Endometriosis Explained: An Integrative Overview & How Acupuncture Can Help

Endometriosis is a complex, chronic inflammatory disease that regularly pops up in the clinic. Although it affects hundreds of millions of people worldwide, endometriosis is still not well-understood — there is no known cause, no known cure, not even an international consensus on how to describe it (Lee et al, 2020)! Let’s take a look at what is known about endo, and how Traditional Chinese Medicine can help.

There are a wide variety of symptoms a person with endometriosis may (or may not) experience, to varying degrees of intensity. For some, these can be constant, debilitating and life-altering while others experience a cyclical nature to their symptoms. Some people have no symptoms at all! It can occur anytime within reproductive years, from menarche to menopause, and it is much more likely than not to affect people with a uterus.

Endometriosis can look like:

• Infertility
• Irregular periods
• Heavy periods
• Dysmenorrhea: painful periods
• Dyspareunia: pain during or after sex
• Dyschezia: pain with bowel movements
• Dysuria: pain with urination
• Back pain
• Leg pain
• Fatigue
• Digestive issues: nausea, bloating, food intolerances, constipation
• Anxiety, depression and low self-esteem
• Reduced capacity to work, go to school or perform extracurricular activities

From a Western Medical Perspective

It is understood that with endometriosis, cells from the inner lining of the uterus, or endometrium, grow in places outside of the uterus. Over time, these cells form tissues or lesions that can cause inflammation, pain and disrupt hormones. They are most typically found in the pelvis (think: ovaries, fallopian tubes, uterine walls and ligaments), though endometriosis has been found in other places in the body such as the lungs, kidneys and diaphragm. Although there is no confirmed cause, a few theories exist including retrograde menstruation (menstrual blood that did not fully exit the body during a period), gut dysbiosis, prolonged infections and epigenetics which may contribute to its formation. Because there is no cure, treatment focuses on reduction and management of symptoms through surgery and medications.

Traditional Chinese Medicine and Endometriosis

There is a strong need for further high quality research to understand endometriosis and its possible treatments. That said, there is actually already quite a bit of published research that suggests acupuncture and moxibustion, alone or in conjunction with conventional medical treatments, can help reduce the frequency and severity of pain, regulate hormones, improve blood flow and circulation, as well as digestive functioning — all commonly experienced symptoms of endometriosis.

For example, a 2023 systematic review of 15 randomized controlled trials examined the effects of acupuncture and moxibustion on symptoms and quality of life in endometriosis patients. They found manual acupuncture was more effective when compared to sham acupuncture at improving quality of life and reducing levels of pelvic pain, dyspareunia, dysmenorrhea and size of ovarian cysts. They also found that acupuncture and moxibustion in conjunction with conventional treatment was more effective than conventional treatment alone (Wang et al).

It is interesting to note that from a Traditional Chinese medical perspective, endometriosis lesions can also be caused by a variety of pathogenic factors, the most common being blood stagnation. Blood can stagnate in the pelvis due to a number of reasons, including qi stagnation, excess cold or an underlying deficiency, which, according to Zhao et. al’s research can happen from a number of factors such as chronic illness, genital infections, excess cold exposure, surgery, emotional stress and more (2012).

One of my favorite quotes from the Huangdi Neijing, or Yellow Emperor’s Classic, beautifully simplifies this concept of stagnation:

“When there is free flow, there is no pain; where there is pain, there is no free flow.”

This ancient wisdom reminds us that the key to treating pain is restoring movement of blood, of qi, in the body, mind and spirit. The tools of Traditional Chinese Medicine — acupuncture, moxibustion, herbs, nutrition and lifestyle adjustments, to name a few — work to restore this flow, addressing both the symptoms and the root causes of stagnation and offering a path toward balance and harmony in the body.

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Works Cited

Buggio, L., Barbara, G., Facchin, F., Frattaruolo, M. P., Aimi, G., & Berlanda, N. (2017). Self-management and psychological-sexological interventions in patients with endometriosis: Strategies, outcomes, and integration into clinical care. International Journal of Women’s Health, 9, 281–293. https://doi.org/10.2147/ijwh.s119724

Edmonds, K. (2022). Heal endo: An anti-inflammatory approach to healing from endometriosis.

Guo, Y., Liu, F., Shen, Y., Xu, J., Xie, L., Li, S., Ding, D., Zhang, D., & Han, F. (2021). Complementary and alternative medicine for dysmenorrhea caused by endometriosis: A review of utilization and mechanism. Evidence-Based Complementary and Alternative Medicine, 2021, 1–14. https://doi.org/10.1155/2021/6663602

Jones, M. (2024, August 29). Acupuncture for endometriosis — Heal Endo. Heal Endo. https://www.healendo.com/blog-1/2023/8/15/acupuncture-for-endometriosis

Lee, S., Koo, Y., & Lee, D. (2020). Classification of endometriosis. Yeungnam University Journal of Medicine, 38(1), 10–18. https://doi.org/10.12701/yujm.2020.00444

Li, P. S., Peng, X. M., Niu, X. X., Xu, L., Ng, E. H. Y., Wang, C. C., Dai, J. F., Lu, J., & Liang, R. N. (2023). Efficacy of acupuncture for endometriosis-associated pain: A multicenter randomized single-blind placebo-controlled trial. Fertility and Sterility, 119(5), 815–823. https://doi.org/10.1016/j.fertnstert.2023.01.034

Veith, I. (2015). The Yellow Emperor’s classic of internal medicine. https://doi.org/10.1525/9780520963245

World Health Organization. (2023, March 24). Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis

Zhao, L., Liu, B., Li, T. C., & Jing, Z. (2012). Treating endometriosis with the integration of traditional Chinese medicine and Western medicine. Journal of the Association of Traditional Chinese Medicine and Acupuncture (UK), 19(2). https://www.zhongjinguk.com/docs/Endomitriosis%20-%20Final.pdf