Endometriosis

Endometriosis is a devastating menstrual-related disorder. It is thought to develop when blood and uterine lining, normally shed during your monthly menstrual cycle, are somehow thrown into a retrograde motion: instead of leaving your body, they are sprayed backward into your system. Once inside, this material can land anywhere in your pelvic cavity, take root, and begin to grow, treating these organs as a sort of substitute uterus. Because this misplaced endometrial tissue is nourished each time your estrogen level climbs, as it does at the start of every menstrual cycle, it continues to grow month after month, continually being joined by new deposits left after every period.

SYMPTOMS OF ENDOMETRIOSIS

• Severe menstrual cramps
• Ovulation pain (mittelschmerz)
• Pelvic pain that worsens before a period
• Dyspareunia (painful intercourse)
• Recurring bladder infections
• Painful pelvic cysts and tumors
• Lower back pain
• Nausea, vomiting, and dizziness during menstruation

Sometimes, however, endometriosis can have no symptoms at all.

HOW ENDOMETRIOSIS AFFECTS YOUR FERTILITY

I have devoted more than twenty years to researching and treating endometriosis.

In the thousands of cases I have seen, the most popular sites for endometrial deposits to grow are the ovaries, the fallopian tubes, and the uterus. These growths (or their resulting scar tissue) can cause obstruction so severe that, if treatment is not received, the organs themselves can cease to function. The most common fertility-related complications of endometriosis are:

• Blood-filled "chocolate" cysts (so named because of their chocolatelike texture and color), which form on the ovaries and restrict egg development and release

• Damaged fimbria, whereby the fingerlike ends of the fallopian tubes stick together, blocking an ovulated egg from entering

• Intertubal blockage, which hampers egg transport or blocks sperm passage

When I first began to study endometriosis, I saw many patients whose condition had gone undiagnosed and untreated for so long that their lesions had turned into sticky masses of scar tissue that bound into a solid mass not only all their reproductive organs, but their bladder, bowels, and abdomen as well. For these women the only alternative was drastic surgery to save their lives.

HORMONES, ENDOMETRIOSIS, AND INFERTILITY

In addition to structural damage, I have also seen endometriosis affect fertility on a biochemical level, with problems that range from increased risk of miscarriage to complete inability to conceive. In 1980 Dr. Terranee Drake, head of reproductive endocrinology at the National Medical Center in Washington, D.C., conducted experiments that have helped us understand how and why this occurs. It was Dr. Drake who discovered that active endometrial lesions emit extraordinarily high levels of prostaglandin, the hormone-like chemical responsible for the severe menstrual cramps that often accompany this disease.

Much the way they normally cause your uterus to contract, an excess of prostaglandins can cause spasms in your fallopian tubes. If you should conceive, these spasms can move your fertilized egg to your uterus so quickly that it may not have the time to prepare adequately for a healthy implantation. The end result is often a miscarriage or premature labor. When combined with damage to the uterine lining, another effect of endometriosis, the risk of miscarriage becomes three times greater than normal.

Moreover, excessive prostaglandins in your body before you conceive can cause your internal environment to become so biochemically hostile that both sperm and egg are destroyed before fertilization can take place.

ARE YOU AT RISK FOR ENDOMETRIOSIS?

No one is really sure why some women get endometriosis and others do not. However, the following factors have been identified with increased risk:

• Immune system deficiencies. Although the backward bleeding of endometriosis is said to occur in every woman who menstruates, a healthy immune system is thought to be the line of defense that keeps the renegade tissue from taking root and growing. If a malfunction in your immune system occurs, this protection is suddenly lost, and you become a victim of endometriosis.

• Stress. I have observed that endometriosis proliferates or recurs in a woman's body faster and in greater quantity during times of extreme emotional stress, such as divorce, job loss, or the death of a spouse, parent, or other loved one.

• Early menstrual periods. If you experienced an early menstrual cycle (before age twelve) and your flow was exceptionally heavy at that time, you may be at higher risk for endometriosis.

• Family history. This disease can be hereditary. If your mother or another close female relative had endometriosis, studies at the Baylor College of Medicine in Texas reveal that you are seven times more likely to be afflicted by this problem than are women who have no family history of it.

HOW TO PROTECT YOUR FERTILITY

As devastating as endometriosis can be, there are things you can do to protect yourself and your fertility even if you are at high risk. One of the best ways is through diet, which can help control the growth of any endometriosis that has already appeared and, in some cases, prevent it from occurring at all. In fact, I am continually amazed at how many of my patients are able to manage this problem — and in some cases even cure it completely — simply by eliminating certain foods from their diet.

What should you avoid eating if you are at high risk?

• High-fat dairy products:
• cream cheese
• cream
• high-fat yogurt
• ice cream
• whole milk
• cheese

The high fat content of these foods may stimulate an estrogen overload, which can accelerate the growth of endometrial tissue.

• Fresh fruit and fruit juices, including:
• oranges
• nectarines
• grapefruits
• melons
• peaches

Nearly every fruit contains a natural substance called bioflavinoids, which has been linked to an excess of estrogen.

• Foods containing arachidonic acid (a saturated fat), an essential fatty acid, include:
• kidney
• lard
• liver
• butter
• red meat

Foods high in saturated fats can exacerbate inflammatory conditions like endometriosis.

WHAT SHOULD YOU EAT IF YOU HAVE ENDOMETRIOSIS?

A diet high in complex carbohydrates (grains, vegetables, and pasta), the skinless white meat of chicken and turkey, and broiled fish is recommended.

There is also evidence that foods containing GLA, another essential fatty acid may help counteract the effects of arachidonic acid. GLA can be found in cold-pressed sesame seed or walnut oil, and I recommend two tablespoons of either, once a day, if you have endometriosis. Whenever possible eat natural foods that you cook yourself, rather than fast foods or the prepackaged variety, which are generally loaded with sodium, and can exacerbate some of your symptoms, especially abdominal cramping.

MORE WAYS TO PROTECT YOUR FERTILITY

Even if endometriosis does occur, it doesn't have to mean the end of your childbearing options. With early diagnosis and treatment, you can check it and help overturn most of its fertility-robbing consequences. In fact, with new medications and the advent of laser surgery, even the most severe damage can often be corrected, fertility and your partially or even fully restored.

What can help you?

• Medications. Since endometriosis needs estrogen to survive, medications that limit the production of this hormone allow your endometrial masses to shrivel and die. If treatment is received early enough, little or no scar tissue results. The three drugs currently used for this purpose are danazol (Danocrine), leuprolide acetate (Lupron), and Nafarelin. I have successfully prescribed these and have seen incredible results, often in a relatively short period of time.

• Birth control pills. Because they suppress your natural production of estrogen, I often prescribe birth control pills to prevent further development of mild cases of endometriosis. Although this is not a cure, I have seen it keep many women from succumbing to advanced stages of this disease.

• Micro laser surgery. Used to remove endometrial lesions and their resulting scar tissue, micro laser surgery, especially when teamed with danazol or leuprolide acetate (given three months prior to surgery and continued for three months afterward), can help most women experience a complete recovery and a total restoration of all reproductive functions. Studies are currently underway using Nafarelin for this same purpose.