Endometriosis is a condition in which tissue that normally lines the uterus grows where it should not. For example, it might grow on an ovary, or on the abdominal wall. Endometriosis can cause many different symptoms, either by causing inflammation or by taking up space. The most common symptoms are heavy menstrual bleeding, painful periods, pain with intercourse and constipation/diarrhea.

Endometriosis is also associated with infertility and miscarriage. In about 5 percent of infertility cases, endometriosis is the only cause. Endometriosis is present as a contributing factor in at least 25 percent of infertility cases. Sometimes endometriosis causes scarring that inhibits ovulation or fertilization of the egg cell, but it is probably the effect of endometriosis on the immune system that has the greatest impact on fertility.

Diagnosing endometriosis can be difficult because its symptoms can have many other explanations, and because the definitive method of diagnosis is by laparoscopy, which is quite invasive. Typically, the first step in diagnosis is to have an ultrasound done. An MRI might also be used. When both infertility and chronic pelvic pain are present, I design my treatment plan assuming that endometriosis is present.

The naturopathic approach to endometriosis addresses the multiple contributing factors:

  • looking for and treating inflammation
  • balancing estrogen, progesterone and testosterone
  • treating stress, which animal models suggest may aggravate endometriosis symptoms

Providing pain relief and decreasing menstrual blood loss would also be part of the treatment plan.

Conventional treatment of endometriosis includes NSAIDs (for pain), hormones and surgery.
For most women, endometriosis will only delay having a baby, not prevent it.

Dr. Andrea Hilborn is a naturopathic doctor in Kingston, Ontario

Infertility. endometriosisinfo.ca/infertility_e.aspx. The Society and Gynecologists and Obstetricians of Canada. Online. Accessed Dec 4 2017.

Association between surgically diagnosed endometriosis and adverse pregnancy outcomes. Innie Chen, M.D., M.P.H., Shifana Lalani, M.Sc., M.D., Ri-hua Xie, Ph.D., R.N., Minxue Shen, M.D., Ph.D, Sukhbir S. Singh, M.D., Shi-Wu Wen, M.B., Ph.D. Fertility and Sterility. Nov 29 2017.

Endometriosis, especially mild disease: a risk factor for miscarriages. Alexandra Sabrina Kohl Schwartz, M.D, Monika Martina Wölfler, M.D., Vira Mitter, M.Sc., Martina Rauchfuss, M.D., Felix Haeberlin, M.D., Markus Eberhard, M.D., Stephanie von Orelli, M.D., Bruno Imthurn, M.D., Patrick Imesch, M.D., Daniel Fink, M.D., Brigitte Leeners, M.D. Fertil Steril. 2017 Nov;108(5):806-814.e2. doi: 10.1016/j.fertnstert.2017.08.025.

Dx with pelvic exam, US and MRI.
Imaging in the initial and preoperative assessment of endometriosis. Thomassin-Naggara I, et al. Presse Med. 2017 Nov 16. pii: S0755-4982(17)30442-6. doi: 10.1016/j.lpm.2017.09.020. [Epub ahead of print]

A preliminary evaluation of influence of body mass index on in vitro fertilization outcome in non-obese endometriosis patients. Garalejic E, et al. BMC Womens Health. 2017.

Stress During Development of Experimental Endometriosis Influences Nerve Growth and Disease Progression. Cuevas M, et al. Reprod Sci. 2017.

Environmental Manipulations as an Effective Alternative Treatment to Reduce Endometriosis Progression. Torres-Reverón A, et al. Reprod Sci. 2017.