Endometriosis is a western medical term for the presence of endometrial tissue growing outside the uterus. It commonly involves the lining of the pelvis, ovaries, fallopian tubes and in some cases, the bowel. This tissue can thicken and bleed, often causing pain and bleeding outside of menstruation. The period itself can leave many in debilitating pain, with heavy and prolonged bleeding. Aside from impacting daily life, the presence of endometriosis can have a big impact on fertility, depending on where it’s located, as well as digestive & bowel issues.
Signs and symptoms of Endometriosis
In addition to pain, bleeding and infertility, some of the other signs and symptoms include:
- constipation or diarrhoea
- pain during defecation
- abdominal pain and/or bloating
- spotting before periods
- pain during intercourse
- pain that goes down into the thighs when menstruating
In my clinical experience, Endometriosis is investigated initially due to the extreme pain in can cause during, as well as outside of menstruation.
In conventional medicine we can look at Endo from a few angles. It’s important to look at the hormones involved, inflammation & how the liver is processing these hormones & clearing inflammation.
In endometriosis there is typically an excess of Estrogen, often coinciding with a deficiency of progesterone. I think it’s important to point out here the correlation of estrogen & progesterone in TCM terms, as this estrogen dominance would be synonymous with stagnation of blood & yin, & progesterone deficiency with a deficiency of yang.
The liver is also involved in endo from both a TCM & western framework. The liver’s job is to “detox” helping to clear inflammation, which is a big part of endo. In Lara Briden’s book, the period repair manual, she discusses the immune system producing inflammatory cytokines that inflame the endometriosis lesions & promotes growth.
Getting back to the liver, we also know it acts to metabolise excess estrogen, so if the liver isn’t functioning properly & the bowels aren’t flushing out daily, we can get a backlog of toxins & reabsorption of estrogen which fuels hormonal imbalance.
To add further insult to injury, inflammation increases the activity of an enzyme called aromatase which converts testosterone to estrogen (Beyond the pill by Dr Jolene Brighten), thus this vicious cycle continues.
In western terms, the reason for painful periods (typically the primary symptom in endometriosis) are prostaglandins. These chemicals stimulate the contraction of the uterus. Pain occurs when there is too much contraction occuring (beyond the pill).
Endometriosis is a relatively new term when we look at Chinese medicine as having been around for thousands of years. It is also diagnosed purely through laparoscopy which was not a method in ancient times. As such, endometriosis in traditional text would have fallen under/within the categories of heavy bleeding, painful periods & abdominal mass depending on presenting symptoms. As already discussed, In clinic, heavy periods but especially pain is what motivates patients to find a diagnosis & what brings them in for treatment.
In TCM, painful periods is a stagnation of qi & blood, primarily liver qi & blood.
There are usually underlying patterns involved but the defining characteristic, just as in western diagnosis is blood stagnation.
Having said that, I will mention that there is a form of endometriosis which is non bleeding & defined as non pigmented lesions. This in tcm is usually related to spleen qi deficiency, damp & qi stagnation, However the most common cases we see in clinic are bleeding pigmented lesions.
To paraphrase Jane Lyttleton’s examination, there is a level of back flow of menstrual blood & endometrial matter which flows upwards through the fallopian tubes & into the peritoneal cavity. If there is enough yang, or warming energy (progesterone) the body will reabsorb this blood. However if there is not enough, the blood may stagnate & lead to endometriosis. In addition to this, if there is qi stagnation, typically from the liver not being able to do its job or regulating the smooth flow of qi & blood, stronger uterine contractions can occur. This leads to more backlash of blood & more blood stagnation. It is here we can further see the correlation between the liver in Chinese medicines & western medicine.
One of the aspects of Endo that is highlighted well through a TCM diagnosis is an underlying pattern of deficiency as well as the excess. Clinically patient may present with either flooding/heavy periods or very light in flow. In TCM, both these symptoms are often coming from a deficiency of blood. In the later, there is not enough blood to get things flowing, hence it is light & often brown & stagnant. While with the former, the body may be so deficient it can’t effectively hold onto the blood. In Chinese medicine we often discuss this as not holding the blood in the blood vessels. Patients that bruise easily are often seen in both patterns.
What I love about tcm is that we follow the cycle, varying methods depending on where you are in your cycle. This is where I believe we shine in our approach.