Endometriosis

Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis.

These ectopic endometrial tissues may be found in the myometrium when it is called endometriosis internal or adenomyosis. More commonly, however, these tissues are found at sites other than uterus and are called endometriosis externa or generally referred to as endometriosis.

During the last couple of decades, the prevalence of endometriosis has been increasing both in terms of real and apparent. The real one is due to delayed marriage, postponement of first conception and adoption of small family norm. The apparent one is due to increased use of diagnostic laparoscopy as well as heightened awareness of this disease complex amongst the gynaecologists. The prevalence is about 10 percent. However, prevalence is high amongst the infertile women (30–40%) as based on diagnostic laparoscopy and laparotomy.

Sites:

Abdominal
Extra-abdominal
Remote

Abdominal:

It can occur at any site but is usually confined to the abdominal structures below the level of umbilicus.

Extra-abdominal:

The common sites are abdominal scar of hysterotomy, caesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix.

Retrograde menstruation: In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
Transformation of peritoneal cells: In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells.
Embryonic cell transformation: Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.
Surgical scar implantation: After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
Endometrial cell transport: The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Immune system disorder.: A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.

Superficial peritoneal endometriosis: The peritoneum is a thin membrane that lines your abdomen and pelvis. It also covers most of the organs in these cavities. In this type, the endometrial tissue attaches to the peritoneum. This is the least severe form.
Endometriomas: These are dark, fluid-filled cysts. They’re also called chocolate cysts. They vary in size and can appear in different parts of your pelvis or abdomen, but they’re most common in the ovaries.
Deeply infiltrating endometriosis (DIE): In this type, the endometrial tissue has invaded the organs either within or outside your pelvic cavity. This can include your ovaries, rectum, bladder, and bowels. It’s rare, but sometimes a lot of scar tissue can bond organs, so they become stuck in place. This condition is called frozen pelvis. But this only happens to 1%-5% of people with endometriosis.
Abdominal wall endometriosis: In some cases, endometrial tissue can grow on the abdominal wall. The cells may attach to a surgical incision, like one from a C-section.

Patient Profile

The age is between 30–45. The patients are mostly nulliparous or have had one or two children long years prior to appearance of symptoms. Infertility, voluntary postponement of first conception until at a late age and higher social status are often related. Thus, it is more common in private than hospital patients. There is often family history of endometriosis. Outflow tract obstruction is an important cause when it is seen in teenagers (10%)

Symptoms

About 25 percent of patients with endometriosis have no symptom, being accidentally discovered either during laparoscopy or laparotomy.
Symptoms are not related with extent of lesion. Even when the endometriosis is widespread, there may not be any symptom; conversely, there may be intense symptoms with minimal endometriosis.
Depth of penetration is more related to symptoms rather than the spread. Lesions penetrating more than 5 mm are responsible for pain, dysmenorrhea and dyspareunia.
Non-pigmented endometriotic lesions compared to the classic pigmented “powder burns” lesions produce more prostaglandin F (PGF) and hence are more painful.
The symptoms are mostly related to the site of lesion and its ability to respond to hormones. Midline lesions are more symptom producing. Degree of pain is not related to the severity of endometriosis.

Dysmenorrhea (70%)

There is progressively increasing secondary dysmenorrhea. The pain starts a few days prior to menstruation; gets worsened during menstruation and takes time, even after cessation of period, to get relief of pain, (co-menstrual dysmenorrhea). Pain usually begins after few years pain-free menses. The site of pain is usually deep seated and, on the back, or rectum. Increased secretion of PGF 2α, thromboxane β2 from endometriotic tissue is the cause of pain.

Abnormal menstruation (20%):

Menorrhagia is the predominant abnormality. If the ovaries are also involved, polymenorrhagia or epimenorrhagia may be pronounced. There may be premenstrual spotting.

Infertility (40–60%):

Whether endometriosis causes infertility or infertility produces endometriosis is not clear.

(20–40%)

The dyspareunia is usually deep. It may be due to stretching of the structures of the pouch of Douglas or direct contact tenderness. As such, it is mostly found in endometriosis of the rectovaginal septum or pouch of Douglas and with fixed retroverted uterus.

Chronic Pelvic Pain

The pain varies from pelvic discomfort, lower abdominal pain or backache. The cause may be multifactorial. These include—(i) Inflammation in the peritoneal implants and release of PGF, and also due to adhesions and ovarian cysts. (ii) Action of inflammatory cytokines released by the macrophages. (iii) Invasion of nerves or involvement of bladder and bowel. The pain aggravates during period.

Abdominal Pain

There may be variable degrees of abdominal pain

around the periods. Sometimes, the pain may be acute due to rupture of chocolate cyst.

Other Symptoms

The symptoms are related to the organ involved.

Urinary—frequency, dysuria, back pain or even

haematuria

Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena
Chronic fatigue, perimenstrual symptoms (bowel, bladder)
Hemoptysis (rarely), catamenial chest pain
Surgical scars—cyclical pain and bleeding

What to Eat for Endometriosis

Anti-inflammatory Foods – Turmeric, ginger, and garlic help reduce inflammation and ease symptoms.
Omega-3 Fatty Acids – Fatty fish (salmon, sardines), flaxseeds, and walnuts help lower inflammation.
Fiber-Rich Foods – Whole grains, beans, lentils, and vegetables aid digestion and hormonal balance.
Cruciferous Vegetables – Broccoli, cauliflower, and Brussels sprouts support liver detoxification of estrogen.
Iron-Rich Foods – Spinach, pumpkin seeds, and lean meats help counteract heavy bleeding.
Plant-Based Proteins – Tofu, legumes, and quinoa reduce red meat consumption, which may worsen symptoms.
Magnesium-Rich Foods – Bananas, almonds, and dark chocolate help with muscle relaxation and pain relief.
Hydrating Foods – Cucumbers, watermelon, and coconut water reduce bloating and inflammation.
Herbal Teas – Green tea and chamomile tea provide antioxidants and pain relief.
Avoid Processed & Sugary Foods – Reduce dairy, gluten, caffeine, and alcohol to prevent inflammation.

To fight inflammation and pain caused by endometriosis, it’s best to consume a nutrient-dense, well-balanced diet that’s primarily plant-based and full of vitamins and minerals. Add these to your diet:

fibrous foods, such as fruits, vegetables, legumes, and whole grains
iron-rich foods, such as dark leafy greens, broccoli, beans, fortified grains, nuts, and seeds
foods rich in essential fatty acids, such as salmon, sardines, herring, trout, walnuts, chia, and flax seeds
antioxidant-rich foods found in colorful fruits and vegetables, such as oranges, berries, dark chocolate, spinach, and beets

Make sure you pay attention to how your body acts when you eat certain foods. Keeping a journal of the foods you eat and any symptoms or triggers you have may be helpful.

Consider meeting with a registered dietitian. They can help you plan meals that work best with you and endometriosis, as there’s no one-size-fits-all approach.

Exercise:

Exercise may help with the management of endometriosis, too. This is because exercise can reduce estrogen levels and release “feel-good” hormones.

In addition to conventional methods of treatment, alternative treatments may be very helpful for women with endometriosis. For example, relaxation techniques may be beneficial. These can include:

Meditation
Yoga
Acupuncture
Massage

Homeopathic Medicines for Endometriosis:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Cimicifuga. [Cimic]

The characteristic indication for this remedy in dysmenorrhea is pain flying across the pelvic region from one side to the other. It is especially useful in rheumatic and neuralgic cases, and in congestive cases it may also be thought of along with Belladonna and Veratrum viride. Headache preceding menses; during menses sharp pains across abdomen, has to double up, labor-like pains, and during menstrual interval debility and perhaps a scanty flow. The resin Macrotin is preferred by many practitioners. The pains of Cimicifuga are not severe and intense nor felt with such acuteness as are those of Chamomilla.

Caulophyllum. [Caul]

The dysmenorrhea of Caulophyllum is essentially spasmodic in character; the pains are bearing down in character. It produces a continued spasm of the uterus simulating first stage of labor; the flow is mostly normal in quantity. The spasmodic intermittent pains which call for Caulophyllum are in the groins, a useful remedy in these spasmodic cases if given between the periods. to various part of the body.

Magnesia muriatic is also a remedy which may be studied in uterine spasm. Gelsemium is similar in many respects to Caulophyllum. It is very useful remedy in neuralgic and congestive dysmenorrhea when there is such bearing down. The pains are spasmodic and labor-like, with passages of large quantities of pale urine. It is one of the best given low in hot water. It will surely relieve the pains at the start.

Belladonna. [Bell]

The congestive forms of dysmenorrhea would call for Belladonna. There is pain preceding the flow and a sensation of heaviness as if everything would protrude from the vulva, relieved by sitting up straight. The pains come on suddenly and cease suddenly; the flow is offensive and clotted. The dysmenorrhea is intensely painful, the vagina is hot and dry and the pains are cutting through the pelvis in a horizontal direction, not around the body, as in Platinum and Sepia.

Veratrum viride is use with benefit in congestive dysmenorrhea, in plethoric women, accompany with strangury and preceded by intense cerebral congestion, also spasmodic dysmenorrhea at or near the climacteric. These are conditions in which the old school knows only Opium, yet these remedies are far superior to that drug, often curing permanently while Opium is only palliative.

Viburnum opulus. [Vib]

This remedy produces a sudden pain in the region of the uterus before menstruation and much backache during menses. In neuralgic and spasmodic dysmenorrhea, it has achieved considerable reputation. Dr. Hale considers it specific in this form of painful menstruation. Its chief indications seem to be in the character of the pains, which are spasmodic. Spasmodic dysuria in hysterical subjects also calls for Viburnum.

Its keynotes, therefore, are bearing down, aching in sacral and pubic region, excruciating, cramp, colicky pains in hypogastrium, much nervousness, and occasional shooting pains in the ovaries. Like Sepia, Viburnum has pains going around the pelvis and also the empty, gone feeling in the stomach; but the bearing down is more violent, culminating in an intense uterine cramp. More indicated by clinical experience than by its pathogenesis.

Xanthoxylum. [Xanth]

This remedy has about only one use in homoeopathic medicine, and that is in dysmenorrhea and uterine pains. It is useful where the pains are agonizing, burning, extending down thighs along the crural nerves with a feeling as if the limbs is paralyze, the menstruation is usually profuse and with it agonizing bearing down pains; chiefly left sided are the pains of Xanthoxylum, though it also affects the right ovary.

It corresponds closely to the neuralgic form of dysmenorrhea. Hale says that the neuralgic element must predominate to have the remedy efficacious. Some further symptoms may be headache over the left eye the day before the menses, and it seems to correspond to women of spare habits and of a delicate, nervous temperament.

Magnesia Phosphorica. [Mag-p]

Perhaps no remedy has achieved a greater clinical reputation in dysmenorrhea than has Magnesia Phosphorica. The pains calling for it are neuralgic and crampy preceding the flow, and the great indication for the use of this remedy is the relief from warmth and the aggravation from motion. In neuralgia of the uterus Magnesia Phosphorica vies with Cimicifuga. Uterine engorgements with the characteristic crampy pains will indicate the remedy. It has also been used successfully in membranous dysmenorrhea. We have very few remedies for this affection.

Borax is one, but it is often unsuccessful, there seems to be no very special characteristic for it, unless it be the fear of downward motion which might exist in some cases. Hale mentions Viburnum, Guaiacum and Ustilago, besides

Borax, for membranous dysmenorrhea. Their indications are chiefly empirical. Colocynth, a useful remedy in dysmenorrhea, may be compared with Magnesia Phosphorica. The symptoms of Colocynth are severe left-sided ovarian pains, causing patient to double up; pains extend from umbilicus to genitals.

Pulsatilla. [Puls]

Dysmenorrhea calls for Pulsatilla when the menses are dark in color and delayed; the flow will be fitful and the more severe the pains are the chillier the patient will get. The pains gripe and double the patient up. It is perhaps more useful when give between the periods, and in congestive dysmenorrhea, from wetting of the feet, it is compared with Aconite, but in Aconite the discharge is bright red instead of dark.

Chamomilla and Cocculus are two remedies which run along side by side with Pulsatilla in dysmenorrhea, and all need careful individualization. Chamomilla has also a dark flow, but it has such characteristic mental symptoms of crossness and incivility that it cannot be mistaken. It will relieve many cases (12X). Cocculus also has dark flow. It has a pain as if sharp stones were rubbing against each other in the abdomen from accumulation of flatus; the pains are worse at night, awaken the the patient and make her irritable. Menses come too early, sometimes nausea is an accompaniment. It also is said to be more efficacious given between the periods. The mental condition of Pulsatilla, if present, will always indicate the remedy. Further, if the pains shift about the indications of Pulsatilla are still stronger.

Cocculus. [Cocc]

A most useful remedy in dysmenorrhea and scanty, irregular menstruation. Uterine cramps. Profuse discharge of clotted blood and severe headache accompanied by nausea; a heaving up and down of the stomach as in seasickness. It suits cases on the borderland between the neuralgic and congestive types of dysmenorrhea. Uterine cramps with suppressed irregular menstruation and a sero-purulent bloody discharge were favorite indications of Dr. Conrad Wesselhoeft. Gelsemium IX has also proved useful in the spasmodic form. Ignatia has dysmenorrhea with menstrual colic or bearing-down in the hypogastric region, hysterical labor-like pains relieved by pressure.

What is Endometriosis?