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AYURVEDIC APPROACH TO THE MANAGEMENT OF ENDOMETRIOSIS

Endometriosis is (an often) painful and chronic gynecological disorder, where tissue similar to that which normally grows in the lining of the uterus (endometrium), grows outside of the uterus. The condition most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis, but in some cases can extend beyond these areas.

During a female menstrual cycle, endometrial tissue lining the uterus tissue builds up. If a woman does not fall pregnant, this tissue lining is shed during the period/menses. However, in women with endometriosis, this endometrial tissue develops outside of the uterus, usually on other reproductive organs inside the pelvis, or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle – it builds up and breaks down (in the same way as endometrium), which then results in small bleeds inside of the pelvis, which will lead to inflammation, swelling, as well as scarring of the surrounding normal tissue. When the ovary is involved, blood can be embedded within the normal ovarian tissue and form a blister of blood, which is surrounded by a fibrous cyst, called an endometrioma.

The cause of the condition is idiopathic (unknown). There are a few current theories, with one postulating that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, which is referred to as retrograde menstruation. A second theory postulates that endometrial tissue travels and implants via the blood or lymphatic channels, similar to the pathway of spread of cancer cells. A third theory formulates that cells in any location may transform into endometrial cells. Endometriosis can also inadvertently occur as a result of e.g. a caesarean section. Genetics may also play a role.

The most common sites of endometriosis include: the ovaries, fallopian tubes, uterosacral ligaments, the space between the uterus and rectum, the space between the uterus and bladder, the outer surface of the uterus, and the lining of the pelvic cavity. Occasionally, endometrial tissue can be found in the intestines, rectum, bladder, vagina, cervix, vulva and within/around abdominal surgery scars. In very rare cases, the condition can spread to such areas as the lung tissues.

Risk factors include: those who have a first-degree relative with the condition, those who are first time mothers after 30-years of age, and those with an abnormal uterus.

Symptoms can include:

  • Pain, especially excessive menstrual cramps in the area of the abdomen and/or lower back
  • Pain during intercourse
  • Abnormal and/or heavy menstrual flow
  • Infertility
  • Painful urination during menstrual period
  • Painful bowel movements during menstrual period
  • Diarrhoea, constipation and/or nausea

There are four stages of endometriosis, being minimal, mild, moderate and severe – with the classification dependent on the extent of spread of the endometrial tissue, the involvement of pelvic structures, extent of the adhesions, and any involved blockage of the fallopian tubes.


Conventional Treatments:
Treatment for endometriosis is dependent on one's overall health and symptoms, medical history, existing conditions, extent of the disease, personal preference(s) and expectations, and plans for future pregnancy.

As such, treatment may involve planned observation (watching of the condition), pain medication, hormone therapy, and/or surgical techniques, or a combination of these. Some treatment lines may also involve the use of alternative and integrative medicine pathways.


Ayurvedic Approach to Endometriosis:
From an Ayurvedic point of view, Endometriosis is a tridoshic condition, involving Vata, Pitta, and with a predominance of Kapha – resulting from from toxin accumulation, poor nutrition, poor digestion, and/or imbalances of the mind and nervous system, such as stress, grief, anger, anxiety and/or unprocessed emotions. It tends to affect Kapha, Kapha Vata and Kapha Pitta types more than others. Genetic predisposition can also play a role.

According to Ayurveda, the condition begins in the plasma (Rasa) component of the blood – the essence of the food that circulates all over the body and nourishes all the body's tissue. Most commonly, due to causative factors, Ama (toxins/undigested food matter) accumulates in the GI tract and then overflows into Rasa dhatu. Subsequently, in a somewhat complicated process, due to the disturbance in the normal bodily processes, an excess of Kapha is produced, which then leads to the abnormal development of the endometrial wall. This then leads to the disturbance of cellular digestion and assimilation at the site, leading to the migration of the endometrial tissue to other locations.

Ayurvedically, there are two pathways/components to endometriosis, according to the doshic involvement:

Vata dosha pushing Kapha: This leads to pain in the pelvic area, lower abdomen, rectal area, vagina and/or lower back, with the pain coming at certain times of the cycle, or all of the time. Often the woman can become anxious, fearful, constipated, and can experience insomnia. With Vata involvement, the spread of the condition is slower.

Pitta dosha pushing Kapha: This leads to abnormal bleeding, heavy menses, spotting or bleeding between periods, bleeding after sex, blood in the urine or in the stools. Women can also experience swollen breasts, sore nipples and/or diarrhoea. When Pitta is involved the spread can be faster to other areas.


BENEFICIAL AYURVEDIC HERBS FOR ENDOMETRIOSIS:
Vata Pitta Balancing: punarnava, triphala, guduchi, amalaka, turmeric, shatavari, licorice, aloe vera juice, musta
Vata Kapha Balancing: punarnava, triphala, guduchi, amalaka, turmeric, ashwaganda, aloe vera juice, chitraka, guggulu, trikatu, shilajat
Pitta Vata Balancing: punarnava, triphala, guduchi, amalaka, turmeric, shatavari, licorice, aloe vera juice, musta
Pitta Kapha Balancing: punarnava, triphala, guduchi, amalaka, turmeric, arjuna, aloe vera juice, ashoka, manjista,
Kapha Vata Balancing: punarnava, triphala, guduchi, amalaka, turmeric, ashwaganda, aloe vera juice, chitraka, guggulu, trikatu, shilajat
Kapha Pitta Balancing: punarnava, triphala, guduchi, amalaka, turmeric, arjuna, aloe vera juice, ashoka, manjista


Traditional Ayurvedic Treatment(s) for Endometriosis:
Ayurvedic treatment approach(es) are individualised and are fully dependant on a full consultation with an individual, the current imbalances, age, strength, severity of the condition, and if other conditions are also present. Treatment approaches can include:

  • Panchakarma detox treatments (when deemed appropriate)
  • Avoid causative factors
  • Balance Jataragni and digestion
  • Remove Ama (toxins within the digestive tract)
  • Weight reduction to decrease Kapha
  • Balance doshic imbalances through diet/lifestyle/herbs
  • Intake of clean, wholefood, organic eating as much as possible
  • Build immunity
  • Abhyanga massage, sweat therapies (swedana), lepas/poultices
  • Oil bastis if required to balance Vata.
  • Abdominal bastis (similar to kati basti)
  • Nasya
  • Counselling for emotional issues and better coping with the pain


General Ayurvedic Nutritional Guidelines for Endometriosis:
Ayurvedic nutritional approach(es) are individualised and are fully dependant on a full consultation with an individual. One should eat compatible foods, and in accordance to one's imbalances. Some additional general guidelines include:

  • One should eat the foods that one does not react to. If one is sensitive to lactose and/or gluten, look at avoiding these foods if necessary.
  • One should eat according to the digestive capacity, keeping meals light, cooked, warm moist and easy to digest. As a guide, eat to fill the stomach 1/3 with solid food, 1/3 with liquid and leaving 1/3 empty to allow room for digestive secretions in the stomach.
  • One should eat at regular times/intervals.
  • One should eat wholegrains and non-processed foods.
  • Foods to avoid: Cold foods, raw foods, leftover foods (24 hours), frozen foods, cold water, processed and packaged foods, soft drinks, high fat foods, greasy foods, chocolate. Minimise intake of red meat.
  • One should avoid overeating. Allow 6 hours between meals and snack 3 hours after a meal and eat only if hungry. If digestion is poor, then 4 light meals per day is advisable in place of three regular meals.
  • Ensure there is sufficient consumption of iron rich foods, as well as foods high in essential fatty acids.
  • Breakfast should be easy to digest, lunch the main meal, and dinner should be lighter than lunch.
  • A small amount of buttermilk consumed after meals is advisable
  • Eat home cooked meals, preferably made on the same day as being prepared.
  • Water should be drunk warm in the cooler months and room temperature in the summer months. Avoid chilled water.
  • Use all of the five senses at mealtimes. Savour the food that you are eating.
  • Eat in a pleasant environment. Eat seated and try to avoid TV and electronic devices whilst eating.
  • Eat slowly, eat with respect/reverence for what you are eating, chew thoroughly. 


General Ayurvedic Lifestyle Guidelines for Endometriosis:
Ayurvedic lifestyle approach(es) are individualised and are fully dependant on a full consultation with an individual. Some general guidelines include:

  • Allow for sufficient rest and sleep. Go to bed at a regular time each day, and best before 10pm. Avoid also sleeping during the day.
  • Keep to a routine as much as possible during the day.
  • sufficient daily activity and exercise, without overdoing exercise. Balanced activity/exercise is healthy, but avoid over-exertion.
  • Avoid stress, anxiety, fear and tension.  Look at counselling for self-care and working through any stress, anxiety, anger or any other mental health and/or emotional issues.
  • Deep breathing for 10 minutes a day is very beneficial. Meditation, yoga and pranayama can also be highly beneficial.
  • Avoid constipation by following good eating and exercise habits.
  • Avoid suppressing natural urges, e.g. bowel movements, burping etc.
  • Avoid smoking and minimise and caffeine alcohol intake.
  • Avoid sex just before, during and just after menses.
  • Avoid endocrine disrupting chemicals, which can be found in some cosmetics, synthetic fragrances, personal care and cleaning products. It is better to use natural products instead.
  • Keep a diary of the symptoms that are experienced and when they occur.
  • A warm castor oil and/or flax seed oil pack on the abdomen can help with the symptoms.


If you have any concerns about your health please be sure to consult an Ayurvedic Practitioner or your local health physician. See our Ayurvedic Practitioner Services and Consultation Page for more information.

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Disclaimer:
The above information is for information and educational purposes. As such we are not, diagnosing, treating, curing, mitigating, or preventing any type of disease or medical condition. Before taking any form of natural, integrative or conventional treatment regimen, it is advisable to seek the advice of a licensed healthcare professional.

 

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