Naturopathic Approaches to Endometriosis
Endometriosis is more than just “bad” periods - it is a painful and sometimes debilitating condition that can affect people year-round. Despite being a common health complaint - around 1 in 9 women and gender diverse people will be diagnosed with the condition - it is poorly understood and getting a diagnosis for treatment can be difficult. In fact, receiving a diagnosis of endometriosis often takes 7-10 years from the onset of symptoms! Because of the chronic nature of endometriosis, it’s a condition that is frequently seen in naturopathic clinics. Let’s take a look at what endometriosis is and how naturopathic treatments can help.
What is Endometriosis?
Endometriosis is a condition whereby endometrial-like tissue grows in the uterus and/or other areas of the body. This tissue is similar to endometrial tissue, which is the lining made by the endometrial cells inside the uterus that is shed each month in your period, but it is not the same. The endometrial-like tissue forms small lesions that attach to various areas of the body, where they react to cyclical changes in hormones and cause symptoms. Endometriosis can range from minimal to severe. The endometrial deposits can proliferate and form adhesions and scarring, inflammation, and even cysts. Endometriosis is an oestrogen-dependent inflammatory condition, meaning symptoms are driven by high levels of oestrogen.
Where Does Endometriosis Occur?
Endometriosis most often occurs in the pelvis, near the uterus. However, it can be found in various places in the body, including:
Pelvic cavity, including on ovaries, fallopian tubes and the outside of the uterus
Bowels and rectum
Bladder
Cervix, vagina and vulva
What Causes Endometriosis?
There are a number of different theories about the cause of endometriosis, but the truth is, it’s not fully understood yet why or how this condition occurs. Retrograde flow is the most common theory explaining its development and is the theory that is currently most widely accepted. This theory states that because some menstrual blood is washed back up the fallopian tubes and into the pelvic cavity during menstruation, it is this displaced menstrual blood containing endometrial tissue and cells that implants onto organs in the pelvic cavity and beyond. Once implanted, the tissue responds to changes in oestrogen levels much the same way, leading to proliferation and then bleeding and inflammation. Whilst this is the most commonly accepted theory, it doesn’t fully explain the condition. Retrograde menstrual flow is a normal occurrence for 70-90% of people who menstruate, so this alone doesn’t explain the development of the condition. Retrograde flow also doesn’t explain how or why endometriosis lesions differ from normal endometrial tissue. Other contributing factors include:
Prostaglandin imbalance, which triggers inflammation
An altered immune response - endometriosis has been likened to autoimmune conditions, but it doesn’t behave the same way as a “typical” autoimmune disease
Cellular changes in the deposited endometrial tissue
High oestrogen levels
Genetic susceptibility - people with family members who have endometriosis have a higher likelihood of developing the condition
Symptoms of Endometriosis
Symptoms of endometriosis are many and varied and include:
Significant pain before or during your period
Pain when having sex
Pain when opening your bowels
Pain during ovulation
Pain when urinating
Pain in your lower abdomen, back and legs
Urinary frequency or urgency
Heavy and/or irregular menstrual bleeding
Infertility or difficulty conceiving
Treating Endometriosis
Standard Western medicine approaches to endometriosis feature either medications or surgery, or a combination of both. Surgery can range from laparascopic removal of adhesions through to hysterectomy, depending on disease severity and the patient’s wishes. Unfortunately, surgical removal does not cure the condition and repeat surgical interventions are often required.
The Naturopathic Approach to Endometriosis
It’s important to remember that there is no cure to endometriosis. It is considered to be a life-long condition, so treatments are focused on disease/symptom-management and improving quality of life. The goals of treatment and strategies used will vary from patient to patient - some may prioritise improving fertility and chances of conception, while others may prioritise pain management or delaying surgery. There are some wonderful naturopathic approaches that can help to ease symptoms and prevent disease progression.
Herbal Medicines for Endometriosis
Herbs are one of my favourite healing modalities when it comes to hormonal conditions like endometriosis, and for good reason. Using liquid herbal tonics means we can create custom, individualised blends that suit your individual symptom picture and target the underlying bodily processes that are most contributing to your condition - health conditions don’t occur in a vacuum, and many people of 2 or more health complaints they deal with at once. It also means we can adapt and change your treatment as your health picture changes. Below are some of my most-used herbs for endometriosis, but there are countless others that might be right for you, depending on your presentation.
Cramp Bark
For managing cramping, menstrual pain, there are few herbs that can rival cramp bark. This wonderful herb hails from Europe, Africa, and Central Asia and is a fantastic anti-spasmodic and mild sedative that can reduce uterine and ovarian pain in conditions like endometriosis. A recent animal study found cramp bark could also help to reduce the size of endometriotic lesions.
Milk Thistle
Milk thistle, sometimes also known as St. Mary’s thistle, is another go-to herb for conditions like endometriosis. A recent animal study found that silibinin, one of the active constituents in milk thistle, was able to reduce the size of endometriotic lesions via its anti-inflammatory effects. In addition to the direct effects described above, milk thistle can also help by improving liver function. Healthy liver function is required in order to metabolise and excrete excess oestrogen from the body. If the liver is over-burdened or is functioning optimally, we risk having elevated levels of oestrogen, which can exacerbate oestrogen-driven conditions like endometriosis. Milk thistle supports liver function and improves its ability to metabolise waste products, like excess oestrogen. Be aware though that any herb or drug that increases or improves liver function may increase the metabolism of prescription medications - always check with a qualified naturopath or herbalist before using liver herbs like milk thistle, to be sure it is safe to use with any medications you are taking.
Turmeric
Turmeric is such a wonderful anti-inflammatory herb that can make a big difference in conditions like endometriosis that involve chronic inflammation. Like milk thistle, turmeric is also a powerful liver support herb and can help to improve the liver’s ability to metabolise excess oestrogen. An animal study has also modelled how it can reduce endometrial lesion size, thanks to its angiogenic properties.
Calendula
Calendula has been used in the treatment of endometriosis for centuries. This beautiful herb is anti-inflammatory and a lymphatic tonic, as well as having antispasmodic properties.
Ladies’ Mantle
Beautiful ladies’ mantle is a herb used to reduce heavy bleeding, with its astringent and anticoagulant properties. This herb has been traditionally used since antiquity for the treatment of endometriosis.
Vitex
Vitex, sometimes also known as Chaste Tree, is a hormonal modulator, able to improve the ratio of oestrogen to progesterone in the body, an important process for managing hormonal aspects of endometriosis.
Nutritional Medicine for Endometriosis
There are a number of nutritional strategies that can help with endometriosis. Here are a few of my go-tos:
Include plenty of anti-inflammatory foods, such as turmeric, ginger, garlic, fresh nuts and seeds, fruits and vegetables in the diet.
Eat plenty of fibre to encourage regular bowel motility and improve excretion of excess oestrogen
Exclude caffeine, sugar, alcohol, and deep-fried foods from the diet, which can all worsen inflammation
Exclude gluten from the diet - this can be beneficial in up to three-quarters of endometriosis patients
Specific nutrients in the form of supplements may also be used as part of your treatment, depending on your symptom picture. These may include:
Iron - particularly if you have a history of heavy periods because of your endometriosis. Low iron levels can occur with heavy blood loss and can actually lead to even heavier periods
Essential fatty acids - help to reduce inflammation. Omega 3 supplementation has been found to help reduce pelvic pain in those with endometriosis
Magnesium - can be beneficial in reducing cramping-type pain
Vitamin D - an important nutrient for immune regulation and reducing inflammation
Probiotics - can help to modulate immune function and reduce dysbiosis, which can be common particularly in those with advanced-stage endometriosis
Vitamin E - has been found to reduce pelvic and menstrual pain in those with endometriosis, as well as reducing pain during intercourse
An Integrated Approach
Endometriosis is a complex, chronic condition and is best suited to a multi-modality approach. People with endometriosis typically do best when they have a good care team of different practitioners to support them with their health goals, and naturopathy can be a wonderful addition to the care team.
There is no one-size-fits-all treatment when it comes to endometriosis. Both naturopathic and Western medicine treatments have their pros and cons and some will work better for you than others. If you feel like you’d like to try a naturopathic approach to managing your endometriosis, click here to book your appointment now.
About the Author
Lizzie Stow is a degree-qualified naturopath from Newcastle, Australia.
To find out more about Lizzie, click here.
Book an appointment with Lizzie click here.
References
Australian Institute of Health and Welfare. (2019). Endometriosis in Australia: Prevalence and hospitalisations. https://www.aihw.gov.au/reports/chronic-disease/endometriosis-prevalence-and-hospitalisations/summary
Bahat, P. Y., Ayhan, I., Ozdemir, E. U., Inceboz, U., & Oral, E. (2022). Dietary supplements for treatment of endometriosis: A review. Acta Biomedica, 93(1).
Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. Elsevier.
Endometriosis Australia. (2022). What is endometriosis. https://www.endometriosisaustralia.org/about-endo
Ham, J., Kim, J., Bazer, K. F. W., Lim, W., & Song, G. (2019). Silibinin-induced endoplasmic reticulum stress and mitochondrial dysfunction suppress growth of endometriotic lesions. Journal of Cellular Physiology, 234(4), 4327–4341.
Hechtman, L. (2019). The female reproductive system. In Clinical naturopathic medicine (2nd ed.). Elsevier.
Johns Hopkins Medicine. (2023). Endometriosis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
Vercellini, P., Vigano, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: Pathogenesis and treatment. Nature Reviews Endocrinology, 10, 261–275.
Zhang, Y., Cao, H., Hu, Y.-Y., Wang, H., & Zhang, C.-J. (2011). Inhibitory effect of curcumin on angiogenesis in ectopic endometrium of rats with experimental endometriosis. International Journal of Molecular Medicine, 27(1).