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The AANP and INM would like to acknowledge Marianne Marchese, ND and Amy Rothenberg, ND for their contributions to the content of this FAQ.Endometriosis is one of the common yet misunderstood medical conditions, affecting 10-15 percent ofwomen of childbearing age. Licensed naturopathic doctors (NDs) utilize effective diagnostic interventions for discovering underlying causes of endometriosis. Trained extensively in clinical nutrition, botanical medicine, pharmaceuticals, and lifestyle counseling, naturopathic doctors provide patients with various options for a comprehensive treatment plan catered to the patient’s personalized needs.

Endometriosis: What is it and what are the symptoms?
Endometriosis is the presence of endometrial tissue outside the uterus. This uterine tissue is not restricted to the uterus and can be found on the ovaries, fallopian tubes, in the abdominal cavity and in other places throughout the pelvic area. This misplaced uterine tissue responds to monthly hormonal cycles and wreaks havoc in many ways. Depending on where the uterine tissue located symptoms caninclude painful periods, pain during or after intercourse, persistent lower back and pelvic pain, discomfort during bowel movements or urination, menses lasting longer than seven days, bloating, constipation, and diarrhea or nausea during menstruation. Endometriosis is also a common cause of infertility or endometrial cysts.

Endometriosis symptoms may include painful periods, persistent lower back and pelvic pain, bloating, constipation, infertility, and more.

Physicians diagnose endometriosis based on findings during a pelvic exam, presenting symptoms, and a thorough medical history. During the pelvic exam, doctors manually palpate the pelvis for abnormalitiessuch as scars behind the uterus or growths on reproductive organs. Pelvic ultrasound and MRI are often ordered to rule out other causes of the patient’s symptoms. Laparoscopy remains the gold standard for the diagnosis of endometriosis.

Underlying Causes
While the exact cause of endometriosis is unknown, there are several hypotheses regarding how endometriosis may develop. One possible factor is retrograde menstruation, when the endometrial tissue flows backward, out through the fallopian tubes, and into the abdomen to implant and grow on organs in the pelvis. In addition, endometriosis lesions may arise from Mullerian anomalies that did not correctly differentiate or migrate during fetal development. Other factors such as hormonal imbalance, inflammation, toxic environmental exposures, and immunologic dysfunction may determine why lesions implanted in the pelvic cavity cause symptoms and/or persist. There is also likely a genetic component as endometriosis does run in families.

Naturopathic Treatment
Understanding multifaceted causes of endometriosis guides treatment for both acute and long-term challenges. Treatment for endometriosis begins by stimulation of the body’s innate ability to heal through restoring healthy inflammatory response, balancing hormones, and aiding the liver’s ability to break down environmental toxins and naturally occurring estrogens. For some, the treatment of endometriosis will also include surgery performed by a gynecologic surgeon.

Some factors that may contribute to endometriosis may include genetics, hormonal imbalance, environmental exposures, and immunologic dysfunction. Naturopathic treatment also addresses the whole patient. For many women, endometriosis can causehigh levels of stress, often due to pain, difficulty in diagnosis, and the trials associated with an often invisible illness. NDs help treat not just the body, but the symptoms of the mind and spirit too.

There are numerous nutritional influences related to endometriosis. Licensed naturopathic doctors often begin with the diet, where patients are able to take an active part in the management and prevention of symptoms. The recommendation of an anti-inflammatory diet is often part of the plan in order to reduce inflammation and help with the balance of estrogen.

In a study of 500 women, there was a significantly decreased risk of developing endometriosis with higher consumption of fruits and green vegetables. Conversely, an increased risk for endometriosis was associated with high intake of red meat. Foods high in dietary fiber are associated with a healthy balance of microorganisms in the gut flora, where they play a significant role in breaking down estrogens and also reducing inflammation. Studies show that the inclusion of soy with its isoflavones can reduce the proliferation of endometrial cells.

Naturopathic treatments including nutrition and dietary changes, botanical medicine, and supplementation have been shown to provide relief for endometriosis symptoms.

Botanical medicine
Botanical medicine has been shown to provide relief for some endometriosis patients, including:

  • Vitex (Chaste Tree) has traditionally been used as a treatment for hormone imbalances in women, causing estrogen to be less available to stimulate endometrial tissue growth. Motherwort gently soothes cramps and pain during times of extreme discomfort in the uterus and other lower abdominal regions. As a mild sedative, motherwort helps with needed relaxation during menstrual cramps.
  • Rosmarinus officinalis (Rosemary) has been researched as a strong anti-inflammatory herb and can be helpful for those with endometriosis pain.
  • Curcumin has also been shown to reduce estradiol which helps to reduce endometriosis symptoms.
  • Flax seeds with their anti-inflammatory impact and their capacity to reduce inflammation are also recommended.
  • Pycnogenol derived from Pine Bark has been studied and shows the capacity to reduce many of the painful symptoms of endometriosis.
  • Green tea has also shown promising results in the treatment of endometriosis.

Another natural treatment for endometriosis may include supplementation such as:

Treating endometriosis can be challenging and requires a whole-patient approach encouraged by naturopathic doctors. Natural therapies that address the root cause can lead to appropriate treatments to support the body in restoring optimal function.

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