Abigail Rist, a registered nurse and registered acupuncturist with a specialty of herbalism, who has worked with midwives and treated many women with menstrual disorders, believes that sufferers of endometriosis may gain some benefits from a number of herbal remedies. She follows the Chinese school of thought, viewing disease as imbalances of female (yin) and male (yang) energies, heat and cold, expansion and contraction. The herbal teas or tinctures she recommends arc based on these evaluations.

Since this system of medicine does not specify the disease precisely, “endometriosis is diagnosed and treated by its more irritating symptoms,” Ms. Rist told me. “In this sense, endometriosis is a tightening and over cooling of what is called ‘the lower burner,’ or urogenital area. For this area, we prepare an herbal remedy to replenish heat (or yang) and reestablish a balance, in another example, it’s as if you have a fever or sore throat, accompanied by thirst. The remedy prescribed will bring down body heat, soothe the rawness of the throat, and help quench thirst. Dandelion tea, for example, induces these qualities. The same will be done for endometriosis.”

Using this reasoning, the overcooling effects of endometriosis would need to be treated or counteracted with warmth. The herbs used would tonify the blood, stimulate and warm the organs. “In traditional Chinese medicine,” Ms. Rise continued, “doctors attribute the function and regulation of some aspects of the blood to the liver and spleen. If a woman has dark clots during menstruation, it is attributed to an imbalance of the liver. If a woman has lighter red blood but profuse bleeding, this would be related to an imbalance of the spleen. The herbs prescribed would be “tissue specific,’ that is. herbs with some affinity to each organ which can, if possible, influence and regulate its function.”

There are teas and tinctures that Ms. Rist recommends. The white peony has specific liver action, so it will actually decrease abdominal tightness and pain. The peony, which may be either dry-roasted or cured, depending on what the herbalist decides for each case, is often one of four other herbs blended in a concoction and prepared to be taken as tea. “Its nature is to be cooling,” says Ms. Rist, “so when it enters the spleen and liver channels, it can tonify the blood. The herbs can also help stop pain by relaxing the tendons and tissues.”

Another popularly used herb is dong quai, considered a “female” root plant, the way that ginseng it assigned male properties. Dong quai is found in many “female trouble” herb blends that are commercially made and distributed to hearth food stores. It is a cured root that, says Ms. Rist, “is thought to help establish an endocrine balance, increasing tissue sensitivity to estrogen and helps with ending menstrual cramps and pelvic congestion.”

Another tea suggested by this herbalist is raspberry tea, handed down as a remedy from grandmother’s rime to its use by present-day midwives. It is reputed to help relax muscles and dilate the cervix. Other teas that are toning or can help reduce inflammation or relieve pain arc rosemary tea, licorice tea, chamomile, and witch hazel tea.

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Sometimes endometriosis only lasts for a few cycles, but it may also continue throughout reproductive life, getting worse as women enter their thirties and forties. The behaviour of endometriosis in pregnancy is highly variable and it rarely disappears permanently after pregnancy. Published reports indicate that some women continue to have problems due to endometriosis after menopause. It can limit bending, stretching, standing and taking exercise, especially on days of menstrual bleeding. Although it is also associated with infertility, many women with endometriosis become pregnant without difficulty.

Endometriosis is regarded as the most common cause of chronic pain in women aged from fifteen to fifty-five years. This pain is nearly always cyclical, that is, it tends to occur at about the same time in most menstrual cycles. It may be experienced by a woman when she ovulates, menstruates or is about to menstruate. It may also occur when she has sexual intercourse, urinates or passes a bowel motion. It sometimes causes spotting between periods. Although it has much in common with period pain it does not respond to medications, such as anti-prostaglandins, found helpful in that disorder. When Laura sought advice from her doctor about chronic pelvic pain, a number of factors in her history suggested a diagnosis of endometriosis. These included a history of painful periods which had worsened with age, short menstrual cycles with a relatively large number of days of bleeding, and a family history of pelvic pain among her female relatives. Despite this suggestive evidence, Laura’s doctor advised her that the diagnosis required a laparoscope entailing a visual inspection of her abdominal organs. He said a number of other procedures might assist in arriving at a diagnosis but he preferred not to perform a biopsy of suspected lesions, a vaginal ultrasound and blood tests until he did the laparoscopy. In fact, the laparoscopy was sufficient to reveal the endometriosis and he and Laura discussed a number of possible treatments, including drug treatment and surgical removal.

The diagnosis of endometriosis usually relies on a laparoscopic examination, a procedure that enables a doctor to examine the contents of the abdomen without making a big opening in. Instead several small incisions are made and a long thin tube specially equipped with thin glass fibres is inserted through one of the incisions. Light travels along the fibres to ’spotlight’ internal organs and a periscope-type attachment allows the doctor to see into the abdomen and pelvis. Other instruments used with the laparoscope (hence the need for the other incisions) enable the doctor to make photographic records of the inside of the abdomen, obtain samples (biopsies) of tissue for laboratory analysis and remove abnormal tissue. Using this technique, doctors have learned that the appearance of endometriosis varies markedly. Younger women tend to have clear growths or red lesions, whereas the lesions of older patients tend to be black or yellow-white.

Various theories have been advanced about why endometriosis occurs, but these are hotly disputed. Suffice it to say that no one yet knows if some women are born with a tendency to develop it or if endometrial-type tissue spreads in the body due to some unusual abdominal structure or function.

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The procedures, which will be performed as part of a laparotomy, may include any of the following:

• removal or destruction of implants and small cysts

• removal or destruction of large cysts and endometriomas

• removal of adhesions

• removal of an ovary or an ovary and fallopian tube

• removal of the appendix

• surgery on any other affected organs such as the bowel or bladder

• suspension of the uterus

• pre-sacral neurectomy or utero-sacral neurectomy

• any surgery necessary to correct other abnormalities found.

Implants and small cysts

Where possible any superficial implants and small cysts on the ovary and peritoneum will be removed or destroyed by cutting, cauterization or vaporization, provided that there is no danger to any underlying organs such as the bowel or bladder.

Large cysts and endometriomas

Any endometriomas will usually be removed by cutting them out. This often involves removing a small amount of the surrounding ovary as well to ensure that all the endometrial tissue is removed. Sometimes, endometriomas will be destroyed by puncturing them and then cauterizing or vaporizing their lining. Large cysts on the peritoneum will be removed by cutting them out.

Adhesions

Any adhesions will be cut, cauterized or vaporized and separated so that the normal positioning of the reproductive organs can be restored.

Ovaries

Sometimes an ovary will have to be removed because an endometrioma lying within it cannot be removed safely. Similarly, if one ovary and fallopian tube are severely diseased they may be removed, provided that the other ovary and tube are normal. The removal of an ovary and tube on one side does not seem to decrease the likelihood of pregnancy following surgery but does seem to reduce the risk of the disease recurring.

Appendix

Some surgeons routinely remove the appendix during a conservative laparotomy, especially if the endometriosis is extensive, but most will remove it only if endometrial implants are present.

Bowel and bladder

Most small implants on the bowel and bladder are superficial and can be removed or destroyed without any danger of damaging the underlying organs. If the implants have penetrated the wall of the bowel or bladder they must be carefully cut out and the affected area repaired. Occasionally a section of the bowel will have to be removed if the implants have surrounded and constricted it; if there is any possibility of this being done it is highly advisable that a bowel surgeon be on hand to assist.

Suspension of the uterus

Suspension of the uterus involves tightening or shortening the utero-sacral and/or the round ligaments in an attempt to hold the uterus in its normal position. This procedure is not commonly performed by gynecologists in Australia though it is quite common in America.

Presacral and utero-sacral neurectomy

A pre-sacral neurectomy and an utero-sacral neurectomy are two similar procedures which are only occasionally performed by gynecologists in this country, although they are performed much more commonly overseas. Both procedures involve cutting the nerves that transmit pain from the uterus to the brain. The same nerves are cut in both procedures but in the case of an utero-sacral neurectomy the nerves are cut closer to the uterus than is the case with a pre-sacral neurectomy. The two procedures are performed to relieve chronic pelvic pain but they are usually only effective for a maximum of about twelve months as by then the nerves have re-grown.

If you are contemplating a pre-sacral neurectomy or an utero-sacral neurectomy it is worth remembering that pain is one of the body’s warning mechanisms. If you cannot feel pain in the pelvic area you may not be aware that your endometriosis could be worsening or recurring. If you go into labour you may not be able to feel the contractions which signal the onset of labour. In addition, both procedures can occasionally interfere with normal bowel and bladder function.

Other

If your fallopian tubes are damaged or if you have any other disease or abnormality of the reproductive organs these will usually also be repaired.

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