The uterus has a tissue lining on the inside called the “endometrium.” It makes a bed for a fertilized egg — once the egg implants itself into the endometrium, pregnancy occurs. When pregnancy does not occur, the endometrium breaks down and sheds (this is called “menstruation”), and the body then starts making a new lining for the next chance of pregnancy. Women have a cycle of growing and shedding this endometrial lining every month. This endometrium is supposed to exist only inside the uterus; however, endometrial tissue can sometimes migrate to other places in the pelvic cavity, such as the ovaries, fallopian tubes, the ligaments supporting the uterus, the area between the vagina and the rectum (known as the Pouch of Douglas), the outer surface of the uterus, and the lining of the pelvic cavity (called the “peritoneal membrane”). When this happens, it is called endometriosis.

• ✓Painful periods (dysmenorrhea) – usually pelvic pain, but also abdominal and lower back pain before and during periods and at ovulation. Some women have such severe pain that they are unable to perform normal activities.
• ✓Heavy periods (menorrhagia/hypermenorrhea) or bleeding between periods (metrorrhagia)
• ✓Infertility – not all women with endometriosis have infertility, but 30–40% of women with infertility have endometriosis
• ✓Pain during and after sexual intercourse
• ✓Pain with urination or bowel movement during the week of menstruation
• ✓Other symptoms – diarrhea or constipation, urinary frequency, abdominal swelling, bloating, nausea/vomiting, etc., especially during menses

If there is free flow, there is no pain; if there is pain, there is no free flow.

• ✓Early sexual activity before, during, and within 2 years of puberty – Chinese medicine views the uterus of a young girl as vulnerable and easily affected by pathogenic factors such as cold. This cold pathogen congeals the blood, causing blood stasis.
• ✓Intercourse during menstruation – menstrual blood is supposed to flow down; however, when a woman becomes sexually aroused, the Qi and fire in the body rise. This upward movement of Qi blocks the downward outflow of menstrual blood, causing blood stasis.
• ✓Excessive physical work, exercise, or sports during periods and pregnancy – Chinese medicine advises women to avoid excessive physical activity during their periods. Excessive physical activity has a greater negative impact on young girls at puberty, because their bodies are not yet fully developed and are therefore more vulnerable.
• ✓External cold – women are vulnerable to external pathogenic factors such as cold weather, especially before, during, and just after their periods, as well as just after childbirth. Sitting on a cold or wet surface, not wearing enough clothing, or even wearing wet clothing can all lead to exposure to external cold.
• ✓Tampons and intra-uterine devices (IUD) – a tampon or an IUD can physically block the discharge of menstrual blood, which can cause blood stasis.
• ✓Emotional strain, including anger, resentment, worry, and stress, affects the liver’s function of promoting the free flow of Qi, causing Qi stagnation. Long-term Qi stagnation leads to blood stasis.

Endometriosis is treated by medication and/or surgery; however, there is no medication that treats it completely. Western drugs either alleviate pain (pain killers such as non-steroidal anti-inflammatory drugs, or NSAIDs), or inhibit ovulation so that there is no menstruation and bleeding from the migrated endometrial tissue (using gonadotropin-releasing hormone analogs, oral contraceptive pills, or progestins, etc.). They are more likely to mask symptoms than to treat the disease itself. Surgery, on the other hand, can be done to remove implanted endometrial tissue for long-term pain relief. Surgical methods include laparoscopic surgery, and for women who do not plan on childbearing, a radical surgery such as hysterectomy with oophorectomy (removal of the uterus and both ovaries) along with removal of the endometrial tissue may be chosen. However, the former does not guarantee alleviation of pain, while the latter effectively puts the woman into immediate menopause.