Issues: Endometriosis

Endometriosis is the name given to the condition where cells like the ones in the lining of the womb are found elsewhere in the body.

Each month these cells react in the same way to those in the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood has no way to escape. This causes inflammation, pain and the formation of scar tissue. Endometrial cells can migrate to other parts in the pelvis and on to other organs such as the bowel and bladder. Cells can attach to nerve endings and scar tissue can effectively stick internal organs and the pelvis together.

It is a chronic and debilitating condition that causes painful or heavy periods. It may also lead to infertility, fatigue and bowel and bladder problems. Around 1.5 million women in the UK are currently living with the condition. Endometriosis can affect all women and girls of a childbearing age, regardless of race or ethnicity.

Endometriosis can have a significant impact on a woman’s life in a number of ways, including:

  • Chronic pain at the site of the endometrial cells
  • Fatigue/lack of energy
  • Depression/isolation
  • Problems with a couple’s sex life/relationships
  • An inability to conceive
  • Difficulty in fulfilling work and social commitments

Current conventional treatment includes:

  • Combined oral contraceptive pill or contraceptive patch – sufferers are often encouraged to tri-cycle or only have a period once every 3 months.
  • Levonorgestrel-releasing intrauterine system (LNG-IUS) – such as the Mirena coil.
  • Gonadotrophin-releasing hormone (GnRH) analogues – which induces a medical and temporary menopause. This is normally combined with HRT.
  • Progestogens – which aims to prevent or slow down the growth of the endometrial lining.
  • Keyhole surgery via a laparoscopy (2 incisions into your stomach) is used to confirm the condition and endometrial implants are removed via cutting or ablation.
  • A hysterectomy is seen as the final option if you have tried everything else. Surgeons will try to keep your ovaries unless they are comprised so that women continue to have the hormonal protection. However, leaving the ovaries means that endometriosis can return. If the ovaries are removed there is the added complication that HRT is not really appropriate as oestrogen will encourage regrowth of any endometrial cells that haven’t been cut away during surgery.

Adenomyosis is a condition that often goes hand in hand with endometriosis, especially if women have had multiple abdominal surgery or caesarean sections. This is where the endometrial cells move into the wall of the womb. Therefore, a sufferer with both conditions will have a monthly bleed in the womb, in the wall of the womb and outside of the womb.

 

For those women who have tried conventional medicine or don’t want to take multiple drugs then alternative therapies, changes to diet and yoga can be beneficial.

Yoga for endometriosis

As the symptoms of endometriosis vary from woman to woman and can change during the month then the yoga ‘prescription’ needs to alter depending on what the women is presenting with. You also need to be careful not to undertake inversions when the woman is menstruating as you don’t want to encourage and further retrograde menstruation which is thought, by some, to be a cause of endometriosis in the first place.

Painful periods and cramping

Balasana/child’s pose 

This posture opens the back and hips. It can help relieve cramping, soothe anxiety, and release tension. If the woman is presenting with really bad cramps you can advise taking the legs more apart, supporting the head with their hands, block or rolled up blanket and using a hot water bottle wrapped in a towel or blanket that can be placed under the stomach. This is really soothing.

Baddha Konasana/Bound Angle Pose

This posture helps to open the hips and stretch the groin and inner thighs. It stimulates the abdominal organs and circulation in the pelvic area. It helps relieve painful cramps.

Supta Baddha Konasana/Reclined Bound Angle Pose

This posture can be very relaxing in a supported version, using blocks and blankets to relieve and pressure in the hips and lower back. It reduces stress, calms the mind and increases mobility in the hips.

Pelvic pain

Malasana/garland pose 

This posture is great when experiencing pelvic pain. It opens up the pelvic area and helps ease pain and increase circulation. If the woman is having trouble balancing or feel pain in the knees, put a soft yoga block or blanket beneath their bottom.

Scar tissue

My experience with scar tissue in my abdomen from a hysterectomy is that backbends feel great.  You often feel the scar tissue ‘shortening’ or pulling you down and instinct makes you want to arch your back.

Salabhasana/Locust Pose

This posture improves strength and flexibility in the back muscles, stretches the front of the body and stimulates the abdominal organs. Be careful if the woman has painful cramping. A folded blanket underneath the torso may help

Ustrasana/Camel Pose

This posture opens the belly, chest, heart, shoulders and upper back. It stretches the whole front of the body including ankles, thighs and groin. You can also use this posture if the woman has leg pain associated with endometriosis – it often affects one leg and causes nerve pain.

Lower back ache

Twists stretch the tissues and stimulate the liver, which can be beneficial for endometriosis. They may not be comfortable if the woman is menstruating. Again, these feel great if scar tissue is shortening.

Marichyasana/Marichi's Pose

This posture keeps the spine healthy and mobile. It stimulates and strengthens the muscles around the ribs and back. Many women with endometriosis have digestion and bowel problems and this posture massages the abdomen which may help with digestion and elimination.

Leg pain

Viparita Karani/legs up the wall pose 

Many endometriosis suffers have period pain that travels into their legs. This posture helps to improve the flow of blood to the pelvic region, refresh tired legs, and relive lower back pain. Again, you can also add a hot water bottle wrapped in a blanket if stomach cramping is an issue. A rolled blanket under the lower back and flat blanket under the head can be used for additional support.

General balancing of hormones

Salamba Sarvangasana/ Supported Shoulder stand

Only to be practised when not menstruating. This posture is particularly beneficial to women with endometriosis as it helps to balance the endocrine system. For those new to yoga – this is too extreme, and Setu Bandha Sarvangasana/Bridge Pose is a good starting point.

Salamba Sirsasana/Supported Headstand

Again, this posture is only to be practised when not menstruating. It’s a great one as it improves your mood and makes you feel like you can take on the world. Something you need when you are suffering with endometriosis. Again, for those who are new to yoga – this is too extreme and Forearm Adho Mukha Svanasana/Dolphin pose will start the process.

External websites

The following websites can help you and give you more in-depth information:

Endometriosis UK

Endometriosis Org

NHS