March 2019 was international Endometriosis month. As subscribers to many endo facebook/group chat/ dedicated web pages on endometriosis we were bombarded with yet more self help info. Most of it is the same information; what are the ‘in supplements’, ‘what to do when surgery doesn’t change anything’, ‘what foods are good and what foods are bad’ etc …
It made us think about our own practice here at ben & biao and how we try and help women with endometriosis.
Generally, the most pressing symptom is PAIN. In order to understand how we treat it you have to understand what causes it.
Pain is the nervous system’s way of letting the body know that there is something majorly wrong going on. It’s the body’s way of saying ‘STOP..we’ve got a problem that needs to be sorted out’.
There are a few different ways the nervous system makes pain but let’s focus on endometriosis pain.
Endometriosis gives different types of pain signals:
- Nociceptor pain. A nociceptor is a sensory neuron that responds to damaging stimuli by sending ‘possible threat’ signals to the brain and spinal cord which immediately sends out pain signals to tell the body ‘we have a problem’. When the endometrial tissue expands or invades the wrong parts of the body it’s these nociceptors and the brain interaction that cause the initial pain.
- Inflammatory pain. The body responds to this nociceptor pain by sending in the army. Our body’s army is called our IMMUNE SYSTEM. Like any great army it’s big with many divisions. The division that is sent down to deal with the invading tissue is called the inflammatory response. This ‘Inflammation’ is a complex team made up of different cells that go in and try and destroy the invading endometrial tissue and mop up the damage to the surrounding tissue. As it goes to work it causes swelling, heat and yet more pain!!! Inflammation is supposed to be a short-lived experience. Go in, do the job and leave. However, because endometrial tissue responds to sex hormones it grows each month meaning that the body has this response continuously leading to greater and greater inflammation in the area. This causes so many other problems which I don’t have time to write about here but the bottom line is that the body moves into a state of chronic inflammation and that short term pain becomes constant.
- Neuropathic pain. This can arise in various ways such as traumatic injury, infection or metabolic issues. In the case of endometriosis nerve pain may be the result of nerve damage or impingement caused by the invading tissue but when the body has experienced many cycles of endometrial pain the nervous system can malfunction and cause a kind of ‘ghost pain’ where the tissue and the inflammation may have gone away (for example after surgery) but the nervous system which is no longer functioning properly still believes there is a problem and sends pain signals. It’s different from the nociceptor pain in that it is usually heavy, stabbing or burning in sensation.
So that explains about what causes the pain now what do we do at the clinic to help stop it?
- Lower inflammation. We do this via herbal support, specific PH changing supplements, lifestyle and dietary changes. We will discuss these options with you at your consultations and support you as you engage with changes along the way.
- Use Acupuncture to deaden the pain signals. Acupuncture is one of the best ways to influence the neurological system. Your body has millions of nerves and we use our knowledge of the nervous system to influence both the local nerves (near where the endometrial tissue is growing) and the ones near the brain stem and spinal cord to deaden the pain. The tiny needles are put into areas of the body that we know to have the most influence. It’s not painful and after a course of treatment you should start to notice a difference in your pain thresholds and pain response.
So that’s the way to deal with the immediate pain. However, the other problem is that the body is still growing the tissue in an amount and often in areas it’s not wanted.
This is the CAUSE and this is more complex to deal with.
While we may not know exactly what kicks off your endometriosis, we know that there are links with hormone imbalance, inflammation and of course your genetic dispositions (IE if mum had it you may be more likely to get it).
- Hormone imbalances we attempt to deal with by using Chinese herbs. We have some great evidence-based herbs and herbal formulas that effect female sex hormones and can help balance them out.
- While science can’t (yet) do anything specific to your genes, science is starting to show that the gut microbiome can affect your gene expression. Therefore, we work with you to get your digestion and specifically your gut into tip top condition using supplements and specific strains of probiotics that have evidence of improving and readdressing gut flora.
- Endometriosis and inflammation are like chicken and the egg. One can breed the other. Of course, not everyone with inflammation will get endometriosis but chronic long term inflammation can and does cause a heap of problems for the body and if you have endometriosis as your main problem then your slant is that you are going to increase endometriosis if you have systemic inflammation! Co-incidentally the immune system starts in the gut and we know that bad gut microbiome is a breeding ground for systemic inflammation so yes, we look to stop the inflammation with gut changing probiotics. We use herbs that have anti-inflammatory effect, but we also take a look at the other factors which we know to cause inflammation such as stress, diet, lifestyle, alcohol and work with you to build strategies that will help deal with these.
Lastly, I want to add that we aren’t against surgery. Surgery/ablation will get rid of a lot if not all the endometrial tissue and local inflammation. You will not know until afterwards how successful it is for your pain or if it will come back again. We are always happy to work with women pre/post-surgery.
We hope that we’ve given you a bit of a different slant on the normal ‘endometriosis blog’ and that you will see that you need to treat the ‘cause’ as well as the ‘symptom’ or as we say the ben & biao (root and branch) if you really want to get a handle on endometriosis.