Endometriosis
Endometriosis
An Integrated Overview of Pathophysiology, Treatment Perspectives, and Lifestyle Guidance
1. What Is Endometriosis?
Under normal circumstances, endometrial glandular cells line the inside of the uterus. During each menstrual cycle, these cells respond to hormonal changes by thickening, shedding, and exiting the body through the vagina as menstrual flow.
Endometriosis occurs when tissue with similar characteristics appears outside the uterus, such as in the ovaries, fallopian tubes, pelvic cavity, rectum, or bladder.
A helpful way to visualize this is:
Endometrial cells can be thought of as a “lost expedition team,” settling in places where they do not belong, digging in, invading surrounding tissue, and triggering local inflammation and structural changes.
2. Why Can Endometriosis Cause Pain and Infertility?
1️⃣ Structural Changes and Adhesions
Normally, immune cells within the abdominal cavity are responsible for engulfing and breaking down misplaced endometrial tissue and menstrual blood, followed by tissue repair. However, this repair process often leaves behind irreversible scar tissue (fibrosis).
Repeated injury and repair in the same area may lead to:
Adhesions
Altered pelvic anatomy
Ovaries becoming encased by surrounding tissue
Loss of the fallopian tubes’ natural flexibility and ability to “capture” the egg
These changes may interfere with ovulation, conception, and may also cause pain during sexual activity.
2️⃣ Immune Dysregulation and Chronic Inflammation (Western Medicine Perspective)
From a Western medical standpoint, endometriosis is closely associated with chronic inflammation driven by immune system dysregulation, not merely the presence of tissue in the wrong location.
When peritoneal macrophage function is impaired:
Retrograde endometrial tissue is not adequately cleared
White blood cell levels increase within the pelvic cavity
Inflammatory mediators and stromal secretions accumulate
This results in an environment rich in inflammatory and toxic substances, which is highly unfavorable for implantation, fertility, and tissue healing.
3. Menstruation as a Signal From the Body (Traditional Chinese Medicine Perspective)
In Traditional Chinese Medicine (TCM), menstruation is viewed as a monthly reflection of the body’s internal state.
When the flow of qi and blood is impaired, it may manifest as:
Painful menstruation
Excessive or scanty menstrual flow
Irregular cycles
If these signals are repeatedly ignored, small localized stagnations may gradually accumulate into larger, more entrenched blockages, potentially progressing into conditions such as endometriosis.
4. Core TCM Understanding of Endometriosis
1️⃣ External Cold and “Cold-Induced Constriction”
In TCM theory, cold has a constricting nature that impairs circulation.
Common contributing factors include:
Consuming cold foods or drinks during menstruation
Prolonged exposure to cold environments
Wind-cold infections
Washing hair during menstruation
Frequent or excessive use of pain medications
These factors may cause menstrual blood to stagnate or be inadequately discharged, potentially contributing to retrograde flow into the pelvic cavity and worsening endometriosis-related symptoms.
2️⃣ Emotional Stress and Disruption of Qi Flow
Chronic emotional stress—such as irritability, anxiety, anger, grief, or resentment—may impair:
Digestive (spleen–stomach) function
Blood circulation
Immune regulation
This internal imbalance can increase susceptibility to the development or progression of endometriosis.
5. Different Approaches to Assessing Disease Severity
🔹 Western Medicine
Severity is typically assessed based on:
Extent of ectopic lesions
Number of organs involved
Depth of invasion (e.g., deep infiltrating endometriosis affecting the rectum)
🔹 Traditional Chinese Medicine (Perspective of Dr. Lai Rong-Nian)
TCM often distinguishes two stages:
Qi-Level Disorder (Early Stage)
Symptoms are present, commonly dysmenorrhea
No obvious structural changes detectable by imaging
Western diagnostic tests may appear normal
Treatment is often evaluated in three-month phases
Blood-Level Disorder (Advanced Stage)
Structural or organic lesions are present
Ectopic tissue can be identified via Western diagnostic methods
Treatment typically requires at least six months or longer
6. Diagnostic Limitations
Currently, there is no reliable blood test to definitively diagnose endometriosis
Laparoscopic surgery remains the gold standard for confirmation
TCM diagnostic methods (observation, listening, inquiry, palpation) cannot formally diagnose endometriosis as a Western medical entity
An ideal clinical approach is:
Western medical diagnosis → TCM-based treatment and regulation
In TCM, endometriosis is often described as involving “blood heat,” which does not imply elevated blood temperature, but rather localized congestion, inflammation, and tissue expansion.
7. Treatment Duration, Expectations, and Goals
Endometriosis is not an easily treated condition.
Early-stage (qi-level) intervention may offer a higher likelihood of improvement or stabilization
Long-standing disease often requires long-term management and realistic expectations
⚠️ Conservative minimum treatment duration estimates
Qi-level stage: at least 3 months
Blood-level stage: at least 6 months
(these represent bare minimums; actual treatment often takes longer)
Treatment goals should be clearly defined, such as:
Supporting fertility
Reducing pain and improving quality of life
Managing bleeding or other symptoms
Different goals require different therapeutic strategies.
8. How TCM May Provide Support
TCM approaches may include:
Acupuncture and moxibustion
Pulse diagnosis and pattern differentiation
Herbal medicine commonly used in gynecology
These approaches may help:
Modulate immune responses
Regulate menstrual cycles
Support fertility-related concerns
Improve overall physical and emotional resilience
Because many patients exhibit a pattern of blood heat with mixed cold and heat, excessive or prolonged use of tonifying herbs is generally discouraged, as it may exacerbate inflammation.
9. Important Notes on Surgical Treatment and the Role of TCM
It is important to clarify that:
If the primary goal is complete removal of established ectopic lesions, Western medical surgical intervention (such as laparoscopic surgery) is often required.
The role of TCM in endometriosis is typically focused on:
Constitutional regulation
Reducing inflammation
Symptom management
Supporting recovery before and after surgery
Assisting fertility when appropriate
However, in early-stage, qi-level cases without significant structural damage, there may be an opportunity for meaningful improvement or clinical stabilization using TCM alone, without immediate surgical intervention. This depends on individual response and requires careful follow-up.
10. Lifestyle and Exercise Guidance
Prolonged sitting and lack of physical activity may impair pelvic circulation, making it more difficult for inflammatory substances and retrograde menstrual material to disperse, potentially worsening symptoms.
Regular, moderate exercise may be beneficial by:
Improving pelvic blood circulation
Supporting clearance of inflammatory mediators
Maintaining tissue mobility and reducing discomfort related to adhesions
Enhancing overall resilience and well-being
Low-impact, gentle activities (such as walking, stretching, or yoga) are generally recommended. High-intensity or strenuous exercise should be avoided. Any activity causing significant pain or discomfort should be stopped immediately.
11. Mental–Emotional Health and Daily Care
Dr. Lai Rong-Nian emphasizes that, for women experiencing infertility, post-treatment lifestyle habits, emotional regulation, and daily self-care are critically important.
A stable psychological and emotional state may help the body return to a more balanced condition, potentially supporting fertility.
👉 Even subtle menstrual abnormalities should not be overlooked.
References
IVF Taiwan:
https://www.ivftaiwan.com/share-detail/endometriosis-suggestion/Lai Rong-Nian, Good Pregnancy Is Not Too Late (好孕不遲到)