Endometriosis, Uterine fibroids, Ovarian cysts, Polycystic Ovary Syndromes

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Abnormal tissue growths in the reproductive tract are a prevalent problem with women today, especially in industrial countries, and result in serious problems with fertility, pregnancy and menstruation, and often result in symptoms of pain and menstrual irregularity. Endometriosis is a pathology of the uterine lining, or endometrium, and affects over 5-10 percent of women in the United States. Many cases of endometriosis are asymptomatic and go unreported and unnoticed, so the exact percentage of women who experience these abnormal tissue growths is impossible to determine, and the United States Centers for Disease Control and Prevention stated that they now believe that endometriosis affects significantly more than 10 percent of reproductive age women in the United States. Symptoms related to uterine fibroids develop in an estimated 30-50 percent of women by the age of 40, and some studies have indicated that ovarian cysts are found on transvaginal sonograms in nearly all premenopausal women (Bottomley C et al, Best Pract Res Clin Ob Gyn. Oct 2009;23(5):711-24), and up to 18 percent of postmenopausal women (McDonald JM et al, Clin Obstet Gyn.Sep 2006;49(3):506-16).

These health issues have been successfully ignored for too long. Understanding endometriosis, uterine fibroid and ovarian cyst formation is thus important to all women, and maintenance of the health of these tissues, and homeostasis is something that shouldn't be ignored. The specialized tissues that line the uterus, which we call the endometrium, may grow abnormally even outside of the uterus, most commonly up into the Fallopian tubes, as well as into the ovaries, and in rarer cases, into the outer intestinal layers, the pelvic cavity, the liver, the lung, and even the brain. While endometriosis is not technically a cancer, it may act like a cancer in its ability to spread in the body, and both endometriosis and polycystic ovarian syndrome are associated with a higher risk of cancer.

While endometriosis, uterine fibroids and ovarian cysts may not cause noticeable or alarming symptoms, a significant percentage of women with these growths do experience a variety of symptoms, although these are often not attributed to endometriosis, fibroids or ovarian cysts. As many as 98 percent of patients diagnosed with endometriosis experience dysmenorrhea, or painful cramping during onset of the menstrual flow. A significant percentage experience pain with sexual intercourse, or dyspareunia. Myofascial and referred musculoskeletal pain are reported in a high percentage of patients with endometriosis as well, and the pelvic pain syndrome is not uncommon. Abnormal menstrual bleeding is also not uncommon with these disorders, as well as premenstrual symptoms, and often, problems with subfertility are attributed to these abnormal growths. It is believed that up to 90 percent of cases of dysfunctional uterine bleeding (DUB) may be attributed to anovulatory mechanisms, with a large percentage of these related to PCOS (polycystic ovarian syndrome).

Endometriosis, uterine fibroids and ovarian cysts are diseases related to abnormal growth of tissues in the reproductive tract and may have systemic consequences. The causes of these growths are multifactorial, but abnormalities of the menstrual cycle associated with hormonal imbalance lie at the root of the pathology. Once these growths occur, deficient immune responses are associated with the inability of the body to clear the unwanted cells, and inflammatory imbalance leads to continued growth. In 2016, the American Heart Association published a large study that showed that women with endometriosis, especially those that acquire the disease at age 40 or younger, had a risk of heart attack 3 times that of women without endometriosis, and were 1.35 times more likely to need heart surgery or a stent to clear atherosclerotic arteries. This study of 116,430 women enrolled in the Nurses' Health Study II found that standard treatment of endometriosis, with hysterectomy or removal of the ovaries, accounted for a considerable percentage of this risk. Clearly a holistic approach to maintaining homeostasis and providing support for the immune protections inherent in our bodies is important. Complementary and Integrative Medicine (CIM/TCM) provides such comprehensive therapy and serves in preventive medicine as well as an aid to clearing these malignant tissue growths before serious health problems and symptoms occur. Clearly this study shows that to first try to use conservative treatment with CIM/TCM to try to correct endomestriosis, fibroids and ovarian cysts is the sensible approach.

Endometriosis may occur at any time during the reproductive years, but most commonly will be diagnosed at age 25-30. Uterine fibroids are growths that may occur in the uterus, and are classified according to the layer of the endometrium or outer uterine wall where they occur. Ovarian cysts and other abnormal lesions of the ovaries and fallopian tubes are growths that may come and go, and may interfere with reproductive function. Polycystic ovarian disease is a type of ovarian cyst pathology that may be associated with other endocrine pathologies as well. The link to all of these abnormal tissue growth pathologies is hormonal imbalance. Sexual steroid hormones stimulate the cells and tissues of the reproductive tract to go through appropriate changes during menstrual cycles, and hormonal imbalance may result in abnormal tissue changes and inappropriate growth, just as hormonal imbalance may result in a premenstrual syndrome.

The causes of endometriosis and uterine fibroids remain unclear even after decades of extensive scientific study. What we do know is that a variety of pathological causes may contribute, such as hormonal imbalance, retrograde flow of the menstruation, immune reaction to retrograde menstrual flow, allergic reaction, autoimmune reaction, reaction to environmental chemicals and toxins, birth defects, tissue lesions, chronic inflammation, and inherited tendencies of cells to express as endometrial cells. Recent research shows that a common trait of pathological endometrial tissue is progesterone insensitivity, and an imbalance of estrogen receptors and growth factors, such as VEGF, an epidermal growth factor.

The body must maintain a balance of estrogen and progesterone for healthy function, and this balance changes during the menstrual cycle, as different tissue needs are present for preparing the uterine lining for egg implantation and growth. Various types of estrogen and progesterone receptors express during the menstrual phases, and are also modulated by the balance of estrogen and progesterone. These estrogen receptors and growth factors vary within the menstrual cycle, and a complex array of modulating and regulating factors keeps all of this function healthy. Complementary and Integrative Medicine, and Traditional Chinese Medicine specifically (CIM/TCM), seeks to restore this healthy complex homeostasis, thus restoring function and healthy tissue growth and maintenance. Complementary Medicine will recognize that some or all of these many causative factors combine in the etiology of these health problems, and work to address them all with a holistic treatment protocol. Modern allopathic medicine will usually try to narrow the treatment focus to one cause, and this approach is what keeps the understanding of the pathology of these diseases unclear, and the standard treatment ineffective, except when the disease becomes severe and needs surgical intervention.

In 2012, the Chair of the Department of Obstetrics/Gynecology and Reproductive Science at the University of California, San Francisco, Dr. Linda C. Giudice, wrote of the current understanding and treatment of endometriosis in the journal Sexuality, Reproduction and Menopause (cited with a link below). Here, Dr. Giudice stated that the current thinking attributes endometriosis primarily to retrograde menstruation and attachment of endometrial cells to the peritoneum, or serous lining of the abdominal cavity, where they create growth of new blood vessels and grow abnormal tissue. These growths may cause an inflammatory response, and may affect nerves, creating pain. She stated that 95 percent of women have retrograde menstruation, but that a relatively small percentage of these women develop endometriosis. In these women this is primarily due to the lack of healthy inflammatory response by the immune system. A number of environmental and genetic, or epigenetic factors may be involved in this scenario, such as the exposure of a fetus to DES, or diethylstilbestrol, a synthetic estrogen. DES was given to pregnant women from about 1940 to 1970 to reduce pregnancy complications, miscarriage, and fetal loss, but not only was this a mistaken benefit, but DES was found to cause vaginal tumor growth in the mother and child, and was finally withdrawn from the market by the FDA. Often, these complications and cancers caused by DES occurred much later in life. The study of DES showed in a particular group how this synthetic hormone was strongly linked to development of endometriosis.

DES was also used as a treatment for menopause, for treatment of breast and prostate cancers, and used in the growing of beef, exposing many women unwittingly to the synthetic hormone. Despite large studies showing no benefit for reduction of pregnancy complications, the drug was routinely prescribed through the 1960s, and was not withdrawn from the market for this type of treatment until 1975. During this time period, the drug was also marketed to prepubescent girls when the first menstruation did not occur at an ideal age, and to teenage girls to stop excess growth in height. DES was also prescribed as a post-coital contraceptive in the early 1970s, and later prescribed to inhibit lactation in mothers to prevent breast engorgement. Finally, DES was used to treat breast and prostate cancers until it was fully removed from the human market in 1997, but not from beef production. We see from this history that a large number of persons were exposed to DES, which is proven to increase the risk of endometriosis. In addition, Dr. Giudice notes that other xenoestrogens, which are estrogen-like chemicals used in industry, of which there are now many, are also proven to increase risk of endometriosis. These chemicals should be regulated and removed from human exposure, and they are accumulative in the environment and in human tissue. Other risk factors, such as onset of first menstruation and puberty at an early age, which is increasing in frequency at an alarming rate in the last 10-15 years, also increases the risk, and this too may be attributed to the array of xenoestrogens and xenoandrogens in the environment and products we buy or ingest.

Understanding of just what types of xenoestrogens and xenoandrogens (synthesized chemicals in industrial products that mimic human hormones and cause disease) we need to be most concerned with is a problem, not because there is insufficient evidence to prove harmful effects of hormonal disruption, but because there are now so many of these chemicals in our environment, and thus in our bodies, and these chemicals do not break down easily. There has been much emphasis placed on plastics, with BPA, phthalates, TPP, bisphenol S, and other chemicals proven to be endocrine receptor disruptors, but an array of these synthesized hormone mimics are also found in foods, sprayed on crops and ending up in the water, added to products as fire retardants, used in electronics manufacture and not disposed of properly, and used in the manufacture of a wide array of industrial products that are also not disposed of properly, with combustion releasing these chemicals into the air. The most studied of these xenoestrogens and xenoandrogens are BPA, DDT, dioxins, atrazine, PBB, PCBs, phthalates, endosulfan, perflourinated compounds, and zeranol, but the current list goes on an one, and world health authorities now widely acknowledge that these chemical hormone disruptors are ubiquitous in the environment, and in the human organism. Food preservatives and additives created to maintain the illusion of freshness in packaged foods, and growth stimulators such as antibiotics and synthesized steroids, widely used in meat production, are the focus of increasing concern as well, as well as common chemicals widely used in cosmetics. While avoidance of these chemicals is important, as well as pressure on the industries and governments to regulate and ban them, an overlooked aspect of the problem is human adaptation to these chemicals, and a holistic approach to mollify the harmful effects by improving the homeostatic mechanisms we inherently have to protect us from these harmful effects. It is widely known and understood that not all humans exposed to these chemicals suffer significant harmful effects, and much can be done to help our bodies to counter these harmful effects, by detoxification, immune tonification and modulation, and natural hormonal balancing. Obviously, a thorough and holistic approach needs to be taken when dealing with a problem of an environmental hormonal disruption that is ubiquitous. By focusing on just one aspect of this big problem, limited benefits will be seen. With so many xenoestrogens and xenoandrogens in the environment it is important to focus on the big picture, not just one of these chemicals and acute exposure.

These findings by experts at the University of California San Francisco (UCSF) point to the focus of treatment strategies for endometriosis, hormonal balancing and restoration of natural hormone mechanisms, and balancing of the inflammatory responses of the immune system, supporting the integration of Complementary Medicine. Standard medicine has taken the approach that stopping menstruation with various synthetic hormones will prevent endometriosis, and a combination of oral contraceptives, progestins, synthetic estrogens, gonadotropin releasing hormone agonists and antagonists, androgens, aromatase inhibitors, and antiestrogens are prescribed, as well as aromatase inhibitors, which decrease the local conversion of other hormones to estradiol. Of course, women whose menstrual cycle is not disrupted may establish endometrial lesions, and this strategy would be ineffective. In this case, anti-inflammatory drugs may be prescribed. Doctors also note the rate of angiogenesis in endometrial lesions, and drugs to inhibit angiogenesis, commonly prescribed to treat cancerous growth, are considered in the overall protocol.

Of course, all of these drug therapies come with considerable risk of adverse effects. For this reason, Dr. Giudice stated that Chinese herbal medicine has become a first-line therapy today in Northern California, where she practices. She states that the array of studied effects of these herbal chemicals show promise, providing some efficacy with inflammatory regulation, anti-angiogenesis, antiproliferative growth effects, and pain relief, as well as antioxidant effects, and increasingly, specific effects to inhibit the main linked cytokines, TNF-alpha, Interleukin-1 beta, and Interleukin 8, as well as COX-2 and NF-k beta. She also cautions against the assumption that estrogen inhibition is the sensible approach, and instead gives credence to the need for balancing estrogens with progesterone. While standard medicine is loath to encourage so-called "alternative" medicine, it does appear that integration of these treatments in Traditional Chinese Medicine are gaining some acceptance.

The physiological mechanisms that drive endometriosis and uterine fibroid growth may also be responsible for a majority of breast, uterine and ovarian cancers

These same underlying homeostatic imbalances that are seen in endometriosis and uterine fibroids, such as the imbalance of estrogen receptors and growth factors, and progesterone insensitivity, are also now recognized as integral to a majority of breast, uterine and ovarian cancers, and researchers have noted a twofold increase in risk of developing ovarian cancer with endometriosis in general, and a further fourfold increase in high risk endometriosis with infertility problems. A meta-review of research from Penn State University showed that women with PCOS may be at increased risk of endometrial cancer, and the esteemed Cleveland Clinic notes on its website that "polycystic ovarian syndrome (PCOS) is associated with hyperandrogenism and infertility early in life, it is a harbinger of a lifelong condition that can lead to serious sequelae such as endometrial or ovarian cancer, diabetes mellitus, and coronary heart disease". One of the important reasons for utilizing Complementary and Integrative Medicine (CIM/TCM) when diagnosed with endometriosis, uterine fibroids, or ovarian cysts, is to correct these underlying homeostatic imbalances that increase the risk of cancers in these tissues later in life. We see that another reason to use restorative holistic medicine in treating these disorders is to protect against heart disease, one of the major causes of death in women.

Frequently seen in ovarian cancers is the presence of clear cell carcinoma, and there has been speculation that clear cell tumors develop from endometriosis. Further investigation into this histological connection found that the expression of hepatocyte nuclear factor-1beta (HNF-1beta), which is related to liver cells, or hepatocytes, is significantly upregulated, or genetically overexpressed, in clear cell carcinoma of even benign ovarian tumors, or cysts, when these tissues are related to endometrial tissues that are affected by endometriosis. In fact, 40 percent of endometriotic cysts without a finding of cancer in biopsy also expressed HNF-1beta with inflammatory states. Such findings indicate that more systemic imbalances underlie the development of endometriosis and ovarian cancers, and that a more holistic approach should be utilized to try to correct these imbalances. Now, Traditional Chinese Medicine (TCM) has always sought to define health problems by empirical observation and subsequent theories of holistic connections between homeostatic systems in the body. TCM physicians have long linked liver dysfunction to menstrual pathology and endometriosis, as well as problems with ovarian pathology and infertility. Such research as this (see research links below in information resources) show that TCM physicians hundreds of years ago were correct with their theories. Modern allopathic medicine gives the patient a number of therapies to act in specific ways, with surgery and drugs, to save the patients with more threatening aspects of these diseases, but does little to correct the underlying health imbalances that cause them. This is where the intelligent patients integrate Complementary Medicine and the Licensed Acupuncturist and herbalist to help restore health homestatic mechanisms and prevent future health risks.

TCM and Complementary Medicine may be integrated into standard care not only as a preventive medicine, but as a successful adjunct to treat these abnormal tissue growths themselves, and also as a sensible adjunct to more successfully recover from surgical interventions and restore homeostatic hormonal balance as much as possible. A high recurrence rate of endometrioma is seen after laparoscopic cystectomy, which is utilized when the pathological endometriosis tissues have traveled to the ovaries. Current treatment guidelines in standard medicine have suggested that a course of hormonal suppression with drugs should be utilized to prevent this recurrence. Studies in 2009 (cited below in information resources) show that some randomized placebo-controlled trials indicate that this therapeutic approach has no significant effect on the recurrence rate of ovarian endometriosis. The side effects of this drug therapy are also harsh. Another approach is to integrate Complementary Medicine into the protocol to reduce recurrence of the ovarian endometriosis. This type of therapy is gaining recognition rapidly, with evidence of clinical success, and is able to incorporate a variety of therapeutic protocols individually tailored, with inexpensive monitoring of key active hormonal metabolites in saliva and veinous blood stick samples. There is no reason that this safe and healthy approach should not be integrated into care. Waiting until large studies are performed and go through the stages of human clinical trials, which is underway but underfunded, is not a sensible option for patients today when deciding whether to utilize these extremely safe treatment protocols.