What I Tell My Patients About Endometriosis + How To Manage It Naturally

Integrative Medicine Doctor By Aviva Romm, M.D.
Integrative Medicine Doctor
Aviva Romm, M.D. is both a midwife and an Internal Medicine and Board Certified Family Physician with specialties in Integrative Gynecology, Obstetric and Pediatrics, with a focus on women’s endocrinology.
What I Tell My Patients About Endometriosis + How To Manage It Naturally

Liz is a patient who joined my medical practice at 36 because she was popping doctor-prescribed Percocet before breakfast, taking several ibuprofen before lunch, and adding another round of narcotics in the late afternoon — all to cope with her chronic pelvic pain.

Liz has suffered for well over a decade with debilitating endometriosis pain. She’s undergone multiple surgical procedures that have only temporarily eased her discomfort, and she’s now dependent on strong and potentially dangerous medications to get her through the day with a manageable pain level.

Her story echoes that of so many women suffering daily with endometriosis. But I believe it doesn't have to be this way.

What Is Endometriosis?

Endometriosis affects 1 in 10 women in America, and likely many more, due to growing awareness that it may be highly under-diagnosed, especially in younger women.

It's a condition where tissue that normally lines the uterus — called the endometrium — grows in other parts of the body where it’s not supposed to be, most commonly the abdominal cavity, where it can land on the intestinal lining, ovaries and fallopian tubes.

This tissue is triggered by the same hormonal changes that trigger your period to come each month, causing this tissue to bleed as well. The blood in the abdomen causes irritation to the local nerves, which can be extremely painful. Over time, this bleeding can also lead to chronic inflammation and the formation of scar tissue, which in turn causes adhesions to form on the intestines, bladder, and reproductive organs, potentially leading to a whole host of symptoms.

Women with endometriosis often struggle with awful menstrual cramping that sometimes won’t even go away with NSAIDS (a group of common pain killers, like Motrin and ibuprofen). Some other common symptoms are long heavy periods (“periods from hell” is something I often hear), pelvic pain between periods, constipation and bloating, painful sex, urinary problems, low back ache, and chronic fatigue. These symptoms are a result of the inflammation, irritation, and adhesions.

In some cases, the first noticeable "symptom" is difficulty conceiving. In fact, up to 50% of women with infertility have endometriosis.

Nobody knows exactly why endometriosis happens. But some factors might be impairment to the immune response, compounded by exposure to environmental toxins. Unfortunately, endometriosis can progress and worsen over time if not addressed.


Medication and Surgery: The Conventional Treatments for Endometriosis

Conventional medicine hasn’t actually figured out how to best treat endometriosis — so it mostly focuses on symptom relief through medications and surgery.

While the use of Ibuprofen and other NSAIDS can provide temporary relief of pain, these drugs do carry risks. Hormonal therapies can relieve symptoms of mild to moderate pain but also have potential side effects, and they don't get to the root causes of the problem.

Surgery, or the removal of endometrial tissue via a laparoscopy, can relieve symptoms for as long as two years. However, the symptoms eventually return in most cases, and it could lead to more scar tissue.

Finally, a hysterectomy is sometimes recommended as a last resort, but this is not an option for women who want to become pregnant. Plus, this is often considered one of the most over-performed, unnecessary surgeries — including its use for endometriosis.

A Natural Approach to Managing Endometriosis

As a natural doctor focused on women’s health, my approach is to address the root causes of a condition. In this case, to calm inflammation, support natural detoxification, and bring hormones into healthy balance so there isn’t excess triggering of the endometrial tissue to grow, as happens with estrogen dominance. Natural pain relief is also important in order to avoid regular use of potentially harmful medications.

In my approach, diet, appropriate herbs, and supplements are the primary methods of managing endometriosis.

My plan involves four steps. I recommend taking on one new step every five days, and then staying on the plan for about six to 12 months. Keep a record of how you’re feeling on a 1 to 10 scale, especially during the times where your pain is usually the worst. This will help you understand if your symptoms are improving.

One thing to note: The herbs and supplements mentioned should not be taken during pregnancy, but can be taken up until conception. They can be taken safely if you’re breastfeeding.


Step 1: Avoid Triggers

  • Remove environmental triggers: Numerous environmental toxins in our food, food packaging, air, water, and homes can increase our hormone burden, cause inflammation, and also have the capacity to cause our immune cells to malfunction. Do your best to avoid foods that come into contact with plastic. Go organic with your foods to the best of your ability, and use clean and green products for cosmetics and household cleaners. When possible, avoid flame-retardant treated fabrics. My favorite source for all things green is the Environmental Working Group.
  • Remove dietary triggers: In terms of diet, the main triggers of inflammation are dairy products, gluten-containing products, all corn, and sugar. Coffee can be a problem for some women with endometriosis. Plan to remove all food triggers for at least three months and observe for major improvements in pain, as well as “relapses."

Step 2: Detoxify and Reduce Inflammation

  • Eat a low-inflammatory diet: A plant-based, Mediterranean style diet rich in leafy greens and antioxidant-rich fruits and vegetables, with minimal red meat, and small amounts of poultry and fish helps to reduce inflammation. All meat should be organic to avoid chemicals used in meat production.
  • Load up on greens: Include up to a pound of combined fresh vegetables, especially leafy greens (kale, collards, broccoli, Brussels’s sprouts) and fresh fruits (especially berries) every day.
  • Consider supplements to support detox: I recommend taking the following combination of detox and anti-inflammatory support supplements daily for a minimum of six months:
  • B-vitamins, magnesium, and zinc are important co-factors in detoxification, so make sure you’re getting a multivitamin daily along with a healthy plant-based diet!
  • Curcumin (1000 mb twice daily)
  • Quercetin (250 mg three times daily)
  • Ginger root (500 mg twice daily)

Step 3: Balance Hormones

  • Fill up on fiber: When estrogen is running wild, it not only can increase the size and number of the endometrial tissue, but certain forms of it also contribute to inflammation. Getting enough fiber (at least 25 grams per day) and having a daily bowel movement are essential for reducing inflammation, overall body toxin load, and eliminating excess estrogen.
  • Consider supplements: I recommend taking one to two tablespoons of freshly ground flax seed daily in a smoothie, or mixed into food, to support elimination of excess estrogen. If constipation is a problem, consider 600 mg of magnesium citrate before bed each night to ensure a healthy movement the next morning.

Step 4: Soothe and Heal

  • Focus on antioxidants: Antioxidants can prevent and reverse local tissue damage from inflammation. Some of the best antioxidants come from foods high in vitamins E, A, and C. You can also supplement by taking a daily multivitamin. Here are some of the antioxidant supplements that have been shown to be especially helpful in treating endometriosis:
  • N-acetylcysteine (NAC): This is a powerful antioxidant with some impressive data behind it specifically for endometriosis. In a 2013 study of 92 women in Italy, 47 took NAC and 45 took a placebo. Of those who took 600 mg of NAC three times a day, three consecutive days each week for three months, 24 patients cancelled their scheduled laparoscopy due to a decrease or disappearance of endometriosis, improved pain reduction or because they had gotten pregnant! In the other group, only one patient cancelled surgery.
  • Pine Bark Extract: In yet another study of an antioxidant herb, this time pycnogenol from pine bark, women taking 30 mg twice daily for 48 weeks showed a 33% reduction in pain, including severe pain, and while the pain reduction was not as strong as hormonal treatment, it actually persisted without relapse, unlike the medication group. Further, five women in the pycnogenol group became pregnant.
  • Find natural methods of pain relief:
  • Ginger root powder (or the equivalent in extract form): A dose of 500 mg two to four times per day can be helpful in reducing pain.
  • Melatonin: One study demonstrated that 10 mg of melatonin per day significantly reduces chronic pelvic pain due to endometriosis, pelvic pain during menstruation and during sex, pain during urination and associated with bowel movements — to the tune of an overall 80% reduction in the need for pain medication. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue. I recommend starting at one to three mg/day, and build up. Preferably take it in the evening, as it can make you feel tired.

My patient Liz’s story is a cautionary tale of what can happen when we focus solely on managing pain of endometriosis with medication, rather than getting to the root causes. My hope is that this information will help to relieve your suffering, but more than that, improve your health so you can feel like yourself again.

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