Endometriosis is a prevalent gynaecological condition affecting women of reproductive age. From a Western medical perspective, endometriosis is a condition where endometrial tissue (which is what grows and sheds inside the uterus resulting in a period) grows outside the uterus, resulting in pelvic pain, irregular bleeding/spotting, heavy periods, digestive issues and infertility. The pain with endometriosis can vary and is often quite severe, and can be described as a stabbing sharp pain or a dragging down sensation, chronic pain in the lower abdomen, deep pain during or after sex, painful bowel movements and painful menstrual cramps that get worse over time.
The exact cause is unclear, however researchers suggest it to be due to retrograde menstrual flow, genetics, immune system disorders, hormone imbalances such as excess oestrogen, and abdominal surgeries.
Causes of endometriosis:
Retrograde menstruation- when menstrual blood that is supposed to flow out the vagina flows back through the fallopian tubes, past the ovaries and into the peritoneal cavity. This menstrual blood then causes inflammation and adhesions in the abdominal cavity. Retrograde menstruation can be due to tampon use, period sex, or abnormal contracting of the uterus at period time (and potentially a uterus that is positioned abnormally).
Genetics- majority of women that have endometriosis have family members with the condition.
Immune system disorders- endometriosis sufferers often have a reduced amount of certain immune cells that act to clean up the lesions that are outside the uterus. This lack of immune cells fails to do the job at cleaning up any residue.
Hormone imbalances- the endometrial lining is oestrogen dependant, which means that it requires oestrogen to grow. When oestrogen is in excess it can stimulate a thicker endometrium and therefore more lesions grow. Excess oestrogen can be due to a sluggish liver, sluggish digestion and slow transit time, chemical/plastics/hormone disruptors, obesity/excess body fat, alcohol, certain medications, and even stress.
Abdominal surgeries (e.g. Cesarean or hysterectomy)- endometrial tissue may be improperly relocated and attach to abdominal scars.
Treatment options include hormonal contraceptives such as the oral contraceptive pill or intrauterine device, surgery to remove endometrial lesions, pain medications or optionally complimentary therapies such as chiropractic, herbal medicine, supplementation and acupuncture. The condition cannot be cured, but the pain reduces after menopause due to the cessation of menstruation and lowered oestrogen levels.
Endometriosis leaves many women with severe pain and limited options for relief. Research indicates that acupuncture may be an effective treatment option with long lasting relief.
From a Chinese medicine perspective, endometriosis falls under the category of painful periods, abdominal masses, heavy periods and Beng Lou (flooding and trickling). It is commonly due to Blood stasis, Kidney deficiency, Cold in the uterus, or a combination of all. It’s aetiology includes intercourse during menstruation, tampon use, emotional stress, excessive exercise, external invasion of cold, and/or an irregular diet (Maciocia, 2011). Treatment is focused firstly on relieving pain and addressing the underlying pattern which often includes breaking up blood stasis, promoting adequate circulation, warming the womb, and supporting the Kidneys (which correlate to hormone balance). Prognosis is good with the use of acupuncture and Chinese herbal medicine. Research shows that acupuncture can be an effective pain relief option for women with endometriosis. With treatments continuing weekly/fortnightly for 3-6 months and having a low recurrence rate of symptoms in follow up studies, suggesting that acupuncture may be addressing the root of the issue rather than just the symptoms.
How does acupuncture work to relieve endometriosis?
Acupuncture is well known to relieve pain conditions, and particularly in chronic pain. This is because it addresses the various physiological and psychological processes of pain. Acupuncture activates the body’s endogenous descending pain inhibitory systems (aka the body’s own pain killers), deactivates brain areas that relay pain signals and affects the interaction with nociceptive signals and somato-visceral reflexes. Essentially, endometriosis has 3 main components that acupuncture acts on:
Pain- acupuncture increases pain thresholds by activating the release of neuro-humoral factors such as adenosine, opioid peptide, acetylcholine, dopamine and more. Electroacupuncture leads to the production of dopamine in the adrenal medulla
Endocrine- acupuncture can suppress serum oestradiol levels and thus may inhibit the growth of ectopic endometrium and relieve pain.
Immune- acupuncture enhances the immune system by increasing the cytotoxicity of NK cells by promoting cross-talk between neurotransmitters and the immune system which is sedated by nitric oxide, beta-endorphins, and cytokines.
Acupuncture’s effects are therefore likely due to it’s analgesic, anti-inflammatory and endocrine & immune system modulation.
In most cases, I will prescribe Chinese herbal medicine and/or supplementation to combine with weekly/fortnightly acupuncture appointments. Treatments can vary in length, but the minimum is typically 3 menstrual cycles, and can be 6-12 months depending on how long you have had the condition for. It is important to remember that acupuncture is very effective when used regularly to support the body back to its happy balanced state… we are working to heal the root of the issue so you can be free from the condition for good. Maintenance appointments every 6-12 months may be required in some cases.
Book an appointment if you feel you are ready to get started on your healing journey, or book a 10min phone call if you have any further questions.
Xu, Y., Zhao, W., Li, T., Zhao, Y., Bu, H. and Song, S., 2017. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLOS ONE, 12(10).
Maciocia, G., 2011. Obstetrics and gynecology in chinese medicine.. 2nd ed. Elsevier Health Sciences, pp.849-861.
Zhu, X., Hamilton, K. and McNicol, E., 2011. Acupuncture for pain in endometriosis. Cochrane Database of Systematic Reviews, (9).
Womenshealth.gov. 2022. Endometriosis | Office on Women's Health. [online] Available at: <https://www.womenshealth.gov/a-z-topics/endometriosis#references>