Research & Education

Understanding Endometriosis

Endometriosis is one of the most common reproductive disorders, affecting nearly 10 percent of all women in their reproductive years (aged 15 to 49 years). Many cases are undiagnosed, or accidently discovered during an unrelated pelvic or abdominal procedure. Its effects can be devastating and reduce a woman’s quality of life as it leaves her struggling with infertility, chronic pelvic pain, dysmenorrhea and dyspareunia.

The Role of Inflammation

Endometriosis is closely associated with inflammation and immunological dysfunction, including autoimmunity. In fact, this painful condition is well-recognized as a chronic inflammatory condition. As endometrial tissue finds its way outside the uterus and implants into organs within the pelvic cavity (occasionally extending into other cavities), it begins to grow and slough with the cyclical pattern of estradiol. Much like malignant cells, endometrial implants both produce and initiate an infiltration of cytokines, interleukins, and tumor necrosis factor, enhanced by angiogenesis, which encourages further adhesion of endometrial cells. Scar tissue quickly builds up with the increase in endometrial adhesion. The inflammatory environment, increased vascularization, and scarring contribute to the chronic pelvic pain, characteristic of endometriosis.


Estrogen-dominance, coupled with progesterone resistance, is another influential consideration in the development of endometriosis. The prevalence of estrogen residues in our environment is undisputed and contributes to estrogen-dominance. Estrogen use in animal husbandry has left much of our meat and dairy supply riddled with hormones, but we are increasingly identifying common ingredients in cosmetics, sunscreens, lotions, hair care products, and plastics with estrogenic activity including bisphenol A (BPA), parabens, phthalates, and others.

HPA Axis Dysfunction

Interestingly, hypothalamus-pituitary-adrenal (HPA) axis dysfunction is closely related to endometriosis. Chronic stress marks our age and is an established contributor of infertility and reproductive problems because of the close relationship between sex hormones and cortisol. Stress initiates the phenomenon known as “pregnenolone steal” which depletes the body of vital sex hormones and their precursors. Further, women with endometriosis commonly experience increased anxiety and stress as a result of the pain and reproductive consequences of endometriosis, creating a circular problem.

Supporting Nutraceuticals

Adrenal Support

Supporting the HPA axis with adaptogens and glandulars, as well as embracing stress-management techniques, is vital for helping to correct sex hormone imbalances related to HPA dysfunction. Ashwagandha (Withania somnifera), Rhodiola rosea, and Licorice (Glycyrrhiza glabra) are effective adaptogens that will support a normal cortisol response and increase resilience in the face of chronic stress.

Liver Support

Enhancing estrogen detoxification is another critical factor in resolving estrogen-dominant conditions such as endometriosis. Detoxification can be supported through diet and phase 1 and 2 liver support. Patients should be encouraged to regularly consume cruciferous vegetables which supply indole-3-carbinol and lignans found in flaxseed, both of which are estrogen binders and detoxifiers. Dandelion root and milk thistle (Silybum marianum) are standard liver-supportive botanicals. MTHFR polymorphisms may compromise the sulphation detoxification pathway important for eliminating excess steroid hormones. In these cases, it is important to support methylation with bioactive folate and a comprehensive B vitamin combination.

Anti-inflammatory Support

Since inflammation is a primary factor in the etiology of endometriosis, and the cause of pain associated with this condition, anti-inflammatory support is essential. Endometrial tissue uses arachidonic acid to produce prostaglandins. Therefore, supplanting this fatty acid with GLA from evening primrose oil and EPA from fish oil will increase the anti-inflammatory eicosanoids. A newer approach to pain-management in endometriosis is the use of cannabinoids. Endocannabinoid receptors infiltrate endometrial tissue and studies have shown that cannabinoids can effectively help manage endometriosis-associated pain.

Sex Hormone Balance

Finally, we target the heart of endometriosis with estrogen-balancing botanicals. Chaste tree (Vitex agnus castus) is one of the most well-known and researched botanicals used in the management of hormone imbalances and abnormal menstruation in women. It acts on the hypothalamus and pituitary to effectively shift the hormone balance toward progesterone and away from estrogen. Dong quai and black cohosh are popular botanicals used to reduce pain and inflammation of the endometrium. Dong quai inhibits inflammatory prostaglandins and has antispasmodic properties, while black cohosh is an analgesic for uterine pain.

Endometriosis is certainly a multifaceted condition, but strongly associated with adrenal and liver health, estrogen dominance, and inflammation.  Addressing all four aspects of endometriosis can help improve the quality of life and reproductive outcomes for women suffering from this common condition.

 By Nicole Spear, MS, CNS