Ayurvedic Approaches to Treat Endometriosis: A Comprehensive Review

POOL INTO THE WORLD OF ENDOMETRIOSIS

"A powerful woman builds a strong society."

To have a strong society, the woman herself should be physically and mentally fit. She is the creator of the future generation. Compared to men, a woman is subjected to various physical and anatomical changes throughout her life during puberty, pregnancy, delivery, and menopause and is prone to various ailments pertaining to her reproductive organs. 

INTRODUCTION

Endometriosis is a benign chronic estrogen-dependent painful gynecological condition that affects woman in their reproductive age and is one of the major causes of growing infertility.

WORD DERIVATION

 The word endometriosis is a word derived from  the Greek  word

·       Endo means  ''inside'',

·       Metra means ''uterus''

·       Osis means "disease"

LAYERS AND FUNCTIONS  OF THE UTERUS

·       Perimetrium-outer protective layer reduces friction

· Myometrium- middle layer- thickest layer- consists of smooth muscle which expands during pregnancy

· Endometrium- inner layer lining of the uterus, which gets shredded off during the periods.

What is endometriosis?

It is explained as retrograde menstruation or the presence of endometrial-like tissue outside of the uterine cavity.

What is its  incidence?

It affects 1 in 10 women in the reproductive stage

Where are its common sites?

·        Ovaries,

·       Uterine ligaments

·       Recto vaginal septum

·        Pelvic peritoneum

·       Large, small intestine

·       Diaphragm

·       Umbilicus

·       Appendix

·       Scars after laparotomy, hernia sac, etc.

What are the causes pertaining to endometriosis?

The precise cause is not very clear yet. There are various theories explaining the same, which are mentioned below.

·       Implantation theory

·       Genetic theory

·       Cellular Metaplasia theory

·        Immune deficiency theory

·        Lymphatic theory

·        Blood born spread theory

·        Hormones-oestrogen

·        Retrograde menstruation/reverse menstruation

·       Stem cells can give rise to the disease, which then spreads through the body via blood and lymphatic vessels.

·       Blood or lymph system transport:

·       Direct transplantation.

·       Transformation.

What are its SYMPTOMS?

·       Painful  periods

·       Painful intercourse

·       Painful urination and bowel evacuation.

·       Chronic  pelvic  pain, 

·       Low  backache,

·       Abnormal uterine bleeding- heavy/scanty/ prolonged

·       Fatigue, diarrhea, constipation, bloating, or nausea

·       Infertility

What are the common Treatments available in Western science?

·       Hormonal therapy-like birth control pills, Gonadotropin-releasing hormone (GnRH) medication, Danazol , IUD

·       Pain management- NSAIDS, painkillers

·       Surgery-laparoscopy or laparotomy

·       Lifestyle changes(diet,exercise,stress management)

What is the AYURVEDIC CONCEPT of endometriosis?

Endometriosis is very difficult to bring this ailment into one disease category of Ayurvedic diagnosis, and there is no direct explanation found in the classics. Acharya Charaka himself has clearly mentioned that it is not always possible to name disease in a definite term. It should be understood by factors like dosa dusya etc.

Acharyas have beautifully explained all  the problems pertaining to female reproductive organs under the context of YONIVYAPAT

Importance and role  of APANA VATA

·       One among the 5 types of Vata Dosha

·       Physiological entity

·       Active in the pelvic region.

·       Governs the physiological process like Micturition, Defecation, Menstruation, and childbirth.

NIDANA

·       Ahara- Katu and LaghuAhara like dry leafy vegetables, 

·       Heavy fried, oily food intake

·       Incompatible food

·       Excessive Non-veg intake and junk food

·       Tikta and RukshaAhara

·       KashayaPradhanaDravya,

·       overeating and irregular eating, fasting

VIHARA

·       Excessive  coitus, 

·       Sedentary lifestyle

·       excessive journey,

·       day sleep,

· Suppression of natural urges

Dhatu Kshaya forms the Viharaja causes.

Pradushta Artava (abnormal hormonal imbalance leading to various menstrual patterns)

Bijadosa and Daiva (idiopahic causes)

PATHOGENESIS

Ayurveda says the Arthava (complete reproductive organ with menstrual blood)as the upadhathu formed from rasa dhatu(the first body tissue formed after metabolism)

Due to the above-mentioned causes, there is the formation of AMA which is endotoxins or toxic metabolic formation leading to malabsorption commencing from rasa dhatu, altered immune response in the reproductive system leading to excessive endometrial growth.

Ama by nature causes  Shrotorodha in the Artavahasrotasha, leading to Vata Dosha Prakopa and Vatadosha Vimarggaman can contribute to the exacerbation of endometriosis symptoms. Because of the normal dysfunction of apana vata, there is a retrograde or reversal menstrual spill leading to endometrial growths implanting in different areas outside the uterus.

Dosha        :  TRIDOSHAJA

Dushya      :   Rasa, Rakta.

Srotas        :   Artavavaha Srotas.

Srotodusti    :   Vimargagamana

What are the dos and don'ts (PATHYA AND APATHYA)?

·       Avoid white flour, curd, white sugar, eggs, chicken, processed food, refrigerated food, fermented,alcohol, and carbonated drinks

·       Less oily, less spicy , warm, light fresh food should be consumed.

·       Avoid physical exercise during menstruation and maintain moderate exercise on the rest of the days.

· Don't suppress your natural urges.

· Get sufficient sleep of 7-8 hours.

·       Practise yoga and pranayama.

Are any yogas recommended ??

·       Supta Matsyendrasana

·       Ananda Balasana

·       Bhujangasana

·       Balasana

·       Malasana

·       Paschimottanasana

·        Baddha Konasana (Butterfly pose)

·       Viparita karanai (legs-up-the-wall)

·       Yoga Nidra

SINGLE DRUG FOR UTERINE HEALTH.

·       satapushpa

·       sathavari

·       lasuna

·       Ashoka

·       Guduchi

·       Lodhra, 

·       arjuna,

·       daruharidra

AYURVEDIC LINE OF TREATMENT

·       Nidana parivarjanam first line of treatment is  to avoid the causative factors

·       Agni Deepanam- Improving the metabolism

·       Aam Pachan- Correction of digestion and metabolism with medication

· Shrotoshodanam- removing the channel blocks

·       To maintain the proper function of Apanavayu.

·       Sodhana and samana

·       Sodhana means cleansing 

·       Vata Anuloman-Channelizing vata with Panchkarma like Abhyangam, Vasti(medicated enemas), uttara vasti,snehapanam, vamanam, virechanam, yonipichu, lepanam, local dhara, etc

·       SAMANA CHIKITSA focuses on treating mainly Vata Dosha. Treatments involving Granthi, Shophara and Raktaprasada should be given, which include internal medicines to pacify the aggravated dosas like sukumaram ks,sapthasaram ks,manjistadi ks varanadi ks,gulgulupanchaphal choornam,sukumara gritham,varanadi gritham,kalyanaka ksharam, etc

· Finally,Rasayan Chikitsa treatment to avoid remissions and also to keep the reproductive organ healthy.

CONCLUSION

Ayurvedic treatment is tailored specifically to the individual's body constitution and the imbalance by addressing the root cause of the disease promoting long-term healing. The treatment for endometriosis focuses on a holistic approach, considering not just the physical symptoms but also emotional, mental, and lifestyle factors. Following a proper dinacharya(daily regime) and ritucharya(seasonal regime) will reduce these kinds of gynecological disorders to a major extent.

What is the retrograde menstruation theory in endometriosis?

During a typical menstrual cycle, the filling of the uterus thickens to prepare for a potential pregnancy. However, the filling shanties and is expelled from the body through the vagina as menstrual blood, If gestation doesn’t do. In the retrograde period, still, this process doesn't do entirely as anticipated. Rather of all the menstrual blood flowing out of the body, some of it — on with endometrial cells — flows backward through the fallopian tubes into the pelvic depression. This backward inflow happens because the usual passage for the menstrual blood( the cervix and vagina) is blocked or dammed in some way, allowing some blood and endometrial towel to inflow in the contrary direction.

What Happens After Retrograde Flow?

Once these endometrial cells enter the pelvic depression through the fallopian tubes, they can implant on organs and apkins similar as The ovaries The external face of the uterus The fallopian tubes The bowel The bladder These endometrial cells that are now outside the uterus act also to the cells inside the uterus — they respond to hormonal signals during the menstrual cycle by thickening, breaking down, and bleeding. Still, since there's no way for the towel to leave the body, it causes inflammation and vexation, leading to pain and the conformation of scar tissue ( adhesions) and excrescencies( like endometriomas in the ovaries). Over time, this habitual vexation and inflammation can lead to other complications, including fertility issues. 

Are Candida and endometriosis linked?

There is no direct, proven link between Candida and endometriosis, but they may be connected due to shared factors like inflammation, immune system dysfunction, and hormonal imbalances. Both conditions involve inflammation, and Candida overgrowth can worsen symptoms of endometriosis. Additionally, hormonal changes, particularly high estrogen levels, may contribute to both conditions.

Can lifestyle changes cure endometriosis?

No, lifestyle changes cannot cure endometriosis. Endometriosis is a chronic condition with no known cure, but lifestyle changes can help manage the symptoms and improve your quality of life. These changes may reduce pain, inflammation, and discomfort, but they won’t make the condition go away completely.

Is there a link between Ehlers-Danlos syndrome and endometriosis?

Yes, there is a potential link between Ehlers-Danlos syndrome (EDS) and endometriosis. People with EDS, especially the hypermobile type, may have a higher risk of developing endometriosis. This is because EDS affects the connective tissues in the body, making them more flexible or fragile, which can lead to issues in the pelvic area where endometriosis typically develops.

While the exact cause of the connection isn’t fully understood, both conditions can involve chronic pain, inflammation, and issues with connective tissues, which might make symptoms worse if both are present.

So, while EDS doesn't directly cause endometriosis, if you have EDS, you may be more likely to have endometriosis as well.