Integrative Therapies for Endometriosis

Integrative Therapies for Endometriosis

While there is no known cure for endometriosis, several mainstream treatment options can help manage the symptoms and improve quality of life. These are primarily focused on surgery and hormonal therapy.   Research is ongoing to find additional multidisciplinary treatment options on the basis of immunomodulation, anti-inflammatory therapy, and molecular pathway signal alteration. Absent curative mainstream therapy, an approach that has gained popularity in recent years to help reduce symptoms and treat some underlying endo pathology, is “integrative therapy,” which adds a holistic natural component. 

What is integrative therapy?

Integrative therapy is an approach to healthcare that takes into account the whole person, including their physical, emotional, and spiritual health. It involves combining conventional medical treatment with complementary therapies such as nutrition, supplementation, botanicals, acupuncture, massage, yoga, and much more. Integrative therapy aims to address the underlying causes of a person’s health concerns rather than simply treating the symptoms. While it often employs some aspects of Eastern medicine, it is not the same as “alternative therapy,” which can be ineffective, costly, and even dangerous in some situations. This overview article only scratches the surface of available options and is not meant to be authoritative in scope or depth. 

Some of the complementary therapies that may be used in integrative therapy for endometriosis include:

Acupuncture

Everybody has heard of this, but briefly, acupuncture is a form of Traditional Chinese Medicine that involves the insertion of extremely thin needles into specific points along body pathways called meridians. These meridians and acupoints are close to where we know peripheral nerves course through your body. It has been used for centuries to treat a wide range of conditions, including chronic pain, headaches, anxiety, and infertility.

Acupuncture is believed to work by stimulating the body’s natural healing mechanisms, promoting the flow of energy, or Qi, throughout the body. It could also have an effect on the nerves from a mainstream perspective. In the context of endometriosis, acupuncture is thought to help by reducing inflammation and promoting the relaxation of the pelvic muscles, which can reduce pain and improve fertility.  

One thing is for sure; it is not just a placebo effect. A systematic review published in the Cochrane Library in 2018 evaluated the effectiveness of acupuncture in treating pelvic pain associated with endometriosis. The review included seven randomized controlled trials involving a total of 527 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity compared to no acupuncture or sham acupuncture. 

Another systematic review published in the Journal of Obstetrics and Gynecology in 2021 evaluated the effectiveness of acupuncture in treating endometriosis-related dysmenorrhea. The review included 17 randomized controlled trials involving a total of 1232 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity and duration compared to no acupuncture or sham acupuncture. They concluded that acupuncture might be a safe and effective therapy for managing endometriosis-related dysmenorrhea.

While the evidence for the effectiveness of acupuncture in treating endometriosis is promising, it is important to note that acupuncture is not a cure for endometriosis. Acupuncture may help to manage pain and other symptoms associated with the condition, but it does not address the underlying disease process other than helping reduce inflammation. Therefore, it should be used as part of a comprehensive treatment plan that includes conventional medical treatment as well as lifestyle modifications and other complementary therapies.

Acupressure

Acupressure is a related form of traditional Chinese medicine that involves applying pressure to specific points on the body to promote healing and reduce pain. Acupressure points that are commonly used in the treatment of endometriosis include the lower abdomen, lower back, and inner ankle. These points are believed to help regulate menstrual flow, reduce inflammation, and promote relaxation.

A randomized controlled trial published in the Journal of Complementary and Alternative Medicine in 2013 evaluated the effects of acupressure on pain and quality of life in women with endometriosis. The study included 60 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Another study published in the Journal of Obstetrics and Gynaecology Research in 2018 evaluated the effects of acupressure on menstrual pain and quality of life in women with endometriosis. The study included 62 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in menstrual pain intensity and an improvement in quality of life.

Massage therapy

Massage therapy is a complementary therapy that involves the manipulation of soft tissues in the body, such as muscles and tendons, to promote relaxation and reduce pain. It has been used for centuries to treat a variety of conditions, including chronic pain, anxiety, and depression. We are talking about massage that is in addition to 

Endometriosis can cause significant pain and discomfort, particularly during menstruation. Massage therapy can help ease tension in the pelvic muscles and reduce pain. A systematic review published in the Journal of Nursing Scholarship in 2019 evaluated the effectiveness of massage therapy in reducing pain and improving the quality of life in patients with endometriosis. The review included 13 studies involving a total of 602 participants. The authors found that massage therapy was associated with a statistically significant reduction in pain intensity and duration and improvements in quality of life and anxiety levels. 

Massage therapy may also be beneficial for reducing stress and anxiety, which are common symptoms of endometriosis. Chronic pain can cause significant emotional distress, and massage therapy has been shown to be effective in reducing anxiety levels and promoting relaxation. A randomized controlled trial published in the Journal of Psychosomatic Obstetrics and Gynecology in 2018 evaluated the effects of massage therapy on anxiety levels in women with endometriosis. The study included 60 participants who received either massage therapy or no treatment. The authors found that massage therapy was associated with a statistically significant reduction in anxiety levels compared to no treatment.

In addition to its potential benefits for reducing pain and anxiety, massage therapy may also help to improve circulation and promote lymphatic drainage, which can help to reduce inflammation and promote healing. A review published in the Journal of Manual and Manipulative Therapy in 2016 evaluated the effectiveness of massage therapy for managing chronic pelvic pain, including endometriosis. The authors concluded that massage therapy might be a safe and effective therapy for managing chronic pelvic pain, mainly when used with other therapies.

Mind-body Techniques

Meditation, yoga, Tai chi, and others are complementary therapies that can be used in the treatment of endometriosis to help manage physical, emotional, and mental support. These techniques focus on the connection between the mind and the body and are designed to help individuals learn how to use their thoughts and emotions to promote healing and reduce pain.

Endometriosis is often associated with significant emotional and mental distress, including anxiety, depression, and stress. Mind-body techniques can help to manage these symptoms by promoting relaxation and reducing stress levels. A systematic review published in the journal Obstetrics and Gynecology Clinics of North America in 2020 evaluated the effectiveness of mind-body therapies for managing chronic pain, including endometriosis. The review included 20 studies involving a total of 1126 participants. The authors found that mind-body therapies, including meditation, yoga, and Tai chi, were associated with statistically significant reductions in pain intensity, pain duration, and stress levels.

Meditation is a mind-body technique that involves focusing the mind on a particular object or thought to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Pain Medicine in 2018 evaluated the effects of mindfulness meditation on pain and quality of life in women with endometriosis. The study included 20 participants who received either mindfulness meditation or no treatment. The authors found that mindfulness meditation was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Yoga is a mind-body technique that combines physical postures, breathing exercises, and meditation to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Obstetrics and Gynecology in 2018 evaluated the effects of yoga on pain and quality of life in women with endometriosis. The study included 90 participants who received either yoga or no treatment. The authors found that yoga was associated with a statistically significant reduction in pain intensity and improved quality of life.

Tai chi is a mind-body technique that involves slow, gentle movements and deep breathing exercises to promote relaxation and reduce stress levels. A systematic review published in the journal Pain Medicine in 2015 evaluated the effectiveness of Tai chi for managing chronic pain, including endometriosis. The review included ten studies involving a total of 494 participants. The authors found that Tai chi was associated with statistically significant reductions in pain intensity and duration and stress levels.

Diet and Nutrition

Diet modification can directly impact inflammation, hormone balance, and immune system function. While no specific diet has been shown to cure endometriosis, dietary changes, and nutritional supplements may be beneficial in reducing inflammation and pain associated with the condition.  

Inflammation is a key factor in the development and progression of endometriosis. Certain foods and nutrients can contribute to inflammation in the body, while others have anti-inflammatory properties that can help to reduce inflammation. Omega-3 fatty acids, found in fatty fish such as salmon and mackerel, as well as in flaxseeds and chia seeds, have been shown to have potent anti-inflammatory effects. Magnesium, found in leafy greens, nuts, and whole grains, can also help to reduce inflammation and muscle tension. Vitamin D, found in fatty fish, eggs, and fortified dairy products, may help to regulate immune system function and reduce inflammation. Overall, the most anti-inflammatory antioxidant diet is whole-food plant-based.

Hormone balance is another important consideration in the management of endometriosis. Certain foods can help to balance hormones, while others can disrupt hormone balance and exacerbate symptoms. Phytoestrogens, found in foods such as soy products, flaxseeds, and lentils, can help to balance estrogen levels and reduce symptoms of endometriosis. On the other hand, foods high in saturated and trans fats, such as red meat and processed foods, can increase inflammation and disrupt hormone balance.

A systematic review published in the journal Nutrients in 2021 evaluated the effectiveness of dietary interventions for managing endometriosis. The review included 17 studies involving a total of 1311 participants. The authors found that dietary interventions, such as increasing intake of fruits and vegetables, omega-3 fatty acids, and phytoestrogens, and decreasing intake of saturated and trans fats, were associated with improved pain and quality of life, and other symptoms of endometriosis.

Supplements

Similar to diet, supplements may be beneficial in managing endometriosis by reducing inflammation, promoting hormonal balance, and supporting immune system function. While it is best to focus on transitioning to an anti-inflammatory, antioxidant diet, targeted supplementation may enhance the effect in some cases. 

A randomized controlled trial published in the Journal of Reproductive Medicine in 2013 evaluated the effects of omega-3 fatty acids on pain and quality of life in women with endometriosis. The study included 59 participants who received either omega-3 fatty acids or a placebo. The authors found that omega-3 fatty acids were associated with a statistically significant reduction in pain intensity and improved quality of life.

A systematic review published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology in 2017 evaluated the effectiveness of magnesium for managing menstrual pain, including endometriosis-related pain. The review included 13 studies involving a total of 1870 participants. The authors found that magnesium was associated with a statistically significant reduction in menstrual pain intensity and duration.

The study mentioned above also evaluated the effectiveness of vitamin D for managing menstrual pain, including endometriosis-related pain. The review included five studies involving a total of 238 participants. The authors found that vitamin D was associated with a statistically significant reduction in menstrual pain intensity and duration. Vitamin D supplementation is often essential because even in sunbelt areas of the world, up to 30% of the population is deficient.  

It is important to note that supplements can have side effects and may interact with other medications, so it is essential to consult with a healthcare provider before using supplements for endometriosis. 

Herbal Medicine 

Herbal medicine, also known as herbalism, is the use of plants or plant extracts to treat or prevent disease. Many herbs have anti-inflammatory and pain-relieving properties, making them useful in managing endometriosis. While further research is needed to understand the effectiveness of herbal medicine for endometriosis fully, many women have reported positive outcomes from using herbal remedies as a complementary therapy.

Turmeric is one herb that has been suggested to effectively reduce inflammation and pain associated with endometriosis. Turmeric contains a compound called curcumin, which has potent anti-inflammatory effects. A randomized controlled trial published in the journal Complementary Therapies in Medicine in 2013 evaluated the effects of curcumin on pain and quality of life in women with endometriosis. The study included 67 participants who received either curcumin or a placebo. The authors found that curcumin was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Ginger is another herb that has been suggested to be effective in reducing inflammation and pain associated with endometriosis. Ginger contains compounds called gingerols and shogaols, which have anti-inflammatory and pain-relieving effects. A randomized controlled trial published in the journal Pain in 2014 evaluated the effects of ginger on pain and menstrual symptoms in women with endometriosis. The study included 70 participants who received either ginger or a placebo. The authors found that ginger was associated with a statistically significant reduction in pain intensity and an improvement in menstrual symptoms.

Chasteberry, also known as vitex, is an herb that has been suggested to be effective in regulating hormones and reducing symptoms of endometriosis. Chasteberry contains compounds that can help to balance estrogen and progesterone levels, which can help to reduce inflammation and pain. A systematic review published in the journal Complementary Therapies in Medicine in 2018 evaluated the effectiveness of chasteberry for managing endometriosis-related pain. The review included six studies involving a total of 596 participants. Chasteberry was associated with a statistically significant reduction in pain intensity and duration compared to no treatment in this study.

Just as in the case of supplements, work with an expert in the field to avoid interactions with prescription medications. 

Aromatherapy

Aromatherapy is a form of complementary therapy that involves using essential oils to promote health and well-being. Essential oils are concentrated plant extracts that are believed to have therapeutic properties. They can be used in several ways, such as inhaled, applied topically, or added to a bath.

While there is limited scientific research on the effectiveness of aromatherapy for endometriosis, some women with the condition have reported that it has helped to manage their symptoms. Aromatherapy may be particularly helpful for managing emotional symptoms, such as anxiety and depression, which are all too common. 

A short list of essential oils that may be helpful for women with endometriosis includes Lavender, Clary sage, Rose, Peppermint, and Eucalyptus. 

When using aromatherapy, it is important to dilute the essential oils with a carrier oil, such as coconut oil or almond oil, as they can be irritating to the skin when used undiluted. Aromatherapy should also be used with caution in women who are pregnant or breastfeeding, as some essential oils may not be safe for use during pregnancy or while breastfeeding.

Hyperbaric Oxygen Therapy (HBOT)

The theory behind using HBOT for endometriosis is that the increased oxygen levels in the body may help to reduce inflammation and promote the healing of damaged tissues. Some preliminary studies have suggested that HBOT may be effective in reducing pain and improving quality of life in women with endometriosis, although larger studies are needed to confirm these findings.

It is important to note that HBOT is not currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of endometriosis, and it should only be used under the guidance of a qualified healthcare provider. There are also some risks associated with HBOT, including ear pain, sinus pressure, and oxygen toxicity, which can be serious in rare cases.

Summary

By addressing both the physical and emotional aspects of endometriosis, integrative therapy can help women to achieve a better quality of life and attach some of the suspected root causes of endo as well. This can include improvements in energy levels, sleep quality, and overall sense of well-being.

Integrative therapy is not a replacement for conventional medical treatment for endometriosis but rather a complementary approach that can be used in conjunction with conventional treatments to achieve better outcomes. 

In conclusion, endometriosis is a complex condition that requires a multidisciplinary approach to treatment. Integrative therapy offers a promising addition to managing the symptoms of endometriosis by combining conventional medical treatments with complementary therapies that address the physical, emotional, and spiritual aspects of care. 

Your endometriosis specialist can help guide you to practitioners who may be best suited for applying integrative therapies to endometriosis. It is ideal if you can find a specialist who is also certified in some aspect of East-West integrative medicine. These are hard to find but are out there. 

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

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