Naturopathy utilisation by Australian women with diagnosed endometriosis: A cross-sectional survey

Highlights

• Women with endometriosis who consult with a naturopath also consult with laparoscopic surgeons, acupuncturists, physiotherapists, nutritionists/dietitians, or homeopaths.

• Women with endometriosis who consult with a naturopath are more likely to consult with an acupuncturist than non-naturopathy users.

• Women with endometriosis who consult with a naturopath are more likely to experience dyspareunia and diarrhoea than non-naturopathy users.

• Women with endometriosis who consult with a naturopath are more likely to use vitamin D supplements than non-naturopath users.

Abstract

Background and purpose

Endometriosis is a painful female reproductive disease resulting in unmet health needs. Women with endometriosis frequently access different types of health care, yet little is known about naturopathic use. The purpose of this study is to explore the naturopathic utilisation by women with endometriosis in Australia.

Materials and methods

This study reports a cross-sectional survey of Australian women with endometriosis. Participants were recruited through the not-for-profit organisations Endometriosis Australia and EndoActive social media platforms. Data was collected through a self-administered questionnaire by those eligible to participate. Participants were included if they self-reported a diagnosis of endometriosis via laparoscopic surgery and were an Australian resident.

Results

Of the recruited 303 women with endometriosis, 60 women reported consulting with a naturopath for endometriosis care. Women consulting with a naturopath, reported also consulting with a laparoscopic surgeon (66.7%, p = 0.01), acupuncturist (53.3%, p ≤ 0.01), physiotherapist (41.7%, p = 0.01), nutritionists/dietitians (n = 22, 36.7%, p = 0.01) or homeopath (15.0%, p ≤ 0.001), in addition to their naturopath in the previous 12 months for endometriosis management. Compared to non-naturopathic users, women reported frequently experiencing dyspareunia (OR 2.9, CI 1.4–5.9, p = 0.002) and reported a higher use of vitamin D supplementation for endometriosis management (OR 4.9, CI 2.5–9.9, p ≤ 0.001).

Conclusion

Women who use naturopathy for endometriosis appear to be high users of health care services, both within complementary medicine and conventional medicine. The efficacy and role of naturopathic treatments and care for women with endometriosis requires further investigation.

Introduction

Women with endometriosis – known as a chronic and painful female reproductive disease – experience many difficulties when seeking care or obtaining adequate treatment [1]. In addition to direct impacts on the menstrual cycle such as dysmenorrhea and menorrhagia, women with endometriosis can also present with urinary and bowel irregularities, dyspareunia, chronic pelvic pain, and physiological difficulties with fertility. While less frequent, women can also experience nausea, and fatigue and some women can be asymptomatic [2]. Unfortunately, due to various reasons such as limited medical education and menstruation stigmatisation, women with suspected endometriosis often face a delay in diagnosis, barriers to early intervention, and limited or delayed access to specialist care [3].

Current evidence indicates that 1 in 10 women are diagnosed with endometriosis with approximately 176 million women and young girls diagnosed with the disease across the globe [4]. Within Australia, recent research estimates that 3.4% of women of reproductive age are diagnosed with endometriosis, however, due to the potentially asymptomatic nature of the disease, an accurate prevalence rate is difficult to determine [5]. Both at the individual and population level, women with endometriosis report a substantial burden of disease, which impacts all areas of life including social and economic areas such as absenteeism and excessive health care costs [4]. These reasons, among others, led women to seek care from various avenues.

Women with endometriosis, are known to seek care from multiple health care professionals and use self-care treatments for symptom relief [6,7] but also report high levels of dissatisfaction with their care and the available treatments for both symptom management and disease cure [6]. The degree of dissatisfaction is subject to the woman's experience of care but can be influenced by the perception of insufficient treatment options, dismissal of women's concerns by health care professionals, inadequate improvement in outcomes, and the need for repeated surgeries particularly for those with severe endometriosis [8]. Partly because of this dissatisfaction, some women explore treatment options beyond mainstream health care.

Women are increasingly stepping out of the conventional health care domain in search of treatments that can assist in reducing symptoms associated with menstrual irregularities including endometriosis [[9], [10], [11]]. There is some evidence to suggest that women are now looking to holistic and patient-centric forms of health care [12].

Naturopathy is a traditional system of health care defined by a set of philosophical principles classified in the late 19th and 20th centuries with succinct roots from European traditional medicine and later codified by key founders of the Germanic Nature Cure movement and eclectic medicine pioneers [13,14]. As a profession, naturopathy is practised across the globe [15] and is considered one of the main complementary medicine (CM) professions [16]. The approach to care is defined by philosophical principles and frameworks that focus on elements of patient-focused care [17]. However, research has yet to fully explore naturopathy and its role in providing care for women with endometriosis. Recent Australian research has highlighted that women experiencing common menstrual complaints are consulting with naturopaths [[9], [10], [11]]. This body of research suggests women exhibiting known symptoms of endometriosis or with a diagnosis of endometriosis are consulting with naturopaths to manage the disease [10]. However, the extent of naturopathy use by women with endometriosis has yet to be fully examined. As such, this study aims to identify the prevalence of consultations with a naturopath by Australian women with endometriosis for managing their disease, and the characteristics of these women.