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Endometriosis: an Ayurvedic perspective
Endometriosis is a gynecological condition in which endometrial cells from the lining of the uterus appear outside the uterus in the pelvic cavity. The main theory for how this happens is ‘retrograde menstruation’, or the movement of endometrial debris upward through the Fallopian tube instead of downward through the vagina.
From a western medical perspective it is unclear what causes this to happen, but these wayward growths of endometrial cells (known as ‘implants’) can be found on the ovaries, the Fallopian tubes, the outside of the uterus itself, other organs or the peritoneum (lining of the abdominal cavity).
Even though they are outside the uterus, these implants function and respond to hormones just as they would if they were inside the uterus. They therefore bleed at the time of menstruation. This localized accumulation of blood causes inflammation and swelling, which can in turn cause scar tissue and adhesions to form.
The most common symptom of endometriosis is pelvic pain. Pain is often worse around menstruation but can occur throughout a woman’s cycle. Women may also experience pain during sex, pain in the lower back and thighs and pain while voiding their bowels or bladder. It is important to note that the degree of pain is not necessarily an indication of the severity of the condition.
A high percentage of women with endometriosis also have endometriosis-associated infertility. It is unclear why this occurs, but it is suspected that adhesions may change the shape or function of the ovaries, Fallopian tubes or uterus, and hormonal and chemical changes may occur that affect female fertility.
In western medicine there is no cure for endometriosis, but it may be managed using anti-inflammatory and pain medication, hormonal treatments and surgery to cut away or ablate (burn) the implanted endometrial tissue. In the case of longstanding severe endometriosis that has not responded to previous repeated treatments or surgery in women experiencing ongoing severe chronic pain, a hysterectomy (removal of the uterus) and the removal of one or both of the ovaries and Fallopian tubes (a salpingo-oophorectomy) may be recommended.
The Ayurvedic View
From an Ayurvedic point of view, retrograde menstruation takes place as a result of disturbed vata dosha. When looking at an Ayurvedic model of physiology, there are five sub-types of vata that govern and direct all movement in the body, in five directions: upwards, downwards, inwards, outwards and around.
One of the most influential of these is apana vata. Apana vata is the downward moving wind that is in charge of initiating all elimination impulses—including urination, bowel motions, ejaculation, childbirth and menstruation.
Keeping in mind that for the most part apana is busy removing waste or unwanted materials from the body, if it is interrupted or obstructed for some reason, this will begin to create problems. In the case of endometriosis it begins (to a greater or lesser degree) to move upward instead of downward. This means that a portion of the endometrium that should be passed out during menstruation is also propelled upward through the Fallopian tubes and into the peritoneal cavity.
The obstruction and subsequent upward movement of apana vata can occur for several reasons.
Most commonly it is due to ama (toxins or undigested food waste) that accumulates in the channels and prevents the normal downward flow. Ama can cause obstruction alone or can become associated with pitta dosha (causing heavy, thick, congested menstrual blood) or kapha dosha (causing thick, sticky, fluid or mucous secretions), that also block apana’s preferred course. Disturbed vata can also create dryness, which in turn creates tension and contraction in the channels, resulting in vata effectively blocking its own movement.
This blockage of vata dosha creates pain, so painful menstruation (dysmenorrhoea) is naturally the most common symptom of endometriosis.
More inflammation, heavy bleeding and loose bowel motions can be attributed to associated pitta involvement, and more swelling, heaviness and slimy mucous-like blood can be attributed to kapha. As the condition progresses, more inflammation (pitta) will cause more pain, and scar tissue and adhesions (kapha) will develop.
The other causes of aggravated apana vata include: eating too much cold, dry, rough, bitter, astringent or pungent foods (including an excess of raw foods); excessive dieting, fasting or colonics; excessive exercising; irregular schedules or meal times; excessive traveling; constant multitasking and rushing around; lack of sound sleep; excessively cold or dry environments; taking drugs; excessive stimulation and movement; and suppression of the 13 urges (urination, defecation, ejaculation, yawning, sneezing, vomiting, hunger, thirst, breathing, crying, sleep, farting and belching).
But, the single greatest cause of disturbed apana vata is mental stress. This can be general mental tension, excessive mental activity, mental over-stimulation, overwork, emotional stress, grief, fear or anger. All of these will cause apana’s movement to become more chaotic, erratic or stuck.
Another cause that must be mentioned separately is overwork or excessive physical activity during menstruation. Menstruation is a time of elimination, of ama and excess pitta being removed from the body. As such, women need to rest as much as possible for at least the first three days of their periods to ensure apana vata moves in the right direction and can carry out its role effectively. It is particularly important for women who practice rigorous yoga to avoid their usual sequence during menstruation and stick to a very gentle, restorative practice.
As always in Ayurveda, treatment involves removing the cause. In the case of endometriosis, there are four main aspects to focus on:
1) Balancing vata
2) Balancing pitta
3) Strengthening agni
4) Eliminating ama
Calming and stabilizing apana vata is definitely the most important of these. Although there are many diet and lifestyle recommendations, herbal medicines and treatments to help with this, one of the best remedies is learning to care for the mind. Learning how to slow down and cultivate calm and steadiness is key. Without this essential medicine it is impossible to pacify a vata disturbance in the body/mind. Approaches to working with the mind such as those of Ayurvedic psychology and of mindfulness can help enormously.
In the case of endometriosis, in which one of the most debilitating aspects is chronic pain, learning to relate to pain in a different way can be very helpful, so that the inevitable growing fear of pain does not further aggravate apana vata. Many research studies have now confirmed the benefits of simple mindfulness practice in the management of chronic pain.
The second best remedy for aggravated apana vata is REST. Some Ayurvedic teachers recommend women to rest for at least 20 mins a day, for a longer period once a week and then a day or more if possible each month (on the first day of their menstruation, if still menstruating). For women with endometriosis, regular rest is even more important.
Introducing a vata- and pitta-pacifying, agni-promoting and ama-eliminating diet is also recommended. Favor warm, light and slightly oily, fresh, home-cooked meals. Avoid dry, cold, excessively heating or fermented foods. Particularly avoid alcohol, caffeine (especially coffee), carbonated drinks, red meat and refined sugar or flour. Red wine, chili, coffee and red meat (all very heating) should be the first things to go.
As mentioned, women should avoid exercise during menstruation and should keep their exercise relatively moderate throughout the month. Forms of exercise that regulate the flow of vata and nourish the nervous system—such as walking, swimming, Tai chi, QiGong and some forms of yoga—are great!
Regularity in daily routine (going to bed and waking up at a similar time each day, and keeping regular meal times) is very important for calming aggravated vata, as is regular self-abhyanga (warm oil massage—always excellent in conditions of excessive dryness).
Specific Ayurvedic herbal remedies are used to alleviate pain, break up any blockages, reduce inflammation, stem heavy bleeding, reduce the accumulation of endometrial tissue outside the uterus and reduce any scar tissue that has formed.
If the individual is strong enough, the most effective and direct form of treatment is to engage in an Ayurvedic cleansing and rejuvenation program involving:
– virechan, or purgation (for directly removing excess ama and pitta); and
– basti, or medicated enemas (for removing ama and rectifying/stabilizing the movement of vata).
Such a program should be specifically designed for the individual and closely overseen on a daily basis by a trained Ayurvedic practitioner. Ayurveda’s approach to cleansing and rejuvenation is unique amongst all traditional medical systems. It uses the body’s natural forms of elimination to cleanse disease-causing agents (including excess doshas and ama) from the deepest tissues and channels of the body, without causing further aggravation to the body/mind. Throughout such a program, specific lifestyle and dietary recommendations must be followed to ensure the five sub-types of vata move in the right directions and to help maintain a balanced digestive fire. Any in-depth cleansing regime is then followed by a period of rejuvenation to rebuild digestive, immune and tissue strength.
Ayurveda and western medicine can work hand in hand to help women with this debilitating condition. Even if you have turned to western medicine to help manage the symptoms of endometriosis, and even if you have had surgery or are considering surgery in the future, simple Ayurvedic dietary, lifestyle, herbal and physical remedies can help prevent any recurrence by addressing the deepest causes of endometriosis.
As always, if you are in any doubt about your health please be sure to consult an Ayurvedic practitioner or your local health physician.