What Is Adenomyosis?

Adenomyosis is endometriosis of the uterus. It occurs when the endometrial glands grow into the myometrium in addition to being in the endometrium.

Adenomyosis is a type of chronic pelvic pain.

Who Gets Adenomyosis

People used to think that only women in their 40s and 50s who had already had a baby were at risk of adenomyosis.

Now, with the wide-spread use of ultrasound, gynecologists are checking the uterus for younger women with painful periods and noticing the uterus looks thicker and more globular like the adenomyosis uterus.

About 50% of women with adenomyosis also have fibroids.

What Are the Symptoms of Adenomyosis

• 1/3 women asymptomatic
• Heavy menstrual bleeding
• Irregular bleeding
• Pelvic pain with period
• Pain with sex
• Infertility

Cause of Adenomyosis

• Injury from cesarean, D&C, or pregnancy
• Altered lymph and venous drainage
• Abnormal initial development of the layers of the uterus

Hormones and Adenomyosis

Adenomyosis presents as an estrogen-dominant condition. However, generally women do not have higher levels of estrogen.

The issue is that there are more estrogen receptors, and the estrogen receptors are more sensitive, so the same amount of estrogen has a bigger effect.

There are also problems with estrogen metabolism so you have recirculation of estrogen.

Additionally, there is an excess of inflammatory prostaglandins with adenomyosis. This leads to painful periods and heavy bleeding.

How To Diagnose Adenomyosis

• 2 or 3 dimensional transvaginal ultrasound
• Pelvic MRI

Biomedical Treatment of Adenomyosis

• No FDA approved treatments
• NSAIDS
• Hormonal menstrual suppression
• Gonadotrophin-related drugs
• Hysterectomy (80%)

Natural Care for Adenomyosis

• Castor oil packs
• Visceral/vascular/lymphatic manipulation
• Improve estrogen metabolism – detox
• Down-regulate estrogen receptors with adaptogens
• Treat underlying conditions such as infection and inflammation
• Modify environmental exposures to estrogen

What Is Pudendal Neuralgia?

Pudendal neuralgia is pain experienced in the pelvic floor or external genitalia that is caused by microtrauma to the pudendal nerve.

Pudendal neuralgia is worse with sitting, and better with standing, laying down, or sitting on the toilet.

Why Do Some People Have Pudendal Neuralgia?

Trauma to the pudendal nerve most commonly can occur with childbirth, pelvic prolapse surgery, cycling, or excessive sitting.

If your pain has not resolved with decompression surgery or pelvic floor myofascial release, other causes of pudendal neuralgia include endometriosis, viral infections, venous congestion, diabetes, and autoimmune conditions.

How To Diagnose Pudendal Neuralgia

You will be diagnosed with pudendal neuralgia if all the following are true.

• Pain in the area of the pudendal nerve
• Pain primarily with sitting
• Pain is not worse at night
• No sensory loss
• No itching with pain
• Pain is not fleeting
• Imaging doesn’t identify a different reason for pain
• Pudendal nerve block relieves the pain

Biomedicine’s Approach to Pudendal Neuralgia

• Pain killers and muscle relaxants
• Myofascial pelvic floor therapy
• Pudendal nerve block
• Surgical decompression

My Holistic Approach to Pudendal Neuralgia

• Set up the drainage system of the body
• Optimize organ mobility (especially kidneys and uterus)
• Address fascial constraint
• Address ligamentous and joint imbalance
• Optimize posture, breathing mechanisms, and postural muscle strength/activation

What to Expect

I will not be exclusively treating the pelvic floor

I will be identifying all the structures that have a bearing on the function of the pudendal nerve and optimizing their function.

If there is an underlying process like a viral infection, diabetes, or an autoimmune condition, we will treat that, too.

• 20 hours of hands-on manual therapy
• 2 hours of exercise
• 1-4 hours internal medicine

I feel like patients get better faster if they get treatments close together in the beginning.

People usually do well with a minimum of 2 hours of care a week.

If you are coming in from out of town for care, we should be able to complete the care within 7-10 days.

What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome occurs when the veins that are supposed to drain the pelvis cannot do their job adequately. The vein that most commonly has problems is the left ovarian or testicular vein.

Women or men can experience this syndrome and is characterized by

• Pelvic pain of >6 months duration
• Possible external genitalia varicosities
• Possible lower extremity varicosities or insufficiency
• Pain after or during sex (most diagnostic symptom)
• Pain worse with standing and walking
• Bladder or rectum discomfort
• Painful menstruation
• Swelling of lower extremities

Risk factors for pelvic congestion syndrome include

• PCOS
• Having had at least one baby
• Obesity
• Varicose veins

Biomedical Treatment

• Blocking the incompetent veins by embolization or sclerotherapy is considered to be the best treatment.

My Natural Approach
I recommend a trial of conservative therapy for patients to are interested in, and able to, exercise. Passive care without exercise might not be enough to improve function
My approach includes

• Treating any underlying conditions (such as PCOS, which generally is related to insulin-resistance, so requires dietary and lifestyle changes)
• Visceral manipulation (left kidney is commonly involved, as is uterine retroversion, pelvic organ prolapse, and adhesions from prior surgeries)
• Vascular manipulation (draining the veins, opening up the main venous and lymphatic returns to optimize movement)
• Botanical support for strengthening vessels and mobilizing lymph, fish oil to thin the blood, nattokinase to prevent clots associated with venous congestion
• Homeopathic suppositories for hemorrhoids (which are varicose veins)
• Instruction on physiologic breathing
• Hydrotherapy such as sitz baths or cold plunges to reset veins and wring out pelvic congestion
• Instruction on core strengthening

What To Expect

• Approximately 20 hours of manual hands-on visceral and vascular and lymphatic manipulation
• Approximately 2 hours of internal medicine consults
• Approximately 2 hours of exercise practice

How Long Does the Treatment Last?

I find people do better if the initial treatment sessions are frequent and close together.

People who are not too inflamed do well with a minimum of 2 hours of manual hands-on therapy weekly, and commonly more.

If you are coming in from out of town, we can complete all the therapy within 7-10 days.

Because some of the underlying conditions such as PCOS can take 3-6 months to heal, the final improvements will not be fully appreciated until the underlying conditions have healed.

There is one normal position of the uterus: slight anteflexion.

The uterus should be slightly bent forward, hovering over the bladder.

In biomedicine there is only one abnormal position of the uterus, and that is prolapse – or falling out.

All other positions of the uterus are considered to be normal variants.

I think biomedicine has come to this conclusion for two reasons:

1) The paradigm that biomedicine functions under is largely biased toward the diagnosis and treatment of pathology.

Things that are not pathology are often considered to be normal variants.

2) Biomedicine does not have a form of intervention that suits addressing a uterus that is not in the optimal, or normal, position of slight anteflexion.

So there is no reason to identify a problem if there is no way to address it.

Possible Positions of the Uterus

In natural medicine and in indigenous medicine, such as Maya medicine, there is one normal position of the uterus:

In slight anteflexion.

The standard medical literature talks about normal variants for the position of the uterus as

Retroversion – Uterus Leaning back

Retroflexion – Uterus bending back

Anteflexion – Uterus leaning forward too far

In my practice, I also see the uterus leaning to one side, or torqued. I have not seen these positions mentioned in the medical literature.

The normal position of the uterus is for the non-gravid (not pregnant) fundus to be two inches above the pubic bone.

The uterus should also palpate as two inches wide in this area.

If the uterus is lower than two inches above the pubic bone, this suggests prolapse.

Parts of the uterus

The uterus is divided into sections

The cervix is the lowest section. It is in the top of the vagina and is the neck of the uterus

Above the cervix is the lower uterine segment.

The top of the uterus is the fundus

The arms of the uterus, called the fallopian tubes, come out of the fundus and end in hands, called the infundibulum, and fingers, called the fimbriae.

The fimbriae reach to draw the egg up into the uterine hand and arm.

Ligaments of the uterus

The ligaments of the uterus are different from most other ligaments in the body because some have muscles fibers in them, and all have some capacity to stretch and lengthen to respond to the uterine changes of pregnancy.

The main ligaments of the uterus are the

Broad ligament: The broad ligament is actually a big sheet of fascia that goes over the front an back of the uterus, in which the fallopian tubes and ovaries are inserted. It hooks on to the sides of the pelvis and is a major stabilizer of the uterus. I call the broad ligament the wings of the uterus. (The yellow in the picture)

Round ligaments: The round ligaments are also embedded in the broad ligament; one on each side of the uterus. But they are true ligaments, even though they have smooth muscle fibers in them. Each of the two round ligaments originates in the cornu of the uterus (the upper outer part of the fundus close to where the fallopian tubes attach), travels through the inguinal canal (like the spermaticord in males), and inserts into the labia majora by the perineum.

Utero-sacral ligaments: These ligaments originate below the broad ligament on the cervix and go on either side of the rectum to insert onto the sacrum. They also have smooth muscle fibers in them.

Cardinal ligaments

The cardinal ligaments originate on either side of the cervix and insert into the sides of the pelvis.

 Pubocervical ligaments

The pubocervical ligaments originate in the front of the cervix and insert into the pubic bone

Why the uterus is in a non-ideal position

The uterus generally moves out of its normal anteflex position due to trauma.

This trauma could happen at any time of life.

I have treated little girls all the way through to elderly women who have a uterus out of position.

Many times people do not even have an overt association of injury when we start to talk about the position of the uterus.

For active children and adults, falls are a normal part of athletics, and play.

Our shared cultural paradigm does not indicate that playful falls could cause alterations to our insides.

But they can.

Slip and falls, falls off horses, falls skiing or snowboarding, cannon balls, falls rollerskating, and pregnancy/birth are some of the common ways a uterus becomes displaced.

When an organ is displaced, commonly there is no immediate associated symptom.

If there was a fall, there could be a muscle or joint injury that will heal up within a matter of days or weeks.

If an organ is displaced, the associated symptoms will arise gradually over time, and are generally due to an alteration of venous or arterial blood, or lymph flow.

These symptoms, although caused primarily by the displaced organ and secondarily by the change in fluid flow, will often present as musculoskeletal complaints.

If you have a musculoskeletal symptom that does not respond to chiropractic, massage, acupuncture, stretching and strengthening think of the possibility of an organ or fluid component.

When I work with a displaced uterus, the body will usually indicate when the injury occurred and what type of injury it was.

Once we are working with the organ and have an idea of the time-period when the organ became displaced, the patient will also usually have a recollection of some type of trauma at that point in their life, even if it didn’t seem major at the time.

As the patient recounts the trauma, the uterus will begin to move to reposition herself.

The uterus and all the organs like to have their stories told and listened to.

That is part of the healing journey.

What happens if the uterus is in a non-ideal position

If the uterus is not in slight anteflexion the whole relationship of the pelvic organs and abdominal organs are thrown off.

The uterus in strong anteflexion will impair the function of the bladder.

The uterus that is retroverted or retroflexed will lay on the rectum and could cause constipation.

This leaning or bending back of the uterus can also cause low back pain and pelvic pain because the uterus is laying on the vascular or lymph drainage pathways.

The uterus that is leaning to the side or twisting can influence the function of the sigmoid colon, the cecum, and the ovaries or ureters.

Any of these altered positions can challenge the vascular and lymphatic drainage out of the pelvis.

Sometimes the symptoms are subtle and seemingly unrelated.

Sometimes the symptoms are dramatic and the relationship between the uterus and the symptom is overt.

Movement

Everything in the body is designed to move.

All movement occurs in relationship to all other movement.

Organ position can throw off proper relationship.

Proper movement is also influenced by a variety of experiences including a history of surgery, a history of inflammation or infection, trauma to connective tissue, congenital variants, chronic spasms, and deconditioning.

What to do

In the next video I will teach you how to palpate your own uterus and give you tips on treating it yourself.

You can also look for a practitioner of Arvigo Maya Abdominal Therapy or the Barral Technique to help you out.

The Mayans say the uterus is the queen of the body.

When the uterus is in her ideal/normal position she is on her throne.

When she is out of her normal position she is not on her throne and nothing in life will be easeful.

Find a way to put your queen back on her throne so you can have the easeful life you deserve and yearn for.

Your fluid body is made of arteries, veins, lymph, and cerebral spinal fluid.

I have come to see the fluid system of the body as part of the infrastructure of the body.

In my experience, the musculoskeletal system can collapse if the fluid body (and the organ body) are not functioning properly.

If the fluid system is not functioning properly, there will be too much fluid pooling in one area, and the area that excess fluid is supposed to be will experience a deficit. Both the areas of excess and deficit can experience pain.

There are many reasons the fluid body might not flow optimally.

The lymphatic fluid is largely reliant on physical movement and proper breathing to mobilize it.

Most people, in my experience, are too sedentary and also do not breathe properly.

This can create stagnation in the lymphatic fluid.

Obstruction by an organ, constraint of fascia, varicosities, and poorly toned muscles can also contribute to poorly moving lymph.

Of course, lymph stagnation can also occur secondary to surgery and excision of a lymph node, or if there is an infectious or inflammatory process the lymph fluid will slow down to try to address it.

Organs that are not moving properly can have a huge impact on the ability of the vascular system to mobilize.

If an organ is not suspended properly, it can kind of lay on the vascular structures and impede flow.

For instance, in my experience pelvic congestion (a vascular syndrome) often has an organ origin.

Three veins (well actually 5 if you count both sides) drain the pelvis: the internal iliac vein, the ovarian vein, and the inferior mesenteric vein.

Problems with the left ovarian vein is the number one cause of pelvic congestion syndrome.

Why? because it has a complicated journey to get that pelvic blood back to the vena cava. The left ovarian vein drains into the left renal (kidney) vein. If there is a problem with left kidney movement almost always you will have problems draining the left ovarian vein and the pelvis. In this case, you cannot just take care of the ovarian vein and tah-dah the pelvic congestion vanishes. You must address any organ involvement and also address the venous involvement (there will be lymph involvement, too).

In my experience in manual medicine, the fluid body is the least appreciated of all the bodies, and the most important to address since it influences so much.

Because of the intrinsic challenges of the venous system, it requires rehabilitation to a degree far greater than the musculoskeletal system, and often will required some degree of support for life once it has been compromised.