How Naturopathic Doctors Treat Endometriosis

Endometriosis is one of the common yet misunderstood medical conditions, affecting 10-15 percent of women of childbearing age.¹Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. https://doi.org/10.1007/s13669-017-0187-1 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.

What Is Endometriosis, and What Are the Symptoms?

Endometriosis²Alimi Y, Iwanaga J, Loukas M, Tubbs RS. The clinical anatomy of endometriosis: a review. Cureus. 2018;10(9):e3361. Published 2018 Sep 25. https://doi.org/10.7759/cureus.3361 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 is 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 and cysts.

Diagnosing Endometriosis

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 scars³Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited added value of magnetic resonance imaging after dynamic transvaginal ultrasound for preoperative staging of endometriosis in daily practice: a prospective cohort study. J Ultrasound Med. 2019;38(4):989-996. https://doi.org/10.1002/jum.14783 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.⁴Taylor HS, Adamson GD, Diamond MP, et al. An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. Int J Gynaecol Obstet. 2018;142(2):131-142. https://doi.org/10.1002/ijgo.12521

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Underlying Causes

Some factors that may contribute to endometriosis include genetics, hormonal imbalance, environmental exposures, and immunologic dysfunction. While the exact cause of endometriosis is unknown, there are several hypotheses regarding how it may develop. One possible factor is retrograde menstruation,⁵Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. https://doi.org/10.1007/s13669-017-0187-1 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, lesions may arise from Mullerian anomalies⁶Sourial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. Int J Reprod Med. 2014;2014:179515. https://doi.org/10.1155/2014/179515 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 a genetic component, as endometriosis runs in families.

Natural Treatment for Endometriosis

Understanding multifaceted causes of endometriosis guides treatment for both acute and long-term challenges. Treatment begins by stimulating 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, endometriosis treatment also includes surgery performed by a gynecologic surgeon.

Naturopathic treatment addresses the whole patient. For many women, endometriosis can cause high levels of stress,⁷Cuevas M, Flores I, Thompson KJ, Ramos-Ortolaza DL, Torres-Reveron A, Appleyard CB. Stress exacerbates endometriosis manifestations and inflammatory parameters in an animal model. Reprod Sci. 2012;19(8):851-862. https://doi.org/10.1177/1933719112438443 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 considerations when managing 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 endometriosis⁸Parazzini F, Chiaffarino F, Surace M, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755-1759. https://doi.org/10.1093/humrep/deh395 with higher consumption of fruits and green vegetables. Conversely, an increased risk for the condition was associated with a 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 reducing inflammation. Studies show including soy,⁹Takaoka O, Mori T, Ito F, et al. Daidzein-rich isoflavone aglycones inhibit cell growth and inflammation in endometriosis. J Steroid Biochem Mol Biol. 2018;181:125-132. https://doi.org/10.1016/j.jsbmb.2018.04.004 with its isoflavones, can reduce endometrial cell proliferation.

Botanical Medicine

Botanical medicines, including the following, have been shown to provide relief for some endometriosis patients.

• Vitex¹⁰Ishaq, Sumira & Zahid, Hina & Rizwani, Ghazala. (2016). Phytopharmacological review on vitex agnus-castus: a potential medicinal plant. Chinese Herbal Medicines. 8. https://doi.org/10.1016/S1674-6384(16)60004-7 (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.
• Motherwort¹¹Wojtyniak K, Szymański M, Matławska I. Leonurus cardiaca L. (motherwort): a review of its phytochemistry and pharmacology. Phytother Res. 2013;27(8):1115-1120. https://doi.org/10.1002/ptr.4850 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-inflammatory¹²Lai CS, Lee JH, Ho CT, et al. Rosmanol potently inhibits lipopolysaccharide-induced iNOS and COX-2 expression through downregulating MAPK, NF-kappaB, STAT3 and C/EBP signaling pathways. J Agric Food Chem. 2009;57(22):10990-10998. https://doi.org/10.1021/jf9025713 herb and can be helpful for those with endometriosis pain.
• Curcumin¹³Zhang Y, Cao H, Yu Z, Peng HY, Zhang CJ. Curcumin inhibits endometriosis endometrial cells by reducing estradiol production. Iran J Reprod Med. 2013;11(5):415-422 has 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 painful endometriosis symptoms.
• Green tea¹⁴Xu H, Becker CM, Lui WT, et al. Green tea epigallocatechin-3-gallate inhibits angiogenesis and suppresses vascular endothelial growth factor C/vascular endothelial growth factor receptor 2 expression and signaling in experimental endometriosis in vivo. Fertil Steril. 2011;96(4):1021-1028. https://doi.org/10.1016/j.fertnstert.2011.07.008 may inhibit endometriosis growth.

Supplementation

Various supplements may help with endometriosis management:

• DIM or diindolylmethane is a natural plant-based chemical found in cruciferous vegetables. DIM has been shown to be helpful¹⁵Morales-Prieto DM, Herrmann J, Osterwald H, et al. Comparison of dienogest effects upon 3,3′-diindolylmethane supplementation in models of endometriosis and clinical cases. Reprod Biol. 2018;18(3):252-258. https://doi.org/10.1016/j.repbio.2018.07.002 in reducing excessive bleeding that many endometriosis sufferers have.
• Beta-carotene encourages enhanced immunity¹⁶Sawatsri S, Desai N, Rock JA, Sidell N. Retinoic acid suppresses interleukin-6 production in human endometrial cells. Fertil Steril. 2000;73(5):1012-1019. https://doi.org/10.1016/s0015-0282(00)00483-0 and decreases inflammation.
• Essential fatty acids¹⁷Moro K, Nagahashi M, Ramanathan R, Takabe K, Wakai T. Resolvins and omega three polyunsaturated fatty acids: Clinical implications in inflammatory diseases and cancer. World J Clin Cases. 2016;4(7):155-164. https://doi.org/10.12998/wjcc.v4.i7.155 decrease inflammatory responses through pathways that produce prostaglandins in the body.
• N-acetyl cysteine (NAC) has been examined¹⁸Porpora MG, Brunelli R, Costa G, et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evid Based Complement Alternat Med. 2013;2013:240702. https://doi.org/10.1155/2013/240702 for its role in helping those with endometriosis. In particular, it helps reduce cyst size.

Some licensed naturopathic doctors use acupuncture, which has a proven benefit in relieving endometriosis symptoms.¹⁹Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017;12(10):e0186616. Published 2017 Oct 27. https://doi.org/10.1371/journal.pone.0186616

Treating endometriosis can be challenging and requires a whole-person approach. Addressing the root cause can help identify natural treatments that support the body’s ability to restore optimal function.

Provided by 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 this article.

Footnotes

• 1
  Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. https://doi.org/10.1007/s13669-017-0187-1
• 2
  Alimi Y, Iwanaga J, Loukas M, Tubbs RS. The clinical anatomy of endometriosis: a review. Cureus. 2018;10(9):e3361. Published 2018 Sep 25. https://doi.org/10.7759/cureus.3361
• 3
  Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited added value of magnetic resonance imaging after dynamic transvaginal ultrasound for preoperative staging of endometriosis in daily practice: a prospective cohort study. J Ultrasound Med. 2019;38(4):989-996. https://doi.org/10.1002/jum.14783
• 4
  Taylor HS, Adamson GD, Diamond MP, et al. An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. Int J Gynaecol Obstet. 2018;142(2):131-142. https://doi.org/10.1002/ijgo.12521
• 5
  Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. https://doi.org/10.1007/s13669-017-0187-1
• 6
  Sourial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. Int J Reprod Med. 2014;2014:179515. https://doi.org/10.1155/2014/179515
• 7
  Cuevas M, Flores I, Thompson KJ, Ramos-Ortolaza DL, Torres-Reveron A, Appleyard CB. Stress exacerbates endometriosis manifestations and inflammatory parameters in an animal model. Reprod Sci. 2012;19(8):851-862. https://doi.org/10.1177/1933719112438443
• 8
  Parazzini F, Chiaffarino F, Surace M, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755-1759. https://doi.org/10.1093/humrep/deh395
• 9
  Takaoka O, Mori T, Ito F, et al. Daidzein-rich isoflavone aglycones inhibit cell growth and inflammation in endometriosis. J Steroid Biochem Mol Biol. 2018;181:125-132. https://doi.org/10.1016/j.jsbmb.2018.04.004
• 10
  Ishaq, Sumira & Zahid, Hina & Rizwani, Ghazala. (2016). Phytopharmacological review on vitex agnus-castus: a potential medicinal plant. Chinese Herbal Medicines. 8. https://doi.org/10.1016/S1674-6384(16)60004-7
• 11
  Wojtyniak K, Szymański M, Matławska I. Leonurus cardiaca L. (motherwort): a review of its phytochemistry and pharmacology. Phytother Res. 2013;27(8):1115-1120. https://doi.org/10.1002/ptr.4850
• 12
  Lai CS, Lee JH, Ho CT, et al. Rosmanol potently inhibits lipopolysaccharide-induced iNOS and COX-2 expression through downregulating MAPK, NF-kappaB, STAT3 and C/EBP signaling pathways. J Agric Food Chem. 2009;57(22):10990-10998. https://doi.org/10.1021/jf9025713
• 13
  Zhang Y, Cao H, Yu Z, Peng HY, Zhang CJ. Curcumin inhibits endometriosis endometrial cells by reducing estradiol production. Iran J Reprod Med. 2013;11(5):415-422
• 14
  Xu H, Becker CM, Lui WT, et al. Green tea epigallocatechin-3-gallate inhibits angiogenesis and suppresses vascular endothelial growth factor C/vascular endothelial growth factor receptor 2 expression and signaling in experimental endometriosis in vivo. Fertil Steril. 2011;96(4):1021-1028. https://doi.org/10.1016/j.fertnstert.2011.07.008
• 15
  Morales-Prieto DM, Herrmann J, Osterwald H, et al. Comparison of dienogest effects upon 3,3′-diindolylmethane supplementation in models of endometriosis and clinical cases. Reprod Biol. 2018;18(3):252-258. https://doi.org/10.1016/j.repbio.2018.07.002
• 16
  Sawatsri S, Desai N, Rock JA, Sidell N. Retinoic acid suppresses interleukin-6 production in human endometrial cells. Fertil Steril. 2000;73(5):1012-1019. https://doi.org/10.1016/s0015-0282(00)00483-0
• 17
  Moro K, Nagahashi M, Ramanathan R, Takabe K, Wakai T. Resolvins and omega three polyunsaturated fatty acids: Clinical implications in inflammatory diseases and cancer. World J Clin Cases. 2016;4(7):155-164. https://doi.org/10.12998/wjcc.v4.i7.155
• 18
  Porpora MG, Brunelli R, Costa G, et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evid Based Complement Alternat Med. 2013;2013:240702. https://doi.org/10.1155/2013/240702
• 19
  Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017;12(10):e0186616. Published 2017 Oct 27. https://doi.org/10.1371/journal.pone.0186616