Endometriosis is the presence of endometrial tissue outside of the uterus. The diagnosis of endometriosis is often made clinically based on history, with women reporting dysmenorrhea, pelvic pain, dyspareunia, and fertility issues. Endometriosis can sometimes be detected on transvaginal ultrasound. However, definitive diagnosis requires laparoscopy with biopsy.

Approximately 10% of women are affected by this condition.  Risk factors include an affected first-degree relative, no previous use of oral contraceptive pills, history of Graves’ disease, and history of inflammatory gynecologic disease^1,2

There are many theories regarding the pathogenesis of endometriosis. The most commonly accepted theory is that endometriosis is caused by retrograde reflux of menstrual tissue through the fallopian tubes into the pelvis.  Endometriosis involves overproduction of local estrogen from increased aromatase activity, and pain results from the production of inflammatory prostaglandins and development of lesions near nerve fibers.³

Conventional treatment approaches depend on whether future fertility is desired. Options include anti-inflammatory approaches such as NSAIDs and medical suppressive therapies including hormonal contraceptives and gonadotropin-releasing hormone (GnRH) agonists. If painful symptoms persist, surgical intervention includes ablation or excision of the endometriomas or hysterectomy. The American College of Obstetricians and Gynecologists reviews these interventions in their guidelines for the management of endometriosis.³

Despite a lack of research on integrative approaches to treating endometriosis, they offer potential benefits with limited risks and should be considered.

1.  Prevention

There is not much evidence for interventions to prevent the development of endometriosis.  For women at increased risk due to an affected first-degree relative, consider increasing dairy intake and encouraging breastfeeding, if applicable. Women in the Nurses’ Health Study who ate three or more servings of dairy per day were 18% less likely to be diagnosed with endometriosis.⁴.  Evidence suggests that breastfeeding may be protective.⁵

2.  Inflammation

Reduce inflammation with an anti-inflammatory diet.  Consider anti-inflammatory botanicals such as ginger (Zingiber officinale) and turmeric (Curcuma longa), in addition to omega-3 fatty acid supplementation of 1,000-2,000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) daily if dietary intake is inadequate.