Abstract
Endometriosis is a heterogenous, and oestrogen dependant inflammatory disease that is characterised by morphological and biologically active endometrium (composed of endometrial-type glandular tissue and stroma), that is present in sites outside of the uterine cavity. The disease is complex in nature with the implantation of tissue occurring due to phenomena known as retrograde menstruation. While this is considered central to the pathogenesis of endometriosis, 90% of women that experience this event do not have endometriosis, while the remaining 10% of this population do have endometriosis. The role of the immune system may explain why some women develop endometriosis and why others don’t. Alterations in the immune system (Increased TNF-α, PGE2 and reduced NK cells) have been proposed to play a key role in the establishment of endometrial implants and sustained its growth and development. In order to treat aspects of immunity, it is important to improve relative oestrogen excess which triggers a pro-inflammatory cascade and to regulate immune system abnormalities. With continued unopposed oestrogens, the immune system will not regulate, so this must be a primary treatment aim. Prostaglandin synthesis must be regulated to ensure normal uterine function, healthy flow of menstruation and reducing pain experienced. Key herbs that help address inflammation, immune alterations and oestrogen clearance include Turmeric, Echinacea, Green tea, Caledula and Gotu cola. These herbs have multi-factorial actions that address the underpinning pathology of endometriosis and help rectify and improve reproductive function.
Highlights
Endometriosis is a heterogeneous, and oestrogen dependant inflammatory disease that is characterised by morphological and biologically active endometrium, that is present in sites outside of the uterine cavity [1]
The disease is complex in nature with the implantation of tissue occurring in the first instance due to phenomena known as retrograde menstruation first described by Sampson in 1927 [5]
It has been shown that alterations in the endometrial and peritoneal cell adhesion molecules (CAMs) facilitate the binding of retrograde menstruated endometrium [8]
Summary
Endometriosis is a heterogeneous, and oestrogen dependant inflammatory disease that is characterised by morphological and biologically active endometrium (composed of endometrial-type glandular tissue and stroma), that is present in sites outside of the uterine cavity [1]. The disease is complex in nature with the implantation of tissue occurring in the first instance due to phenomena known as retrograde menstruation first described by Sampson in 1927 [5] While this is considered central to the pathogenesis of endometriosis, 90% of women that experience this event do not have endometriosis, while the remaining 10% of this population do have endometriosis [6,7]. There are a number of sites in the body that produce oestrogen supporting the inflammation in endometriosis, including; Oestradiol (E2) secreted by the ovary reaches endometriotic tissue through the circulation, Follicular rupture during ovulation causes spillage of large amounts of E2 directly onto endometrial implants that are in the pelvis, Aromatase in adipose tissue catalyses the conversion of circulating androstenedione to oestrone (E1) that is subsequently converted to E2 form – which can enter the circulation and reach endometrial tissue. Alterations in cellular immunity together with inflammation allows for the retrograde endometrial cells to invade and survive in foreign sites outside of the reproductive system
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