Just as its name suggests, endometriosis is a condition in which endometrial tissue, which ought to remain inside the uterus, implants and proliferates in ectopic locations outside the uterus—such as the ovaries, fallopian tubes, urinary bladder, intestines, or even the lungs. This endometrial tissue settled in unfamiliar sites responds to hormonal fluctuations according to the monthly menstrual cycle, causing hemorrhage and triggering an inflammatory response just like the lining inside the uterus. However, because this blood and tissue cannot be discharged outside the body and remain trapped in place, they produce severe pain, tissue adhesion, and scar tissue. It is easy to see how distressing this process can be.
The most common symptoms are chronic pelvic pain and severe dysmenorrhea, and the intensity of this pain significantly disrupts daily life and substantially lowers quality of life. Patients may also complain of mittelschmerz, dyspareunia, and dyschezia, and in severe cases, it can cause infertility. It is certainly not an issue that should be dismissed as merely having bad period cramps.
Modern medicine has not yet clearly determined the precise cause of endometriosis, but there are several prominent hypotheses. The most representative is the retrograde menstruation theory, which posits that menstrual blood flows backward out of the uterus, travels through the fallopian tubes into the abdominal cavity, and allows endometrial tissue to implant. However, the question remains as to why endometriosis develops only in specific women when all women experience retrograde menstruation.
Recently, immunological factors, genetic factors, and inflammatory responses have been recognized as playing significant roles. Endometrial tissue implanted in ectopic sites interacts with surrounding tissues to induce a chronic inflammatory response, and these proinflammatory cytokines stimulate nociceptors, creating a vicious cycle that intensifies pain. You can understand this as a small ember continuing to burn inside the body.
In addition, from a neurological perspective, suffering from chronic pain can trigger central nervous system sensitization, in which the pain matrix of the brain is reorganized. This causes one to perceive pain more acutely even from minor stimuli. Hormonal imbalance cannot be overlooked either; an excess of estrogen or an imbalance of inflammation-inducing substances called prostaglandins is known to promote lesion growth and pain.
The stagnation of qi and blood (氣血凝滯) mentioned earlier in the Donguibogam aptly describes what modern medicine explains as a chronic inflammatory response and tissue adhesion. When internal circulation is impaired, inflammatory substances and waste products accumulate, ultimately forming an abdominal mass (積塊) in the lower abdomen—that is, a lump such as an endometriosis lesion. The adverse effects that stress and cold dietary habits have on the immune system and hormonal balance are also noteworthy. Once again, we are reminded of how organically connected our bodies are, across both Eastern and Western perspectives.
