Complementary Endometriosis Therapy Related to Pelvic Pain

Endometriosis, a medical condition that affects nearly one in ten women worldwide, is characterized by persistent pelvic pain that can significantly hamper their quality of life. While we await more research in diagnosing endometriosis and effective non-hormonal treatments, not to mention better research regarding excision surgery and improved access to care, it is crucial that patients have access to effective pain management strategies. Complementary therapies offer promising avenues for managing pelvic pain resulting from endometriosis, providing patients with a sense of control and agency in their own treatment. This article will delve into these natural therapies, offering a comprehensive guide to several popular and easily accessible options.These natural therapies include Transcutaneous Electrical Nerve Stimulation (TENS) units, dietary changes, Cannabidiol (CBD), turmeric, meditation, yoga, and acupuncture. While these therapies show promise, more research is needed to fully understand their efficacy and mechanisms of action.

The Pain Experience in Endometriosis

Understanding the pain associated with endometriosis is complex. It’s believed to be multifaceted, involving nociceptive, inflammatory, and neuropathic components. Endometriosis lesions can cause mechanical pain through compression and infiltration of nerves, and the chronic inflammatory state associated with the condition can lead to elevated levels of inflammatory cytokines and markers. Neuropathic pain can result from damage to neurons, as well as from central sensitization of pain in the central nervous system.

Pain from endometriosis can wax and wane, presenting in “flares” of variable duration that can significantly impact patients’ lives, often requiring increased pain medication. Those with endo may have cyclical or non-cyclical pain, and many people suffer from ovulation pain, which you can read more about here.

Self-management, involving active participation in managing one’s chronic condition, has been associated with improved knowledge and self-efficacy, and can be particularly important during times of isolation and distancing, such as during a pandemic. 

Transcutaneous Electrical Nerve Stimulator (TENS)

TENS units are handheld devices that deliver small electrical pulses to the body, providing a form of pain relief. These units work by the Gate Control theory, inhibiting the transmission of pain through smaller nerve fibers. They offer a patient-controlled, non-pharmacological option for pain management that is readily accessible and inexpensive.

Research has shown TENS units to be well-tolerated, with minimal side effects, and effective in reducing pain. Patients have reported significant decreases in pain scores and reduced need for pain medication with TENS unit use. While most studies have focused on the effectiveness of TENS for primary dysmenorrhea, there is a need for more research to understand its applicability to patients with endometriosis. If you are interested in learning more about TENS therapy, and the Apollo TENS, check out our recent blog here.

Dietary Modifications

Diet can play an essential role in managing endometriosis symptoms and is an important aspect when it comes to gastrointestinal symptoms. Certain nutritional deficiencies can contribute to metabolic changes that increase oxidative stress and epigenetic abnormalities, potentially exacerbating the condition. A balanced diet rich in specific nutrients such as folic acid, methionine, zinc, vitamins B12, B6, A, C, and E can help prevent these negative impacts.

Conversely, certain foods, such as red meat and processed foods, have been associated with increased inflammation and the development of endometriosis. Consuming foods rich in omega-3 fatty acids, such as fish oil, and foods containing polyphenols, like citrus fruits, apples, green tea, olive oil, and chocolate, may help prevent and improve inflammatory markers and in turn, modulate disease progression. It is important to note that there is currently no specific guidance on the optimal diet for endometriosis, and more research is needed to establish evidence-based dietary recommendations. Of course, we understand that there may be overlapping conditions that impact the tolerance of these foods in people with endometriosis and it is important to work with a trained provider for individualized recommendations. 

Cannabidiol (CBD)

CBD, a cannabinoid derived from the cannabis plant, has been gaining attention for its potential health benefits and its role in pain management. The endocannabinoid system, which CBD impacts, has direct effects on various physiological functions, including pain perception and inflammation. CBD is generally well-tolerated, with side effects including decreased appetite, fatigue, sleep disturbances, gastrointestinal upset, and hypersensitivity reactions. While there are no published randomized control trials of CBD use in endometriosis, surveys show a positive impact on endometriosis pain, and anecdotal evidence suggests it may be a useful adjunctive treatment. 

Turmeric

Turmeric, a spice derived from the curcuma longa plant, has been used for centuries for its medicinal properties. Its active ingredient, curcumin, has anti-inflammatory properties and has been shown in animal studies to have potential therapeutic effects against endometriosis.

While the benefits of turmeric for endometriosis are not well-studied, no harmful side effects have been reported with supplementation. More research is needed to determine the optimal dosage for managing endometriosis symptoms.

Meditation

Meditation, specifically mindfulness meditation, has been associated with improved outcomes in chronic pain syndromes. It involves focusing on the present and cultivating an attitude of acceptance and non-judgment, which can help manage the stress and psychological comorbidities often associated with chronic pain conditions like endometriosis.

Research has shown that meditation can significantly improve pain catastrophizing scores, suggesting a beneficial effect on pain perceptions. However, more studies are needed to confirm its effectiveness and to understand how best to integrate it into treatment plans for endometriosis.

Yoga

Yoga, a mind-body intervention, has been reported to improve pain and quality of life in patients with endometriosis. While research on the efficacy of yoga for endometriosis management is limited, preliminary studies suggest it may provide beneficial effects. However, more research is needed to understand the specific mechanisms by which yoga may alleviate endometriosis-related pain and to determine the optimal type and duration of yoga practice for maximum benefit. 

Acupuncture

Acupuncture, a component of Traditional Chinese Medicine, involves the insertion of thin needles into specific points on the body. It has been used as a complementary therapy in endometriosis management, with studies showing a small but overall positive effect on endometriosis symptoms. To read more about the impact of acupuncture on endometriosis, read our blog here: Acupuncture: An Underexplored Solution for Endometriosis Pain.

Conclusion

Complementary therapies offer promising options for managing endometriosis-related pelvic pain. While more research is needed to validate and understand their effectiveness fully, they provide patients with accessible, patient-controlled strategies for managing their pain. By incorporating these therapies into their treatment plans, patients can take an active role in managing their condition, improving their quality of life, and gaining a sense of control over their health. You can read more about integrative therapies for endometriosis here. 

References:

1. Li, Linda ; Lou, Kristie ; Chu, Amanda et al. / Complementary therapy for endometriosis related pelvic pain. In: Journal of Endometriosis and Pelvic Pain Disorders. 2023 ; Vol. 15, No. 1. pp. 34-43.