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Endometriosis?"Is there any way of treating endometriosis other than with hormonal drugs such as Synarel?"-- Madelein van Emmenes (Published 11/15/2001)Endometriosis can be very difficult to treat. It develops when tissue that looks and acts like endometrium - the lining of the uterus - grows outside the uterus and implants itself elsewhere in the body. The abnormal tissue may grow in the ovaries, on the fallopian tubes and the ligaments supporting the uterus, in the internal area between the vagina and rectum, on the outer surface of the uterus, and on the lining of the pelvic cavity. The most common symptom is pain, particularly severe menstrual cramps. Between 30 and 40 percent of affected women may become infertile as a result of endometriosis.Nobody knows what causes endometriosis. One theory holds that during menstruation some menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. The condition may have a genetic basis since it seems to run in families. Or the errant tissue may have developed in the wrong place as far back as embryonic life.The drug most often recommended for treatment of endometriosis is Danazol, a weak synthetic male hormone that shuts off ovulation and eases symptoms in 80 to 90 percent of women treated. Synarel (nafarelin acetate), the drug you ask about, is a synthetic analog of GnRH, a naturally occurring gonadotropin-releasing hormone. Treatment with this type of drug blocks a woman's hormonal cycle by interfering with secretion of the pituitary hormones needed to stimulate production of estrogen and progesterone by the ovaries. I often don't recommend drugs for endometriosis because while they may suppress ovulation and ease symptoms, they don't cure the problem and, in the case of Danazol, may cause side effects.Since you've asked for an alternative to Synarel, a number of dietary measures can help relieve symptoms by reducing inflammation and helping to lower the amount of estrogen in your system:Eliminate polyunsaturated vegetable oils (corn, safflower, sunflower) and sources of trans-fatty acids such as margarine and partially hydrogenated vegetable oils. Add sources of omega-3 fatty acids such as sardines and other oily fish, and ground flax seeds. Avoid foods (including dairy products) from commercially raised animals; their feed may contain hormones. Emphasize soy foods such as tofu, tempeh, and soy milk, which are rich in plant estrogens and seem to block more harmful forms of estrogen. Limit alcohol intake, since alcohol boosts estrogen production.San Francisco gynecologist Monica Stokes, MD, a graduate Fellow of the Program in Integrative Medicine, emphasizes the need to include lots of fiber in your diet to help your body eliminate estrogen.In addition, regular aerobic exercise (which reduces circulating estrogen levels) and mind-body medicine, especially guided imagery, can be helpful. Traditional Chinese medicine has a good track record in managing endometriosis in terms of both pain relief through acupuncture as well as in healing the condition at a deeper level. Be sure, too, that your gynecologist is someone you trust and is willing to work with you as a patient in an active partnership.Dr. Andrew Weil
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