This blog post is a personal one for me. I don’t make a habit of using my practice to talking about my own health, but this month I am feeling inspired to share. March is endometriosis awareness month. As an acupuncturist, nutritionist and primary care provider living with endometriosis, it is safe to say I have some thoughts and experiences on the subject. I used to suffer greatly. Some months, I still do, but most of the time, I am ok. Most of the time, I’d go so far as to say I feel great.
After many years of trial and error, of passing out in airport bathrooms, missing job interviews and many other important and not-so-important life events, I have figured out how to manage my endo. Below is my story.
What is Endometriosis?
Those of you who know what endometriosis is likely know the pain, suffering and frustration that can come with the disease, either firsthand or from watching someone you love go through it. It can take even the strongest, toughest women down at the knees.
For those of you who are less familiar, Endometriosis is a disease in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus, often attached to the ovaries, bladder, bowels and/or elsewhere in the pelvic cavity. Rarely, however, it can even travel through the blood stream to other parts of the body. Endometriosis is thought to be genetic, and is often seen in mothers and grandmothers of women who have the disease. In fact, my grandmother who had endometriosis had a spot on her neck that would ache and bleed every month as she started her period. She called it her “pressure release valve.” She laughed about it then, but I know that she suffered greatly with gynecological issues throughout her life.
Endometriosis induces a chronic inflammatory reaction that may result in scar tissue and extraordinary pain for some or all of the month. It is a common cause of infertility for women, and there is no cure.
Endometriosis is estimated to affect nearly 1 in 10 women. It is not well understood by modern medicine – no one really knows what causes, or how to treat it. Most Western protocols for endometriosis involve pain management via strong pain medications, hormone prescription and other medications to manipulate hormone production and function. These tools can often be effective for managing the pain that comes with endo, but it is a short term solution to a long term condition. Such medications are not sustainable to stay on, as they can be addictive, and can cause major damage to the digestive system, liver and kidneys long term.
I remember so clearly my first “episode,” as I’ve come to call them, when my uterus felt like it was being crushed by an elephant. I was 13, and had been sent home from school with “menstrual cramps.” I remember the look of shock and concern on my mothers face when she picked me up. I was doubled over in pain, barely able to walk. I vomited in the car and then passed out on the way home. It was pain like I’d never experienced before. I was terrified and miserable. My mom called the pediatrician, who said it was just bad menstrual cramps. Take some ibuprofen and go to bed.
These episodes became worse and more frequent as I grew older. I have more stories about awful endo-episodes that I care to count. For so long, I lived in fear about when one might next strike. They’ve occurred on the way to job interviews, in airplanes, first dates. My favorite (read: most traumatic) episode was the time I was alone in the house and I passed out from pain while sitting in the bathroom. I hit my head on the wall, woke up on the floor, nauseated and unable to stand. It was perhaps one of the scariest endo-moments I’ve experienced.
How I’ve Managed
I’ve had many occasions of pain since then, but none quite so bad as the one described above. Since that time, I’ve experimented with a myriad of endo-management tools, ranging from diet and lifestyle, acupuncture and Chinese medicine, naturopathic medicine, endoscopic surgery, Western pain management and even hormonal contraception.
This last one, the pill, was particularly difficult for me to implement – there was a lot of negotiating with my MD before I went on it. It is a medication which, most of the time, I recommend against for most of my patients, as I believe the long term effects of the pill on the endocrine and immune system are poorly understood by Western medicine. There are scenarios where hormonal contraception is appropriate, of course, but personally, I think it is widely overprescribed. That is a conversation for another day, however. I agreed to try the pill short term, to see if it would help manage the pain, and honestly, it did – for a little while. I hated the idea of being on it until menopause, however, and eventually, the side effects were too much for me to tolerate. I am off of the pill now, and feel more like myself than I have in a while.
After a lot of trial and error, I have learned that the best way for me to keep my endo-pain in check is a combination of diet, lifestyle, acupuncture, herbal medicine and strategic supplementation to support the various phases of my cycle. It does require some planning, but it is nothing compared to the fear and pain that I previously lived with. I still get twinges of pain throughout the month, but most of the time they are mild and manageable. There are still days that I wish I didn’t have to get out of bed, but most of the time I can.
I now have an “endo-emergency kit” that I carry with me pretty much all time – there’s one in my purse, one in my car, and in my spouse’s car, just in case. It contains 4 magical goodies, which I will list out for you later in the article. Knowing that I have it gives me peace of mind when I’m out in the world – if an episode should strike, I will be prepared!
The Big Picture
My story is just one of many. Each woman who has endometriosis experiences it differently. Some women, who’s endometriosis is not attached to a part of the body with a lot of nerve endings, may not experience much pain. In fact, they may not even know they have endo until they have trouble getting pregnant.
Other women suffer throughout the month, some with crippling, life shattering, untouchable pain that keeps them home from work, from participating in their family and social life. I happen to fall somewhere in the middle of that spectrum. Thankfully, my background in healthcare has given me tools to help myself in a way that many women don’t have.
My hope is that through my practice as an acupuncturist and nutritionist, I can help other women who are suffering every month take control of their endometriosis. I am not offering a cure, but I do believe that there are ways to support the body to reduce inflammation, promote circulation, and create a balanced and harmonious conversation between the endocrine (hormone) system and the rest of the body.
Endometriosis and Chinese Medicine
There are several different health patterns in Traditional Chinese Medicine (TCM) that may lead a woman to have endometriosis. These patterns are complex and are deeply rooted in Chinese diagnostic theory, so I won’t dive too deep into them here. The end result of each pattern, however, is what TCM practitioners understand as “qi and blood stasis.” Where there is stasis, there is often pain. Blood and other bodily fluids essential for health aren’t flowing as freely as they should be, an immune response occurs creating chronic inflammation, and thus, pain, scarring and adhesions result.
How do you treat endometriosis with acupuncture and Chinese Medicine? The simple answer is: figure out which pattern led the patient to have qi and blood stasis. Treat the root pattern, and treat the stasis.
Treating such patterns take time. Blood stasis like that found in endo can be very challenging to treat, and often require using several different approaches, including diet, lifestyle, Eastern medicine including acupuncture and herbal medicine, Western medicine including surgery and more.
Tips for Managing Your Endometriosis
Eat an anti-inflammatory diet – It’s no secret that diet plays an important role in health, but it’s an aspect that is often overlooked in conventional endometriosis treatment. Eating a well balanced diet high in dark leafy greens and good quality protein rich in omega-3 fatty acids can help to reduce inflammation, which in turn will help reduce pain. The role of inflammation in chronic pain is huge, and managing it can yield big changes in how you experience your monthly cycles.
Foods to include:
- Leafy greens like kale, spinach, collard greens and Swiss chard
- Berries like blueberries, strawberries, acai berry etc
- All vegetables and fruits (excluding nightshades)
- Omega-3 rich fish/fish oil
- Naturally fermented vegetables high in probiotics like raw sauerkraut, kimchi, borsch, yogurt (for those who can tolerate dairy)
- Bone broth
- Veggie Mineral broth
- Legumes, nuts and seeds in moderation
- Coconut oil as primary cooking oil
- Olive oil in moderation
Equally important is making sure your keep your blood sugar stable by eating regularly. It’s easy to forget to eat in the midst of a busy day, but keeping healthy snacks around like nuts and seeds or a piece of fruit will ensure that your blood sugar doesn’t dip too low. This is important because when blood sugar does get too low, it stimulates the production of cortisol, aka “the stress hormone,” which, although necessary in our day-to-day lives, can be highly inflammatory in excess.
Understand your hormone balance – Endometriosis is what is known as an “estrogen sensitive” or “estrogen dominant” condition. Learn more about estrogen dominance here. Most women who have endometriosis also have some issues metabolizing estrogen efficiently. Whether they have too much estrogen, not enough progesterone and/or another hormone imbalance related to DHEA and/or testosterone can be determined via hormone testing. Many of these patterns may be discernable through TCM diagnostics as well. In my practice it is my preference to start with TCM diagnostics and use labs for confirmation where needed. There are wonderful supplements and herbs for regulating estrogen dominance. Recommendations will vary depending on exactly what type of estrogen dominance you have.
Avoid environmental estrogens – Also known as xenoestrogens, environmental estrogens are “estrogen like” substances that mimic estrogen in the body. They can be particularly problematic for women who are dealing with estrogen sensitive conditions like endometriosis. They may also contribute to early onset of menses in girls, stubborn weight gain, the development of gynecomastia, aka the development of breasts in men, and much more.
These substances may be found in products like:
- 4-Methylbenzylidene camphor (4-MBC) (sunscreen lotions)
- Parabens (methylparaben, ethylparaben, propylparaben and butylparaben commonly used as a preservative)
- Benzophenone (sunscreen lotions)
Industrial products and plastics:
- Bisphenol A (monomer for polycarbonate plastic and epoxy resin; antioxidant in plasticizers)
- Phthalates (plasticizers)
- DEHP (plasticizer for PVC)
- Polybrominated biphenyl ethers (PBDEs) (flame retardants used in plastics, foams, building materials, electronics, furnishings, motor vehicles).
- Polychlorinated biphenyls (PCBs)
- Erythrosine / FD&C Red No. 3
- Phenosulfothiazine (a red dye)
- Butylated hydroxyanisole / BHA (food preservative)
- Pentachlorophenol (general biocide and wood preservative)
- Polychlorinated biphenyls / PCBs (in electrical oils, lubricants, adhesives, paints)
- Atrazine (weed killer)
- DDT (insecticide, banned)
- Dichlorodiphenyldichloroethylene (one of the breakdown products of DDT)
- Dieldrin (insecticide)
- Endosulfan (insecticide)
- Heptachlor (insecticide)
- Lindane / hexachlorocyclohexane (insecticide, used to treat lice and scabies)
- Methoxychlor (insecticide)
- Nonylphenol and derivatives (industrial surfactants; emulsifiers for emulsion polymerization; laboratory detergents; pesticides)
Consider herbal treatment – Chinese herbal medicine can be very helpful for the treatment and management of endometriosis, in large part because unlike many Western pharmaceuticals, Chinese herbs can be custom tailored to each person’s unique pattern. Always work with a qualified provider when using Chinese (or any) herbs. When taking Chinese herbs, it is important to know where your herbs are coming from. Build a relationship with your provider, and ask questions!
Have an “endo-emergency kit” – You’ll want to create your own with a qualified healthcare provider who can tailor your kit according to your health pattern. Some herbs and supplements are not right for everyone. Please note, this is NOT my recommendation for daily endometriosis care. A daily treatment plan can be constructed according to your cycle patterns. This is for emergency situations only.
My kit includes:
- Cramp bark – An herb that has literally saved me from many extreme endo-episodes. Cramp bark is a natural muscle relaxer, and when taken in adequate doses can reduce or stop the extreme cramping pain that often comes with the start of menses.
- Ibuprofen – I don’t often recommend ibuprofen because of it’s potential to do damage to the gut and the burden it places on the kidneys over time. However, in emergency situations, ibuprofen, can stop pain from keeping reaching emergency levels. See the next supplement listed for ways to counter some of the negative effects of ibuprofen on the gut.
- L–Glutamine – This is an amino acid that has shown to have a protective, restorative action on the lining of the gut. When a situation arises that I need to take ibuprofen, I will also take some L-Glutamine to help protect my gut lining. This supplement is not suitable for folks who have seizure disorders or who are sensitive to MSG.
- Instant heat pads – Heat helps improve circulation and can reduce cramping.
Manage stress – This is a big one. As mentioned above when discussing blood sugar, stress triggers the secretion of a hormone called cortisol. This is the hormone responsible for waking us up in the morning and keeping us going throughout the day. It is also what gives us that “fight-or-flight” surge of energy in an emergency. In a balanced person, cortisol is naturally highest in the morning and tapers off as we near bed-time. Some folks, especially folks who are chronically stressed, may experience a sensation of being “tired and wired.” This is often do to overstimulation of the adrenal glands, which are responsible for responding to chronic elevated stress levels. In excess, cortisol is highly inflammatory and can lead to increased pain. The good news is that it is possible to retrain the body to respond in a healthy way to stress.
Exercise – Nothing moves qi (energy/oxygen) and blood better than good old-fashioned exercise. Remember, endometriosis is a result of qi and blood stagnation. Anything you can do to gently get blood circulating will serve you well in reducing pain as well as PMS. I can also promote a healthy stress response, a better ability to detox naturally, and can boost energy. A caveat here is to limit vigorous exercise during the first couple days of your period. For women who do not have endometriosis, exercise might help with mild cramps. However, with endo, extreme exercise or even moderate exercise may make symptoms worse.
Avoid caffeine & sugar – Especially around for the week before your cycle starts. Both caffeine and sugar are highly inflammatory and excitatory to the nervous system. When the nervous system is overstimulated, we are more likely to experience pain.
Try acupuncture – Yes, I am a little biased here, but acupuncture did not earn it’s reputation for being a pain-fighting-super-hero for nothing. It can work tremendously well for reducing inflammation and promoting circulation and healthy blood flow. It can also work with the endocrine system to promote healthy hormone production. Visit my practice in Carlsbad, CA, or look for an acupuncturist near you who specializes in women’s health.
Endometriosis can be incredibly frustrating to live with. Just when you think you’ve made progress, you have another flare-up. The truth is, living with endometriosis is a part of your journey in this life that you get to learn how to “dance” with. It may feel sometimes like you’re taking two steps forward, then one step back – that’s ok. Approach the condition, and yourself, with compassion, love and patience. Find the support you need to get through each month – build a team if you need to. Some patients have a full fledged “endo network” including a naturopathic physician, MD, acupuncturist, nutritionist, massage therapist and behavioral/emotional therapist. I have used all of these methods to cope with my endometriosis over the years, and have found extraordinary benefit from each. Find what works for you. Ask for help when you need it.
I wish you health, happiness and peace.
Yours in better health and wellness,
Merritt Jones, LAc, MS, CNC