Supporting endometriosis patients with natural post-surgery care

by Jade Walker BHSc, Clinical Naturopath in Reproductive Health.

Reproduced with permission from the author. First published by the ANTA in the “Natural Therapist Journal” article of the same name. This post is sponsored by Khapregesic® [ka-pra-geez-ic] a new fast-acting natural pain & anxiety reliever. Combining plant-based anti-inflammatories and antioxidants, with prebiotics for a calmer gut and fast-acting pain relief. If you need to book a consultation, please make an appointment with Jade here.

Important notice: Be sure to talk to your healthcare professional if your endometriosis or pain symptoms are severe. 

Background

Endometriosis now affects 1 in 9 Australian women[1]. The gold standard to receive a diagnosis is still invasive laparoscopic surgery of which there are around 34,000 endometriosis-related hospitalisations annually.

Endometriosis can have a devastating effect on the quality of life of sufferers due to the painful symptoms that the disease carries and the fact that it is the biggest cause of infertility in women. 

Given its prevalence, complementary medicine and dietary modifications can play an important role in improving the patient’s experience with post-surgical healing and prevention of further growth.

[1] Australian Government Research 2019: https://www.aihw.gov.au/news-media/media-releases/2019/august/first-national-report-shows-1-in-9-australian-wome

My Story My Clinic

As a Naturopath with endometriosis, I have experienced its full array of challenges; the GP dismissals, an unsuccessful laparoscopy at 21 years of age, hospitalisations from significant dysmenorrhoea, and a 17-year road to a diagnosis at 29, this is a condition you can say I am more than passionate about. 

Unfortunately, I’m not alone. Diagnosis and management of endometriosis is complex and there is no known cure.

In my clinic, I now see people with endometriosis on a weekly basis and not one patient is the same. One may have stage 4 endometriosis and experience no pain, whilst one may have stage 1 endometriosis and have debilitating pain every day of the week. For some, they will respond really well to herbal medicines and key dietary changes. For others, you can throw the whole book at them, and you barely touch the sides.

Common Misconceptions

Unfortunately, there are still some common misconceptions amongst our profession about how we should support endometriosis. Often people assume that you should avoid surgery, saying things such as “surgery will make it worse” or “you’ll just end up with more adhesions”. Whilst that can be true for some poorly performed surgeries, and surgery always comes with its risks, this advice is ill-informed. 

Video: IGTV recorded by Jade Walker outlining natural products that can manage the pain of endometriosis. For the full video visit Jade’s Instagram @jadewalkerhealth

Endometriosis diagnosis

Figure 1: A Laparoscopy is the only way to truly confirm endometriosis

Firstly, a laparoscopy is the only way to truly confirm endometriosis.

For many, that diagnosis can be a validating and relieving experience. There are some highly skilled specialists who can pick up some forms of endometriosis on a transvaginal ultrasound. However, many types of endometriosis won’t be detected using this non-invasive method. Thus, telling someone they do or don’t have endometriosis off the back of an ultrasound alone, is incorrect (and unfortunately, I still see this happen all too often).  

Secondly, the surgeon makes all the difference to the patient’s outcomes. The one thing that would have sped up my diagnosis, had I known at 21 years of age, was understanding just how important this factor is. 

There are many gynaecologists who perform laparoscopies who can identify the classic “chocolate cysts” and other visually obvious lesions. But not all gynaecologists have added several years of further training to become an “advanced trained excision surgeon in endometriosis”

There are two key differences. One is that they understand how to identify some of the more inconspicuous looking lesions and explore deeply in and around all organs. Another being that they use excision surgery as opposed to ablation.

 

Think of ablation like burning off a mole; you only get the top, meaning it can grow back. Meanwhile excision is like cutting the root of a mole and all of its surrounds. It’s the same principle with endometriosis. Excision surgery can make a significant difference to the time in between further surgeries, or ever needing another one at all. Again, endometriosis can significantly vary in severities, and thus some need several surgeries, whilst one might only need one.

 

Supporting patients’ post-surgery

What is just as important as the excision of endometriosis, is supporting the patient’s healing, reducing pain, and correcting imbalances that could be enabling the condition. 

Reducing pain

Combining natural analgesics, anti-inflammatories and warming circulatory stimulants is key. Corydalis, californian poppy, black haw, cramp bark, cinnamon, turmeric and ginger are just some of the most commonly used herbs. A new herbal pain reliever that is showing promise as being highly effective is Khaya senegalensis, which is currently only found in the aptly named fast-acting formula “Khapregesic” by BioActive Natural Health.

As Khapregesic comes in tablet form, patient compliance is greatly increased as they can take it to replace or reduce the need for over-the-counter pain medications such as paracetamol or NSAIDs, without the abrasive side effects on the GI tract from the NSAIDs. Also be mindful when it comes to recommending paracetamol. Often seen as a benign analgesic, recent research says that “even taking one or two more tablets than recommended can cause serious liver damage and possibly death.” Accidental paracetamol overdose is one of the leading causes of liver failure.[1]

Furthermore, as nausea is also a common complaint with both dysmenorrhoea and post-surgery, liquid herbs may not always be appropriate.

Palmitoylethanolamide (PEA) is also another promising product that can act on both acute and chronic pain, which can in some ways serve as an alternative to CBD oil. It goes without saying that high doses of magnesium bis-glycinate or citrate must be used daily. Magnesium citrate can provide the added benefit of softening the stools as constipation is common post-surgery after using opiates. Acupuncture can also be a great adjunct to the patient’s care plan if finances permit.

[1] Researchers shed new light on how paracetamol causes liver damage – British Liver Trust

Preventing further growth

Key treatment aims in endometriosis include modulating the immune system, reducing inflammation, correcting gut flora imbalance (dysbiosis) and supporting detoxification pathways. This must be commenced immediately post-surgery.

Studies have found those with endometriosis have a higher presence of gram-negative bacteria, specifically, endometriosis appears to be associated with an increased presence of Proteobacteria, Enterobacteriaceae, Streptococcus and Escherichia coli across various microbiome sites[1], and thus lipopolysaccharides (LPS) in the peritoneal fluid promoting early endometrial-peritoneal interactions[2].

In addition to promoting early endometrial growth, LPS has been proven to drive up inflammation and disrupt the immune response[3].

These gram-negative bacteria translocate from a dysbiotic gastrointestinal tract, thus treating the gut with products such as berberine, probiotics, calcium-D-glucarate and gut healing nutrients should be the first priority.

Interestingly, the newly rediscovered traditional medicine herb Khaya senegalensis, a strong natural COX-2 inhibitor is also rich in prebiotics and has been shown to help with IBS, which is a common comorbidity with endometriosis sufferers. Other clinically trialled essentials include using daily N-acetyl cysteine, curcumin, and immune supporting nutrients such as Vitamin D and zinc.

[1] Scientists reviewed a series of papers up to May 2019 sourced via: https://www.researchgate.net/publication/335434619_Endometriosis_and_the_microbiome_a_systematic_review

[2] Lipopolysaccharide promotes early endometrial-peritoneal interactions in a mouse model of endometriosis https://pubmed.ncbi.nlm.nih.gov/31064958/

[3] Chronic Niche Inflammation in Endometriosis-Associated Infertility https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121292/

Can a patient avoid surgery by using natural medicine?

Given how much endometriosis varies, there is no hard and fast answer as to whether or not someone could avoid surgery. However, you may also meet some patients who do not wish to have surgery, which is why the majority visit a natural therapist. 

For patients who present with some small non-obstructive lesions, natural medicine can provide a path to avoid surgery, which I will get to in a moment. However, for some forms of endometriosis, there is no herb or massage technique that will free up several adhesions sticking the bowels together or obstructing tubes. If patients fail to respond to natural medicine, the gold-standard for diagnosis, laparoscopic surgery should be recommended.

Contact your GP or Endometriosis Australia for more information regarding endometriosis diagnosis [1]

[1] https://www.endometriosisaustralia.org/about-endo 

Is there a non-invasive alternative to a laparoscopy?

 As we look into alternatives to a laparoscopy, we need a specialist to also determine how severe the endometrial adhesions are?

A transvaginal ultrasound and pelvic exam with a skilled specialist will at least be able to get a sense of what’s going on. For example, my first appointment with my surgeon, before surgery, involved him having a feel “up there” and seeing if the left or right side felt hitched up, feeling for how mobile the organs were. A transvaginal ultrasound can also provide some clues, however, in isolation these tests should not be relied on for a final diagnosis for endometriosis. 

 

Key strategies to adopt

So what are some of the key strategies you can adopt with your patients to avoid surgery?

As always, determine what your patient’s key priorities are. For some it’s only the dysmenorrhoea often accompanied with painful intercourse (dyspareunia).

For some it’s menorrhagia, looking out for athletes and the physically fit as research has confirmed that close to one third of female athletes suffer heavy bleeding leading to anaemia and fatigue [1]. It should be noted further that 20% of those with menorrhagia have a blood clotting disorder[2] which can be tested through their GP. 

For others it’s fertility or the dark shadow of infertility as endometriosis is the leading cause of infertility. Always start your patient’s key priorities to give them peace of mind, then move on to finding relief as soon as possible. Just by using key analgesic and anti-inflammatory herbs like those mentioned, NAC, supporting gut health, and adopting an anti-inflammatory diet you could make a profound difference without the need for surgery in those mild cases. 

For more daily education on natural medicine for endometriosis, you can follow @jadewalkerhealth or @khapregesic on Instagram or join Facebook groups, “Natural Medicine for Endometriosis”, “PCOS/Endometriosis Natural Support Group” or “Endo Diet support group & Natural remedies – Endometriosis”. 

[1] Recent Australian research confirmed that close to one third of female athletes suffer heavy bleeding leading to anaemia and fatigue: M.Amour, et al, “Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present”, International Journal of Sports Science & Coaching”, https://doi.org/10.1177/1747954120916073

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878476/ 

Jade Walker BHSc is a Naturopath with a special interest in endometriosis and reproductive health. After a long battle with debilitating dysmenorrhoea and navigating a health care system that was not set up for recognising endometriosis, it took her 17 years to finally get a diagnosis. Jade now dedicates her online practice to helping people across Australia find a better quality of life with endometriosis and other reproductive conditions. Jade can be found at www.jadewalkerhealth.com or @jadewalkerhealth on Instagram.

The makers of Khapregesic® BioActive Natural Health, source their plant material from a sustainable Certified Organic Australian farm. Khapregesic® is available for purchase at www.khapregesic.com.au   

Important notice: Be sure to talk to your healthcare professional if your endometriosis or pain symptoms are severe.  

Khapregesic®

Khapregesic® [ka-pra-geez-ic] is the non-drug alternative for a range of menstrual related pains and anxiety symptoms. It combines plant-based anti-inflammatories and antioxidants with prebiotics for a calmer gut and fast-acting pain relief.