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Understanding Endometriosis: Endometriosis is a mostly hidden disease that has doctors foxed. Although it runs in families, no one really knows what causes it or why some women with only a mild form suffer excruciating symptoms, while others have a severe form but no symptoms. The disease means that patches of the endometrial tissues, normally found only in the lining (endometrium) of the uterus, also grow outside the womb. One theory is that the cells involved, which mimic cancer but are not cancerous, migrate from the uterus and attach themselves to other parts of the body, where they continue to grow. Another suggestion is that they are not womb-lining cells but began as ones that later mutated because of an error in their genetic programming. This most commonly occurs in the ovaries, the ligaments supporting the uterus, the Fallopian tubes, the bladder and the bowel. Less commonly, endometriosis may be found on the outer surfaces of the small and large intestines, the ureters (tubes leading from the kidneys to the bladder), on the bladder itself, in the vagina or around abdominal surgical scars. The disease can very rarely occur in the lungs. Conventional diagnosis is difficult because even using a technique such as laparoscopy, in which the abdominal cavity is inspected through a fibre-optic tube inserted through a small incision at the navel, in many cases the endometriosis cannot be seen. Often the first clue a doctor has, especially if there are no obvious symptoms, is when a woman complains of infertility. But for most sufferers, the symptoms are obvious and painful. Since endometrial tissue responds to the same hormones as the uterus does at menstruation, the sufferer has the same cramping pains, bleeding and irritation that are a familiar part of a normal menstrual cycle. Imagine agonising period pains that spread throughout the abdominal cavity and you understand why some women with severe endometriosis faint with pain. Orthodox treatment is with drugs that all have unpleasant side-effects. According to Merck Manual of Medical Information, danazol, one of the most common treatments, can lead to weight gain, acne, a lowered voice, hot flashes, vaginal dryness, muscle cramps, bleeding between periods, mood swings, hair growth, liver malfunction and carpal tunnel syndrome. Complementary health has no magic cure, but action can be taken to manage the symptoms and alleviate the pain. Dian Mills is a qualified nutritionist and endometriosis sufferer who works at the Centre for Nutritional Medicine in London. She has investigated how nutrition can help women to cope with the condition; she says the starting point should be the digestion. "A lot of women with endometriosis have been given antibiotics and may now have irritable bowel syndrome, which will affect the absorption of nutrients that could otherwise help," she says. "Many have been misdiagnosed - pelvic inflammatory disease, say - and so may have taken antibiotics that have disrupted their digestive tracts." After prescribing probiotic supplements to help to restore good digestion, together with digestive enzymes, Mills recommends an increase in essential fatty acids. These contain prostaglandins, which have an anti-inflammatory action and can provide pain relief. The two best sources of prostaglandins are evening primrose oil and fish with teeth, such as salmon and mackerel. Most endometriosis sufferers leave Mills's clinic with strict instructions to cut out caffeine, chocolate and alcohol, which can exacerbate the condition. Sufferers are also told to switch to a healthier diet supplemented by a good multivitamin, magnesium (which helps to relax the uterus and muscular tissue) and, if they are trying to conceive, zinc, which is essential for the optimum health of the ovaries. Mills recommends aiming for at least six portions of fresh fruit and vegetables each day; these should include two dark green varieties and two red ones. These will provide bioflavanoids, which can relieve heavy menstruation. Women with endometriosis have high levels of oestrogen. This makes the B vitamins important as well because they help to generate the liver enzymes that can convert oestrogen in the form of oestradiol - which causes the endometrial cells to proliferate - into a safer form called oestriol, which can be excreted. Citrus fruits, which can irritate the digestive tract, should be avoided and replaced with berry fruits, which have an anti-inflammatory action. The usual food intolerance culprits also need to be investigated, says Mills. She adds that, in her experience, wheat intolerance causes constipation, and intolerance to dairy produce causes diarrhoea. The third treatment step is to support the reproductive system. But since nutrients that do this best - including zinc and vitamins C and E - can also have an adverse effect on conventional drugs that sufferers are taking, this is not something they should try on their own. Mills says her goal with any new client is to eliminate period-type pains. She adds that she can usually help sufferers to achieve this in two or three months. Many sufferers report higher energy levels, clearer skin and better overall health. Researchers are also investigating the benefits of Chinese herbs. A project being undertaken by Herbal Research, a Kent-based company, came about by accident when an endometriosis sufferer at the company took a different product to treat a severe case of flu. To her astonishment, the product tackled the flu, and also produced her first pain-free menstrual cycle for years. Having monitored the woman over several cycles, the company has formulated a product that is being tested on a number of women. The remedy, a combination of 16 herbs, is said to relieve pain, break down oestrogen so it can be excreted, and clean up the liver. In this trial stage, it also includes an antibacterial and antiviral element, since these have not been ruled out as factors that can exacerbate an underlying problem with endometriosis. The new Herbal Research preparation for endometriosis will be available from August. The makers do not claim that it will cure the condition, but it has been shown to offer significant relief from pain. Susan Clark is health journalist of the year
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