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Endometriosis: A Natural Approach

Endometriosis is a common, and unfortunately commonly under-diagnosed pain condition that occurs in people who menstruate. It is estimated that 10-15% of women have endometriosis (meaning, around 1 in 10 women – and that is a conservative number). It is characterized by extremely painful or crippling menstrual cramps, along with other symptoms such as:

  • Pain during sexual activity
  • Pain during bowel movements
  • Pain during exercise
  • Bowel or urinary pain or dysfunction
  • Heavy or irregular bleeding
  • Bloating, nausea or vomiting
  • Infertility, difficulties getting pregnant, or recurrent pregnancy loss
  • Allergies, migraines or fatigue that worsens around menses
  • Lower back pain or leg pain during menses

What is endometriosis?

Endometrial pain and related symptoms are caused by the presence of inflammatory, endometrial-“like” tissues located outside of the uterus. These lesions can arise in a variety of locations, including on the ovaries, around uterine ligaments, fallopian tubes, intestines, the appendix, diaphragm or even in the lungs. Endometriosis tissue has hormone-producing enzymes and hormone receptors, are inflammatory, and over time can develop into adhesions, fibrosis, endometriomas (“chocolate cysts”) and cause dysfunction in the organs that they are attached to. These tissues respond to estrogen, other hormones and inflammatory molecules. Due to the hormone component, endometriosis affects women ages 25-35 most severely, although teens and women in their 40s are also affected.

I emphasize that these tissues are “like” but not the “same as” the endometrium. The endometrium is the normal inner lining of the uterus that responds to monthly hormone fluctuations and sheds once a month as a period. Many medical resources will describe endometriosis as “abnormally displaced endometrium cells” located in areas they shouldn’t be, contributing to the pain symptoms. However, microscopic analysis of endometriosis tissue reveals that they are actually much different than the normal endometrial lining: they have altered hormone production and altered hormone receptors compared to normal endometrium. These factors all contribute to a much higher production of inflammatory cells, which seems to be what causes the pain and dysfunction.

Unfortunately, endometriosis is often misdiagnosed as “dysmenorrhea” (painful cramps) and it can take as long as 7 to 10 years for a woman to get a correct diagnosis. I have many women in my practice who have struggled with being taken seriously by their health care practitioners about the pain they suffer from. Almost all women feel fatigued from being in so much pain, which in turns contributes to difficulties at work, in relationships, or even just getting out of bed each morning.

In this article, I want to explain endometriosis and give you an overview of how I approach the treatment and management of endometriosis using diet, nutrients, and other forms of natural medicine. My goal is to empower you with knowledge so you know that you can take more control of your healing journey with endometriosis.

How is endometriosis diagnosed?

Endometriosis is diagnosed by laparoscopic surgery when a doctor visually sees the abnormal growth of endometrial-like tissues located outside of the uterus. There is a grading system for diagnosing how “severe” a woman’s case of endometriosis is depending on how extensively the lesions are dispersed throughout the pelvis or abdomen. However, this “scale of severity” does not actually correlate well with how painful her symptoms are. This means that a woman with crippling, debilitating pain may have “minimal” or “mild” (grade 1 or 2) endometriosis, while a woman who has uncomfortable periods could have “severe” (grade 4) endometriosis, based on what is seen on laparoscopic evaluation. It’s not the greatest diagnosis tool and some organizations are advocating for changes to this.

What causes endometriosis?

The cause of endometriosis is poorly understood and highly debated. Several different theories exist as to why it occurs. Here are a few of them:

  • Sampson Hypothesis: Retrograde Menstrual Flow – This theory suggests that the cause of endometriosis is menstrual blood flowing in the wrong direction, out the fallopian tubes and into the abdomen. However, retrograde menstruation appears to be a near-universal occurrence (76-90% of all women are estimated to experience this), and doesn’t explain why endometriosis persists over time and worsens, while in other women it doesn’t at all.
  • Autoimmune/Altered Immunity – Some new research is suggesting that endometriosis may have an immune dysfunction, inflammatory, or autoimmune component. This may be involved in the progression of the disease but doesn’t explain the initial cause. Studies suggest that people with endometriosis do experience significantly more hypothyroidism, fibromyalgia, chronic fatigue syndrome, pain syndromes, autoimmune diseases, allergies and asthma compared to the general population. The endometriosis tissues also exhibit different hormone characteristics and heightened inflammatory responses.
  • Environmental Toxicants – pollutants (ex. dioxins, phthalates) have been hypothesized to induce certain cell changes, which in turn may contribute to abnormal immune response allowing for the disease to take hold.
  • Estrogen Dominance – Typical North American diets, sedentary lifestyle, and xenoestrogens and plastics in our environment set the stage for “estrogen dominance”, promoting estrogen’s influence on endometriosis tissue. Studies in mice have shown that estrogen can abnormally activate the immune system. Estrogen dominance may contribute to altered immunity, which may then contributes to development and/or progression of endometriosis (Frank, P)
  • Genetics – The presence of certain genes may result in abnormal migration of cells during development in the womb, which may later give rise to endometriosis. There is a strong family link; women with a family member with endometriosis are 7 times more likely to develop it themselves.

Medical treatment of endometriosis

Endometriosis symptoms rely on the cyclic production of hormones; therefore, hormone therapy is often a first-line treatment for patients. For example, the birth control pill, progestogen agents (synthetic progesterone), Danazol, and gonadotropin-releasing hormone (GnRH) analogues are mainstay options. Many women are given pain medication such as NSAIDS (ex. Advil) or stronger pain medications along with hormone therapy. If these aren’t sufficient, then surgery is another option. Some surgeries involve removing just the endometriosis tissue; other surgeries may involve removing the uterus and/or ovaries altogether.

A Naturopathic Approach to Endometriosis

As a Naturopathic Physician, I provide support for women at any stage in their endo journey. Some women suffering from endometriosis come to me because they:

  • Want to know what they should be eating to help manage their symptoms,
  • Want to know what supplements they could take to help their symptoms,
  • Want help with their fatigue, low mood, or other symptoms that their doctors can’t seem to help them with,
  • Want to explore alternative (or additional) options to pain medication, hormone therapy or surgery,
  • Want to come off their medications to try to have a family,

Whatever their reason, I treat each woman uniquely, depending on her needs, goals and where she is at. Often, my treatment plan will involve dietary guidance, lifestyle support, acupuncture, and specific nutritional or herbal supplements to reduce pain, improve quality of life, balance hormones and support fertility (if desired). As a Naturopathic Physician, my therapeutic goals in treating endometriosis are:

Reduce inflammation in the body. Because endometriosis is an inflammatory condition, one of the most important factors for supporting women with endo is eliminating inflammatory foods and greatly increasing the healthy anti-inflammatory foods in the diet. Specific herbs and high-dose nutrients also help to enhance the anti-inflammatory actions that help reduce severity of endo symptoms.

  • Foods to focus on: fresh, organic vegetables and fruits, high fiber foods (such as apples, pears, legumes, beans, whole grain oats, ground chia seeds, raw flax seeds), non-dairy milk and cheese (such as almond, coconut, cashew milk and cashew cheese), gluten-free grains (for example, rice, quinoa, millet, buckwheat), poultry, fish, and vegetarian protein sources (beans, legumes, organic soy, etc.), and liver-friendly vegetables and herbs including broccoli, kale, cauliflower, beets, lemons, onions, garlic, turmeric and ginger.
  • Foods to reduce or eliminate: processed/refined/synthetic foods, dairy, red meat, pork, gluten, trans fats, caffeine, alcohol, and sugar.

Reduce pain and enhance quality of life. Specific nutrients, herbs and other treatments help to modulate inflammation in the body, which helps to reduce pain as part of a comprehensive treatment plan for endometriosis. Some of these natural treatments include:

  • Omega 3 Fatty Acids. A study found that the women with the highest consumption of long-chain omega-3 fatty acids were 22% less likely to be diagnosed with endometriosis. Excellent food sources include wild salmon, herring, sardines, anchovies, and Atlantic mackerel. Consider supplementing with a high quality omega 3 fish oil with approximately 4g fish oil, per day.
  • Curcumin. Curcumin is an anti-inflammatory compound extracted from turmeric. Increasing your dietary intake of turmeric is helpful, and consider adding 2 or 3 doses of a curcumin supplement to your routine.
  • Acupuncture. One study examining the impact of an acupuncture protocol on endometriosis pain found that 82% of participants had at least “marked” reduction in pain, if not “significant” reductions.

Reduce environmental factors that could be exacerbating symptoms and support the body’s natural detoxification process. Studies have demonstrated that exposure to environmental toxicants (such as dioxins or phthalates) increase your likelihood of being diagnosed with endometriosis. Further, the liver is one of the most important organs for detoxing and eliminating hormones, medications, and toxicants from the body. Reducing your exposure to harmful chemicals is an important component of treatment, as is supporting your body’s natural detoxification process.

Support hormone balance. As previously described, endometriosis is often related to excess estrogen, or tissues that are responding excessively to estrogen, and a relative deficiency of progesterone. Many women are treated with hormone therapy to manage their symptoms. We can support the body’s natural production of hormones through the diet, herbal medicine, healthy digestion and liver function, and sometimes acupuncture. This is very important for women who want to have a family, or who are going through fertility treatments.

Provide adjunctive support for medical treatment to prolong the duration of pain-free months or years following surgery. For women currently managing their symptoms with hormone therapy, or planning for surgery, I tailor her supplements and treatment plan around her medical program in order to enhance her results and prolong the duration of pain-free months or years post-surgery.

As you know, endometriosis is a multi-faceted condition, and a treatment plan needs to be just as multi-faceted. I’ve seen incredible results in pain reduction, symptom management, and supporting women in growing their families despite their diagnosis of endometriosis. For now, I will leave you with 3 research-proven supportive supplements for endometriosis.

Specific Supplements for Endometriosis

Several natural treatments have been shown to be effective for reducing endometriosis pain and severity of lesions. Here are a few of the supplements I turn to as part of a comprehensive treatment plan for endometriosis:

N-Acetyl-Cysteine (NAC)

NAC is an amino acid derivative. In endometriosis and in the treatment of endometriomas, NAC decreased abnormal cell growth, decreased inflammation and reduced inflammatory genes. NAC also supports the production of glutathione in the liver, which is a potent antioxidant. For these reasons, NAC is often a component of my treatment plan for endometriosis.


One study demonstrated that 10mg melatonin dosed before bed reduces endometriosis-associated pelvic pain, pain during menses, in addition to: pain during vaginal penetration, urination, defecation that is statistically and clinically significant. It reduced pain by about 35% and reduced the use of pain medication by 85% in this study.

Pycnogenol (pine bark extract)

One study compared the efficacy of a pine bark extract (30mg, twice a day, for 48 weeks) versus a common hormone-suppressing medication (gonadotropin releasing hormone agonist, GnRHa) called leurorelin acetate depot. Patients in the pycnogenol group experienced a reduction from “severe” to “moderate” pain (33% improvement overall), maintained normal menstruation, with 5 women becoming during treatment. The Leuprorelin group had a greater response during treatment (greater pain reduction), but relapsed after 24 weeks, and had suppressed menstruation due to the nature of the medication.

If you are suffering from endometriosis, speak to your Naturopathic Doctor to check in on your current treatment protocol and find out what natural medicine options would be most appropriate for your particular symptoms.

Yours in health,
Dr. Kathleen Mahannah, ND


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