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How To Manage Endometriosis Naturally, According To An Integrative Doctor

Aviva Romm, M.D.
Updated on October 15, 2020
Aviva Romm, M.D.
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.
October 15, 2020

Liz is a patient who joined my medical practice at 36 because she was coping with chronic pelvic pain. She had suffered for well over a decade with debilitating endometriosis pain. She'd undergone multiple surgical procedures that have only temporarily eased her discomfort, and she was 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 fertility struggles have endometriosis.

Nobody knows exactly why endometriosis happens. Unfortunately, endometriosis can progress and worsen over time if not addressed.

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 NSAIDS can provide temporary relief of pain, these drugs can 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 an integrative medicine doctor focused on women’s health, my approach is to address the root causes of a condition. In this case, to calm inflammation, support the body's natural detoxification process, and support a healthy hormones 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 6 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. It's also a good idea to speak with your medical provider before trying any new treatments or taking regular supplements.

Step 1: Avoid triggers

  • Remove dietary triggers: In terms of diet, triggers of inflammation can range from dairy products to 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: 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–can help to reduce inflammation.
  • 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: I recommend taking the following supplements daily for a minimum of six months: curcumin (1000 mb twice daily), quercetin (250 mg three times daily), ginger root (500 mg twice daily).

Step 3: Support hormone balance

  • 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 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

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 endometriosis1, 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 pain2, 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) is one of my go-tos. A dose of 500 mg two to four times per day can be helpful in reducing pain.

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.

Aviva Romm, M.D. author page.
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. She’s also a world renown herbalist, and author of the textbook, Botanical Medicines for Women’s Health, as well as 7 other books, including The Adrenal Thyroid Revolution. A practitioner, teacher, activist and advocate of both environmental health and women’s reproductive rights and health, she has been bridging the best of traditional medicine, total health ecology, and good science for over three decades. She practices medicine in both NY and MA, and lives in the Berkshires of Western MA.