Exploring a Western Herbal Medicine
Approach to the Treatment of
Endometriosis
By
Jane Ramsden
2011
‘Research’ holding the torch of knowledge (1896)
Herbal Medicine BSc. (Hons.)
Faculty of Health & Social Science
LEEDS METROPOLITAN UNIVERSITY
1
Table of Contents
Contents
Page Number
Table of Contents.........................................................................................
i - iii
List of Tables and Figures...........................................................................
iv
Abstract........................................................................................................
v
1. Introduction ..........................................................................................
1
1.1 Background ...........................................................................................
1
1.2 Aims ......................................................................................................
2
1.3 Objectives .............................................................................................
2
2. Literature Review .................................................................................
3
2.1 Background............................................................................................
3
2.2 Methodology..........................................................................................
3
2.3 Selection criteria....................................................................................
4
2.3.1 Key words................................................................................
4
2.3.2 Exclusion criteria.....................................................................
4
2.4 Limitations............................................................................................
4
2.5 Historical Background to Endometriosis..............................................
5
2.6 Impact of Endometriosis on Women.....................................................
5
2.7 Allopathic Approach to the Treatment of Endometriosis......................
7
2.8 Allopathic Research Associated with Endometriosis............................
8
2.9 The Western Herbal Medicine Approach to the
Treatment of Endometriosis...........
9
2.10 Western Herbal Medicine Research and Endometriosis.....................
12
2
3. Methodology.........................................................................................
15
3.1 Introduction.............................................................................................. 15
3.2 Secondary Research................................................................................. 15
3.3 Primary Research..................................................................................... 15
3.3.1 Primary data collection............................................................... 15
3.3.2 Research Instrument Design....................................................... 16
3.3.3 Questionnaire (A) – Endometriosis sufferers............................. 16
3.3.4 Questionnaire (B) – Western Medical Herbalists....................... 17
3.4 Piloting the Research Instrument............................................................. 17
3.5 Sampling Strategy.................................................................................... 18
3.6 Conducting the Research......................................................................... 20
4. Results......................................................................................................
21
4.1 Data analysis............................................................................................ 21
4.2 Section1: Results from Questionnaire (A) to Endometriosis sufferers.... 21
4.2.1 Respondent’s Profile................................................................... 21
4.2.2 Symptoms associated with Endometriosis.................................. 22
4.2.3 Allopathic treatment with medication and Surgery.................... 22
4.2.4 Alternative therapies to alleviate symptoms of Endometriosis... 22
4.2.5 Treatment by an Herbalist or Self Treat...................................... 23
4.2.6 Herbs used by sufferers of Endometriosis................................... 24
4.2.7 Length of herbal treatment and effectiveness.............................. 25
4.2.8 Symptom relief............................................................................ 26
4.2.9 Herbal Medicine and Allopathic medication............................... 27
4.2.10 Recurrence of Endometriosis Post surgery................................ 27
4.3 Section 2: Results from Questionnaire (B) to Western Medical
Herbalists................................................................................ 28
4.3.1 Respondents Profile..................................................................... 28
4.3.2 Treatment of Endometriosis by Herbalists.................................. 29
4.3.3 Endometriosis and Infertility....................................................... 30
3
4.3.4 Case study to identify herbs used to treat Endometriosis............ 31
4.3.5 Identification of key herbs in a prescription................................ 32
4.3.6 Additional Comments from Herbalists........................................ 33
5. Discussion.................................................................................................. 37
5.1. Introduction.................................................................................... 37
5.2 Literature review............................................................................. 37
5.3 Questionnaire (A) - Endometriosis sufferers.................................. 38
5.4 Questionnaire (B) - Western Medical Herbalists............................ 39
6. Conclusion................................................................................................. 41
References
Illustration: Research Holding the Torch of Knowledge by O.L. Warner, (1896).
Bibliography
Appendices
Appendix 1: Word-processed questionnaires:
Questionnaire (A) – Sufferers of Endometriosis
Questionnaire (B) – Western Medical Herbalists
Appendix 2: Online questionnaires (SurveyMonkey):
Questionnaire (A) – Sufferers of Endometriosis
Questionnaire (B) – Western Medical Herbalists
Appendix 3: Full Results from Questionnaire (A)–Sufferers of Endometriosis
Appendix 4: Full Results from Questionnaire (B)–Western Medical
Herbalists
Appendix 5:
A List of 82 herbs identified by a sample of Western Medical
Herbalists to treat a Case Study of Endometriosis
4
List of Tables
Table
Page Number
Table 1: Symptoms of Endometriosis and indicated herbal actions
10
Table 2: Diet and Supplement recommendations for Endometriosis
11
Table 3: Breakdown of herbs within herbal mixture - Weiser et al 2009
13
Table 4: A List of Forums on which Questionnaire (A) was posted
19
Table 5: Herbs used by women suffering from Endometriosis
24
Table 6: Cross reference of Figure 5 and Figure 6 correlating time with
efficacy of treatment
26
Table 7: Top 15 herbs indicated for use with a Case History of Endometriosis
31
Table 8: Top 15 herbs indicated for use in a Prescription of Endometriosis
34
List of Figures
Figure
Page Number
Figure 1: Endometriosis sufferers - Number of Children of Respondents
21
Figure 2: Questionnaire (A) - Symptoms experienced by sufferers
22
Figure 3: Alternative therapies used to alleviate symptoms of endometriosis
23
Figure 4: Did you consult with an Herbalist or self treat?
24
Figure 5: Length of time respondents took herbal medicine
25
Figure 6: Effectiveness of Herbs in Treating Endometriosis
26
Figure 7: Symptoms herbal medicine was effective for
27
Figure 8: Recurrence of symptoms following surgical treatment?
28
Figure 9: Institution where Herbalists received their qualification
29
Figure 10: Have you treated endometriosis in your practice
29
Figure 11: Number of cases of endometriosis treated by Herbalists
30
Figure 12: Cases of endometriosis which involved infertility
30
5
ABSTRACT
Endometriosis is a gynaecological condition conservatively affecting 10% of the female population.
The global call for research into this debilitating condition has resulted in well documented
advances covering associated physiological pathways and diagnostics.
Identification of early
diagnostics may lead the way to recognition of treatment pathways for herbs to achieve positive
outcomes with minimal side effects. Allopathic medicine cannot cure this condition but there is
mounting evidence which suggests that Western medicinal herbs may be used effectively for
treatment.
This study explores the Western Medical Herbalist’s (WMH’s) approach to the treatment of
endometriosis, aiming to highlight a wide range of herbs, their actions and chemical constituents.
To achieve this, a questionnaire was sent to registered WMH’s to gather knowledge about treatment
strategies. Results demonstrated that as well as prescribing herbs, tailored to suit the needs of the
individual, close attention was paid to diet and lifestyle.
An online questionnaire was sent to sufferers of endometriosis to learn of their experience of using
herbs and how effective they were at treating symptoms. Results highlighted a direct correlation
between the length of time herbs were taken and efficacy.
The conclusion reached by this study was that Western herbal medicine may not be able to cure
endometriosis but it may be possible to alleviate symptoms and improve quality of life. Many
sufferers favour a combination of herbal medicine and diet as alternative therapy to treat symptoms.
6
Introduction
1.1 Background
Endometriosis has been the subject of research since it was first described in 1860; however
there is still no definitive explanation of the aetiology and pathogenesis of this dysplastic
disease (Roth-Kauffman 2009). It is acknowledged to be the most frequent cause of pelvic pain
in women of reproductive years and has been conservatively estimated to affect between 6-10%
of the female population (Oehmke et al 2009). Symptoms which may be experienced include
chronic pain, dyspareunia, fatigue and infertility (Evans 2006). The impact on quality of life is
seen in many areas with evidence of professional, social, physical, emotional and psychological
consequences. Additionally there is an economic impact with employees providing either a
reduced performance at their place of work or having to take time off (Oehmke et al 2009).
Conventional medicine cannot cure endometriosis although drug therapy is available which
may alleviate some symptoms.
Surgery includes laparoscopic ablation and hysterectomy
however as many as 50% of women undergoing invasive procedures experience a recurrence of
symptoms at 1 year follow-up (Vercellini et al 2009).
Growing evidence suggests that
Western medicinal herbs may be used effectively for the treatment of endometriosis which will
improve the quality of life for sufferers and delay invasive surgery (Wieser et al 2009).
Consequently there is global interest in establishing definitive research into this degenerating
condition, to establish early diagnostic techniques and identify effective treatment.
This study aims to explore the Western Medical Herbalists’ approach to treating endometriosis
including the identification of individual herbs and why they have been selected. A literature
review aims to highlight the current allopathic and Western herbal medicine focus for research
in this area. As part of this study, women with a confirmed diagnosis of endometriosis were
asked to complete a questionnaire to assess their experience of treatment by herbal medicine.
The objective is to provide clarity and a depth of knowledge amongst Herbal Practitioners and
expand the existing knowledge base for the benefit of endometriosis sufferers and conventional
medical professionals.
7
1.2 Aims
To explore the Western herbal medicine approach to the treatment of endometriosis.
1.3 Objectives
 To provide an overview of literature regarding allopathic and Western herbal medicine
treatment methods and research trends into the condition of endometriosis.
 To investigate and analyse the experiences of women with a confirmed diagnosis of
endometriosis who have used Western Herbal Medicine to manage their symptoms.
 To investigate and analyse the Western Medical Herbalists’ approach to the treatment of
endometriosis.
 Summarize findings and expand an existing knowledge base on endometriosis with a view
to improving management for sufferers and treatment approaches by Western Medical
Herbalists and allopathic clinicians.
8
Literature Review
2.1 Background
This chapter critically reviews literature regarding the gynaecological condition of endometriosis
and explores both Western herbal medicine and allopathic treatment approaches. Research
trends are examined including the need to develop non-invasive diagnostics to identify treatment
pathways.
2.2 Methodology
This study has conducted a thorough review of literature in respect of the following topics:

Historical background to the condition of endometriosis

Allopathic approach to the treatment of endometriosis and associated research

Impact of endometriosis on women

Western herbal medicine approach to the treatment of endometriosis and associated
research
All articles were critically reviewed to assess their relevance for the purposes of this research. A
number of databases were utilised including:

http://clinicaltrials.gov

http://www.cochrane.org

http://www.ncbi.nlm.nih.gov/pubmed

http://www.sciencedirect.com

http://www.elsevier.com

http://googlescholar.co.uk
A selection of online and hard copy journals was accessed to obtain a broad spectrum of data.
These included:

Primary Health Care

Human Reproduction

Gynaecological Endocrinology

Herbal Gram

EPD Sciences

Functional Foods & Nutraceuticals

Integrative Medicine

Current Medicinal Chemistry
9

Oxford University Press

BMJ
Good quality data was accumulated from a diverse range of systematic reviews, primary
research, articles and random controlled double-blind trials. Less robust research was included
where the data was considered to illustrate a point of controversy or to demonstrate future
direction either in management or research of endometriosis.
2.3 Selection criteria
2.3.1 Key Words
Information was successfully located using keywords associated with the subject area:

Endometriosis

Western herbal medicine

Phytotherapy

‘Endo’

Laparoscopy

Herb

Alternative therapy
2.3.2 Exclusion criteria
Every effort has been made to use the latest research material available and in general only data
from the last 15 years has been included. Clinical trials carried out in foreign languages, without
reliable translations were rejected. Traditional Chinese medicinal herbs are excluded except
those which have been incorporated into the modern Western Herbalist’s tool kit.
2.4 Limitations
Endometriosis was only defined as a condition in 1921 therefore historical data before this date
cannot be included.
10
2.5 Historical Background to Endometriosis
Endometriosis is defined as “the presence of endometrial-like tissue located in sites outside the
uterus cavity, in so far as the lesions have many cellular and molecular characteristics in
common with eutopic endometrium” (NHS Evidence 2010).
The earliest description of endometriosis in 1690 is accredited to Daniel Schroen who describes
an inflammatory disease of the peritoneum and bowel, leading to adhesions forming between
these organs (Benagiano 2006). However by 1921 these symptoms were given the term of
endometriosis, by Dr John Sampson who put forward a theory that “during menstruation a
certain amount of blood is regurgitated, or forced backwards from the uterus through the
fallopian tubes and into the pelvic organs and pelvic lining” This is known as retrograde
menstruation and is still the most popular theory for the cause of endometriosis (Marcheser
2009).
Today, although research has expanded the knowledge base surrounding endometriosis, the
aetiology and pathogenesis is still unknown and there is much to learn about this debilitating
auto-immune condition (Giudice, Kao, 2004).
2.6 Impact of Endometriosis on Women
The current prevalence and epidemiological picture in respect of endometriosis was summed up
in the 2009 Annual Endometriosis Update produced jointly by the Royal College of Obstetrics
and Gynaecology and The European Society for Human Reproduction and Embryology
(ESHRE). Of the female population, worldwide, in reproductive years, it is estimated that 10%
to 15% demonstrate the effects of endometriosis of which 70% experience symptoms of
infertility (Wieser et al 2009). The most common point of diagnosis in women is between the
ages of 25 – 30 years (Marcheser 2009). Genetic factors are indicated in the pathogenesis of
endometriosis with an increased prevalence in first degree relatives (Stefansson et al, 2002). The
condition causes chronic inflammation, fibrosis, adhesions and ovarian cyst formations and if
left untreated may lead to malignant disease (Somigliana et al 2006).
Symptoms of
endometriosis include: pain at ovulation, pelvic pain, deep dyspareunia, severe dysmenorrhoea,
painful bowel movements, chronic non-menstrual pain, dysuria, bleeding between periods,
infertility, nausea and chronic fatigue.
11
Detailed history taking and physical examination alone cannot confirm a diagnosis of
endometriosis for women suspected of having the condition. The only definitive method of
confirming diagnosis is with visual inspection of the peritoneal cavity via laparoscopy (ESHRE
guidelines 2009). This is an invasive procedure often causing the patient to experience nausea
and shoulder tip pain as well as more serious complications. Complications such as bowel
perforation occur in 0.6 – 1.8 per 1000 laparoscopy procedures, prompting the need for a noninvasive diagnostic. Once definitive diagnosis of endometriosis has been made medical
management takes place depending upon the needs of the patient (e.g. fertility).
Should
symptoms become unmanageable treatment with invasive surgery is indicated. However surgery
is not the end of the story with endometriosis often recurring and needing further treatment either
with medication or repeated surgery.
For many women diagnosed with endometriosis not only will they have the challenge of coping
with the associated symptoms but also decreased fertility. Dyspareunia is experienced in more
than 50% of cases of severe endometriosis preventing sexual intercourse (Oemkle et al 2009).
Even mild cases of endometriosis cause an altered environment of the uterus, effect ovulation
and hormones and may even have consequences on a newly formed embryo. (Evans 2005).
There can be scarring of the fallopian tubes which may create a blockage and prevent ovulation
or collection of the egg (ovum). Hart et al (2008) argue that, where possible, conservative
surgical intervention of endometriosis, increases the chance of conception by 25% however
Kennedy et al (2005) states there is not sufficient evidence to uphold this. There is little option
for treatment medically as GnRH analogues; progesterone and Danazol are not an option.
Definitions of endometriosis indicate that it is a benign condition, however, there has been
debate since 1925 that both endometriosis and cancer share many characteristics including:
unrestrained growth, development of new blood vessels and a reduction in cell apoptosis (Weber
2010). Recent studies have suggested that having endometriosis may increase a woman’s risk of
developing non-Hodgkinson’s lymphoma, malignant melanoma and breast cancer (Swiersz
2006). With there being such strong evidence of links between endometriosis and cancer there is
firm indication for early diagnosis of the condition to start early treatment and halt development.
Jeong et.al (2010) carried out a review to assess research into medicinal herbs which may
provide anti-angiogenic properties. Their findings indicated that there was a strong case for
future research into phytochemicals based on signalling pathways.
12
2.7 Allopathic Approach to the Treatment of Endometriosis
Current conventional treatment of endometriosis centres on providing pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with combined oral contraceptives
(COCs). NSAIDs have demonstrated significant side-effects such as gastric ulcers and an antiovulatory effect when taken mid cycle (ESHRE 2009). This combination has a failure rate of
approximately 25% and is contraindicated for women wishing to conceive.
Alternative
treatment is available with gonadotrophin releasing hormone (GnRH) analogues, progestins and
Danazol however side effects such as loss of bone mineral density, depression and androgenic
effects often prove undesirable to the patient (Roth-Kaufman 2009).
Although there is evidence that medical treatment is effective at controlling various symptoms,
some patients fail to respond at all. Additionally even if symptoms are alleviated for a period of
time symptom recurrence is common. Yap et al (2009) state that endometrial lesions >3cm do
not respond well to medical therapy and ultimately will need surgical intervention. The only
option for women with endometriosis wishing to conceive is to seek conservative surgery as
drugs interfere with ovulation (Vercellini et al 2009).
As medical treatment of endometriosis is not curative and often has unwanted side effects,
surgery is generally considered to be the definitive treatment. A minimally invasive keyhole
surgery, known as laparoscopy, may be used to perform laser oblation which can destroy
endometriotic lesions. In a double blind study performed by Sutton et al in 1994, 63 women
with minimal to moderate endometriosis took part in research to evaluate the effectiveness of
laser ablation. At 6 month follow-up from the treatment group (n=32), 20 patients demonstrated
a reduction in symptoms (63%) compared with 7 patients (23%) in a medical management
group. However, at 1 year follow-up, statistics showed a pain recurrence rate of 44% after laser
treatment and only an absolute benefit increase of surgery being 33%.
Where deep infiltrating surgery is needed to address more complicated and serious forms of
endometriosis (Stage III/IV) procedures may be offered which include laparotomy, hysterectomy
and/or bilateral salpingo-oophorectomy or segmental colorectal resection depending on the
location. Again, there are varying levels of success rates with relief of endometriosis symptoms
reportedly being as high as 70-80% of patients attending 6 month follow up (Vercellini 2009).
When considering whether or not to undergo surgery patients have to weigh up benefits received
against any unforeseen complications. The most frequent experience post operative difficulty
reported being urinary retention (possibly due to the parasympathetic plexus being damaged)
13
(Dubernard et al 2008). However, statistics go on to show that at 1yr follow up a considerable
proportion of the women had resorted to post operative treatment with pain killers or hormonal
medication. (Fleisch et al 2005) and there is insufficient evidence to conclude any significant
benefit gained from surgery (Yap 2009).
2.8 Allopathic Research Associated with Endometriosis
It is fair to say that there is global interest into understanding the aetiology and pathophysiology
underpinning this complex condition. In 2010, the Oxford University Press alone reported 62
research studies ranging from investigating serum markers of oxidative stress and lipid profiles
of infertile women with endometriosis, to the impact of endometriosis on the risk of ovarian
cancer. Research carried out in 2002 by the Genetic Research Centre in Iceland demonstrated
clear evidence that genetic factors contribute to the development of endometriosis. Juneau
Biosciences are extending this research by conducting global studies into genetic factors in the
hope that they will contribute to the design of early diagnostic interventions (Al-jefout et al
2009).
Trials of a new technique for early diagnosis of endometriosis using nerve fibres from the
functional layer of endometrium, obtained by biopsy, have proved successful and are near to the
accuracy obtained via laparoscopy (Al-jefout et al 2009). With the advent of new diagnostics
enabling the early identification of endometriosis, treatment may be more effective in the early
stages. Early intervention may result in a positive impact on symptoms and the quality of life for
sufferers (Al-jefout 2009).
There is mounting evidence to suggest that imbalances in the immune system have a significant
role to play in the development of endometriosis. Endometriotic tissues contain high levels of
prostaglandin E2 (PGE2) which may inhibit the function of B and T cell proliferation and
accessory monocyte/macrophages.
If this is the case then defective cells will multiply,
undetected by the immune system (Kurt 2003).
An international consensus workshop was held in 2009 to prioritise research into endometriosis
which called for every aspect to be investigated to enable effective, accurate and timely
diagnosis to establish those at risk, provide treatment and where possible prevent it.
No less
than 25 recommendations for research were made with their ultimate recommendation calling
for “a multidisciplinary approach to research”. Understanding the origins of pain is a priority for
14
endometriosis research particularly looking at the inflammatory response and progestin activity
as there appears to be a progesterone resistance in endometriotic lesions (Bulun et al 2006).
Understanding and keeping pace with allopathic research into the cause and pathology of
endometriosis will help direct treatment by both allopathic clinicians and Western Medicinal
Herbalists.
2.9 The Western Herbal Medicine Approach to the Treatment of Endometriosis
Western Medical Herbalists do not generally treat ‘conditions’ but look at the individual as a
whole taking into consideration their diet and lifestyle. Carol Rogers, author of ‘The women’s
guide to herbal medicine’ writes “herbs work by supporting the body in the natural healing
process” and goes on to state that “factors affecting the health of the individual” need to be
addressed as well as exhibited signs and symptoms (Rogers 1995).
When presented with a confirmed diagnosis of endometriosis, Western Medical Herbalists will
approach treatment on a number of fronts designed to address the priorities of the individual
patient. As well as any physical problems, a patient’s emotional and psychological mechanisms
for coping will be supported.
Pain is described as the single most debilitating aspect of
endometriosis and is a focus for early treatment (Romm 2010). Herbs with an anodyne action
may be part of the management approach as well as improving pelvic congestion and circulation.
This aims for an efficient supply of nutrients to local areas which would reduce inflammation
and subsequently reduce abdominal pain (Peterson n.d.).
Improving liver function aids
elimination of toxins as well as soothing the urinary tract and encouraging deep tissue healing.
As endometriosis is a gynaecological condition, an important action would be to balance and
regulate hormonal function. There is a role for immunomodulators to counter the inflammatory
response and anti-mitotic activity to reduce cell proliferation. Herbs with a nervine action
should be included to address any areas of anxiety, stress, depression or insomnia. In cases
where fertility has been compromised herbs may be included to improve chances of conception.
Table 1 (overleaf), shows symptoms of endometriosis and how they might be addressed with
herbal actions:
15
Table 1: Symptoms of Endometriosis and indicated herbal actions (Yaso 2006, Romm 2010).
Symptoms of
endometriosis
Abdominal/pelvic pain
Some indicated
herbal actions
Anti-inflammatory
Anodyne
Antispasmodic
Circulatory stimulant
Uterine/Pelvic tonic
Achillea millefolium (Yarrow)
Gelsemium sempevirens (Yellow jasmine)
Viburnum opulus (Cramp bark)
Zingiber officinalis (Ginger)
Alchemilla vulgaris (Lady’s mantle)
Pain at ovulation
Hormone balancer
Ovarian tonic
Vitex agnus castus (Chaste berry)
Paeonia lactiflora (White peony)
Dysmenorrhoea
Antispasmodic
Anodyne
Anti-inflammatory
Viburnum prunifolium (Black haw)
Hyoscyamus niger (Henbane)
Anaemone pulsatilla (Pasque flower)
Menorrhagia
Anti-haemorrhagic
Astringent
Hormone balance
Trilium erectum (Beth root)
Capsella bursa-pastoris(Shepherd’s purse)
Dioscorea villosa (Wild yam)
Dyspareunia
Anti-inflammatory
Anodyne
Cimicifuga racemosa (Black cohosh)
Atropa belladonna (Belladonna)
Dysuria
Astringent
Demulcent
Anti-inflammatory
Equisetum arvense (Horsetail)
Althae officinalis fol.(Marshmallow leaf)
Zea Mays (Cornsilk)
Pain on defecation
Anti-inflammatory
Astringent
Curcuma longa (Turmeric)
Agrimonia eupatorium (Agrimony)
Nausea
Carminative
Matricaria recutita (Chamomile)
Fatigue
Adaptogen
Glycyrrhiza glabra (Liquorice)
Infertility
Hormone balance
Uterine tonic
Nervine
Trifoloium pratense (Red clover)
Rubus ideaus (Raspberry leaf)
Turnera diffusa (Damiana)
Adhesions
Reduce adhesions
Centella asiatica (Gotu kola)
Salvia miltiorrhiza (Red sage)
Tissue proliferation
Antimitotic
Anti-proliferative
Thuja occidentalis (Thuja)
Curcuma longa (Turmeric)
Anxiety, Stress,
Insomnia
Nervines
Leonorus cardiac (Motherwort)
Piscidia erythina (Jamaican dogwood)
Menstrual irregularities
16
Some Indicated herbs
In contrast to the allopathic approach, herbal medicine aims to work with the body to support
homeostasis and the physiology of the body and not just suppress symptoms. As part of the plan
to manage endometriosis, the Western Medical Herbalist might include recommendations on diet
and supplement as shown below.
Table 2: Diet and Supplement recommendations for Endometriosis (Baghurst & Dreosti 1991,
Holford 2007, SHE trust 2005).)
Diet
Reason
Limit excess sugar and fat intake by reducing these To reduce inflammation
elements in the diet
Reduce coffee intake
Caffeine increases oestrogen production
Include adequate protein intake
Metabolise oestrogen in the liver
Ensure sufficient B Vitamins + B6 (found in Encourages progesterone production which
quinoa, bananas, red kidney beans, Brussels helps balance the excess of oestrogen levels.
sprouts)
Decreases muscle spasms and may help with
fatigue
Increase Choline (found in eggs, Cod, Wheatgerm, Associated
with
lower
cruciferous vegetables)
inflammatory markers.
levels
of
Ensure sufficient inositol (Found in fruits, beans, To reduce insomnia and nervous anxiety.
grains, and nuts)
Include essential fatty acids e.g. fish oils, evening Metabolise within the body to form antiprimrose oil, starflower oil, borage oil and linseed inflammatory prostaglandins which help
oil
reduce pain and inflammation. Significantly
reduce endometrial deposits
Magnesium (found in wheatgerm, almonds, cashew Antispasmodic.
nuts, raisins, green peas)
synthesis.
Inhibits
prostaglandin
Zinc (found in oysters, nuts, peas, beans)
Encourage the production of hormones
Vit. A/C/E
Reduces inflammation and adhesions
Calcium (found in cheese, almonds, parsley, Reduces menstrual cramps
artichokes, prunes)
Selenium (found in herrings, oysters, mushrooms)
Reduces inflammation,
immune system.
Sulphur (found in beans, peas, onion, garlic)
Supports the liver to break down oestrogen
17
stimulates
the
Improvements to lifestyle would include smoking cessation and limiting alcohol intake which
may deplete the body’s ‘B’ complex vitamins by disrupting carbohydrate metabolism (Evans
2006). Data regarding alcohol consumption is mixed as it is reported that women who consume
alcohol have a 50% increased risk of endometriosis and yet moderate alcohol consumption may
reduce oestrogen levels (Lark, S). Exercise is advised due to the beneficial release of endorphins
which are natural pain killing chemicals.
Debate continues about the inclusion of phytoestrogens (plant based compounds) within the diet,
as a treatment for endometriosis. Examples of foods which contain phytoestrogens are soybeans,
alfalfa, chickpeas, tofu, apples, cherries, carrots as well as many others. Phytoestrogens behave
like hormones, and like hormones, too much or too little can alter hormone-dependent tissue
function (Endo Resolved 2010). In the book ‘Endometriosis & Other Pelvic Pain’, Dr Susan
Evans (2005) states that “where there is too much oestrogen, such as in endometriosis,
phytoestrogens can reduce the effectiveness of normal oestrogen”.
However, there is
epidemiological evidence which shows Asian women, who include a large amount of
phytoestrogens within their diet, have a higher prevalence of endometriosis (Edmunds et al
2005).
2.10 Western Herbal Medicine Research and Endometriosis
To date, there is inconclusive clinical evidence to demonstrate that Western herbal medicine is
effective in the treatment of endometriosis. However following the Endometriosis International
Consensus Workshop in 2009 there has been a surge in funded research to identify
phytochemicals and medicinal herbs which may prove valuable.
In a study by Fritz Wieser et.al. (2009) a mixture of 9 herbs was tested on an in vitro model of
endometriosis to investigate the effect on cell proliferation, apoptosis and CCL5 expression and
secretion in human endometriotic stromal cells. CCL5 is a protein classified as a chemokine and
plays an active role in recruiting leukocytes into inflammatory areas. The study conclusively
confirmed the efficacy of the herbal extracts in decreasing cell proliferation, inducing apoptosis,
and suppressing CCL5 gene transcription. The 9 herbs included in the mixture are shown in
Table 3 (overleaf) which also demonstrates their chemical constituents and physiological action.
18
Table 3: Breakdown of herbs within herbal mixture. (Weiser et al 2009)
Herb
Chemical Constituents
Physiological Action in
relation to endometriosis
Anti-inflammatory, Antispasmoic, mild laxative.
Glycyrrhiza glabra
(Liquorice)
Glycyrrhizin, Glycyrrhizinic
acid, Flavanoids,
Triterpenoid saponins
Commiphora molmol
(Myrrh)
Terpinoids; commiphoric
acid, aldehyde, resin, cumin
aldehyde, volatile oil
Astringent, carminative,
vulnerary
Peonia lactiflora
(White peony)
Paeoniflorin, lactiflorin,
paeonin, oxypaeoniflorin,
hydroxypaeoniflorin,
daucosterol
Antispasmodic, Antiinflammatory, Sedative
Boswellia carterii
(Frankincense)
3.8% Volatile oil, Terpenes,
Sesquiterpenes, 60-70%
resin, 27 – 35% gum (which
contains polysaccharides)
Anti-inflammatory,
Analgesic, Sedative,
Antioxidant, Antibacterial
Corydalis turtschaninovii
(Corydalis)
20 Alkaloids of which
Tetrahydropalmatine (THP)
is the most potent
Analgesic, Sedative,
Hypotensive, thins blood,
anti-arrhythmic, Antiinflammatory, Antispasmodic
Salvia miltiorrhiza
(Red Sage)
Salvianolic Acid, Tanshinone Stimulate circulation
IIA, Vit.E
Anti-oxidant, Antiinflammatory, Stimulate
apoptosis
Angelica sinensis
(Angelica dahurica)
Essential Oil: Carcacrol,
Safrol
Furanocoumarins
Anti-inflammatory,
Analgesic, Antispasmodic,
circulatory stimulant, Uterine
tonic, Sedative
Cinnamomum cassia
(Chinese cinnamon)
Cinnamic aldehyde 80%, 12% Volatile oil, Coumarins,
Tannic acid
Anti-diabetic effect
Carminative
Mildly astringent
Angelica dahurian
(Angelica dahurian).
Furanocoumarins,
byakangelicol, cnidilin,
scopoletin, phelopterin,
xanthotoxin, essential oil
Diaphoretic
Antiseptic
Analgesic
19
Further studies by Swarnakar and Sumit in 2009 explored the efficacy of Curcurma longa
(Turmeric) to arrest endometriosis by down regulation of matrix metalloproteinase -9 (MMP9)
activity. Their research proved conclusively that MMP9, which has a significant effect on
endometriotic lesions, was arrested by curcumin treatment. Additionally TIMP-1 expression
which has a dampening effect on MMP9 activity was upregulated and resulted in a positive
effect on endometrial tissue (Swarnaker, Sumit, 2009). Curcuma longa again featured in a study
carried out in 2010, this time to assess its potential to inhibit the growth of blood vessels
(angiogenesis) which has been indicated as playing a pivotal role in the pathophysiology of
endometriosis.
The study concluded that although there is a positive indication of anti-
angiogenic activity there was no clinical proof and recommended future research within
medicinal herbs (Soo-Jin et al 2010).
The question of whether or not the inclusion of phytoestrogens within the diet was beneficial
was explored in 2005 when the effects of phytoestrogens on aromatase activity were researched.
Their findings concluded that when genistein, a compound within phytoestrogens, is imbibed in
large quantities it can induce changes in aromatase activity which could lead to endometriosis.
Fritz Weiser et al carried out a landmark study in 2007 which looked at the clinical and
experimental data surrounding the use of medicinal herbs for endometriosis. This systematic
review found few formal studies demonstrating safety and efficacy but that clinical trials were
promising. In particular the anti-inflammatory and pain relieving action of some herbs and their
active components were identified including those exhibiting cytokine suppression and COX-2
inhibition. Also discussed were the benefits and likelihood of synergistic interaction between
herbs and a call for increased support for herb-herb and herb-drug interference in respect of
public safety. The review concluded by proposing an increase in randomized clinical trials,
particularly on adolescents with endometriosis, being the population most likely to benefit from
advances in research.
20
Methodology
3.1 Introduction
A conceptual framework using traditional research methods was undertaken throughout this
study. In the first instance secondary data was collected by undertaking a literature review to
gain a profound and current overview on the topic area. This was followed by the posting of
two questionnaires to collect primary data to provide a substantive and real knowledge base.
This method is supported by (Ghauri, Gronhaug 2005) who state “Research questions can best
be answered by combining information from secondary and primary data”. The research
approach consisted of a positivist and deductive view assessing data based on existing practice
and theories. The primary research was conducted by employing on-line questionnaires. All
data gathered was processed and analysed before comparison with secondary sources of
information.
3.2 Secondary Research
Secondary research involved a literature review to provide the author with a current and
comprehensive representation of the subject matter.
This data was collated to enable a
comparison with the findings from the primary research.
3.3 Primary Research
3.3.1 Primary Data Collection
A methodological approach to address different facets of the research question has been used.
The purpose of the primary research was:

To obtain feedback from women with a confirmed diagnosis of endometriosis about
their experience of the condition and the treatment they have received, especially with
Western herbal medicine.

To gain a representation of real treatment strategies towards endometriosis by registered
Western Medical Herbalists.
The design of the questionnaires had a clear relationship with the aims of the research and
aimed to “place established secondary data into a real social context” (Bowling, Ebrahim
21
2005). Alternative methods of data collection such as focus groups and interviews were
dismissed as this required interaction with the target sample and respondents would be unable
to remain anonymous. To overcome problems of anonymity an electronic version of the
questionnaire was created using an on-line software tool called SurveyMonkey. This software
enabled the author to issue a web-based questionnaire which was efficient in reaching a wider
target sample.
Other advantages included swift response rates with received data being
encrypted and collected in a safe environment, financial savings with reduced stationery and
postal costs, the ability for the respondent to answer in their own time and finally as the
researcher is not present they could not influence the respondent and therefore bias was
reduced.
3.3.2 Research Instrument Design
Design of the questionnaires was crucial as the researcher was not present to provide clarification
on any questions. Peat (2005) emphasises that the most usef
ul questionnaires in research studies “are those that have good content validity”. She goes on to
recommend that “new questionnaires must be tested before a study begins”.
To encourage
respondents to complete the questionnaire, questions were concise and kept to a minimum.
In the first instance the questionnaires were ‘word-processed’ and included the Leeds Metropolitan
University logo to provide authenticity and reputability to the research study. A brief outline of the
study was included at the beginning, demonstrating the aims and objectives of the questionnaire and
clearly stated the target audience. It was specified that the questionnaire was voluntary and that all
data collected would be confidential and only used for the purposes of the research (Appendix 1).
The questionnaires were then transferred to the on-line software where they were adapted to fit the
most appropriate format (Appendix 2). In creating the questionnaire ‘smart branching’ was utilized
to lessen complexity, so that if a responder answered “yes” to a question they would automatically
be routed to the next relevant question.
3.3.3 Questionnaire (A) - Endometriosis Sufferers
Questionnaire (A) was designed for completion by women with a confirmed diagnosis of
endometriosis.
It consisted of 14 questions which were kept as simple as possible to avoid
ambiguity. Peat (2001) states that “when administering questionnaires in the community even
simple questions....can collect erroneous replies”. The first 3 questions asked the respondent’s age,
number of children and whether or not they had a definitive diagnosis of endometriosis. Question 4
22
was multiple choice and enabled the respondent to tick the relevant boxes adjacent to symptoms of
endometriosis they experienced. Questions 5 and 6 explored any allopathic treatment they had
received with Question 7 asking if they had received any alternative therapy including herbal
medicine. Questions 8 to 13 dealt with any treatment the respondent had received with herbal
medicine including which herbs were taken (if known), the length of time taken, if the treatment
was effective and if so, what symptoms did it address. Finally Question 14 enquired whether
symptoms of endometriosis recurred if the respondent had undergone surgical treatment.
3.3.4 Questionnaire (B) – Western Medical Herbalists
Questionnaire (B) was designed for completion by registered Western Medical Herbalists and
consisted of a mixture of 10 open and closed questions. The first 3 questions elicited information
about where the Herbalist gained their qualification, which year they graduated and how many
years they had been practicing. The next 3 questions asked if they had treated endometriosis before,
how many cases and if any involved fertility problems. Question 7 took the form of a fictional case
study, of a patient with a confirmed diagnosis of endometriosis. The respondent was prompted to
use the case study as a basis to list appropriate herbs or proceed to Question 8 where they could
simply identify a list of key herbs they would use. Question 9 asked for justification of why they
had chosen them. Question 10 was provided as a ‘comments box’ to enable respondents to provide
additional information.
3.4 Piloting the Research Instrument
Questionnaire (A) was piloted online to exactly match the way it would be presented to actual
respondents. 10 volunteers undertook the pilot questionnaire and were asked to comment on the
appropriateness and clarity of questions as well as the length and ease of navigation through the
survey.
Questionnaire (B) was first tested on colleagues in order to make an initial assessment as to whether
it was comprehensible and ran smoothly as recommended in ‘A Handbook of Health Research
Methods: Investigation, measurement and Analysis’ (Peat 2001). It is also recommended to
undertake a pilot study amongst a group who “are as similar as possible to the target population”.
A test group of 5 colleagues, representative of the sample frame, were identified who fitted the
demographics of the target population. They were handed a paper copy of the proposed on-line
questionnaire and asked to complete it and provide feedback. A second group of 10 registered
Western Medical Herbalists were identified and sent a paper copy of the proposed on-line
23
questionnaire via the postal service. They were also asked to complete it and give feedback. A
stamped addressed envelope was enclosed for their convenience.
Undertaking this pilot study enabled the author to receive vital feedback which highlighted a
question which was deemed irrelevant and a flaw in the ‘flow’ of one questionnaire.
Positive feedback:

Respondents stated that the length of the questionnaires was adequate

The layout and flow of the questionnaire was logical

Questions were deemed appropriate to answer the research aim and objectives
Negative feedback

It was thought that the ‘occupation’ of endometriosis sufferers was unimportant leading to
the removal of this question from Questionnaire (A)

A request was received to include a question on diet but was rejected on the basis that it
detracted from the main focus of this research question.

The on-line survey ‘flow’ was adjusted to allow respondents who did not fulfil criteria to
exit the questionnaire.

One Herbalist declined to fill in the questionnaire on the basis that they “treat individuals
not conditions” although they did acknowledge that the attached case study did address this
issue.
3.5 Sampling Strategy
“A research study needs to be large enough to ensure the generalisability and the accuracy of the
results, but small enough so that the study question can be answered within the research resources
that are available” (Peat, J. 2005 p128). To gain an overall picture of the treatment approach to
endometriosis and the effectiveness of that treatment, 2 questionnaires were issued. Questionnaire
(A) was exposed to women with a confirmed diagnosis of endometriosis and Questionnaire (B) was
sent to a sample of 502 registered Western Medical Herbalists
Questionnaire (A): was designed to collect the experiences of women with a confirmed diagnosis of
endometriosis. To reach as wide an audience as possible a link was posted in a variety of associated
websites’ forums including:
24
Table 4: A List of Forums on which Questionnaire (A) was posted
Obgyn.net (The Universe of Women’s Health) http://forums.obgyn.net/endo
Endometriosis She Trust (UK)
http://forums.shetrust.org.uk
Pelvic Pain Support Network (UK)
www.pelvicpain.org.uk
Endoboard Discussion Forum
http://endoboard.yuku.com
Endometriosis in the UK
http://www.endometriosis.org.uk/forum
eHealth Forum
www.ehealthforum.com
Amazon Co (UK)
www.amazon.co.uk/tag/herbal20%medicine/forum
World Endometriosis Research Foundation
http://www.endometriosisfoundation.org
Henrietta’s Herbal Homepage
http://www.henriettesherbal.com
Cure Zone
http://curezone.com/forums
Facebook: Endometriosis New Zealand
http://www.facebook.com/NewZealand
Endometriosis Association of
Ireland
Endometriosis Canada
Endometriosis Research Centre
http://www.facebook.com/pages/EndometriosisAssociation-of-Ireland-RegCHY8693
http://www.facebook.com/group
http://www.facebook.com/EndoResCenter
Fundamental questions in Questionnaire (A) focused on establishing the identity of any herbs the
respondent had been treated with and for what symptoms of endometriosis. Additional questions
aimed to identify whether the herbs had been effective and the length of treatment.
On-line questionnaires were chosen as the optimum method of surveying the target group as the
World Wide Web is far reaching and readily accessible by the recognized age group (reproductive
years approximately 12yrs – 50yrs). “Adopting a web-based approach observes netiquette and
means that respondents can remain anonymous and of equal importance” (Witmer et al 1999).
Using traditional postal methods to carry out this survey would have been time consuming, costly
and environmentally unfriendly due to the amount of paper involved. An obvious disadvantage to
using an on-line questionnaire is that not everyone has access to the internet. Explanatory dialogue
outlined the parameters of the survey and discouraged any respondents who did not have a
confirmed diagnosis of endometriosis from completing the questionnaire.
Questionnaire (B): was designed to collect data about the treatment of endometriosis with Western
medical herbs. Registered Herbalists were targeted to receive the questionnaire as being a reliable
source of treatment with Western medical herbs. Over 500 Herbalists are registered with the
National Institute of Medical Herbalists and the College of Practitioners of Phytotherapy including
25
Practitioners in the UK, Canada, Australia, New Zealand etc.
From those registered 502 freely
provide their email information on websites. Each Herbalist who displayed an email address was
sent a message to introduce the author, explain why they were being contacted, outline the purpose
of the research, request their participation in the survey and provide a link to the questionnaire.
This enabled them to voluntarily take part in the survey and undertake the questionnaire in their
own time without bias. The embedded link took the respondent directly to the on-line software
where the respondent anonymously filled out the questionnaire. Questions were designed to collect
data which included the length of time the Practitioner had been practicing and their experience of
endometriosis. This experience may then be taken into account when analysing the herbs they
suggested for the treatment of endometriosis. Additional questions gathered data on why particular
herbs were chosen to establish whether herbal actions and chemical constituents had been taken into
consideration. Analysis of data may subsequently demonstrate trends in treatment associated with
experience and/or advances in scientific research.
Variables which might have an impact on results are individual interpretation of the case study
which may influence the inclusion or exclusion of certain herbs. The cost and environmental
accessibility to certain herbs (such as Canadensis Hydrastis) may also influence inclusion or
exclusion.
3.6 Conducting the Research
Questionnaire (A) was posted on the identified website forums from 5th September 2010 until 10th
September 2010. Response rate was poor considering the web sites were potentially available to a
global audience and after a week of zero responses the survey was closed on 16th November 2010.
A total of 75 responses were collected within the encrypted software.
Questionnaire (B) was sent via email to the target group from 8th September, 2010 – 14th September
2010. Responses were received consistently within the secure software, throughout a 4 week period
but then began to tail off towards the end of October. After a one week period when no further
responses were collected the survey was closed on 13th November, 2010. The on-line method
enabled the author to gain 89 responses from the original target group of 502 (17.7%).
26
Results
4.1 Data Analysis
Results from the primary data were initially processed in SurveyMonkey before being transferred
into Excel for analysis. Results have been displayed in two sections to clarify the findings from the
separate questionnaires.
4.2 Section 1: – Results from Questionnaire (A) Endometriosis Sufferers
4.2.1 Respondents Profile
Questionnaire (A) targeted women with a confirmed diagnosis of endometriosis and was posted on
11 websites for a duration of 10 weeks. A total of 75 responses were received of which 63
completed the survey representing an 84% participation rate. The age of respondents ranged from
21years to 60 years with the greatest feedback of 48% coming from females between the ages of 31
– 40years. Respondents were asked to state their number of children and Figure 1 below provides a
breakdown from the 75 responses. 70% replied that they had no children which may reflect
infertility due to endometriosis however this is only an hypothesis which cannot be proven without
further evidence and research.
Figure 1: Endometriosis Sufferers - Number of Children of Respondents
Please state your number of children?
80.0%
53
70.0%
Percentage of respondents
60.0%
50.0%
40.0%
30.0%
20.0%
8
10
10.0%
2
1
1
0.0%
0
1
2
3
4
5
6
Number of children per respondent
Source: Questionnaire (A) Data (N=75)
27
7
8
9+
4.2.2 Symptoms associated with Endometriosis
Respondents were asked to identify their symptoms experienced with endometriosis and were
provided with a list of possibilities. The respondent was able to select more than one symptom with
the option to provide additional feedback. Painful periods (95.8%), tiredness (91.5%) and pelvic
pain (81.7%) were shown to be the most common symptoms, closely followed by heavy bleeding
(71.8%), pain at ovulation (67.6%) and stress (66.2%). Asking respondents to identify symptoms
provides clear signposts for treatment strategies by herbalists. Figure 2, provides a breakdown of
results (full details Appendix 3).
Figure 2: Questionnaire (A) - Symptoms experienced by sufferers
Number of respondents
Other
Infertility
Pain around scar
Stress
Anxiety
Insomnia
Tiredness
Pain passing urine
Difficulty becoming
pregnant
Heavy bleeding
Bleeding between periods
Pain opening your bowels
Painful sexual intercourse
Pelvic pain between
periods
Pain at ovulation
Painful periods
Symptoms experienced by sufferers
120.0%
100.0%
80.0%
95.8%
91.5%
81.7%
67.6%
71.8%
64.8% 63.4%
60.0%
40.0%
66.2%
54.9%
42.3%
25.4%
35.2%
29.6%
31.0%
42.3%
20.0%
8.5%
0.0%
Symptoms
Source: Questionnaire (A) data (n=71)
4.2.3 Allopathic Treatment with medication and surgery
71 out of 75 respondents (84.5%) specified that they have taken allopathic medication to treat
endometriosis ranging from anti-inflammatory drugs to combined oral contraceptives with a
corresponding number having received invasive surgery (full details Appendix 3).
4.2.4 Alternative therapies to alleviate symptoms of endometriosis
To identify alternative therapies used to alleviate symptoms of endometriosis respondents were
asked to identify which they had used. In total 8 therapies were listed including herbal medicine,
28
reiki, acupuncture, Indian head massage, Shiatsu, reflexology, aromatherapy and crystal therapy. In
addition there were categories for diet/nutrition and the addition of zinc or magnesium to the diet.
Most respondents, 47 replies (66.2%), used diet/nutrition to help alleviate symptoms followed by
herbal medicine with 38 replies (53.5%).
Further analysis demonstrated that 29 respondents
(40.8%) used a combination of herbal medicine and diet/nutrition to alleviate symptoms.
Acupuncture was shown to be the next most effective therapy with a response count of 36 (50.7%)
(full details Appendix 3).
Figure 3: Alternative therapies used to alleviate symptoms of endometriosis
Percentage of Respondents
53.5%
Other
None
Adding magnesium to diet
66.2%
Adding zinc todiet
Diet/nutrition
Crystal therapy
Aromatherapy
Reflexology
Shiatsu
Indian head massage
Acupuncture
Reiki
Herbal Medicine
Alternative therapies used by sufferers
50.7%
21.1%
21.1%
14.1%
9.9%
25.4%
23.9%
12.7%
7.0%
1.4%
1.4%
Alternative therapy
Source: Questionnaire (A) data (N=71)
4.2.5 Treatment by an Herbalist or self treat?
Respondents were asked if they consulted an Herbalist or self treated. Of the 46 respondents 18
(39.1%) had consulted an Herbalist, 13 (28.3%) had self-treated with herbs and 15 (32.6%)
specified they used other sources. Analysis of the replies which specified other sources of herbs
illustrated consultations with Ayurvedic and Traditional Chinese Medicine Practitioners as well as
Homeopaths and Acupuncturists.
29
Figure 4: Did you consult with an Herbalist or self treat?
Did you Consult with an Herbalist or self treat?
32.6%
39.1%
Consult with an Herbalist
Self treat
Other sources
28.3%
Source: Questionnaire (A) data (N=46)
4.2.6 Herbs used by sufferers of Endometriosis
19 respondents supplied details of herbs they had used. Some respondents listed more than one
herb whilst others admitted to not remembering any specific names. 5 replies demonstrated that the
herbs had been procured from practitioners of Ayurvedic or Chinese medicine. 3 respondents
offered evidence showing they had taken tablet formulas containing herbs in small quantities as
well as other compounds. Only Western medical herbs were included for analysis and a brief
summary of those herbs is displayed below (full details Appendix 3).
Table 5: Herbs used by women suffering from Endometriosis
Latin name
Common name
No. of respondents
Anemone pulsatilla
Pasqueflower
1
Angelica sinensis
Chinese Angelica
1
Capsella bursa-pastoris
Shepherd’s purse
1
Curcurma longa
Turmeric
1
Datura stramonium
Thorn apple
1
Echinacea spp.
Echinacea
1
Glycyrrhiza glabra
Liquorice root
1
Matricaria recutita
Chamomile
2
Melissa officinalis
Lemon balm
1
Mentha x piperita
Peppermint
2
Sambucas nigra
Elderberry
1
30
Scutellaria lateriflora
Skullcap
2
Silybum marianum
Milk Thistle
1
Taraxacum officinalis rad.
Dandelion root
1
Viburnum opulus
Cramp bark
2
Vitex agnus-castus
Chaste berry
3
Zingiber officinalis
Ginger
3
Source: Questionnaire (A) data (n=19)
4.2.7 Length of herbal treatment and effectiveness
42 respondents replied clarifying the length of time they had taken herbs. This established a range
in the length of treatment time from 1 week to more than 2 years illustrating that 50% of the
respondents took herbal medicine for 6 months or more (full details Appendix 3).
Figure 5: Length of time respondents took herbal medicine
Percentage of respondents
If you took herbal medicine, how long did you take it for?
20.0%
18.0%
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
8
8
6
4
3
2
3
2
2
1
2
1
Length of time
Source Questionnaire (A) Data (N=42)
31
Respondents were then asked if their treatment had been effective. 26 (57.8%) answered ‘Yes’ and
19 (42.2%) answered ‘No’.
Figure 6: Effectiveness of Herbs in Treating Endometriosis
Did you find the herbal medicine effective in treating your
endometriosis?
No
42.2%
Yes
No
Yes
57.8%
Source: Questionnaire (A) Data (N=45)
Cross-referencing responses regarding the length of time a respondent took herbal medicine with
answers regarding effectiveness resulted in the following information:
Table 6: Cross reference of Figure 5 and Figure 6 correlating time with efficacy of treatment
≤ 3 months
Number of people found
treatment effective
8
Number of people found
treatment ineffective
10
≤ 6 months
7
4
≤ 1 year
9
2
≤ 2 years
1
N/A
25
16
Length of time taken herbs
Total
4.2.8 Symptom Relief
38 respondents gave details of how effective herbal medicine was at relieving symptoms. Results
showed most effect was gained with the relief of pain, regulation of menstrual cycle, easing anxiety
and improving energy levels. Other benefits described were: “ease heavy bleeding”, “aid sleep”,
“improve the function of the bowel” and “pass urine”. Additional positive comments included
32
several references to the effectiveness of herbs to help with nausea as well as one attributing her
success at conceiving to herbal medicine. Negative feedback stated that herbal medicine did not
appear to be at all effective however many put this down to not taking it for a long enough period of
time (full details Appendix 3).
Figure 7: Symptoms herbal medicine was effective for
Percentage of Respondents
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
39.5%
Other
Pass urine more easily
Open bowels more easily
Made me less tired
Made me less anxious
Helped me sleep
Lessen heavy bleeding
Regulated menstrual cycle
Pain relief
Please specify what symptoms the herbal medicine was effective for?
39.5%
31.6%
28.9%
28.9%
23.7%
23.7%
18.4%
2.6%
Symptom
Source: Questionnaire (A) data (n=38)
4.2.9 Herbal Medicine and Allopathic Medication
When asked if herbal medicine was taken at the same time as allopathically prescribed medication
25 (40.3%) respondents stated that they did. 37 (59.7%) respondents did not take herbal medicine
at the same time.
4.2.10 Recurrence of symptoms of endometriosis post surgical treatment?
The final question was whether having had surgery did their symptoms recur? From the 62
respondents 90.3% (56) stated that their symptoms did recur.
33
Figure 8: Recurrence of symptoms following surgical treatment?
If you had surgical treatment for your endometriosis, did the
symptoms recur?
No
9.7%
Yes
90.3%
Yes
No
Source: Questionnaire (A) data (N=62)
4.3 Section 2: Results from Questionnaire (B) – Western Medical Herbalists
Over a 10 day period, 502 emails were sent to Herbalists, who displayed contact details within the
websites of either the National Institute of Medical Herbalists and/or the College of Practitioners of
Phytotherapy. 100 (20%) emails rebounded, displaying comments which included ‘inbox full’ or
“email address no longer in use”. A total of 89 (17.7%) responses were received of which 46
(51.7%) fully completed the survey.
4.3.1 Respondents Profile
Respondents were asked to state where they obtained their qualification in herbal medicine with the
majority demonstrating the United Kingdom. The exception to this was 2 respondents who gained
a degree in Canada.
34
Figure 9: Institution where Herbalists received their qualification
Institution where Herbal qualification was gained
Dominian University, Canada
2
Leeds Metropolitan University
2
Lincoln University
1
Middlesex University
1
N.I.M.H.
1
Location
Napier University
2
School of Herbal Medicine
11
School of Phytotherapy
12
Scottish School of Herbal Medicine
22
Tutorial Course
7
University of East London
2
University of Wales
12
University of Westminster
11
Unknown
3
0
5
10
15
20
25
Number of Herbalists
Source: Questionnaire (B) data (N=89)
Qualifications spanned 21 years with 41% having practised for more than 10years. The shortest
length of time any Herbalist had been in practice was 4 months and the longest period of practice
was 31years. The combined number of year’s knowledge was 869 years (full details Appendix 4).
4.3.2 Treatment of Endometriosis by Herbalists
A closed question asking whether the respondent had experience of treating endometriosis in their
practice brought a mixed response with 61 (69.3%) replying ‘Yes’ and 27 (31.7%) replying ‘No’.
Figure 10: Have you treated endometriosis in your practice?
Have you treated endometriosis in your practice?
No
31%
Yes
69%
Source: Questionnaire (B) data (n=88).
35
A further question identified the number of cases treated which alternated between 0-5 or 11–15
cases.
Figure 11: Number of cases of endometriosis treated by Herbalists
How many cases of endometriosis have you treated?
Percentage of Herbalists
30.0%
27.8%
27.8%
25.0%
19.4%
20.0%
13.9%
15.0%
8.3%
10.0%
5.0%
2.8%
0.0%
0-5
6-10
11-15
16-20
21-25
>25
Number of Patients with Endometriosis
Source: Questionnaire (B) data (n=36)
4.3.3 Endometriosis and Infertility
Herbalists who treated endometriosis were asked to identify how many of those cases had
associated fertility problems. The most respondents, 24 (68.6%) indicated that between 0-5 display
fertility problems.
Figure 12: Cases of endometriosis which involved infertility.
How many of these cases involved fertility problems
associated with endometriosis?
80.0%
Percentage of Herbalists
70.0%
24
60.0%
50.0%
40.0%
30.0%
20.0%
4
2
10.0%
3
2
0.0%
0-5
6-10
11-15
16-20
21-25
Number of cases of endometriosis with associated infertility
Source: Questionnaire (B) data (n=24)
36
>25
4.3.4 Case Study to identify herbs used to treat Endometriosis
Question 7 was posed as a case study to assist Herbalists formulate a prescription. An outline was
provided of a patient with a confirmed diagnosis of endometriosis along with a description of
associated symptoms, diet and lifestyle. The respondent was asked to provide a list of herbs which
they would use to treat the patient and justify their use. A total of 39 herbalists provided answers to
this question indicating 82 individual herbs which might be used in a variety of combinations to
treat this patient. The herb which was indicated most frequently was Vitex agnus-castus with
justification being given as “balancing of hormones” and “regulation of menstrual cycle”. Table 7
displays a list of the top 15 herbs indicated along with their herbal action and use in relation to
endometriosis. An alphabetical list of all 82 herbs identified along with the number of times
indicated by herbalists is provided in (Appendix 5).
Table 7: Top 15 herbs indicated for use with the given fictional Case History
Latin Name
(Common name)
Vitex agnus-castus
(Chaste berry)
Herbal Actions in relation
to endometriosis
Hormonal normaliser
Anemone pulsatilla
(Pasque flower)
Sedative, Analgesic,
Antispasmodic
Zingiber officinalis
(Ginger)
Antinauseant, Anti-emetic,
Anti-inflammatory,
Antispasmodic,
Carminative, Circulatory
stimulant
Viburnum opulus
(Cramp bark)
Antispasmodic, Antiinflammatory, Nervine,
Astringent
Alchemilla vulgaris
(Lady’s mantle)
Astringent, Uterine ‘tonic’,
Anti-inflammatory
Viburnum prunifolium
(Black haw)
Antispasmodic, Nervine,
Astringent
37
Use in relation to endometriosis













Dysmenorrhoea
PMS
Regulate ovulation cycle
Regulate menstrual cycle
Regulate hormones
Dysmenorrhoea
Chronic pelvic pain
Relax uterine smooth muscle
Insomnia
Pelvic pain and congestion
Nausea
Dysmenorrhoea
Digestive problems









Pelvic pain
Dysmenorrhoea
Abdominal pain
Menorrhagia
Menorrhagia
Pelvic pain
Metrorrhagia
Dysmenorrhoea
Uterine atony
Taraxacum off. rad.
(Dandelion (root)
Choleretic, Cholagogue,
Bitter, Gentle laxative,
Diuretic



Piscidia erythrina
(Jamaican dogwood)
Analgesic, Sedative,
Antispasmodic
Achillea millefolium
(Yarrow)
Antihemorrhagic,
Astringent, Bitter, Hepatic,
Haemostatic,
Antispasmodic, Antiproliferative
Anti-inflammatory,
Lymphatic, Astringent,
Anti-haemorrhagic,
Choleretic, Antispasmodic,







Calendula officinalis
(Calendula)
Paeonia lactiflora
(Peony)
Antispasmodic, Antiinflammatory, Sedative
Capsella bursa-pastoris
(Shepherd’s purse)
Antiheamorrhagic
Angelica sinensis
(Chinese angelica)
Anti-inflammatory,
Analgesic, Antispasmodic,
Circulatory stimulant,
Uterine ‘tonic’, Sedative,
Leonurus cardiaca
(Motherwort)
Nervine, Sedative,
Antispasmodic, Uterine
‘tonic’ Bitter
Uterine tonic, Astringent
Rubus idaeus
(Raspberry)
Source: Questionnaire (B) data (n=39)



Constipation
PMS
Elimination of excess hormones
via liver + bowel
Pelvic pain
Dysmenorrhoea
Insomnia
Menorrhagia
Stimulates digestion
Dysmenorrhoea
Reduce endometriotic tissue






Amenorrhoea
Dysmenorrhoea
Elimination of excess hormones
via liver + bowel
Fatigue
Amenorrhoea
Dysmenorrhoea
Infertility
Menorrhoea
Metrorrhagia













Dysmenorrhoea
Amenorrhoea
Infertility
Uterine atony
Pelvic pain and congestion
Fatigue
Pelvic pain + congestion
Uterine pain
PMS
Anxiety
Infertility
Uterine tonic
Pelvic circulation
4.3.5 Identification of key herbs in a prescription to treat endometriosis
Herbalists who preferred not to use the case study were asked to identify the key herbs they would
use in a prescription and justify them. 35 herbalists provided responses highlighting an almost
identical list of herbs to the Case Study.
There was only 1 addition, Filipendula ulmaria
(Meadowsweet), with justification being “transition between different life stages”. Although the
‘top 15 herbs’ were identical to the Case Study, the hierarchy differed. Vitex agnus-castus was still
38
indicated the greatest number of times however, Angelica sinensis rose from 13th to 7th place. There
was no significant difference in justification of why herbs were selected. Table 8 (overleaf)
demonstrates the 15 herbs, in order of preference and includes their chemical constituents (full
details Appendix 4).
4.3.6 Additional Comments from Herbalists
The questionnaire concluded by asking respondents to provide any additional comments they felt
would be useful. This open question received 24 responses and included replies which stressed the
importance of addressing diet and including exercise to enhance treatment with herbs (full details
Appendix 4).
39
82 Herbs identified to treat a fictional Case History of Endometriosis (Top 15 herbs are highlighted in bright green.)
Latin name
Common name
Number
of times
indicated
8
2
14
1
20
1
6
Form
Achillea millefolium
Agrimonia eupatorium
Alchemilla vulgaris
Althea officinalis fol.
Anemone pulsatilla
Angelica archangelica
Angelica sinensis
Yarrow
Agrimony
Lady's mantle
Marshamallow (leaf)
Pasque flower
Angelica
Dong quai
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Arctium lappa
Artemisia vulgaris
Asarum canadense
Atropa belladonna
Avena sativa
Ballota nigra
Berberis aquifolium
1
1
1
1
1
1
1
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Berberis vulgaris
Bupleuremn chinense
Calendula officinalis
Burdock
Mugwort
Wild ginger
Belladonna
Oat seed
Black horehound
Oregon grape
(Mahonia)
Barberry
Buplerum
Marigold
1
1
7
Tr
Tr
Tr
Capsella bursa-pastoris
Capsicum annuum
Carduus marianus
Caulophylum thalictroides
Centella asiatica
Chamaelirium luteum
Chelidonium majus
Shepherd's purse
Cayenne
St. Mary's thistle
Blue cohosh
Gotu kola
False unicorn root
Greater celandine
7
1
2
1
4
3
1
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Action
Circulation/styptic/haemostyptic/anti-inflammatory
Tone bowel
Uterine tonic/astringent to help with menorrhagia + diarrhoea
Demulcent
Pelvic pain/assist sleep/uterine antispasmodic
Tonify reproductive system/
Pelvic circulation/uterine pain/hormone regulator/warming
antispasmodic
Lymphatic
Uterine astringent
Pelvic stimulant
Severe pain
Nervine support
Antispasmodic
Alteritive
Liver tonic
Liver and irritability
Liver and tissue regeneration/vulnerary/lymphatic/antiinflammatory
Astringent for menorrhagia
Improve circulation
Liver support/oestrogen clearance
Pelvic stimulant
tissue healing/nervine/reduce adhesions
Hormone regulation
Anti-mitotic for adhesions
1
Cimicifuga racemosa
Black cohosh
3
Tr
Anti-inflammatory/relaxing nervine/uterine
tonic/hormonal/dyspareunia
Cinnamomum verum
Cordyalis yanhusuo
Curcuma longa
Cynara scolymus
Dioscorea villosa
Echinacea angustifolia
Echinacea purpurea
Escholzia californica
Galium aparine
Gelsemium sempervirens
Glycyrrhiza glabra
Cinnamon
Cordyalis
Turmeric
Artichoke
Wild yam
Echinacea
Echinacea
California poppy
Cleavers
Yellow jasmine
Liquorice
1
1
4
1
4
2
1
1
2
5
3
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Hydrastis canadensis
Hyoscyamus niger
Hypericum perforatum
Iris Versicolor
Lamium album
Golden seal
Henbane
St. John's Wort
Blue flag
White dead nettle
1
1
1
1
1
Tr
Tr
Tr
Tr
Tr
Pain/nausea/blood mover
Anti-inflammatory/liver
Liver support/oestrogen clearance
Nutrify the gut/Git anti-inflammatory
Immune modulator/anti-inflammatory
Alteritive
Antispasmodic
Lymphatic
Pain
GI irritability+ function/adaptogen/antispasmodic/antiinflammatory
Astringent
Severe pain
Stress/anxiety
Alterative
Menorrhagia
Leonorus cardiaca
Matricaria recutita
Melissa officinalis
Mentha x piperita
Mitchella repens
Paeonia lactiflora
Motherwort
Chamomile
Lemon balm
Peppermint
Partridge berry
Chinese peony
6
4
2
2
2
7
Tr
Tr
Tr
Tr
Tr
Tr
Balance hormones/calming/bitter to stimulate liver
Nausea/pain/anti-inflammatory/sedative
Sleep
Liver and irritability
Uterine tonic
Pain/inflammation/antispasmodic/hormone modulation/sedative
Paeonia officinalis
Passiflora incarnata
Peumus boldo
Phytolacca americana
Piper methysticum
Peony
Passion flower
Boldo
Poke root
Kava kava
1
4
1
1
2
Tr
Tr
Tr
Tr
Tr
Pain
Alterative
detoxification
Pain/sleep
2
Piscidia erythrina
Rhodiola rosea
Rosmarinus officinalis
Rubus idaeus
Rumex crispus
Salix alba
Schisandra chinensis
Scutellaria baicalensis
Scutellaria lateriflora
Serenoa serrulata
Silybum marianum
Stachys betonica
Tanacetum parthenium
Taraxacum officinale radix
Thuja occidentalis
Trifolium pratense
Trillium erectum
Turnera diffusa
Urtica dioica
Valeriana officinalis
Verbena hastata
Verbena officinalis
Jamaican dogwood
Aaron's rod
Rosemary
Raspberry
Yellow dock
White willow
Schisandra
Baikal skullcap
Skullcap
Saw palmetto
Milk thistle
Wood betony
Feverfew
Dandelion (root)
Thuja
Red clover
Beth root
Damiana
Nettle
Valerian
Blue vervain
Vervain
Cramp bark
Viburnum opulus
Black haw
Viburnum prunifolium
Periwinkle
Vinca major
Chaste berry
Vitex agnus castus
Ashwaghanda
Withania somnifera
Prickly ash
Zanthoxylum americanum
Ginger
Zingiber officinalis
Zizyphus spinosa
Jujube
Source: Questionnaire (B) data (n=39)
9
1
2
6
1
1
3
2
4
1
1
1
1
9
5
1
4
1
1
5
1
4
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Pelvic pain/sleep/nervine
Nervine/fatigue
Circulation/mood
Uterine tonic/pelvic circulation
Bowel support/inflammation
Anti-inflammatory
Liver support/adaptogen
Anti-inflammatory/anxiolytic/anti-emetic/hepatic
Sleep
14
11
2
26
4
1
16
1
Tr
Tr
Tr
Tr
Tr
Tr
Tr
Tr
antispasmodic
Antispasmodic/pain
Astringent for menorrhagia
Pituitary balance for hormones
Adaptogen/sleep
Circulation
Anti-emetic/circulatory support/pain/circulation/digestive
Aid digestion/nervine/ antispasmodic/anxiolytic/relaxant
Liver support
Nervine support
Pain
Liver support
Anti-mitotic for adhesions
Reduce oestrogen production and aid lymphatic clearance
Astringent for menorrhagia/heavy periods/hormones
Nervine
Anaemia
Sleep
Hormonal regulator/bitter
Nervine
3
DISCUSSION
5.1 Introduction
The aim of this research was to explore the Western herbal medicine approach to the treatment of
endometriosis. To achieve this aim a number of objectives were realised including secondary
research via a literature review and primary research with questionnaires.
5.2 Literature review
The prevalence and epidemiology of endometriosis is well documented as are the symptoms and
treatment approach by allopathic clinicians. Symptoms are at best managed with medication but
often sufferers have to resort to invasive surgery for definitive treatment. There is insufficient
evidence to conclude that surgery provides long term significant benefit for sufferers from
endometriosis.
Allopathic research appears to focus on identifying the aetiology of the condition, with a drive to
design diagnostic biomarkers for early identification of endometriosis. Advantages to be gained
would be an understanding of mechanisms for timely treatment pathways.
Findings highlighted the debilitating impact on the female population with approximately 10%
demonstrating the effects of endometriosis. This impact is reflected in several areas including
health, social and professional environments.
Specific areas of concern is the impact of
endometriosis on fertility and the suggestion that endometriosis may increase the risk of developing
cancer.
In contrast to allopathic medicine Western Medical Herbalists take into consideration diet and
lifestyle as well as addressing physical aspects of pain/inflammation, hormonal imbalance and
challenged immunity. Emphasis is placed on treating the individual, taking into consideration
emotional and psychological mechanisms as well as physical well being. Western herbal medicine
cannot cure endometriosis but literature suggests that its approach of combing herbal treatment with
improvements to diet and lifestyle may be effective in alleviating this debilitating condition.
Research is focused on investigating combinations of herbs which address the inflammatory
response, cell proliferation and inducing apoptosis. There are additional studies suggesting that
1
Curcuma longa has a significant effect on endometriotic lesions and tissue which may impact by
reducing levels of pain which is one of the most debilitating symptoms.
Substantial debate exists on whether or not phytoestrogens are a beneficial addition to the diet with
some sources advocating caution. Epidemiological evidence demonstrates a high prevalence of
endometriosis within Asian populations who include a large amount of phytoestrogens within their
diet. Moderation appears to be indicated however this is an area which may benefit from further
research.
5.3 Questionnaire (A) – Endometriosis Sufferers
This questionnaire received a low response rate considering the number of forums and websites on
which it was posted. Speculation as to why this occurred is beyond the scope of this research but
may indicate the need for greater awareness amongst the public about the efficacy of Western
herbal medicine.
Half the responses came from women between the ages of 31 – 40 which correlated with data found
in the literature review about the age and profile of women suffering from endometriosis.
Respondents also confirmed a 70% infertility rate which matched data reported by Marchese (2009)
in the Townsend letter and was corroborated by data from Questionnaire (B) to Western Medical
Herbalists. The questionnaire failed to ask about first degree relatives with endometriosis which
may have supported global research into identifying the genes responsible.
For many women ‘pain’ was stated as the most debilitating symptom of their endometriosis
followed by ‘menorrhagia’ and ‘stress’, confirming and indicating clear treatment aims with herbs.
When piloting this questionnaire a request was received to include a question about diet but was
rejected on the basis that it detracted from the main focus of the study. It would have been
beneficial to include this question as respondents indicated that they benefited greatly from making
changes to their diet. This feedback highlights an area for further research. One respondent who
recommended an “organic vegetarian” diet stated she is a “firm believer in changing your diet to
help with endo”. Herbal medicine was shown to be the most effective alternative therapy to help
alleviate symptoms but a flaw in the questionnaire did not specify whether it was Western herbal
medicine or traditional Chinese medicine. Studies highlighted in the literature review discussed the
use of phytoestrogens in the diet but these were not mentioned by respondents. With results
confirming the popularity of changes in diet to alleviate symptoms, closely followed by herbal
2
medicine, it would appear that a combination of both may improve symptoms of endometriosis.
These findings justify the treatment approach by Western Medical Herbalists who address diet and
lifestyle alongside herbal medication.
Of the 17 herbs identified by respondents only 2 did not appear in the list of 82 identified by
Western Medical Herbalists.
These were Datura stramonium and Sambucas nigra both
traditionally prescribed for respiratory conditions. As Herbalists prescribe on an individual basis it
may be that these respondents were also suffering from respiratory problems as well as
endometriosis.
Few respondents were able to recall the names of herbs they had used and several cited vitamins
and minerals as being herbs. This may be because they had not been told the names of herbs
included in herbal mixtures and highlights the need for clarity and education for the public.
Although only half of the respondents admitted to benefitting from treatment with herbs it was
demonstrated that there is a positive connection between efficacy and the length of time the herbs
were taken.
5.3 Questionnaire (B) - Western Medical Herbalists
The number of responses received from registered Western Medical Herbalists was an acceptable
sample size and representative of institutions in England, Scotland, Wales and Canada. However
only Herbalists registered at 2 institutions were approached and therefore the results of this research
cannot be wholly representative of all Western Medical Herbalists.
Results were analysed of the respondents who had treated endometriosis in practice to see if there
was a difference in treatment strategy between Herbalists who had been in practice <10 years and
those practicing >10 years. Herbal actions generally stayed the same but the variety and selection
of herbs was different. This demonstrates that the approach to treating endometriosis appears to
remain constant irrespective of how many years an Herbalist has been practicing. Choice of herbs
may be attributable to advances in research, scarcity and price or because an herb is enjoying a burst
of media popularity.
82 herbs were highlighted in response to the case study demonstrating the diversity of herbs
available from which to provide a prescription. A core 15 herbs were favoured covering all the
herbal actions indicated to treat endometriosis apart from immune-stimulating. Only 3 respondents
indicated an herb suited for this purpose which is surprising considering speculative research that
3
endometriosis is an autoimmune condition. Herbalists agreed that addressing inflammation and
pain was the top priority followed by balancing hormones and improving circulation.
Also
featuring highly were herbal actions to support the nervous system and hepatic activity.
There was evidence that Herbalists do not prescribe one mixture but two or even three. These
prescriptions may consist of a ‘simple’ dose of hormone balancing herbs on rising followed by a
mixture that addresses inflammation and immune system stimulation (or similar). There might then
be another mixture that aids relaxation and sleep which would be taken before bed. Further
variations include different mixtures depending on where the patient is in their menstrual cycle and
whether they tend to be hot or cold. Much depends on whether a woman wishes to conceive and is
troubled with infertility and whether they have experienced previous surgery from Caesarean
section surgery and have existing scar tissue. Additional comments also emphasised the need for a
patient to persevere with herbal treatment and that some patients didn’t give the treatment long
enough to have a beneficial effect.
It was expected that Angelica sinensis would feature more strongly as it is traditionally indicated
for use in gynaecological disorders; however it was only indicated by 6 Herbalists. The explanation
for this may have been due to the patient in the case study having an “irregular and heavy”
menstrual cycle and Angelica sinensis is contraindicated in these circumstances. It featured more
strongly when Herbalists designed a prescription without considering the case study. Although this
herb is of Chinese origin it has been incorporated into the Western Medical Herbalist’s tool kit
based on traditional use for gynaecological conditions and evidence from clinical trials showing its
anti-inflammatory properties.
Additional comments from Herbalists confirmed earlier findings that addressing diet and lifestyle
are vital to improving a patient’s health as well as prescribing herbs.
4
CONCLUSION
Endometriosis cannot be cured but it may be possible to alleviate symptoms and improve quality of
life with Western Herbal Medicine. Sufferers of endometriosis may favour a combination of herbal
medicine and diet as alternative therapy to treat symptoms.
The global call for universal partnership in endometriosis research is merited based on the
overwhelming evidence of physical, emotional, social and financial costs. Research into the
identification of a definitive diagnostic is essential for early treatment of endometriosis.
Herbalists have a wide range of herbs at their disposal to treat patients on an individual basis with
strategies that take into account lifestyle and particularly diet.
Herbal actions target anti-
inflammatory pathways and sustain the central nervous system as well as providing support for the
digestive system. Prescriptions are provided which address the holistic needs of the patient.
5
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