I had been expecting the call from Andrea regarding her pelvic pain and excessive menstrual bleeding. Her doctor had called earlier in the day, saying Andrea had tried every endometriosis treatment available except surgery to help reduce her symptoms, with little success. Andrea wanted to try natural medicines and herbal treatments before taking the next step of surgery.
Difficult Diagnosis and Treatment
Medical science has a long way to go before understanding the causes of endometriosis, an understanding that could lead to gentle, safe, effective treatments. Endometriosis involves the tissue that lines the uterus, the endometrium. This tissue responds especially to estrogen, because estrogen is one of the main hormones that readies the uterus for implantation of the fertilized egg, leading to pregnancy. In some women, this endometrial tissue can start growing outside the uterus, especially in the pelvic area. With changing hormone levels during the menstrual cycle, this rogue tissue can begin bleeding, increasing the risk of inflammation, pain and infection.
Endometriosis is difficult to diagnose and treat. Andrea told me that over the last few years she had taken Danazol, a testosterone derivative that has major side effects, such as unwanted hair growth, weight gain, fatigue and lowered sex drive. She also took a gonadotropin-releasing hormone derivative that stopped her period and produced hot flashes. Both drugs gave some relief, but Andrea felt the results were not worth the side effects.
The use of laparoscopic surgery, where a small incision is made in the abdominal wall and a tiny scope inserted, provides an accurate diagnosis and, with the aid of a laser or surgical tools attached to the instrument, more complete and focused removal of the problem tissue. One study showed that after a year, 90 percent of the women receiving this surgery were still relatively pain-free. The problem is that over several years, the tissue can often regrow and symptoms return. Plus, general anesthesia is required for the operation, which is not risk-free. Sometimes the abnormal endometrial tissue growth is widespread in the body, even in such sites as the lungs, and these areas can be difficult to remove.
The Traditional Chinese Medicine Approach
Andrea’s doctor thought about sending Andrea to see me after a conversation we had about the herb vitex (Vitex agnus-castus). Her doctor became interested in this ancient herb, for which a number of good clinical trials have shown effectiveness for relieving breast tenderness and other symptoms associated with PMS.
In the clinic, I felt Andrea’s pulse, checked her tongue, performed abdominal diagnosis and asked her a number of questions about her health habits, family life and work. Herbalists try to look at the whole picture of a person’s life to determine some of the important factors that might play a role in producing internal imbalances acting to produce “dis-ease,” the “absence of ease.”
Andrea’s tongue had a thick yellow coating toward the back, and her pulse was strong. Her abdomen felt especially tight under the right rib cage, all indicating possible liver stagnation and an “excess” condition. In Traditional Chinese Medicine, the liver is responsible for regulating the qi, or internal movement of vital energy throughout the body. The liver is also thought to control the smooth flow of blood in the vessels and is a main organ responsible for regulating estrogen levels in the body.
Seven-part Program for Endometriosis
With Andrea, I recommended a seven-part program, and I anticipated that she would be working with the program for at least three to four months before she would see clear and lasting benefits.
Here is an outline of the program, one that can be modified to fit many women with endometriosis.
Vitex and black cohosh (Cimicifuga racemosa) are hormone-balancing herbs that help reduce estrogen levels and also help promote increased progesterone production.
Red clover extract (Trifolium pratense) contains phytoestrogens to “buffer” the possibly harsh effects of estrogen on estrogen-sensitive tissues, such as endometrial tissue.
Roman chamomile (Chamaemelum nobile). An effective herb for internal and external application. Internally, drink strong chamomile tea; externally, apply the essential oil added to a fixed oil (such as almond oil).
Standardized white willow bark (Salix spp.) and corydalis (Corydalis spp.) tablets to help relieve pain.
Dandelion root (Taraxacum officinale) tea or extract to calm a hyperactive liver and balance overall liver health.
Saw palmetto (Serenoa repens), a tonic for the genitourinary tract.
Castor oil packs to stimulate immunity and promote healing in the pelvic area.
Andrea agreed to start with a strong dose of vitex and black cohosh. Vitex is one of the best herbs available for this condition. It’s an ancient herb with an excellent safety record. The seed extract, either in liquid form (1/2 teaspoon in a little water, twice daily) or standardized extract form (1 to 2 tablets, twice daily with meals) can increase progesterone levels, reduce the impact of estrogen on some tissues and slow excess menstrual bleeding, while often helping to balance emotional swings associated with menstrual imbalances of different kinds.
Black cohosh works well with vitex and helps “move the blood” to reduce pelvic pain, reduce estrogen binding and slow the stimulation of the endometrial tissue. The herb also has natural salicylates (related to aspirin) that help gently reduce pain. I recommend using a double dose recommended by the manufacturer until some results are noticed.
Saw palmetto is an herb with excellent anti-inflammatory effects. I asked Andrea to try a double dose (240 mg twice daily). Early 20th-century American physicians prescribed saw palmetto for similar conditions in women and spoke highly of the benefits.
Teas provide a great way to capture the healing essence of herbs — they are relatively inexpensive, often taste good (or at least interesting) and are something we can prepare ourselves in this ready-made world. I recommended red clover tea, which contains phytoestrogens (such as genistein) that may help buffer estrogen binding; dandelion root tea to regulate her liver; and chamomile, a good-tasting anti-inflammatory herb that can help with relaxation. Gotu kola (Centella asiatica) is a wonderful herb that has been shown to help reduce inflammation and promote healing of wounds.
I strongly recommended that Andrea use external castor oil packs (or compresses) at least several times a week for about 45 minutes in the evening, for reducing pain, stimulating the immune system and promoting healing in the pelvic area. The basic method for making a castor oil pack involves soaking a clean cloth in warm castor oil and laying it over the lower abdomen, then covering it with plastic wrap, followed by another layer of cloth. Place a hot water bottle on top and relax.
Besides the herbal and dietary program, Andrea and I discussed endometriosis risk factors she should avoid. These include coffee, alcohol, some food additives, and pesticide residues in non-organic food, all of which can have an estrogenic action in the body. A list of healthful activities to implement include yoga and stretching, swimming, walking and dancing to regulate blood flow to the pelvic area.
Andrea was good at following the total program we worked out. She didn’t like swallowing too many pills, so she often made teas. She worked and had a 10-year-old, so it was difficult at times to apply the castor oil packs as much as she would have liked. Still, she told me she enjoyed the process, and her daughter thought it was fun to prepare the teas, so the program turned out to be something they could do together.
Andrea felt enough of a benefit that she kept using the herbs and stuck to many of the dietary changes for six months. When I saw her shortly after that, she looked healthier and said she wanted to add a few new herbs. She was sure the whole process had reduced her symptoms and given her more energy, and she didn’t plan to have surgery unless her symptoms worsened. The best benefit she identified was a feeling that she was more in control when it came to her health. “I know now that I don’t have to run to the doctor and depend totally on someone else to fix me when health issues come up,” she said.
Christopher Hobbs’s case studies are gleaned from his 30 years of studying and practicing herbalism. Hobbs, a fourth-generation botanist and herbalist, is the creator of the correspondence course Foundations of Herbalism; www.foundationsofherbalism.com.
“Case Studies” is not intended to replace the advice of your health-care provider.