Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. It is a painful condition that occurs when the tissue that normally lines the uterus grows outside the uterus, often in pelvic and abdominal areas were it is not supposed to grow. Endometriosis is a leading cause of infertility -- up to 40 percent of women with this condition are unable to conceive. It is a precursor to ovarian cancer, women with endometriosis are more likely to have ovarian cancer in the future compared with women who do not have endometriosis.

Endometriosis can result in substantial illness, including pelvic pain, multiple operations, and infertility. Approximately only half of women with endometriosis get pain relief from existing medical or surgical treatments. Medical treatments usually are directed at inhibiting estrogen action or its production from the ovaries and do not address local estrogen biosynthesis by the aromatase enzyme in endometriotic lesions. A single gene encodes aromatase, which is the final enzyme in the estrogen biosynthesis pathway, and its inhibition effectively eliminates estrogen production. Some previous studies have indicated that women with endometriosis may not develop strong bones, but a newer report shows that the condition does not increase the long-term risk of suffering a fracture.

Diet and food
Women who eat lots of tuna, salmon and other foods rich in essential omega-3 oils might be less likely to develop endometriosis than those whose diets are loaded with trans fats. The type of fat in a woman's diet, rather than the total amount, may be a risk factor. A study of more than 70,000 American nurses found that women who ate the most omega-3 fatty acids were 22 percent less likely to be diagnosed with endometriosis than women who ate the least. Women who ate the most trans fats had a 48 percent increased risk of the condition compared with those who ate the least. Trans fats increase the body's level of many inflammatory markers. Dr. Stacey Missmer of Brigham and Women's Hospital and Harvard Medical School in Boston, looked at the diets of 70,709 women followed for 12 years in the U.S. Nurses Health Study. The types of fats the nurses ate were broken down into five categories and the researchers looked to see who later developed endometriosis. Over the course of the study, 1,199 women did. Most of the omega-3 fatty acids eaten by the nurses came from full-fat salad dressing, followed by fatty fish like tuna, salmon and mackerel. Walnuts and flaxseeds are also considered good sources.Omega-3 fatty acids, considered essential for good health, can lower heart disease risk. The major sources of trans fats in the study were fried foods from restaurants, margarine and crackers. Published online in the journal Human Reproduction, 2010.

We analyzed 12 years of prospective data from the Nurses' Health Study II that began in 1989. During follow-up, 1199 cases of laparoscopically confirmed endometriosis were reported. Although total fat consumption was not associated with endometriosis risk, those women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake. In addition, those in the highest quintile of trans-unsaturated fat intake were 48% more likely to be diagnosed with endometriosis. These data suggest that specific types of dietary fat are associated with the incidence of laparoscopically confirmed endometriosis, and that these relations may indicate modifiable risk. Hum Reprod. 2010. A prospective study of dietary fat consumption and endometriosis risk. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Hankinson SE. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

What a woman eats can influence her risk. Endometriosis occurs when endometrial tissue, which normally lines the uterus, grows elsewhere in the pelvis. New research indicates that women who eat the most green vegetables or fresh fruit have a reduction in risk for endometriosis, while those who eat the most beef or ham have an increased risk.. While endometriosis is relatively common, little is known about its cause. Dr. Fabio Parazzini from the University of Milan, Italy, and colleagues surveyed 504 women with endometriosis, and 504 age-matched "controls" regarding their dietary habits. The risk was significantly reduced among women with the highest intake of green vegetables (a 70-percent risk reduction) or fresh fruit (a 40-percent reduction), the researchers report, and significantly increased among women with the highest intake of beef and other red meat (a doubling of risk) and ham (a 1.8-fold increase).

Women who consume more fatty acids such as those found in fish oils are less likely to have this condition, whereas women who eat more trans fats are more likely to have symptoms. Hum Reprod. 2010. A prospective study of dietary fat consumption and endometriosis risk. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Natural and alternative remedy with herbs and supplements
Chinese herbal medicine may offer a natural treatment for endometriosis. In a review of two small clinical trials, researcher Andrew Flower, of the University of Southampton in the UK found that a particular combination of traditional Chinese herbs worked as well or even better than two conventional hormonal therapies for endometriosis. Among treatments for endometriosis are prescription medications that alter women's hormone levels to prevent new scar tissue and relieve pain. However, they can come with side effects -- including acne, unwanted hair growth and menopause-like symptoms like hot flashes. Chinese herbalists randomly assigned women to take either an herbal mixture known as Nei Yi Wan or a hormonal therapy called gestrinone after undergoing surgery to remove abnormal tissue growths. The herbal therapy was given both orally and by enema. After three months of treatment, women in the herb and gestrinone groups showed similar improvements in their symptoms and their chances of becoming pregnant over the next two years. But while the herbal remedy showed no significant side effects, gestrinone caused acne in 13 of the 49 women treated, and infrequent menstrual periods in 31 women. The second study by Andrew Flower compared Nei Yi Wan with danazol, a medicaiton that blocks estrogen secretion. After three months, women in both groups reported symptom improvements, but those who took the herb orally and by enema showed greater improvements in painful periods, and a greater reduction in abnormal tissue growths. One possible mechanism is that the herbs may help regulate pelvic blood flow, as well as influence immune system activity and inflammation. Cochrane Library, 2009.

Endometriosis symptom and sign
Pain is the major clinical problem, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia.

Endometriosis occurs when the tissue lining the uterus, the endometrium, begins to grow and shed in places outside of the uterus, such as the pelvis and intestines, as well as the fallopian tubes, ovaries and other areas. When this tissue is shed during the menstrual cycle, the condition causes premenstrual pain, painful and heavy periods, and sometimes infertility.
    Pregnant women with endometriosis are at increased risk for delivering prematurely as well as suffering a number of other adverse pregnancy outcomes.

Endometriosis treatment
The medical treatment of endometriosis is a critical aspect of the therapeutic approach to this disease. The main purpose of the current medical treatment of endometriosis is to create an amenorrheic state, in other words, to create a hypoestrogenic environment by suppressing estrogen secretion of the ovary. Current research has focused upon medications designed to attack specific aspects of the development and maintenance of endometriosis. This includes progesterone receptor modulators, gonadotropin releasing hormone (GnRH) analogs, aromatase inhibitors and, tumor necrosis factor alpha (TNFalpha) inhibitors, angiogenesis inhibitors, matrix metalloproteinase inhibitors and estrogen receptor beta agonists like inmunomodulators. These drugs show decreased spreading of lesions and reduced disease related symptoms. Medical treatment is moderately effective in reducing pain but ineffective in improving fertility; a combination of medical treatment with assisted reproductive technology may be beneficial in improving fertility.
     Women who undergo laparoscopic resection of bilateral endometriomas will experience ovarian failure after the procedure in 2 to 3 percent of the cases. Laparoscopic resection is considered the first-line treatment for endometriotic ovarian cysts, but recent reports have suggested that it may diminish ovarian reserve. For women with unilateral endometriosis, this would not necessarily be a problem since the intact ovary could compensate. For women with bilateral disease, however, laparoscopic resection could, in theory, cause ovarian failure.

Use of aromatase inhibitors
Successful treatment of refractory endometriosis-related chronic pelvic pain with aromatase inhibitors in premenopausal patients.
Eur J Obstet Gynecol Reprod Biol. 2009. Women's Hospital, Leicester Royal Infirmary, Leicester, UK.
The objective of this study was to determine the efficacy and side effects of aromatase inhibitors in the treatment of premenopausal patients with endometriosis associated with chronic pelvic pain refractory to conventional treatment. Four premenopausal patients with documented refractory endometriosis and chronic pelvic pain were treated with aromatase inhibitors, either anastrazole or letrozole, for 6 months. The treatment was combined with calcium 1.5g per day and vitamin D 800 U per day. Side effects were documented and changes in serum LH, FSH and 17-beta estradiol and bone density (Dexa scan) were measured before, during and after treatment. There was marked improvement in pelvic pain in the four patients. One patient with infertility conceived immediately after completing the treatment. There were no changes in the hormone levels and bone scan scores. The most common side effect was irregular bleeding with anastrazole and joint pains with letrozole. Aromatase inhibitors are beneficial in premenopausal women with chronic pelvic pain secondary to refractory endometriosis without compromising fertility and with minimal side effects. Further cohort and comparative studies are needed to confirm these observations.

Progestin treatment
The progestin dienogest is as effective as the gonadotropin-releasing hormone agonist buserelin for symptoms of endometriosis, with less reduction in bone mass. Dienogest also inhibits cytokine secretion from endometriotic stromal cells. Dr. Tasuku Harada, at Tottori University School of Medicine, Yonago, randomized women in a double-blind, double-dummy manner to treatment with oral dienogest 1 mg after morning and evening meals or to intranasal buserelin spray 300 µg every morning, noon and evening. The two drugs were equally effective in relieving all five documented symptoms during nonmenstruation - lower abdominal pain, lumbago, defecation pain, dyspareunia, and pain on internal examination. Fewer patients in the dienogest group reported hot flushes and more reported genital bleeding, due primarily to spotting or breakthrough bleeding, which resolved over time. Fertility Sterility April, 2009.

Endometriosis and GnRH hormone - Endometriosis and pregnancy
For women with endometriosis who undergo assisted fertilization procedures, treatment with a hormone that decreases the body's production of testosterone and estrogen a few months before the procedure quadruples the chance of successful pregnancy. Dr. Hassan Sallam, from Alexandria University in Egypt, and colleagues used medical databases and reports from major reproductive medicine meetings to look for studies that used pretreatment with gonadotropin-releasing hormone (GnRH) agonists as a way to improve pregnancy rates in endometriosis patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Three trials with a total of 165 women were included in the analysis. Women pretreated with a GnRH agonist were 4 times more likely to become pregnant than their untreated peers. Moreover, the results of one of the studies indicated a 9 fold increase in the live birth rate with use of this strategy.

Bladder endometriosis
Women who have endometriosis around the bladder can suffer from the urge to urinate, frequent urination, vulvar pain, urge incontinence, and painful urination. In fact, the symptoms of bladder endometriosis mirror interstitial cystitis.

Menopause
In many cases menopause ends the activity of mild or moderate endometriosis. Even after radical surgery or menopause, however, endometriosis can be reactivated by estrogen replacement therapy.

Cause of endometriosis, association, contributing factor
Dr. Dan I. Lebovic, of the University of Michigan Health System, Ann Arbor,  says a contributing factor in the development of endometriosis might be a defect in the immune system's ability to clear retrograde menstrual flow. HE examined the association between endometriosis and periodontal disease using data from 4,136 women who were enrolled in the National Health and Nutrition Examination Survey from 1999 to 2004. Women with endometriosis had a 57 percent increased risk of having gingivitis and periodontitis compared with women without endometriosis, the researchers report. Periodontal disease is the infection and inflammation of the gums, tissues and bone around the teeth. Autoimmunity has also thought to play a role in the development of periodontal disease. Fertility and Sterility, February 2009.

Benzophenones are widely used in sunscreens and other products because they protect against UV light. They are associated with an increased risk.

Endometrial cancer
Animal-derived foods increase the risk of endometrial cancer, while foods from plant sources reduce it.

Endometriosis natural treatment questions
I was diagnosed with endometriosis. Will chrysin aid in balancing my hormones?
   We have not seen any research regarding this condition and chrysin.

I have been diagnosed with severe endometriosis can i take acai or goji juice as a treatment?.
   We have not seen any research regarding the use of goji or acai juice or supplements for as a natural treatment.