Reproductive System Herbal Protocol

Endometriosis

Illness/ Disease Definition

From Merck Manual:

                Endometriosis is a disease in which patches of endometrial tissue, which normally is found only in the uterine lining (endometrium), grow outside the uterus.

                Usually, endometriosis is confined to the lining of the abdominal cavity or the surface of the abdominal organs.  The misplaced endometrial tissue (endometrial implant) commonly adheres to the ovaries and the ligaments that support the uterus.  Less commonly, it adheres to the outer surface of the small and large intestines, the ureters (tubes leading from the kidneys to the bladder), the bladder, the vagina, surgical scars in the abdomen, or the lining of the chest cavity.  Rarely, endometrial tissue is found in the lungs.

                Because misplaced endometrial tissue responds to the same hormones that the uterus responds to, it may bleed during the menstrual period, often causing cramps, pain, irritation, and the formation of scar tissue.  As the disease progresses, adhesions (fibrous bands that connect normally unconnected structures) may form.  The misplaced endometrial tissue and adhesions can block or interfere with the functioning of organs.  Rarely, adhesions block the intestine.

Etymology (terms)

  • Endometrium – uterine lining
  • Endometrial tissue – endometrial implant
  • Ureters – tubes leading from the kidneys to the bladder
  • Adhesions – fibrous bands that connect normally unconnected structures

Etiology (causes)

The exact cause is unknown, however there are a number of theories.

  • Retrograde menstruation , or transtubal migration theory – Theorizes that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows
  • Another theory suggests that the endometrial tissue is distributed from the uterus to other parts of the body through the lymph or blood.
  • Exposure to environmental toxins such as Dioxins and PCBs that damage the immune system
  • Surgical transplantation has been cited as a cause in cases where endometriosis is found in abdominal surgery scars. (Although it has also been found in surgical scars when direct accidental implantation seems unlikely.)
  • Remnants of tissue from when the woman was an embryo may later develop into endometriosis  or that some adult tissues retain the ability they had in the embryo stage to transform into reproductive tissue under certain circumstances.
  • My theory that endometriosis is a side effect of untreated thyroid disease or possibly even a symptom of hypothyroidism or of the autoimmune Hashimoto’s Thyroiditis or other autoimmune diseases.

Incidence

From Medscape:

Endometriosis occurs in 6-10% of US women in the general population,  and approximately 4 per 1000 women are hospitalized with this condition each year. The exact incidence in the general population is unknown, because the definitive diagnosis requires biopsy or visualization of the endometriotic implants at laparoscopy or laparotomy. Most prevalence studies are based on a surgical population in which the likelihood of disease is greater, with the best estimates of incidence in the general female coming from women with proven fertility undergoing tubal sterilization procedures.

Endometriosis is an estrogen-dependent disease and, thus, usually affects reproductive-aged women. This condition has a prevalence rate of 20-50% in infertile women,but it can be as high as 71-87% in women with chronic pelvic pain.  In a large series involving adolescent females with chronic pelvic pain, 45% were found to have endometriosis at laparoscopy. Of note, only 25% had a normal pelvis. In that series, the rate of endometriosis was found to increase with age from 12% in females aged 11-13 years to 45% in females aged 20-21 years.  In an earlier study, evidence of endometriosis was found during laparoscopy in 20-50% of asymptomatic women.  A familial association exists, with a 10-fold increased incidence in women with an affected first-degree relative.  Monozygotic twins are markedly concordant for endometriosis.

Most research and case studies have been performed in white populations; however, no difference appears to exist among ethnic or social groups.  Although endometriosis is obviously a disease largely confined to the female population, interestingly, scattered case reports exist of lesions that are histologically indistinguishable from endometriosis found in men exposed to high-dose exogenous estrogens.

Endometriosis is largely confined to women of reproductive age with an active hypothalamic-pituitary-ovarian axis. Pelvic endometriosis typically occurs in women aged 25-30 years. Extrapelvic manifestations of this disorder occur in woman aged 35-40 years. Women younger than 20 years with this disease often have anomalies of the reproductive system. Prepubertal girls do not seem to be at risk for this disease, although the number of reports of endometriosis in young women shortly after menarche is increasing.

Menopause (whether spontaneous or induced through surgical or medical means) usually leads to resolution of symptoms. The disease seems to remain quiescent even in the face of hormone replacement therapy.

Allopathic Treatments

There is no cure for endometriosis but there are a number of treatments aimed at reducing symptoms. 

  • Drugs that suppress the activity of the ovaries and slow the growth of endometrial tissue
  • Surgery that removes as much of the misplaced endometrial tissue as possible
  • Combination of drugs and surgery
  • Surgery that removes the uterus (hysterectomy), often with the fallopian tubes and ovaries

Signs & Symptoms/ Body Systems Affected

Body System AffectedSigns and Symptoms
Reproductive SystemDysmenorrhea (painful period)
Dyspareunia (painful sexual intercourse)
Lower abdominal pain
Metrorrhagia (abnormal bleeding)
Menorrhagia (heavy or prolonged periods)
Ovarian cysts
Infertility
Painful ovulation
Digestive SystemLower abdominal and rectal pain
Pain during bowel movements
Kidney/flank pain
Indigestion
Diarrhea
Constipation
Nausea
Bloating
Nervous SystemSciatica during menstruation
Fatigue
Migraines
Urinary SystemPain during urination
Immune SystemAllergies that get worse around your period

Need Hormonal Normalizers, Uterine Tonics, Antispasmodics, Nervine Relaxants, & liver support for elimination of toxins

HERBACTIONS
CHASTE TREE BERRY
Vitex agnus-castus
Emmenagogue, Galactagogue, Hormone Normalizer, Uterine Tonic
WILD YAM ROOT
Dioscorea villosa
Anti-inflammatory, Anti-rheumatic, Antispasmodic, Cholagogue, Diaphoretic, Diuretic, Expectorant, Hepatic, Nervine Relaxant
BLACK COHOSH
Cimicifuga racemosa
Alterative, Anti-inflammatory, Anti-rheumatic, Antispasmodic, Astringent, Diuretic, Emmenagogue, Expectorant, Hypotensive, Nervine Relaxant, Uterine Tonic
SKULLCAP
Scutellaria lateriflora
Analgesic, Anti-epileptic, Antispasmodic, Antiviral, Bitter, Diuretic, Hypnotic (Moderate), Hypotensive, Nervine Relaxant, Sedative, Tonic (Nervine)
LICORICE ROOT
Glycyrrhiza glabra      
Adaptogen (Possible), Antidiuretic, Antihistamine, Anti-inflammatory, Antioxidant, Antispasmodic, Anti-tumor, Antiviral, Demulcent, Emollient, Expectorant, Hepatoprotective, Immune Amphoteric, Laxative (Mild), Nutritive, Pectoral
GINGKO
Gingko biloba
Anti-inflammatory, Antioxidant, Antispasmodic, Astringent, Bitter, Neuroprotective, Nutritive, Relaxant, Stimulant (Circulatory), Stimulant (Uterine), Tonic (Vascular), Vasodilator
ROSEMARY
Rosmarinus officinalis
Antidepressant, Antimicrobial, Antispasmodic, Antiviral, Carminative, Cholagogue, Emmenagogue, Rubefacient, Stimulant (Liver), Stomachic
TURMERIC
Curcuma longa
Antibacterial, Anti-inflammatory, Antioxidant, Antiviral, Bitter, Carminative, Hepatoprotective
MOTHERWORT
Leonurus cardiaca
Antispasmodic, Anxiolytic, Astringent, Emmenagogue, Hepatic, Hypnotic (Moderate), Hypotensive, Nervine Relaxant, Stomachic, Tonic (Cardiac)
PASSIONFLOWER
Passiflora incarnata   
Analgesic, Antispasmodic, Anxiolytic, Diaphoretic, Emmenagogue, Hepatic, Hypnotic (Strong), Hypotensive, Nervine Relaxant, Sedative, Tonic (Cardiac)
DANDELION ROOT
Taraxacum officinale
Alterative, Aperient, Bitter, Cholagogue, Diuretic, Laxative (Mild), Stimulant (Liver), Stomachic, Tonic
ASHWAGANDHA
Withania somnifera
Adaptogen (Calming), Alterative, Amphoteric (Immune), Anthelmintic, Anti-inflammatory, Antioxidant, Antiseptic, Antispasmodic, Antitumor, Anxiolytic, Aphrodisiac, Bitter, Diuretic, Immunomodulator, Nervine, Thermogenic, Tonic (Reproductive)

FORMULAS

Infusion/Decoction:  

Dandelion root, Ashwagandha, Licorice Root, Gingko, Rosemary, Turmeric, Motherwort, Passionflower

Tincture:

  • Chaste Berry (2 parts), Black Cohosh (1 part), Skullcap (1 part), Wild Yam (1 part); Dosage- 5ml 3x a day
  • Ashwagandha, Turmeric, Passionflower, Dandelion Root, Chaste Berry, Wild Yam

Essential Oils

  • Endometriosis Synergistic Bath Blend –Blend oils together in the following proportions and mix 9 drops into hot bathwater.  Stay in this bath for at least 15 minutes then move to a cold sitz bath for 5 minutes, then repeat the cycle 2-4 times, as needed depending on the severity of your symptoms.  *If you cannot do sitz bath you can place a towel-wrapped  ice pack or bag of frozen peas on your sacrum area for 5 minutes instead.
    • 10 drops Geranium
    • 5 drops Rose Maroc
    • 2 drops Cypress
    • 10 drops Nutmeg
    • 8 drops Clary Sage
  • Endometriosis Massage Oil Synergistic Blend – Massage this blend over the whole of your abdomen and over the hips twice a day.  Dilute below recipe with 2 tablespoons vegetable oil or make a synergistic blend using these proportions and 5 drops per 1 teaspoon base vegetable oil.  *If the pain is particularly bad during menstruation, make up a separate bottle of massage oil using double the quantities- 60 drops of essential oil to 2 tablespoons vegetable oil.
    • 5 drops Clary Sage
    • 5 drops Rose Maroc
    • 10 drops Geranium
    • 10 drops Nutmeg

Contra-indications

  • Black Cohosh- do not use if pregnant – may cause miscarriage.  Use cautiously if you are taking medications to lower blood pressure
  • Chaste Berry–  do not use if pregnant or breastfeeding or if you are trying to get pregnant
  • Dandelion Root- Do not use if pregnant or breast-feeding.  Do not use while taking diuretics, or drugs that lower blood pressure or blood sugar.
  • Gingko-  Do not use if pregnant.  Use caution if taking blood thinners.
  • Licorice Root– do not use if you have high blood pressure;  irregular heartbeat; or cerebrovascular, kidney, or liver disease.  Do not use if pregnant or breastfeeding.  Large doses can be poisonous.
  • Motherwort- Avoid use in pregnancy or if you have a low platelet count.  Do not use if taking Coumadin, drugs to treat liver disease, beta blockers, Lanoxin, or other heart drugs.
  • Passionflower- may increase the effects of prescription sedatives, antispasmodics and anxiolytics – use with caution. Do not use if taking MAOIs
  • Rosemary– do not use if you are pregnant, breastfeeding, or trying to become pregnant.
  • Skullcap- do not use while taking Antabuse or immunosuppressant drugs; don’t use if pregnant or breastfeeding; large doses can be toxic
  • Turmeric- do not use if taking blood thinners, immune system drugs, or NSAIDs.  Do not use if pregnant or breastfeeding; may cause miscarriage.  Avoid using if you have a bleeding disorder, bile duct obstruction, or stomach ulcer.
  • Wild Yam– do not use if pregnant or breastfeeding.

Recommendations for Diet and Lifestyle

Diet:

“Let your food be your medicine.  Let your medicine be your food.”  -Hippocrates

  • Increase Your Intake of Omega-3 Fats.
  • Avoid Trans Fats.
  • Cut Down on Red Meat.
  • Eat Plenty of Fruits, Vegetables and Whole Grains.
  • Limit Caffeine and Alcohol.
  • Cut down on Processed Foods.  
  • Try a Gluten-Free or Low-FODMAP Diet.  
  • Soy May Be Beneficial

Supplements:

  • Evening Primrose Oil
  • Fish Oil
  • B Vitamins
  • Magnesium
  • Calcium
  • Selenium
  • Vitamins E, C, and A
  • Zinc
  • Iron

References & Resources:

Endometriosis: The Complete Reference for Taking Charge of Your Health, Mary Lou Ballweg & the Endometriosis Association.

Foundations of Medicinal Herbalism, Teresa Boardwine RH.

Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656.

Medical Herbalism, David Hoffman, FNIMH.

Medscape. https://emedicine.medscape.com/article/271899-overview#a5.

PubMed. https://www.ncbi.nlm.nih.gov/pubmed/30302765.

The Complete Book of Essential Oils & Aromatherapy, Valerie Ann Worwood.

The Complete Guide to Herbal Medicines, Charles W. Fetrow, Pharm.D. & Juan R. Avila, Pharm.D.

The Merck Manual of Medical Information: Home Edition, Robert Berkow, M.D. & Mark H. Beers, M.D. & Andrew J. Fletcher, M.B., B.Chir. , 1997.

WebMD. https://www.webmd.com/women/endometriosis/understanding-endometriosis-symptoms#1.