via laproscopy, but the disease is often identified by an array of symptoms and elimination of other possible causes.

Modern science does not know why endometrial cells are found elsewhere. One theory of its origin is explained by retrograde menstruation. Another hypothesis is that anatomic abnormalities such as retroverted uteri and small cervical openings do not allow the blood to pass through freely, and it therefore backs up into other areas of the pelvis.

Another theory of the causative origins of endometriosis is that other cells outside of the uterus are transformed by some unknown stimulus into endometrial cells. Whatever the etiology, the misplaced endometrial cells then respond to hormonal stimulus just like the endometrium is supposed to. But, during menstruation there is no way for this menstrual blood to leave the body. Pain, sometimes very severe, is the result. Prostaglandins are said to be the causative factor in menstrual pain. Painful periods are an indication of possible endometriosis, and women with endometriosis have higher levels of certain of the prostaglandins. The bleeding tissue may also cause adhesions and scar tissue.

Common sites of endometriosis include the cervix, the vaginal-rectal space, ovary, fallopian tubes, colon and bladder wall.

Common accompanying symptoms include dysmenorrhea, pathological uterine bleeding, and bleeding at sites other than the endometrium during menstruation. Some women bleed at sites as distant as the nasopharynx during menstruation and get nosebleeds during the menses. Endometriosis is classified as to its severity.

Causes of Endometriosis

Causes are poorly understood

1 in 10 women are affected

Several theories:

Retrograde menstruation - When a woman is supposed to menstruate and blood should be discharged vaginally, it backs up through the tubes and into the abdominal cavity. Yet this happens in most women, and most women do not have endometriosis. - may be worsened by tight cervical os
Congenital - starts in uteruo
Genetic - likely has a genetic component
Possible association with fusibacterium overgrowth - some patients respond to antibiotic therapy - may stop new lesions from forming

Severity of disease and symptom presentation are often mismatched

Symptoms:

painful periods
pain during or around ovulation
pain during or after sex
heavy or irregular bleeding
pain with bowel movements or urination
anxiety & depression
IBS
IC
pain in the pelvic area, lower back, or legs - often cyclic in nature - can be caused by endometriosis lesions growing around nerves
nausea
fatigue
SIBO
infertility

Endometriosis According to the Eastern Perspective:

The pain of endometriosis is most often considered a stagnation of blood. The lack of free flow of qi and blood leads to accumulation, masses, and pain.

Patterns of Endometriosis

Kidney Yang deficiency leading to blood stagnation
Liver Xue Xu (Blood Deficiency)
Liver Xue Yu (Blood Stasis)
dysfunction of the Chong Mai (Penetrating Vessel) and/or Ren Mai (Conception Vessel);
Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel).
Cold invasion leading to congealed blood (Laura Erlich doesn’t use this pattern)
Liver Qi Stagnation - LV qi stagnation from emotional distress, high stress levels, estrogen dominance (ED leads to LV Qi stagnation) Estrogen dominance - associated with excess yin - caution with yin tonics
SP Qi deficiency impacting healthy production of blood - unhealthy blood coagulates more easily or fails to provide adequate nourishment
Toxic heat in the blood - end stage of cycle - this happens when lesions bleed with the period leading to a chronic inflammation, scar tissue, immune system activation
Anxiety - when blood gets too hot qi becomes stagnant
Cold Uterus - extremely painful menstrual cramps with clotting that is eased with heat

can be caused by yang deficiency
nutrition - more warm yang foods and warming herbs - daily treatment
warm castor oil packs, or liquid moxa, or both - all cycle, or pause during luteal if TTC
Moxa, toilet moxa
Keep warm - feet, scarf, lower back, abdomen

Herbal Considerations:

Phasic formulas
Caution with strong blood breakers in the menstrual/follicular phase
Herbs to break up lesions: San leng, e zhu, ru xiang, mo yao bai jiang cao, hong teng

Key Symptom Presentations:

pain started at menarche
dyspareunia
Digestive issues - IBS, nausea, diarrhea - worse with period
Commonly prescribed OCP to promote “remission” - lesions no longer cycle, but still present and causing inflammation
Symptoms typically return once OCP is stopped
Symptoms often worsen over time, especially with hormone fertility treatments

Pigmented Lesions:

most active when superficially implanted and hemorrhagic
Become less active over time as they are replaced with fibrotic or scar tissue
hemorrhagic cysts cause pain when they bleed

Non-pigmented Lesions:

so-called “silent” endometriosis
superficial
Secrete mucus that may coat tubal fimbriae or block tubes leading to infertility
Mucus is inflammatory and implicated in immunologic infertility
Associated with unexplained infertility

How does endometriosis cause infertility

almost ⅓ of endometriosis patients the only symptom is infertility
chronic inflammation from IBS, SIBO, and other inflammatory conditions
Can distort shape of uterus, fallopian tube, and/or ovaries d/t scar tissue
Secretions from superficial endometriosis glands produce blocked fallopian tubes, hydrosalpinx. Increased prostaglandins harm tubal flexibility -
Bleeding lesions and cysts cause inflammation and lead to immunologic infertiity
Endometrial cysts can lead to damaged ovaries and low follicle counts
Higher chance of having uterine septum with endo - 37% with endo patients vs 27% in general population - generally removed with surgery - diagnosed with HSG, confirmed and removed with hysteroscopy
Luteal phase defects d/t low progesterone/estrogen excess or LUFS - spotting
Thickened uterine muscle layer in adenomyosis leads to local inflammation and difficult implantation
Reduced implantation

Scar tissue

damage to the uterus and pelvic cavity
Surgery may be necessary to correct scar tissue if impeding implantation or damaging reproductive organs

Endometriomas

aka chocolate cysts
hemorrhagic cyst in ovary
damages ovary, decreased egg quality, POF

Diagnosis:

Receptiva - can detect inflammatory markers that are closely related to endo
Laproscopy
Endometrial Function Test - not commonly used, developed by Dr. Harvey Kliman at Yale - very comprehensive, includes multiple histologic markers

Endometriosis Surgery - excision surgery is the only good surgical option - avoid ablation.

Lupron - supresses pituitary production of LH/FSH which suppresses estrogen - often used in FET

8 Extraordinary Meridians

The only prenatal vessels
REgulate cycles of jing for fertility

Menstrual Phase:

Follicular: Ren Main & Yin Qiao

Luteal: Ren & Chong, Du for Yang deficiency

Late Follicular - activate HPO Axis - LU7, KD6, UB62, SI3 - treat as a figure 8

REN12, ST36

Nutrition:

The East Asian Medicine pattern known as Blood Stasis refers to impaired blood circulation. Modern research as found that this can have wide-ranging effects from decreased oxygen supply to impaired endocrine and immune system functioning. Diet recommendations for this pattern aim to avoid foods that can impair circulation and increase foods that remove stasis.

Raw foods and cold foods will constrict circulation and should be avoided. Eating while distracted or emotionally stressed should also be avoided. The diet should include plenty of fragrant and lightly spiced dishes. Highly processed foods and well as oily and fatty foods should be avoided.

Specific foods for Blood Stasis Patterns: turmeric, basil, nutmeg, oregano, rosemary, white pepper, hawthorne berries, shallots, leeks, chives, garlic, ginger, taro root, eggplant, mushrooms (especially wood ear mushrooms) aduki beans, chestnuts, kidney beans, crab, jellyfish, mussels, clams, sea cucumber, abalone, red wine (small amounts), kelp and other seaweeds, sugar cane, vinegar, and rose water.

Foods to restrict or avoid: salads, raw fruits, raw vegetables, excess amounts of tofu, dairy or nut butters and other high oil foods overly sweet foods, refined sugars, high doses of vitamin C, cold foods like ice cream or smoothies, iced drinks including ice water.

Supplements:

CoQ10
NAC/Glutathione/antioxidants
NAD
Methylfolate
etc.

Acupuncture for Endometriosis

St-28, St-29 and St-30 (=): regulate menstruation; transform Damp-Heat; relieve Xue Yu (Blood Stasis); warm Lower Warmer Cold; consolidate Jing (Essence).
GB-26, Sp-8, Sp-6 and CV-3 joined to CV-2 for endometritis.
CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep.
Lu-7 and Kd-6: open the Ren Mai (Conception Vessel) which nourishes the Uterus and regulates menstruation; usually indicated by head and neck pain, abdominal distension, vaginal discharge and other symptoms of congestion.
Sp-4 and PC-6: open the Chong Mai (Penetrating Vessel) for which menstrual disorders are a symptom of Shi (Excess) and reproductive disorders are a general symptom of dysfunction.
UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which gynecological problems are a Xu (Deficiency) symptom.
Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which gynecological problems are a Shi (Excess) symptom.

Herbal Medicine for Endometriosis

Dandelion Root, Wild Yam, and Angelica – These can be used as a tea. Measure 1 tea-spoon of each herb per 2 cups of water. Simmer for 5 minutes then steep for 20 minutes. Drink 3 cups per day. They can also be used as a tincture, which is a liquid herbal extract – 20 drops of each 3 times per day in a little water.
Pteropus and Lindera C. (Ge Xia Zhu Yu Tang): Xue Yu (Blood Stasis): severe pain, palpable abdominal masses with fixed pain (Yeung, p. 106; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316)
Cinnamon and Bulrush C. (Shao Fu Zhu Yu Tang): Xue Yu (Blood Stasis) and Cold: palpable masses which may or may not be painful, lower abdominal pain without masses, lower back pain and lower abdominal distention during menses, frequent menses with dark blood and clots (Yeung, p. 195; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316)
Pteropus and Bulrush F. (Shi Xiao San); Wu Jin Wan (patent): more severe Xue Yu (Blood Stasis): irregular menstruation, dysmenorrhea, acute colicky pain in the lower abdomen, severe pain in the middle abdomen or epigastric pain (Pteropus: Hsu, 1980, p. 583; Yeung, p. 211; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316; Wu Jin: Zhu, p. 250)
Cinnamon and Hoelen F.: Xue Yu (Blood Stasis): immobile masses in lower abdomen with pain and tenderness, amenorrhea with abdominal distention and pain, dysmenorrhea, choppy pulse (Hsu, 1980, p. 423; Yeung, p. 113; Bensky and Barolet, p. 322)
Cinnamon and Rehmannia (patent) (Dharmananda, 1992, p. 81)
Persica and Salvia C.: Xue Yu (Blood Stasis) with Xue (Blood) Heat: shortened cycle, constipation (Dharmananda, 1986, p. 326)
Fu Ke Zhong Zi Wan (patent): Xue Yu (Blood Stasis) (Zhu, p. 253)
Tang Kuei, Evodia and Ginger C. (Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang): Xue Yu (Blood Stasis) with Cold in the Channels: extreme stagnancy and weakness: purplish lips/extremities, loose stools, extremely thin pulse (Hsu, 1980, p. 319; Yeung, p. 78; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 217)
Chih-ko and Curcuma C. (patent) plus Lindera 15 (patent): Qi Stagnation with Xue Yu (Blood Stasis) (Dharmananda, 1990: Chih-ko and Curcuma, p. 41: Lindera, p. 49)
Tang Kuei and Evodia C. (Wen Jing Tang): Xue Yu (Blood Stasis) with Chong Mo and Ren Mo Xu (Deficiency) and Cold: weak and cold patient, dry Upper Warmer, irregular menstruation, extended or continuous menstrual flow, bleeding between periods; pain, cold and distention in the lower abdomen; infertility, warm palms and soles (Hsu, 1980, p. 588; Yeung, p. 242; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 324)
Huang lian jie du tang - herbal antibiotic - possibly can treat the fusibacterium - combine with warming herbs

Other Therapies for Endometriosis

Castor oil packs – Moisten a thin cotton cloth with castor oil and place on the lower abdomen. Cover with a plastic bag and then a dry cloth. Leave in place and rest for an hour. A heating pad or hot water bottle can be put on top to heighten the effect.