November 9
Elaine, a 38-year-old woman, 125 lbs., 5’6”, visited my office on February 11, 2021. She had been trying to conceive for six years and was diagnosed with stage 4 endometriosis last August. Her right ovary and right fallopian tube had been removed surgically. The ovarian cyst measured 7.2 × 4.3 × 3.0 cm. She became pregnant one month after the surgery but miscarried at nine weeks. Since then, her cramping had returned. She experienced sharp, paroxysmal pain before and after her period, with a pain score of 8/10, often accompanied by cold sweating. The pain sometimes occurred during menstruation, requiring significant amounts of pain medication. Her symptoms were very disruptive to her daily life and work. In January, a sonogram revealed a 4.8 × 4.5 cm cyst in the right adnexal area. Her doctor suggested another surgery, but Elaine preferred a noninvasive treatment to manage the disease, given how quickly it recurred after the previous surgery.
Gynecological history: Menarche at 14 (5/28–30), ovulation on day 14. G2 A2 (patient had an abortion in 2015). LMP: 02/07/21.
Family history: Unclear.
Elaine initially visited my office to reduce her pain and return to a normal life. She also wished to control her endometriosis to avoid repeated surgeries. She was skeptical about conceiving naturally because her endometrioma had returned so quickly. I explained that Chinese medicine could help control her endometriosis, reduce pain, potentially decrease the size of the endometrioma, and possibly support natural conception. I encouraged her to try to conceive during treatment. I recommended an anti-inflammatory diet, daily herbal supplements, and weekly acupuncture sessions.
Chinese medicine takes a holistic approach: it considers all signs and symptoms (both subjective and objective), family history, lifestyle, cultural background, climate, and seasonal factors. This information is analyzed collectively to determine a pattern of disease, which reflects the stage of the condition and the individual’s response to it, including epigenetic factors.
Elaine was born in Taiwan and moved to the United States at 18. Her diet, climate, and lifestyle had changed significantly, including higher meat consumption, altered sleep patterns, and increased stress. These changes affected her metabolism, gut microbiome, immune system, and hormonal balance, which in turn impacted her pelvic organs and were reflected in her tongue’s color and coating.
Endometriosis is a benign disease characterized by ectopic endometrial glands and stroma, associated with pelvic pain and infertility or miscarriage. Ectopic endometrial tissue typically grows in the ovaries, fallopian tubes, large intestine, and peritoneum. Bleeding during menstruation cannot exit normally, leading to adhesion, scar tissue, and severe pain. Structural changes in the pelvic organs interfere with oocyte development, early embryogenesis, ovum capture, and endometrial receptivity. Stage 3 and 4 endometriosis present significant structural changes.
The causes of endometriosis are complex and not fully understood. Retrograde menstruation and implantation of viable endometrial tissue are possible mechanisms, but not all women develop severe disease. Women with endometriosis may have inherently abnormal endometrial cells, predisposing them to ectopic implantation and propagation. Genetic factors may include genes supporting survival of detached endometrial cells, adhesion and invasion of peritoneal surfaces, proliferation, neovascularization, or inflammatory responses. For example, eutopic endometrial cells in women with endometriosis are resistant to apoptosis; secretory endometrial matrix metalloproteinases are unusually resistant to progesterone suppression, allowing invasive potential; and aromatase expression is abnormal, enhancing local estrogen production.
Endometriosis is also associated with cellular and humoral immune changes, suggesting that impaired immune responses may prevent effective removal of refluxed menstrual debris.
Consequently, endometriosis not only alters reproductive organ structure, reducing the chances of ovulation and fertilization, but also negatively affects oocyte quality, early embryonic development, and implantation, increasing the risk of infertility and miscarriage. Elaine exemplifies such a case.
Elaine conceived quickly after her surgery but miscarried at nine weeks. At this stage, additional surgery was not advisable for fertility preservation. At age 39, protecting her fertility was the priority. While IVF was an option, success would be low if the pelvic and uterine environment remained compromised. Based on my clinical experience, Chinese medicine—including herbal supplements and acupuncture—can benefit women who have experienced recurrent IVF, IUI, or failed natural pregnancy attempts. Studies in China suggest that Chinese medicine can influence gene expression and repair the immune system, creating a healthier environment for conception. I recommended Elaine prepare to conceive for three months naturally, considering IVF only if pregnancy did not occur within that timeframe.
In Chinese medicine, endometriosis presents in several patterns, reflecting variations in gene expression influenced by diet, stress, lifestyle, hormones, and immune function—an area studied as epigenetics. Epigenetic changes are reversible and do not alter the DNA sequence, but they affect gene expression and how the body reads DNA.
I advised Elaine to modify her diet and lifestyle according to her pattern. Herbal supplements were prescribed to alleviate symptoms and potentially modulate gene expression. For example, foods like green tea may influence DNA methylation and regulate methyltransferase levels. Acupuncture was used to reduce stress and anxiety and to balance her neuro-immune-endocrine system.
Elaine’s presentation corresponded to a pattern of qi and blood stagnation with damp-heat, alongside underlying qi and yang deficiency. She took herbal supplements daily and received weekly yin acupuncture sessions. After one month, her menstrual cramping decreased by 50%; after the second month, it decreased by 90%. A sonogram showed the ovarian cyst had decreased from 4.8 cm in January 2021 to 2.8 cm. Elaine conceived naturally in May 2021.
