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 a normal period?

When I ask women about their periods, they will often say they have the “normal” amount of pain, or a “normal” length period, or a “regular” colored period.

What they really are trying to say is that they have a culturally normative, or commonly experienced, type of period.

Today we are going to talk about what a physiologically “normal” period is, and what your body is trying to tell you when you don’t follow this pattern.

First off, there should be no pain or disability with your period.

This is the most important thing because culturally we have come to believe that a painful, grouchy, fatigue-ridden period (or start of the period) is normal, expected, and experienced by everyone.

No.

This is not normal.

Pain and disability is experienced by many girls and women with their periods.

But it is not normal, and should not be tolerated.

We must change out cultural expectation around this because a dysfunctional period leads to a dysfunctional menopause.

And believe me, if you think a dysfunctional period is bad . . . . it’s got nothing on a dysfunctional menopause.

Ok. That’s my intro tirade.

Now let’s look at other components of a normal period

1) Length of Cycle

The normal/optimal length of a cycle is 28 days.

The first day of the cycle is the first day that you bleed.

The last day of the cycle is the last day you do not bleed – that is the day before you bleed again.

The first half of the cycle (first 14 days or until ovulation) is called the follicular (proliferative) phase.

This phase will come to an end when sufficient follicle stimulating hormone (FSH) is produced in the brain to mature the oocyte (egg) that will mature enough to be ovulated mid-cycle.

This first phase of the cycle is largely brain dependent and reflective of the vitality and responsivity of the ovary.

The second half of the cycle (second 14 days or until the bleed starts) is called the luteal (secretory) phase.

The length of your cycle is largely based on hormone fluctuations that are influenced by the mileau of your body.

Hormones

Estrogen causes tissue proliferation.

For the uterus, that means the higher estrogen is the more the uterine lining is built.

Progesterone causes the proliferation to be maintained.

So you need enough estrogen and progesterone to be able to make the uterine lining (called the endometrium).

And you need the estrogen and progesterone to decrease enough so the uterus releases the endometrium and you start bleeding.

Now in standard biomedicine (AKA Western medicine, conventional medicine, standard medicine, allopathic medicine) a cycle is only considered to be abnormal if it is less than 21 days (polymenorrhea), or longer than 37 days (oligomenorrhea), or less frequent than every 90 days (amenorrhea).

The bleeding that we are talking about here is for women who are still cycling and this is the bleeding part of their cycle. We will talk about other types of bleeding outside of the menses on a different video. We are also assuming no pathology, like cancer, is present. We will talk about that type of bleeding in a different video.

2) How many days of bleeding

3-5 is considered normal

For me factors that influence whether someone has a 3 or 5 day cycle have to do with their reproductive vitality.

So women in their 20s and 30s will tend to have bleeds of 4-5 days, and women in their 40s will tend to have bleeds of 3-4 days. Women who are experiencing a physiologic normal perimenopause in their late 40s and early 50s will have periods between 2-3 days.

Over 7 days of bleeding is metrorrhagia.

Long bleeds recapitulate long bleeds.

That is because the underlying hormonal issue persists, and the more blood you lose, the more iron you lose, so it is hard to stop bleeding because iron is one of the things that helps to stop the bleed.

3) Amount of blood

The normal amount of blood lost in a period is 30-50 ml (2-3 tablespoons)

This is hard to measure.

If women have to change a regular tampon, pad, or cup more often than every 2 hours, this is considered to be a heavy bleed.

A light bleed means they only need to change a regular tampon, pad or cup a couple times a day.

Now with menstrual underware it is harder to measure how much you bleed, so you need to check using a pad, tampon, or cup.

4) Color of blood

Normal menstrual blood is bright red.

If your bleed is pink, or light red with kind of a separation of a clear (serous) fluid this means low estrogen

If your bleed is brick red or darker this means you have high estrogen or oxidized (old blood)

If your bleed is brown and sticky this means old blood, probably from that last cycle

5) Clotting

There should be no clotting with a normal period

If you clot, that means you have high estrogen

If you use a cup, you could see clots that are not related to estrogen.

Blood has clotting agents in it, and any blood that sits around will start clotting.

Thank god.

6) Spotting

There should be no spotting running up to your period, or after the bulk of your flow

Often times people who experience spotting will note the spotting is a different color than the period blood.

If the blood is dark and sticky spots before or after the period, this suggests the uterus is not in ideal position.

If the spotting is pink and thin or watery, this suggests there is low estrogen.

The three major things that influence the nature of a menstrual bleed are

1) Hormone levels

2) Iron levels

3) Uterine position or other factor related to the uterus (such as fibroid)

References

James AH. Heavy menstrual bleeding: work-up and management. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):236-242. doi: 10.1182/asheducation-2016.1.236. PMID: 27913486; PMCID: PMC6142441.

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.