How Do Naturopathic Doctors Treat Endometriosis?

Endometriosis is one of the common yet misunderstood medical conditions, affecting 10-15 percent of women 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 can include 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.

Diagnosis

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 abnormalities such 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 cause high 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.

Nutrition

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.

Supplementation

Another natural treatment for endometriosis may include supplementation such as:

Acupuncture, a modality some licensed naturopathic doctors utilize, when studied, showed a clear benefit to those suffering from symptoms of endometriosis.

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. 

A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). The AANP and INM would like to acknowledge Marianne Marchese, ND and Amy Rothenberg, ND for their contributions to the content of this FAQ.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.