Q: I have really horrible, painful periods. Ibuprofen doesn't even touch them. Help!
-Alley Z., New York
A: Run-of-the-mill menstrual cramps are caused by clots of tissue (the monthly shedding of the uterine lining, called the endometrium) pushing through the muscular cervix at the base of the uterus. I prefer 500-1,000 mg of magnesium two to three times daily during the five days before you expect your period. However, more severe pain that doesn't respond to heat or other muscle relaxants may be a condition called endometriosis.
Endometriosis affects some 15-20 percent of women aged 25-40, so it is actually quite common. There are several different theories as to what exactly causes it, including using tampons and having sex during menstruation. Another theory proposes that peritoneal (abdominal lining tissue) cells can transform into endometrium under certain hormonal influences. There also may be genetic factors, since it tends to run in families.
Once endometrial tissue has escaped from the uterus, it can establish itself in many other places in the body. First, it tends to cluster around the ovaries, which are located at the ends of the fallopian tubes. The escaped endometrial tissue can travel far afield, however, and has been found throughout the abdomen, around the lungs, and even on the retinas. At the appointed time each month, all this endometrial tissue bleeds. Ectopic (outside where it's supposed to be) endometrial bleed is usually painful. Pain can occur with intercourse, with bowel movements and urination, and with exercise, and it can be felt in the lower back, abdomen, and pelvis.
Some women can experience "silent" endometriosis, which mysteriously does not cause pain. The diagnosis can be confirmed by laparoscopic exploration. Many women choose to have the ectopic endometrial tissue cauterized surgically so it no longer bleeds. This is a good option, but not always definitive. Pregnancy can sometimes "cure" endometriosis-if pregnancy is desired, and can be achieved.
Diet can sometimes play a role in the development and treatment of endometriosis. One study involving 500 women with laparoscopic-confirmed endometriosis and 500 control subjects without the disease showed that those who consumed the lowest amounts of fresh fruits and vegetables had a 40 percent greater chance of developing endometriosis. This study also found an 80 percent increased risk in women who ate high amounts of beef and other red meats. Estrogen promotes endometriosis and most commercially raised livestock are fed estrogen to "beef" them up.
Since endometriosis is mitigated by hormones-and many pollutants are endocrine disruptors-environmental factors must be considered. Women are advised to minimize their exposure to plastics, bisphenol A, parabens, phthalates, pesticides, dioxins, PCBs, solvents, formaldehyde, and chlorinated water, as well as fried foods which are typically made with poor quality carbs and oils. Endometriosis has been induced experimentally with exposure to dioxin (a chlorine by-product) and has been linked with exposure to many toxic chemical pesticides and herbicides.
Easing Estrogen Overload
Conventional treatment of endometriosis usually begins with estrogen suppression, which prevents the endometrium from growing. Drugs such as danazol, Lupron, or Arimidex are used, along with NSAIDs to decrease inflammation. Laparoscopic cautery is the next step, with hysterectomy being reserved for severe cases.
A naturopathic doctor will also guide the patient in reducing estrogen, which stimulates endometrial growth, while increasing progesterone and androgens, which promote endometrial atrophy. However, naturopathic approaches are tailored to the individual because there is a great variety in how endometriosis presents.
Natural estrogen blockers include plants from the genus Brassica (cabbage, cauliflower, broccoli, bok choy, and kale), as well as a concentrate called DIM (di-indole methane). Flaxseed, fish oil, soy products (especially soy nuts), red clover, and the Chinese herb dong quai (use 1 tsp. of tincture, three times daily) increase the breakdown of estrogen in the body. An effective traditional Chinese medicine formula for endometriosis is Da Huang Zhe Chong Wan.
Nutritional and Herbal Support
Nutrition is always a foundation of naturopathic care-helping the patient commit to eating vibrant, fresh foods, while minimizing refined carbs and poor quality fats. An important approach to hormonal management is helping the liver, the major organ of detoxification and hormone recycling. First, reduce the liver's toxic burden by avoiding alcohol and other drugs. Then begin a liver-supporting regimen. There are many effective ways to support the liver, including a low-estrogen diet (avoid red meat for starters), castor oil packs, milk thistle, dandelion, gentian, and other bile-stimulating herbs. Milk thistle products should be standardized to contain therapeutic amounts of silymarin-I recommend 150-200 mg three times daily for people who weigh 150-200 pounds.
Nature also provides many analgesics, anti-inflammatory foods, and herbal medicines that have extremely low side-effect profiles. Examples of natural analgesics include valerian, cramp bark, kava, Jamaican dogwood, ginger, magnesium, calcium, white willow bark, and meadowsweet. Supplements that help reduce inflammation include quercetin, boswellia, fish oil, turmeric, and Pycnogenol. Shepherd's purse is a marvelous herb for slowing bleeding-whether menstrual or a nosebleed.
Editor's note: For more information, visit endometriosisassn.org.