Endometriosis and Adenomyosis

Conditions & context

Endometriosis still takes years, on average, to diagnose. For many patients, those years have included repeated reassurance that severe pain is simply part of menstruation, suggestions that stress or a low pain threshold may be responsible, and a long process of consultations before the condition is finally recognized. By the time a diagnosis is made, the effort required to obtain it can itself have become part of the burden.

We approach endometriosis as a chronic inflammatory disease, with treatment directed not only at pain but at the broader pattern of symptoms that often accompanies it. This has been part of our work for many years. Adele appears in Endo What?, the 2016 documentary created to address the persistent gaps in information, diagnosis, and care surrounding endometriosis.

Adenomyosis is a related but distinct condition in which endometrial-type tissue is found within the muscular wall of the uterus. It often produces a somewhat different picture — particularly heavy or prolonged bleeding, severe cramping, pelvic pressure or heaviness, and a more diffuse uterine pain. Endometriosis and adenomyosis can also occur together, and we treat both.

What we treat this for

Chinese medicine does not remove endometriosis lesions or adenomyosis. What it can treat is the considerable burden of symptoms that comes with these conditions:

• Pelvic pain, both cyclical and the chronic daily pain many patients also carry
• Severe dysmenorrhea, including pain that begins days before bleeding
• Pain with sex, bowel movements, or urination
• Heavy or prolonged menstrual bleeding
• Fatigue and depletion associated with chronic pain and heavy bleeding
• Bloating, constipation, diarrhea, and other bowel symptoms that may accompany endometriosis
• Pelvic pressure and the heavy, aching uterine pain commonly associated with adenomyosis
• Recovery following surgery, and pain or other symptoms that persist afterward
• Fertility when endometriosis or adenomyosis is a factor — see our fertility page

The extent of endometriosis found on imaging or at surgery does not always correspond neatly to the amount of pain a person experiences. Our treatment is therefore guided not simply by a diagnosis or stage, but by your particular pattern: when the pain occurs, where it is felt, what makes it better or worse, the character and amount of menstrual bleeding, bowel and bladder symptoms, energy, digestion, sleep, and how well you recover between cycles.

How Chinese medicine interprets it

In Chinese medical terms, endometriosis and adenomyosis are understood primarily as disorders involving the circulation of blood. Pain that is fixed, severe, stabbing or cramping; menstrual blood that is dark or clotted; and pain that intensifies before or at the beginning of menstruation are classical signs of what Chinese medicine calls blood stasis.

But blood stasis is rarely the entire picture.

Some patients have significant cold and constriction; others have signs of heat and inflammation. Heavy bleeding may eventually produce considerable depletion. Years of pain can affect sleep, digestion, energy, and the nervous system. Bowel symptoms may become almost as troublesome as the pelvic pain itself.

Treatment therefore changes according to both the person and the phase of the menstrual cycle. Around menstruation, the emphasis may be on relieving pain and improving circulation. At other points in the cycle, we may concentrate more on inflammation, digestion, energy, blood production, or the underlying constitutional pattern that makes symptoms harder to recover from.

That second part matters. If you have lived with endometriosis or adenomyosis for years, the fatigue can be as consequential as the pain. Treating the painful days while ignoring what happens during the rest of the month — or the physical patterns that develop after years of pain — is rarely enough.

There can also be a musculoskeletal component to long-standing pelvic pain. Years of guarding against pain can leave the abdominal wall, pelvic floor, hips, low back, and surrounding tissues chronically tense and reactive. In some patients, this becomes an additional source of pain even when the underlying endometriosis has been medically or surgically treated. When we find this pattern, we address it as part of treatment rather than assuming that every symptom is coming directly from the lesions themselves.

What treatment involves

These are chronic conditions, and treatment is generally measured in months rather than weeks.

We usually begin with weekly acupuncture, sometimes treating more frequently when pain is severe or around particularly difficult points in the menstrual cycle. As symptoms become more stable, visits can be spaced farther apart.

Chinese herbal medicine may be incorporated when appropriate. Formulas are individualized and may change during different phases of the cycle rather than remaining the same throughout the month.

Moxibustion is also frequently useful, particularly when pain is accompanied by pronounced cold, cramping, or constriction. Dietary work may be included when bowel symptoms, inflammation, heavy bleeding, anemia, or significant fatigue are part of the picture.

Three menstrual cycles is a reasonable initial period in which to evaluate whether treatment is changing the pattern. We look for practical changes: fewer days of severe pain, less medication needed to get through a period, lighter or shorter bleeding where bleeding has been excessive, fewer gastrointestinal symptoms, shorter flares, better energy, and faster recovery after menstruation.

The goal is not a perfect period at all costs. It is to steadily reduce the amount of your life the condition takes from you.

Working with surgery and hormonal treatment

Acupuncture and Chinese medicine are complementary to gynecologic care, not a substitute for it.

For some patients, particularly those with significant endometriosis, excision surgery with an appropriately trained specialist can be an important part of treatment. We work with patients before surgery and during recovery afterward, as well as with those who continue to experience pelvic pain or other symptoms following surgery.

Many patients are also using hormonal treatment — including continuous hormonal contraception, progestins, or GnRH medications — to suppress menstruation or control symptoms. You can receive acupuncture while using these medications. Tell us everything you take, prescription and otherwise, particularly if Chinese herbs are being considered.

Where our work can be especially valuable is in the space between these interventions: helping manage pain, bleeding, bowel symptoms, fatigue, medication side effects, recovery from surgery, and the ordinary months and years of life during which a chronic gynecological condition still has to be lived with.

Why patients come to us specifically

Gynecology is a specialty here, not simply one of many conditions on a treatment list.

Adele trained in a Beijing hospital gynecology ward and has taught Chinese medical gynecology to other practitioners for twenty-five years. The practice has treated endometriosis, adenomyosis, menstrual disorders, and complex pelvic pain continuously since 1999.

That experience matters with conditions that rarely present in exactly the same way twice.

Common questions

Can acupuncture cure endometriosis or adenomyosis?

No. Acupuncture does not remove endometriosis lesions or eliminate adenomyosis. Our goal is to reduce the symptoms and functional burden of the disease — pain, excessive bleeding, bowel symptoms, fatigue, and the time it takes to recover from a difficult cycle.

Will treatment shrink my endometriosis lesions?

That is not how we measure treatment. The changes we look for are in pain, bleeding, energy, gastrointestinal symptoms, medication use, and function.

Should I have excision surgery?

That decision belongs between you and a gynecologist or endometriosis specialist who understands your particular case. If your symptoms suggest that specialist evaluation is warranted and you have not had one, we will encourage you to pursue it. Acupuncture can be used before and after surgery as part of a broader treatment plan.

I have had excision surgery and I still have pain. Can you treat me?

Yes. Persistent or recurrent pelvic pain after surgery can have several contributors, and this is an important part of our work. If you have your operative report, bring it with you.

Can I be treated while taking hormonal medication?

Yes. Tell us what you are taking. Treatment can be adapted to patients who are suppressing menstruation as well as those who are cycling naturally.

Does acupuncture help the bowel symptoms?

Bloating, constipation, diarrhea, painful bowel movements, and cyclical gastrointestinal symptoms frequently accompany endometriosis. We include them in the treatment picture rather than automatically treating them as a separate digestive problem.

I want to conceive and I have endometriosis or adenomyosis.

Come and talk to us early. Endometriosis-associated fertility difficulty and acupuncture support during fertility treatment are areas in which we have extensive experience.

How long will I need treatment?

We generally begin weekly and reassess after approximately three menstrual cycles. As symptoms improve, treatment is spaced out. Some patients continue periodically for maintenance, while others return around difficult cycles, during flares, while trying to conceive, or when circumstances change.