Writers note: This article was originally published in August 2020 and has been updated in July 2021.
Endometriosis is a condition that affects 1 in 10 women to varying degrees. It’s a condition that is renowned for slow diagnosis, taking an average of eight to nine years to be confirmed. It’s commonly missed due to the assumption that period pain is normal or that many of its symptoms overlap with other diagnoses. Women with endometriosis are 3.5 x more likely to receive a diagnosis of IBS due to symptom overlap and 6 x more likely to be diagnosed with pelvic inflammatory disease. It is most commonly uncovered when trying to conceive.
Our understanding of endometriosis has come a long way, and it’s so wonderful that there is increasing recognition in the mainstream of this condition. Yet that is so much more work to be done.
Clients that I work with who have endometriosis are among some of the bravest women I have had the privilege of working with. It’s a condition that does not neatly fit into a clinical box. The causes are different from person to person, and even still, elements still remain an enigma.
The experience of having endometriosis can be dramatic yet is largely invisible in our culture. In this article, I’m going to distil some pearls that I’ve learned from working with clients who have endometriosis and what you should know about the recent advances in our knowledge of this condition!
What we know about endometriosis.
Endometriosis is not strictly a reproductive systems issue. It’s an inflammatory, multi-system, complex condition that’s connected to both immune and hormonal dysregulation.
We know that some women are more genetically predisposed to endometriosis and it’s well documented that for severe cases, there are significant links with a past history of trauma (the study reported a 79% increased incidence).
Endometriosis is defined as the growth and presence of endometrial tissue (the lining of the womb) in locations outside of the womb. The most common sites are on the ovaries, Fallopian tubes, bowel, bleeder, peritoneal tissue, ligaments and abdominal cavity.
This displaced tissue then responds to the hormonal ebbs and flows of the menstrual cycle, shedding at menstruation along with the lining of the womb. This bleeding causes inflammation, irritation and can cause scarring and adhesions. While endometriosis is a benign condition, it can be debilitating.
Treatment with conventional medicine often involves pain management strategies and symptom relief. Typically the oral contraceptive pill, hormone replacement therapy or Mirena IUD are suggested and/or surgery. In some cases, the Mirena IUD is well indicated and it’s always important to consider what is right for you at this particular time in your life.
Common symptoms of endometriosis include:
- Heavy menstrual flow
- Menstrual pain (however, this does not indicate the
- Severity of the condition)
- Pain with bladder/bowel function
- Pain with sex (deep penetration)
- Irritable bowel syndrome symptoms – such as bloating, constipation, diarrhoea.
- Commonly correlated symptoms: Inflammatory bowel disease, irritable bowel syndrome, migraines and interstitial cystitis
From a holistic perspective, factors that are typically at play in endometriosis are:
- Immune system dysregulation
- Poor liver clearance
- Gut/microbiome dysfunction
- Poor blood circulation and lymphatic circulation.
- Magnesium and essential fatty acid deficiency
- High fat intake, especially heated fats, fried foods
- Essential fatty acid deficiency
- Excess dietary caffeine and/or alcohol consumption
The constellation of root causes is going to be different from person to person. Therefore, treatment is going to be different for from person to person!
The Importance of Considering Immune Dysregulation.
The uterus is positioned in the peritoneal cavity and is bathed in peritoneal fluid. Recent research is uncovering that the environment within the peritoneal fluid of women who have endometriosis versus those who don’t have significantly different profiles. In women with endometriosis, there are higher concentrations of inflammatory molecules called cytokines and LPSs (lipopolysaccharides) which indicates that there are imbalances in the microbiota (also known as the microbiome).
It is shown there’s also a decreased activity of protective immune cells (called natural killer cells and macrophages) whose job is to address other microbes that shouldn’t be there. It is common in endometriosis to see a pattern where these immune cells are not represented in numbers required to protect the body.
Clinically I’ve seen (and discussions with colleagues have confirmed) that there’s often a link or a trigger with an infection, whether that be a viral infection, a parasitic or a bacterial infection.
When the immune system is dysregulated, this means our defence system cannot properly protect the body and can lead to chronic inflammation. Inflammation is a major root cause of period pain and perpetuates the immune-hormone dysregulation cycle.
The microbiome and immune system are intimately linked. Dysbiosis, which is another way of saying an imbalance microbiome, is seen as a strong risk factor for endometriosis. Our digestive systems have their own microbiome, so does our vaginas and uterine cavities. The microbiome is also deeply linked with our ability to absorb nutrients and to detoxify and balance hormones, environmental toxins.
Endometriosis is a condition that is “estrogen loving”, the more estrogen that is concentrated in the reproductive system, the more advanced that condition.
It’s important to address not only your internal estrogen balance but to ensure that you’re not getting external estrogen from the environment. It’s common for our foods, especially meat and dairy to have higher estrogen residues and many plastics mimic estrogen (these are referred to as ‘xeno-estrogens’.). It’s also important to avoid poor quality forms of soy, as these act like estrogen in the body.
I always recommend to my clients that soy needs to be had in whole, organic forms. In traditionally prepared foods, such as tofu, and tempeh.
What causes the period pain and heavy flow?
The increased concentration of inflammatory compounds (called cytokines and prostaglandins) can sensitize the tissue to period pain. Additionally, in more advanced stages of endometriosis, adhesions can form which structurally impact the womb. As the womb contracts at menstruation, this structural change can result in increased pain.
If there are endometrial lesions that are present in/on the bowel, bladder or other structures within the peritoneal cavity, this will cause an immune response, leading to further inflammation in the peritoneal cavity, resulting in pain.
Also, when there is unopposed or displaced estrogen in the body and not adequate levels of progesterone to balance it, this can build up the uterine lining, resulting in heavier periods.
What you can do.
Working with a holistically minded practitioner who can help guide and support you could be worth considering. There’s also a lot you can do in your self-care to support your body.
This is a collection of nourishing advice and practices that I’ve seen have the greatest positive impact for people with endometriosis.
1. Restful sleep, and getting enough of it!
Sleep is so essential for regulation of both the immune system and hormones. It’s been shown that women who do night shift regularly 50% more likely to develop endometriosis and non-nightshift workers. Your sleep hormone, melatonin, is essential for both hormone balance and for cooling down inflammation.
8 hours of restful sleep and more at menstruation is the aim.
2. Nurture your mind-body connection.
Multiple studies have shown the link of endometriosis with a history of trauma. If this is a part of your story, I highly recommend finding a good therapist or support group you can work with to address this wounding and help to release it from your body. Finding a sensitive therapist (such as a counsellor, psychologist or psychotherapist) that you can work with can make a huge difference.
A very simple and low-cost practice that I recommend to my clients is journalling with your menstrual cycle. It can be a great tool of menstrual cycle awareness (more below) and can be a place where you can tap into one of the most potent healing forces…yourself.
Visualisation meditation is also a powerful practice and can facilitate a sense of working with your body to heal, rather than working against you or betraying you, which is a common theme I see.
Yoga Nidra meditation is excellent during your bleed – it’s a full body relaxation process and can help you drop down past the pain.
3. Realign your nourishment and your environment
Don’t use plastic as much as possible and use glass and stainless steel. Switch all your home and body products to low-tox versions. Buy organic produce where you can afford it. While this is general health advice, it’s particularly pertinent in endometriosis and establishing smooth hormonal function and decreasing your toxic load.
The most common dietary triggers associated with endometriosis are dairy, sugar, gluten, alcohol and caffeine. Switch to A2 dairy (or consider stopping altogether) and keep alcohol to no more than 4 drinks a week. Switch your black tea or coffee with matcha green tea.
Increase your probiotic foods – these include yogurt, kefir, and sauerkraut. If you suffer from migraines, be aware that these can be trigger foods, so opting for a probiotic capsule will be a better option for you.
Increase your prebiotic foods. These are basically whole fruit and veggies and fibres such as flax seeds, psyllium husks and chia seeds.
Increase your healthy fats extra virgin olive oil, flaxseed oil, fish oils, chia seed oils. If you’re taking fish oil, ensure it’s from clean waters and low mercury fish (sardines and anchovies) and ensure you’re getting 1000–1200mg of EPA daily (this is different to total oil content). EPA (eicosapentaenoic acid)
Increase your intake of cruciferous vegetables to assist with liver detox and estrogen clearance. These include broccoli cauliflower, kale, Brussels sprouts.
Have two tablespoons of flax seeds daily + drink plenty of water = simple way of keeping your bowels moving daily. This is a very unsexy yet powerful mechanism of maintaining hormone balance.
Only use organic non-GMO soy x3/week in the form of whole soybeans, tofu or tempeh.
4. Infuse herbs through your day
Have one teaspoon of organic turmeric daily. Some practical ways to having it is in golden milk/turmeric lattes, infusing it in ghee and using in your cooking, sprinkle through roasted vegetables, make it into salad dressing and add it to soups, stews and dahls.
Include as many circulation promoting spices in your daily diet, including ginger, black pepper, fenugreek, cardamom, and cinnamon.
Don’t underestimate the power of spices! 250mg of ginger in capusules four times a day – which is about a 1/4 teaspoon – has been shown to be just as effective as mefanic acid (Ponstan) and ibuprofen for managing period pain. Cinnamon powder (Cinnamomum zeylandicum) 420mg (x2 capsules) three times a day is comparable to ibuprofen and from my clinical practice, I see cinnamon decrease volume of bleeding significantly.
Connect with your womb with aromatherapy. Making a little massage oil bottle with lavender, Clary sage and Rose oil in a base of almond oil not only smells divine but is also very effective at relieving menstrual pain. Massage into you womb throughout the month.
Herbal Teas – two of my favourites for endometriosis.
Womb Nourish – This is a favourite combination that is energetically balanced (this is a herbal term to mean that the formula is not too heating or cooling) and works well when drunk throughout the month. These herbs tonify the pelvic organs, nourish and move the blood and offer nervous system support.
20g Ladies mantle 20g Raspberry leaf 20g Nettle 10g Tulsi 10g Mugwort 5g Licorice 5g Ginger
Add 3 heaped tablespoons to 3 cups of boiled water. Allow to steep for 30 minutes (you can leave for longer also) and sip throughout the day during the month.
Pain relief tea – I also call this one “Period Chai”. This combination is very warming, so if your period pain is made worse by a hot water bottle, this may not be the combination for you. It’s very relaxing and best to start taking 1–2 days before your flow begins.
20g Valerian root 20g Chamomile blossoms 5g Angelica root 5g Ginger root 5g Cinnamon bark 5g Licorice root (optional, a piece of orange peel)
Add a heaped teaspoon to 1 cup of boiled water. Cover and let steep for 10 minutes. Consume 1–3 cups a day.
5. Get your blood moving
It’s important to move your body daily to promote circulation. Practices like breath work can be wonderful at circulating blood. Have heat packs on call at menstruation is essential and buying heat pads that you can actually stick to your abdomen can be very useful.
A little more intensive, but wonderfully relaxing is doing castor oil packs three times a week. It’s a very simple home remedy and a highly effective. You can also bring in the aromatherapy element here by adding a couple of drops of lavender, clary sage and rose oil to the castor oil, and then soak your cloth in this. You can keep on reusing the cloth, just pop it in a ziplock bag and you can reuse for 2–4 weeks before needed to refresh.
If you spend a lot of time sitting at a desk, get a standing desk! And take non-negotiable breaks to move your body throughout the day. Even if it’s as simple a stroll around the office.
6. Practice menstrual cycle awareness
Conditions like endometriosis can have a huge impact on your life. And it’s well documented in the literature of just how much it can impact your ability to work, choose a profession that you want to be in and the ease of your intimate relationships.
Mapping your cycle, so you know when you’re bleeding and organizing your month around it can make a huge difference. If you have a workplace that is open and understanding you could negotiate times that you don’t work during the month so that you can have time off during menstruation. This can not only give you break physically but mentally and emotionally it can be a great relief to know that you don’t have to “soldier on” when your body is asking you to stop.
Make sure you’re tracking your:
- Bleeding patterns (including spotting)
- Gastrointestinal symptoms, such as bloating and diarrhea
7. Pelvic Manipulation
Finding a physiotherapist who specialises in pelvic conditions can be a gamechanger – especially if you do experience pain with sex. Arvigo Pelvic Massage and alternating hot and cold sitz baths are also helpful at promoting circulation and preventing adhesions.
8. Ensure you’re nourished!
Make sure you’re taking a good quality multivitamin that has at least 60mg vitamin B6, 30mg of zinc citrate, 200 mcg of selenium and 1000IU vitamin D.
Taking 300mg of magnesium citrate or glycinate twice a day can make a big difference for pain.
9. Have a circle of support.
Don’t be afraid to bring your closest people whether it’s your partner or family members to your consultations as it’s really important that those around you understand the scope and the significance of this condition so they know how to best support you.
I love speaking with family member or partner’s of people with endometriosis and giving them practical ideas of how to care for you…often they feel just as hopeless and having practical and effective strategies in place can make the road to recovery a smoother one.
If you enjoyed this article, you may also enjoy:
Pin “Endometriosis: A Holistic Perspective and Healing Paths” for later:
Jaafarpour, M., Hatefi, M., Khani, A., & Khajavikhan, J. (2015). Comparative effect of cinnamon and Ibuprofen for treatment of primary dysmenorrhea: a randomized double-blind clinical trial. Journal of Clinical and Diagnostic Research : JCDR, 9(4), QC04–7. https://doi.org/10.7860/JCDR/2015/12084.5783
Marino, J. L., Holt, V. L., Chen, C., & Davis, S. (2008). Shift work, hCLOCK T3111C polymorphism, and endometriosis risk. Epidemiology (Cambridge, Mass.), 19(3), 477–484. https://doi.org/10.1097/EDE.0b013e31816b7378
Harris, H. R., Wieser, F., Vitonis, A. F., Rich-Edwards, J., Boynton-Jarrett, R., Bertone-Johnson, E. R., & Missmer, S. A. (2018). Early life abuse and risk of endometriosis. Human Reproduction, 33(9), 1657–1668. https://doi.org/10.1093/humrep/dey248
Kohama, T., Herai, K., & Inoue, M. (2007). Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. The Journal of Reproductive Medicine, 52(8), 703–708. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17879831
Shirvani, M. A., Motahari-Tabari, N., & Alipour, A. (2015). The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial. Archives of Gynecology and Obstetrics, 291(6), 1277–1281. https://doi.org/10.1007/s00404–014–3548–2
Han, S.-H., Hur, M.-H., Buckle, J., Choi, J., & Lee, M. S. (2006). Effect of Aromatherapy on Symptoms of Dysmenorrhea in College Students: A Randomized Placebo-Controlled Clinical Trial. The Journal of Alternative and Complementary Medicine, 12(6), 535–541. https://doi.org/10.1089/acm.2006.12.535
Hansen, S. O., & Knudsen, U. B. (2013). Endometriosis, dysmenorrhoea and diet. European Journal of Obstetrics & Gynecology and Reproductive Biology, 169(2), 162–171. https://doi.org/10.1016/J.EJOGRB.2013.03.028
Marziali, M., Venza, M., Lazzaro, S., Lazzaro, A., Micossi, C., Stolfi, V. M., & Stolfi, V. (2012). Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chirurgica, 67(6), 499–504. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23334113
Khan, K. N., Fujishita, A., Hiraki, K., Kitajima, M., Nakashima, M., Fushiki, S., & Kitawaki, J. (2018). Bacterial contamination hypothesis: a new concept in endometriosis. Reproductive Medicine and Biology, 17(2), 125–133. https://doi.org/10.1002/rmb2.12083
Laschke, M. W., & Menger, M. D. (2016). The gut microbiota: a puppet master in the pathogenesis of endometriosis? American Journal of Obstetrics and Gynecology, 215(1), 68.e1–68.e4. https://doi.org/10.1016/J.AJOG.2016.02.036
Young, K., Fisher, J., & Kirkman, M. (2015). Women’s experiences of endometriosis: a systematic review and synthesis of qualitative research. Journal of Family Planning and Reproductive Health Care, 41(3), 225–234. https://doi.org/10.1136/jfprhc–2013–100853
Sperschneider, M. L., Hengartner, M. P., Kohl-Schwartz, A., Geraedts, K., Rauchfuss, M., Woelfler, M. M., … Leeners, B. (2019). Does endometriosis affect professional life? A matched case-control study in Switzerland, Germany and Austria. BMJ Open, 9(1), e019570. https://doi.org/10.1136/bmjopen–2017–019570
Young, K., Fisher, J., & Kirkman, M. (2015). Women’s experiences of endometriosis: a systematic review and synthesis of qualitative research. J Fam Plann Reprod Health Care. https://doi.org/10.1136/jfprhc–2013–100853