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All about symptoms, development & holistic treatment approaches

Despite its widespread prevalence, endometriosis often goes undiagnosed, is diagnosed too late or incorrectly. In this article you will learn everything about the possible complaints, background facts and possibilities to treat the disease both with conventional medicine and with natural remedies

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Table of Contents

Definition of endometriosis - a disease with many faces

Endometriosis occurs when the tissue that normally lines the uterus grows outside of it. This tissue can be on the ovaries, fallopian tubes, bowel, bladder or other organs. The growths occur both on the outside of the organs and sometimes inside them, which is then referred to as "deep endometriosis" or infiltrating endometriosis. During the menstrual cycle, these tissues bleed like the normal endometrium, but because the blood cannot drain away, inflammation, pain, adhesions and scarring are often the unpleasant result.

Benign in most cases - severe pain is nevertheless one of the most common symptoms

In specialist circles, endometriosis is often referred to as the "chameleon of gynecology", as its manifestations can vary greatly and some sufferers sometimes have no symptoms. Nevertheless, 50% of sufferers complain of a need for action and suffer from chronic back and/or abdominal pain as well as various other symptoms. The problem with the growths is that although they also bleed during the monthly period, unlike the blood of healthy tissue, the blood of endometriosis growths cannot leave the body. This results in blood clots in the abdomen and often leads to blood-filled cysts on the ovaries (also known as chocolate cysts due to their dark color).

Other symptoms of endometriosis: how the disease manifests itself in different ways

In addition to the severe abdominal and back pain mentioned above, especially shortly before and during menstruation, those affected often suffer from daytime tiredness and exhaustion. Unsuccessful attempts to get pregnant are also a typical symptom of endometriosis. As a result, 40 to 50% of all women with this disease remain unintentionally childless. Pain, including nausea and vomiting, or pain during sexual intercourse, gynecological examinations or bowel movements are also common. Periods are often heavier and last longer than in healthy women. In cases where the urinary tract is also affected by endometriosis lesions, pain when urinating, urinary tract infections and blood in the urine are not uncommon. Endometriosis in the intestines causes flatulence, diarrhea and constipation.

The manifestation and intensity of the symptoms vary depending on the location, extent and aggressiveness of the endometriosis lesions. In summary, there are the following symptoms:

  • Intense abdominal pain, especially before and during menstruation (dysmenorrhea), sometimes also around the time of ovulation
  • Pain so severe that the usual painkillers do not provide any relief
  • Pain accompanied by nausea and vomitingPain radiating to the back and hips
  • Chronic pain that interferes with everyday lifePain during bowel movements (dyschezia) and blood in the stool before and during menstruation
  • Pain during sexual intercourse (dyspareunia)
  • Pain during gynecological examinations
  • Heavy and prolonged menstrual bleeding
  • Intermenstrual bleeding and spotting
  • Sudden loss of consciousness with severe menstrual pain
  • If the bowel is involved, digestive problems such as flatulence, diarrhea or constipation may occur
  • If the urinary tract (urinary tract, bladder) is involved, there may be pain when urinating, frequent urinary tract infections (cystitis) or blood in the urine, especially shortly before or during menstruation
  • If the bladder and/or bowel are involved in endometriosis lesions, adhesions can occur between the organs, which increases the symptomsInfertilityPersistent tiredness and fatigue

Risk factors and causes - largely unknown to date according to conventional medicine

How endometriosis develops has not yet been fully researched. What is certain, however, is that the disease also affects the immune system and hormone balance, which is why interdisciplinary treatment approaches from various disciplines are becoming increasingly relevant. The exact causes of how the foci develop are still a matter of conjecture. One theory on the development of endometriosis assumes that so-called retrograde menstruation is the cause of the disease. This means that in this case the menstrual blood moves in the opposite direction in the body. Endometrial cells then enter the abdominal cavity via the fallopian tubes and form foci there. Other scientifically discussed risk factors are short menstrual cycles, a low number of breastfeeding days after giving birth, missed pregnancies and early first menstruations.

Statistics and figures on endometriosis

It can take over ten years for affected women to receive a definitive diagnosis to identify the cause of their prolonged suffering. Often, they have then endured an arduous journey through numerous medical consultations where their symptoms may have been dismissed as psychosomatic or considered a normal cycle-related inconvenience to be dealt with. An estimated 10-20% of women of childbearing age may be affected by what is considered the second most common gynecological disorder in this age group, with uterine fibroids being the most common. Among women with painful menstruation (dysmenorrhea), 40 to 60% may have a link to this condition. Among women with infertility or impaired fertility, this disease may affect 20 to 30 percent of them.1

Fertility with endometriosis

Unfortunately, the chances of pregnancy in the case of endometriosis are low in many cases. A woman is very likely to be infertile, especially if the fallopian tubes are blocked by endometriosis lesions. In addition, operations aimed at removing the lesions often result in scarring of the fallopian tubes, which also leads to sperm leakage and thus prevents pregnancy. As a result, endometriosis is the reason for involuntary childlessness in up to 60% of all infertile women. This is aggravated by the fact that many diagnoses of endometriosis are accidental findings that are only discovered after the woman has undergone a gynecological examination to get to the bottom of the causes of her infertility. This is possible because many cases of endometriosis are completely symptom-free. Nevertheless, it is encouraging to note that 50% of all women with endometriosis can still become pregnant.2

Endometriosis: triggers from a naturopathic perspective

In naturopathy, the development of diseases is influenced by numerous factors. It is assumed here that the colonization of endometrial cells in the abdominal cavity is normally prevented in a healthy body. This also applies if they were to leave the uterus. Naturopathy gets to the bottom of questions that provide the answer as to what could have thrown the organism out of balance in a specific case. The loss of self-regulation and self-healing ability are therefore the main naturopathic causes of disorders that could contribute to endometriosis. Possible causes from a naturopathic perspective include

  • Exposure to chemicals such as certain UV filters, pesticides and other toxic substances that can disrupt the endocrine system
  • Cadmium exposure, which acts as a metalloestrogen and has estrogen-like effects
  • Nickel exposure, as observed in endometriosis patients
  • Possible link between elevated iron levels and an increased risk of disease, as suggested by some studies3
  • Oxidative stress as a risk factor, although antioxidants may offer some protection4
  • Lack of vital substances
  • Stress
  • Disorders of the intestinal flora
  • Oestrogen dominance, when the ratio of oestrogen to progesterone is disturbed, which in turn can have various causes

Endometriosis test: Gynecological diagnostics

As it is not possible to diagnose or rule out endometriosis on the basis of symptoms alone, a gynecological examination by a specialist is recommended in any case of suspicion. Statements such as "These are normal cycle pains" or "This is psychosomatic" should not discourage affected women from having their symptoms examined more closely. A thorough diagnosis always involves several steps:

  • A detailed medical history
  • Gynecological examinations and palpations
  • Transvaginal ultrasound to identify any other causes of your symptoms, such as cysts
  • However, a definitive diagnosis can only be made through a laparoscopy under general anesthesia. A small tissue sample is taken and examined under a microscope to confirm the presence of endometriosis.

Surgery for endometriosis: how the procedure works

According to allopathy, it is recommended that endometriosis lesions be completely removed by surgery as soon as possible. These procedures are usually performed laparoscopically, whereby pelviscopy is also referred to when focusing on pelvic organs. Only in rare cases is surgery with an abdominal incision necessary. (The decision for surgery depends on the individual medical history of the woman and the alternatives already tried). In addition to surgical removal, drug therapy is often recommended to reduce the risk of recurrence of the disease after surgery. However, it is known that women who are already taking medication before the operation have an increased risk of the lesions growing again after the operation. Incidentally, the recurrence rates are particularly high in women with ovarian growths, at 30.6%.

Hormone therapy and its consequences in endometriosis

Due to the oestrogen-driven nature of the growth of growths, drug treatment aims to reduce oestrogen levels. The following hormone preparations are available for this purpose:

  • Progestogens: these synthetic luteal hormones, where the natural progestogen is called progesterone.
  • Oestrogen-progestogen combination preparations: This refers to contraceptive pills that are taken continuously, without a break.
  • GnRH analogs: GnRH stands for gonadotropin-releasing hormone, a hormone that is produced in the hypothalamus of the brain and controls the release of FSH and LH. These hormones in turn regulate the production of oestrogen and progesterone in the ovaries. GnRH analogs are synthetic versions of the natural GnRH. If they are taken, the body suppresses its own GnRH production, as it assumes that sufficient quantities of the hormone are present. However, as the analogs have no effect, hormone production in the ovaries comes to a standstill.

Unfortunately, all three of the above-mentioned medications put the women concerned into a premature menopause, which can bring with it all the symptoms of the menopause. In particular, the risk of osteoporosis increases with the use of GnRH analogs, so that use should always be limited to a maximum of six months. Unfortunately, the symptoms of endometriosis often return after taking them, which is why many doctors are now critical of the effectiveness of hormone therapy.

Chances of recovery with endometriosis

In fact, there are indications that endometriosis can regress spontaneously, especially in milder cases. In more aggressive cases, however, spontaneous remission is rather unlikely. It is important to know that the degree of aggressiveness cannot be recognized by the extent of the growths. The American Society for Reproductive Medicine (ASRM) classifies endometriosis into the four AFS stages: minimal, mild, moderate and severe (grades I to IV). On the other hand, the so-called ENZIAN score also classifies the infiltrating forms. These include retroperitoneal endometriosis, in which the kidneys and ureters are affected and lie behind the peritoneum. For women who are still in their thirties, this information may only be a small consolation, but it has been proven that as soon as a woman enters her natural menopause, endometriosis usually disappears automatically due to the natural decline in hormone production and the onset of the menopause.

Natural treatments for endometriosis

In addition to conventional medical treatment, endometriosis can also be treated using naturopathic methods. It is important to know that it is always advisable to discuss a suitable therapy with a doctor and not to take action on your own. Endometriosis must always be diagnosed by a doctor first and the appropriate treatment should be tailored to this. Naturopathic remedies are therefore merely supplements to this medical therapy, although many women report noticeable relief of their symptoms after using natural remedies. A distinction must be made here between painkillers to treat the symptoms of endometriosis on the one hand and remedies to treat the causes on the other.

Nutrition for endometriosis

A balanced diet plays an important role in health, including endometriosis. Studies have shown that women who eat a diet rich in vitamins are less likely to develop endometriosis. Foods rich in vitamin B1, folic acid, vitamin C and vitamin E are particularly beneficial. A gluten-free diet can also bring relief. In any case, it is advisable to reconsider and adapt your diet, for example by eating a gluten-free diet rich in vital substances. Further information can be found in the links above. A hormone diet such as seed cycling, in which certain seeds are consumed in line with the menstrual cycle, could also help in the treatment of endometriosis.5

Avoiding stress - preventing endometriosis

Continuous stress leads to the release of stress hormones, which can cause hormonal imbalance. In order to prevent endometriosis, it is therefore very important to adopt stress management techniques. Special massage techniques, acupressure and progressive muscle relaxation can help, as can warm baths with Epsom salt, aromatherapy, yoga, Feldenkrais or sauna visits, etc. Above all, it is important that the goal of relaxation is achieved. Certain medicinal herbs or nutritional supplements with sleeping berries (Ashwagandha) or Rhodiola rosea may also be helpful. Both adaptogens naturally promote stress resistance and have a calming and balancing effect on the psyche.

Micronutrients for endometriosis

Vitamin D, B6 and C can be helpful in endometriosis, especially if there was previously a deficiency of these nutrients. Such a deficiency could be a cause of the symptoms. A 2007 study of 222 women who had undergone endometriosis surgery investigated the effect of hormones compared to a placebo and selected supplements such as omega-3 fatty acids, vitamins, minerals and probiotics.6 The results showed that the supplements had similar effects on pain as hormone therapy. In both cases, the participants' quality of life improved compared to the placebo group. The relationship between low vitamin D levels and an increased risk of endometriosis is well documented. A 2013 study showed that women with low vitamin D levels are more likely to suffer from endometriosis, while women with higher vitamin D levels are more likely to be protected from the disease.7 Optimizing vitamin D intake and treating a possible deficiency is therefore recommended as part of treatment for endometriosis. However, it should be noted that it is probably a matter of optimizing vitamin D levels in the medium to long term, as another study from 20198 did not show any significant improvements after administering 50,000 IU of vitamin D over a period of 12 weeks.

Vitamin B6 against oestrogen dominance

According to various studies, vitamin B6 has proven to be a possible treatment for oestrogen dominance. The vitamin was particularly successful against certain pre-menstrual symptoms, with doses of between 40 and 50 mg per day being used together with 250 mg of magnesium.9,10 Due to similar oestrogen problems in endometriosis, this vitamin could possibly also be of importance here. In another study, this vitamin B6 was found to help with acute menstrual pain. When taken 100 mg for 4 days, it reduced the level of a certain messenger substance that causes pain, as well as the pain itself. This was not the case in the placebo group.11

Vitamin C and E as possible support for therapy

As endometriosis is a disease associated with inflammatory and sometimes oxidative processes, the use of antioxidants makes perfect sense, as a study from 2013 shows.12 1000 mg vitamin C and 1200 IU vitamin E were administered over 8 weeks to endometriosis patients aged between 19 and 41 years. Compared to the placebo group, the pain improved in 43% of the women who received the vitamins, while those in the control group either suffered a worsening of their symptoms or experienced no improvement. The results of the study were also underpinned by the inflammation markers (CRP values), which decreased significantly when the vitamins were administered. Finally, a recently published study from 2023 shows that the antioxidant vitamins C, E and to some extent D were able to significantly alleviate the pain of dysmenorrhea and during sexual intercourse.13

Food supplements that can help with endometriosis

In addition to vitamins, there are other dietary supplements that can help to alleviate the symptoms of endometriosis.

Endometriosis: omega-3 fatty acids can help reduce inflammation

As early as 2013, research on mice showed that EPA (omega-3 fatty acids) can protect against the onset of endometriosis due to their anti-inflammatory properties. Another study from 2015 also found that the administration of omega-3 fatty acids was even more effective in reducing endometriosis lesions than the administration of vitamin D.15,16

Natural weapon against endometriosis lesions: curcumin

Curcumin, the active ingredient in turmeric, has anti-inflammatory, antioxidant and immune system-regulating properties.17 A cell study from May 2013 showed that curcumin can inhibit the proliferation of endometrial cells by lowering oestrogen levels.18 A 2020 review confirmed that curcumin inhibits inflammatory processes, alleviates oxidative stress and reduces the adhesion of endometrial cells outside the uterine cavity, all of which are mechanisms required in endometriosis.19

Melatonin: How the sleep hormone can help with endometriosis

Some studies have found that women with endometriosis have low melatonin levels.20 According to another study, the combination of melatonin and curcumin in particular is recommended for the treatment of endometriosis. Melatonin is a hormone that regulates the sleep-wake cycle. An increase in melatonin levels in the evening makes us tired, while it decreases again in the morning and we slowly wake up.

Green tea extract: powerful antioxidant thanks to EGCG

As early as 2013, studies were carried out on mice which showed that the administration of green tea extract was able to reduce the number and size of endometriosis lesions.21 Green tea extract also owes its positive effect on blood vessels to epigallocatechin gallate (EGCG), a strong antioxidant substance with cancer-fighting properties. A French study from 2014 also confirmed these results.22 However, the limited bioavailability of EGCG was criticized, which, according to a study from 2004, could be increased by adding piperine, the active ingredient from black pepper, and vitamin C.23

Probiotics - good bacteria against endometriosis

A disturbed intestinal flora can contribute to various diseases or hinder their healing. It is known that endometriosis foci are also influenced by the composition of theintestinal flora. These foci continuously activate the immune system and thereby promote the release of pro-inflammatory messenger substances and growth factors, which promote their own progression and the typical pain, as discovered by scientists at Saarland University in Homburg in 2016. Probiotic bacterial strains could be useful here, as they not only reduce inflammation but also have a positive effect on oestrogen metabolism. They can also reduce inflammation and have a balancing effect on the immune system.24 A study was first published in 2011 which showed that a certain probiotic bacterial strain was able to inhibit the development of endometriosis lesions by promoting the activation of immune cells.25

This article is based on carefully researched sources:


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