Endometriosis

Endometriosis is a complex condition in which uterine tissue grows outside the uterus. This functionally active tissue is commonly relocated to areas such as the pelvis, abdomen, and even the chest. (1)

It is estimated that 10-15% of women of reproductive age experience endometriosis, and approximately 10% of women who undergo gynecological surgeries have lived with some level of endometriosis. (1)

Although multiple theories exist as to why endometriosis occurs, there is no single explanation or cure has been identified. The best assumption to date is Sampson’s Theory of retrograde menstruation, where rather than being eliminated through the vaginal canal some menstrual blood travels backward from the fallopian tubes into the pelvic and abdominal cavity. These displaced uterine cells then are able to establish themselves and grow. (1)

Given laparoscopy is the gold standard for diagnosing endometriosis, women often live with the condition for a long time before receiving an official diagnosis. Laparoscopy is an imaging and surgical procedure where a thin rod with a camera at the end is inserted into small incisions in the abdomen to visualize and remove displaced, chocolate colored tissue. (2)

How Endometriosis Affects the Body

The uterine lining naturally responds to estrogen fluctuations during the menstrual cycle.

Estrogen is a stimulating reproductive hormone that is responsible for promoting growth of the uterine tissue during the luteal phase. As you can imagine, there is only so much room for growth in a closed system such as the body. When functionally active uterine tissue grows outside the uterus, it builds pressure and can cause chronic inflammation, nerve irritation, and aggravating adhesions between organs. All of these down stream effects of endometrial tissue growth can inhibit proper functioning of impacted organs within the abdominal and pelvic cavities.

While some individuals may remain asymptomatic, many women experience cyclical or persistent pelvic pain, severe menstrual cramps, painful intercourse, fatigue, bloating, nausea, back pain, and infertility in nearly 50% of cases. This can have a profound impact on quality of life, emotional well-being, and daily functioning.

Several risk factors have been associated with endometriosis, including:

• Family history of the condition

• Early onset of menstruation

• Late menopause

• Heavy menstrual cycles

• Never having been pregnant

Supporting Endometriosis with Naturopathic Medicine

The primary goals in managing endometriosis include:

1. Supporting estrogen metabolism

2. Reducing inflammation

3. Alleviating pain.

Conventional approaches often focus on symptom relief through hormonal contraceptives, but many individuals seek additional strategies beyond birth control. If all interventions both conventional and Naturopathic fail to provide relief in cases of severe and debilitating endometriosis, women can elect to undergo a partial or full hysterectomy.

Dietary Support

Nutritional strategies play a key role in managing endometriosis. Elevated dietary sugar has been linked to increased estrogen levels, which may worsen symptoms. Reducing refined carbohydrates and sugar can help regulate hormonal balance and decrease inflammation.

There is also literature suggesting that foods can be used to reduce the experience of pain in endometriosis. Key topics include increased consumption of mono & polyunsaturated fatty acids (ie. Avocado, olives, walnuts, seeds, etc.) and minimizing gluten.(3) Although the latter has been a topic of debate in the literature, clinically I have seen gluten worsen hypersensitivity in the nervous system and resulting pain response. A 4-6 week trial of avoidance is a low risk and high potential for benefit.

The Mediterranean Diet has the greatest amount of literature to support it as an ideal model to ease pain and bloating with endometriosis.

Since estrogen metabolites are eliminated through the our stool, ensuring regularity with bowel movements is essential in preventing the reabsorption of estrogen by our colon cells. Incorporating fiber-rich foods, such as ground flaxseed, can support hormone clearance and increase sex hormone-binding globulin (SHBG), which helps regulate estrogen activity.

Antioxidants are crucial in counteracting oxidative stress and inflammation that can make the pain of endometriosis worse. Nutrient-dense and colorful foods such as leafy greens, berries, carrots, and red onions provide a variety of antioxidants. Furthermore, cruciferous vegetables (broccoli, Brussels sprouts, cauliflower) contain indole-3-carbinol (I3C) and diindolylmethane (DIM), which support healthy estrogen metabolism and promote the production of less potent estrogen metabolites. See my article on DIM here! (4)

Lifestyle Modifications

Movement, environmental toxin reduction, and castor oil therapy are key lifestyle factors that may improve endometriosis symptoms.

Engaging in regular exercise helps regulate blood sugar levels by increasing glucose uptake into muscles. This results in lower insulin levels which, when elevated, can increase the production of estrogen.

Xenoestrogens, or synthetic estrogen-like compounds that disrupt proper estrogen signaling in the body, can be found in everyday products such as plastics, pesticides, cosmetics, and household cleaners.

These environmental estrogens can contribute to hormonal imbalances and may be minimized by:

• Using glass for food and drink storage instead of plastic.

• Avoid heating food in plastic or styrofoam

• Selecting phthalate-free personal care products (EWG-approved brands).

• Cooking with cast iron or stainless steel instead of non-stick cookware.

• Reducing exposure to household dust and air pollutants.

• Avoid stain and water resistant treatments on clothing & bedding.

Additionally, castor oil packs applied to the lower abdomen may provide anti-inflammatory and pain-relieving benefits. While the exact mechanism is not fully understood, castor oil has been traditionally used to reduce pelvic congestion by supporting blood flow to the local tissue.

Botanical & Nutritional Support

Certain botanicals and nutrients can support healthy hormone metabolism, balance blood sugars, and lessen inflammation. (5,6)

Common recommendations include:

• Chaste tree berry (Vitex)

• Melatonin

• Resveratrol

• EGCG (green tea extract)

• Pycnogenol

• Quercetin (7)

• Ginger

• Garlic (8)

• N-acetylcysteine (NAC) (9)

• Astragalus

Recent Evidence for Natural Endometriosis Support

A 2021 randomized controlled trial conducted in Iran showed that 400 mg of garlic extract daily for 1-3 months improved pelvic pain, back pain, and menstrual bleeding. This was linked to garlic’s ability to support estrogen metabolism and its anti-inflammatory compound, allicin. (8)

A 2021 preclinical study published in Molecular Medicine Reports investigated the effects of berberine on human endometrial stromal cells (HESCs) associated with endometriosis. The researchers found that treatment with 80 µM of berberine significantly inhibited the proliferation, invasion, and migration of HESCs. (10)

Finally, a 2023 cohort study evaluated the effects of N-acetylcysteine (NAC) on endometriosis-related symptoms. Participants took 600 mg of oral NAC three times daily for three consecutive days each week for the course of 3-months. The treatment showed significant reductions in dysmenorrhea, dyspareunia, chronic pelvic pain, and ovarian endometrioma size. Additionally, among those desiring pregnancy 75% achieved conception within six months. (9)

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References:

1. Schenken, RS. *Endometriosis: Pathogenesis, Epidemiology, and Clinical Impact.* UpToDate & https://www.ncbi.nlm.nih.gov/books/NBK567777/

2. https://my.clevelandclinic.org/health/procedures/4819-laparoscopy

3. Sverrisdóttir UÁ, Hansen S, Rudnicki M. Impact of diet on pain perception in women with endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2022;271:245-249.

4. Xu T, Zhuang Y, Cao H. The association between vitamin intake and endometriosis: a cross-sectional study of the NHANES 1999-2006. Reprod Health. 2024;21(1):158.

5. Bina F, Soleymani S, Toliat T, et al. Plant-derived medicines for treatment of endometriosis: A comprehensive review of molecular mechanisms. Pharmacol Res. 2019;139:76-90. doi:10.1016/j.phrs.2018.11.008

6. Balan A, Moga MA, Dima L, et al. An Overview on the Conservative Management of Endometriosis from a Naturopathic Perspective: Phytochemicals and Medicinal Plants. Plants (Basel). 2021;10(3):587. Published 2021 Mar 20. doi:10.3390/plants10030587

7. Chaichian S, Nikfar B, Arbabi Bidgoli S, Moazzami B. The Role of Quercetin for the Treatment of Endometriosis and Endometrial Cancer: A Comprehensive Review. Curr Med Chem. 2025;32(1):74-86. doi:10.2174/0109298673269733230921092509

8. Amirsalari S, Behboodi Moghadam Z, Taghizadeh Z, et al. The Effect of Garlic Tablets on the Endometriosis-Related Pains: A Randomized Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2021;2021:5547058. Published 2021 Jul 20. doi:10.1155/2021/5547058

9. Anastasi E, Scaramuzzino S, Viscardi MF, et al. Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes. Int J Environ Res Public Health. 2023;20(6):4686. Published 2023 Mar 7. doi:10.3390/ijerph20064686

10. Gu Y, Zhou Z. Berberine inhibits the proliferation, invasion and migration of endometrial stromal cells by downregulating miR‑429. Mol Med Rep. 2021;23(6):416. doi:10.3892/mmr.2021.12055