Endometriosis is described as the abnormal growth of Endometrial tissue outside the Endometrium. It is an oestrogen-depended inflammatory disease characterized by development of endometrial-like tissue outside the uterine cavity, most commonly in the pelvic peritoneum, ovaries, the uterosacral ligaments, and pouch of Douglas, and in rare cases on the abdominal wall, bladder, diaphragm, and pleura. It is the main cause of pelvic pain, although there are around 40% of women diagnosed with endometriosis report no symptoms other than infertility.
It is estimated that 15 percent of menstruating women between the ages thirty and forty have Endometriosis, although it can begin as early as the teenage years.
The clinical presentation is variable. The main clinical manifestation of Endometriosis is a recurrent, generally cyclical severe lower abdominal cramping pain that gets progressively worse. Other presentations include dysmenorrhea, dyspareunia, pathological vaginal bleeding, painful intercourse and intestinal upset, back pain, tenesmus and infertility. In some cases, the high level of pain caused by endometriosis can deplete a woman’s energy and cause depression and anxiety.
The exact cause of Endometriosis remains unknown, the pathophysiology of endometrium is likely to be multi factorial and several factors are thought to be involved in the development of Endometriosis. Retrograde menstruation remains the dominant theory for the development of pelvic endometriosis. Currently, the gold standard for the diagnosis of Endometriosis is laparoscopy, which permits direct visualization of the lesion.
Western medical treatment has no cure for Endometriosis, therefore, the treatment goal is to restrict progression of the process, to provide pain relief, and to restore or preserve fertility when it is needed. It usually includes pain relieving medication, laparoscopy and laser removal of the endometrial tissue. Other drugs may be used to control the hormonal stimulation of the Endometriosis such as oral contraceptives, progestogens etc. However, for infertile patients caused by Endometriosis, medical treatment has a limited role and has not been showed to improve fertility.
TCM is a viable and effective treatment modality for dealing with Endometriosis and related infertility. Endometriosis can be discerned into a few different TCM disease categories depending on the characteristic pattern of signs and symptoms presented by the patient. The most common ones are referred to Dysmenorrhea, Abdominal masses and Infertility.
The primary pattern of Endometriosis is blood stasis, the objective of TCM treatment is to invigorate blood and remove stasis. In addition to blood stasis, there are often other factors which are part of the patterns of Endometriosis. Kidney deficiency, Liver Qi stagnation, cold retention, phlegm and heat patterns are frequently part of the mix, and are differentiated based on the clinical manifestations associated with each case of Endometriosis. The timing, location, nature, and severity of pain are also taken into account. There are five common patterns of Endometriosis, with the differentiating symptoms and the recommended treatment. TCM practitioners would usually apply acupuncture and/or Chinese medicine for Endometriosis, prescribing different herbal mixtures according to each individual’s pattern differentiation.
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