Table of contents

Endometriosis affects nearly 10% of women of reproductive age worldwide and often takes up to 10 years to be diagnosed. It is a complex disorder involving the growth of extrauterine tissue similar to the lining of the uterus. It can cause chronic pain, inflammation, and, in some cases, infertility. Recognition is complicated by the diversity of symptoms.

The causes and development of endometriosis are not fully understood. Its onset has been linked to hormonal imbalances, environmental factors, lifestyle (diet, sleep, stress), and genetic predisposition. More recently, it has increasingly been recognized as an immune and inflammatory disorder, exacerbated by cyclical hormonal changes and exposure to environmental toxins.

Conventional treatments, such as surgery and hormone therapy, often fail to produce satisfactory results, leading some affected women to turn to an integrative approach. In this model, practitioners offer support by addressing nutrition, supplementation, and lifestyle while considering the person as a whole. Complementing conventional medicine with these tools can help improve quality of life and alleviate the physical and emotional challenges of the condition.

What is endometriosis?

Endometriosis is a chronic gynaecological condition in which tissue similar to the lining of the uterus grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. Less commonly, this tissue may also be found outside the pelvic region, such as in the chest. It is hormonally sensitive and may bleed and become inflamed during the menstrual cycle, leading to pain, scarring, and adhesions in surrounding tissues and organs [1–3]. Essentially, this is an estrogen-dependent inflammatory process. [4]

Diagnosis is typically based on symptoms and medical history, but definitive confirmation often requires laparoscopic examination [3]. Treatments include drug therapy to restore hormonal balance, surgical interventions to remove endometriotic tissue, and complementary approaches addressing nutrition and lifestyle. The most effective treatment strategies often combine these methods to enhance quality of life and reduce complications. [2]

Types of endometriosis

Endometriosis can be classified into three main types based on the location and depth of tissue growth: Superficial endometriosis – appears on the surface of the peritoneum or on the outer surfaces of organs. Deep infiltrating endometriosis – lesions that can invade the intestines, bladder, or muscular layers of other organs, often causing severe pain and additional symptoms. Ovarian endometriosis – characterised by the formation of large cysts on the ovaries, known as endometriomas, which are often associated with infertility and a higher risk of ovarian cancer.

These types differ in clinical presentation and treatment. Superficial endometriosis is generally associated with milder symptoms, whereas deep infiltrating types often lead to significant pain and gastrointestinal symptoms that may require surgical intervention. [5]

Types of endometriosis

Figure 1. Types of endometriosis

Risk factors and comorbidity of endometriosis

Several factors may increase the risk of developing endometriosis, including a family history of the condition, menstrual cycles shorter than 27 days, prolonged menstruation (lasting more than five days), extended exposure to estrogen, childlessness, low body mass index, and Asian ancestry. [3], [5]

Endometriosis is frequently associated with other gynaecological conditions such as ovarian cysts or Asherman’s syndrome (characterised by uterine adhesions), as well as gastrointestinal disorders like irritable bowel syndrome (IBS) [6–7]. It may also co-occur with systemic issues including infections, allergies, autoimmune diseases, psychiatric conditions, and certain cancers, such as ovarian and breast cancer. Although the underlying reasons for these comorbidities are not yet fully understood, the spread of inflammatory cytokines, microRNAs, and stem cells may contribute. [5]

Symptoms of endometriosis

The severity of symptoms varies greatly and does not necessarily reflect the extent of the condition. Small lesions may cause intense symptoms, while extensive tissue growth might result in mild or no symptoms at all. [2–3], [6]

More common symptoms include:

  • Pelvic pain
  • Premenstrual cramping
  • Painful and prolonged menstruation
  • Heavy bleeding
  • Pain during or after intercourse
  • Difficulty conceiving

Less commonly known symptoms include:

  • Gastrointestinal issues (e.g., bloating, nausea, diarrhoea)
  • Painful bowel movements or urination (especially during menstruation)
  • Lower back pain
  • Painful ovulation
  • Interstitial cystitis (painful bladder syndrome)
  • Chronic fatigue or pain
  • Depression and anxiety

How is endometriosis diagnosed?

The diagnostic process for endometriosis typically begins with a review of symptoms and medical history during a consultation with a gynaecologist, especially when the patient presents with pelvic pain or menstrual issues. The physician then performs a physical pelvic examination to palpate the area and identify any tenderness or abnormalities.This is usually followed by an abdominal and/or transvaginal ultrasound, which provides imaging of the reproductive organs and can help detect endometriomas. In some cases, magnetic resonance imaging (MRI) is used to obtain more detailed insights into the location and extent of the lesions. While MRI is useful in visualising endometriotic tissue, laparoscopy remains the gold standard for diagnosis, as it allows for direct visualisation and biopsy of the suspected areas. During laparoscopy, surgeons can also carry out immediate treatment interventions if needed [3], [6]. Endometriosis may also be discovered incidentally, since not all cases present with noticeable symptoms.

In addition to conventional diagnostic tools, functional medicine recommends further laboratory testing to gain a more comprehensive understanding of the condition. These are explored in the following section. [2]

The development of endometriosis

Throughout evolution, multicellular organisms have developed three fundamental principles for tissue organisation: repairing DNA damage caused by internal or external factors, responding to external signals for cell division, and maintaining strict adherence to their genetically assigned location. Endometriosis appears to defy the third principle. Whether influenced by internal or environmental triggers, endometrial-like cells have lost their ability to remain in their designated place within the uterus [5]. Two leading theories attempt to explain the ‘migration’ of these cells: retrograde menstruation and extrauterine stem cell activity. However, neither theory fully accounts for all the clinical and pathological characteristics of the condition. [5]

The precise causes and mechanisms behind the development of endometriosis remain unclear, with ongoing research exploring various contributing factors including hormonal imbalances, genetic predisposition, environmental influences, and lifestyle factors such as diet, sleep, and stress [2]. Furthermore, endometriosis is increasingly recognised as an immune and inflammatory disorder, aggravated by cyclical hormonal shifts and environmental toxins.

Understanding the complex and multifactorial nature of endometriosis is essential for developing effective treatments and improving patients’ quality of life.

Factors associated with the development of endometriosis

Figure 2. Factors associated with the development of endometriosis

Factors associated with the development of endometriosis

Endometriosis is a chronic inflammatory gynaecological condition marked by local inflammation and immune dysfunction. Inflammation occurs as a result of bleeding and tissue damage during menstruation—since endometriotic tissue cannot shed and exit the body like the normal uterine lining. [5]

Endometriotic lesions and peritoneal fluid show increased levels of inflammatory mediators and cytokines, prostaglandins, metalloproteinases, adhesion molecules, and reactive oxygen and nitrogen species, all of which contribute to persistent inflammation [5], [8]. Several types of immune cells also accumulate in the affected area. These include increased and functionally altered macrophages, T- and B-lymphocytes, and reduced natural killer (NK) cells. Thus, immune system dysregulation contributes to the development of endometriosis, as certain immune cells fail to function effectively in eliminating abnormal cells. [2], [8]. A key contributor may be galectin-3, a protein that regulates immune responses. Galectin-3 levels are elevated in the peritoneal fluid of women with endometriosis. It inhibits NK cell function and increases endometrial cell adhesion, promoting scarring, fibrosis, and chronic inflammation. Targeting galectin-3 could offer a novel therapeutic strategy. [1]

Endometriosis resembles a chronic wound that never heals. A major factor in this process is the activation of the NF-κB pathway, a nuclear transcription factor triggered by inflammatory mediators and oxidative stress. It regulates genes responsible for inflammation, and its activation further stimulates the production of inflammatory compounds. Estrogen enhances NF-κB activity, which may worsen hormonal imbalance and intensify symptoms. [5]

At the same time, regulation of pro-inflammatory cytokines and certain immunosuppressive mechanisms may improve the inflammatory response. IL-10, for example, is an anti-inflammatory cytokine that can inhibit the production of proinflammatory cytokines, thereby attenuating responses. Anti-inflammatory cytokines also affect T-cell function, particularly regulatory T-cells, which can help maintain immune balance. The PD-1/PD-L1 pathway is a key immunosuppressive mechanism responsible for inhibiting T cell function. Its activation may contribute to the maintenance of an inflammatory environment by preventing immune cells from functioning efficiently, so inhibiting the pathway may be another promising option for the treatment of endometriosis. [5]

Monitoring specific inflammatory markers, such as hs-CRP, can help assess inflammation levels and track the effectiveness of anti-inflammatory interventions. [2]

Women with endometriosis often exhibit elevated estrogen levels, which stimulate the growth of endometrial tissue outside the uterus. Progesterone, a hormone that normally has anti-inflammatory effects, may be less effective in these women due to progesterone resistance. As a result, endometrial tissue fails to respond appropriately, allowing abnormal growth to continue. These hormonal imbalances can also disrupt the menstrual cycle and contribute to fertility issues. [2], [9]

This imbalance is typically characterised by reduced progesterone receptor (PR) activity and increased estrogen receptor (ER) activity. When PR activity is insufficient, it cannot counteract the pro-inflammatory effects of estrogen, sustaining the disease and complicating treatment. Additionally, women with endometriosis often have increased aromatase activity—an enzyme responsible for estrogen synthesis—leading to further local estrogen production and inflammation. [5]

Because endometrial tissue can produce its own estrogen, conventional hormonal therapies such as contraceptives or GnRH agonists, which aim to reduce estrogen and increase progesterone, don’t always yield the desired results and can come with side effects (e.g., osteoporosis) [1], [5], [10]. To improve treatment outcomes, restoring hormonal balance is crucial. In functional medicine, hormone balance is a key focus. This includes investigating hormone metabolism and detoxification, as well as evaluating the impact of chronic stress and environmental toxins on the hormonal system. [1]

A comprehensive hormone analysis can help tailor treatments to the individual by assessing hormone levels and their metabolites. These tests can guide personalised strategies that reduce inflammation, regulate hormone function, and support overall health. [2]

Many experts agree that retrograde menstruation may play a significant role in the development of endometriosis. In this process, menstrual blood containing live endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of exiting through the cervix and vagina. These cells can then attach to the surfaces of other organs and, under the influence of estrogen during the menstrual cycle, begin to bleed and inflame, causing pain. [9]

Although retrograde menstruation occurs in most women, only a small percentage develop endometriosis. This is likely due to immune system deficiencies that prevent effective clearance of these abnormal cells from the pelvic region [1]. Hormonal imbalances—especially progesterone resistance—also create an environment where these cells can implant, grow, and proliferate. Other contributing mechanisms may include cellular metaplasia (in which peritoneal cells transform into endometrial-like cells) or lymphatic and vascular metastasis (spread of endometrial cells through the lymphatic system or bloodstream) [4]. The retrograde menstruation theory is also closely linked with uterine outflow obstructions—such as cervical stenosis or fibroids—which can increase the risk of retrograde flow. [5]

However, it is important to note that this theory alone cannot fully explain all forms of endometriosis. For example, deeply infiltrating endometriosis, which affects the deeper layers of organ structures, behaves more like cancer metastasis than superficial implantation. Likewise, cases where endometriosis appears in remote areas like the thoracic cavity or brain are not fully explained by retrograde menstruation. [5]

Composition of the microbiome

The gut microbiome is a complex, dynamic ecosystem consisting of bacteria, archaea, fungi, and viruses. It plays a critical role in human health by supporting nutrient absorption, regulating immune responses, and maintaining gut barrier function. [11]

In women with endometriosis, notable alterations in the gut microbiome—known as dysbiosis—have been observed. This imbalance can contribute to disease progression. Specifically, women with endometriosis often show reduced microbial diversity and lower levels of beneficial Lactobacillus species [1], [11–12]. Moreover, both genital and gastrointestinal samples frequently reveal higher proportions of potentially pathogenic bacteria. [12]

According to the bacterial contamination theory, menstrual blood in endometriosis may be heavily contaminated with Escherichia coli, which releases lipopolysaccharide (LPS) endotoxins. These endotoxins can trigger pro-inflammatory responses in the pelvic cavity, potentially promoting endometriosis progression [13–14]. Other pathogens that may be involved include Gardnerella, α-Streptococcus, Enterococcus, and strains from the Proteobacteria and Enterobacteriaceae families [15–16]. Additionally, GnRH agonist hormone therapy may worsen bacterial colonisation, increasing the risk of endometritis—infectious inflammation of the uterine lining. [13]

One particularly important aspect of the microbiome’s role in endometriosis is the estrobolome—a subset of gut bacteria capable of metabolising estrogen. These microbes produce β-glucuronidase, an enzyme that deconjugates estrogen, increasing levels of circulating free estrogen, which in turn can worsen endometriosis symptoms [11–12]. Notably, Escherichia species are among the bacteria that encode this enzyme. [16]

Although the precise relationship between the microbiome and endometriosis is still being investigated, it is clear that microbial imbalances in the gut and reproductive tract may influence disease development and severity. Modulating the microbiome—through probiotics, eradication of harmful strains, or dietary interventions—offers a promising treatment strategy. For instance, specific strains like Lactobacillus gasseri have shown potential in reducing endometriosis-related pain [12]. Comprehensive faecal genomic analysis can support personalised treatment strategies by identifying microbial imbalances and guiding targeted restoration of gut microbiome, ultimately helping to relieve symptoms and improve overall well-being. [2], [11]

Do you suffer from endometriosis?

Examining the composition of the gut microbiome can help uncover the underlying root causes behind the symptoms.

A variety of environmental factors may contribute to the development of endometriosis—most notably environmental toxins, heavy metals, phthalates, pesticides, and other industrial chemicals [9], [17]. These substances are classified as endocrine disruptors, meaning they can interfere with hormonal balance. Common sources include food packaging, personal care products, cosmetics, and plastic bottles. [1], [9]

Studies have found elevated levels of phthalates and bisphenol A (BPA) in the blood of women with endometriosis. BPA closely resembles estrogen in structure, but it is more persistent in the body and can disrupt estrogen signalling, worsening symptoms. [1]

Other environmental toxins, such as dioxins, organochlorine pesticides, and polychlorinated biphenyls, have been linked to hormonal imbalances and chronic inflammation [18]. Furthermore, air pollution, particularly fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs), may increase the risk of endometriosis by promoting inflammation and oxidative stress. [2]

Reducing exposure to these harmful substances is crucial for protecting reproductive health. This includes implementing strict environmental regulations, adopting sustainable practices, improving waste management, and raising public awareness. From a functional medicine perspective, lab testing for heavy metals and other toxins can help assess individual exposure levels. Identifying and addressing these environmental risk factors is a valuable component in the holistic management of endometriosis. [2]

Diet and lifestyle habits play a crucial role in the development, progression, and management of endometriosis. Certain dietary choices—such as consuming red meat, processed foods, and saturated fats—may increase the risk of the condition. In contrast, diets rich in fruits, vegetables, and omega-3 fatty acids are associated with a reduced risk. Incorporating anti-inflammatory foods into the diet can help manage chronic inflammation [2]. Diet also influences the estrobolome and the overall gut microbiome. The intake of phytoestrogens (plant compounds that can have estrogen-like or anti-estrogenic effects) impacts both gut health and estrogen-related disease risk. Depending on their source, phytoestrogens may be either protective or harmful, affecting the likelihood of developing hormone-related conditions [11]. Dietary suggestions are given below under treatment options.

In addition to diet, exercise and stress management are key lifestyle factors. Regular physical activity is associated with a lower risk of developing endometriosis, as it helps reduce inflammation. On the other hand, chronic stress can weaken the immune system and disrupt hormonal balance, potentially worsening symptoms by encouraging endometrial tissue growth [2]. Chronic stress and pain can also lead to central sensitisation, a condition in which the central nervous system becomes hypersensitive to pain, making everyday stimuli feel painful and compounding symptom management challenges [1]. Similarly, sleep deprivation or poor-quality sleep is a risk factor for endometriosis and may intensify pain and inflammation. [19]

In summary, dietary patterns and lifestyle factors significantly influence the course of endometriosis. For those affected, adopting supportive dietary and lifestyle habits can be a powerful way to alleviate symptoms and enhance overall well-being.

Stem cell-based theories of endometriosis suggest that the condition may arise from the activity of stem cells originating from either the endometrium or the bone marrow. Endometrial stem cells are capable of adhering to sites outside the uterus, infiltrating tissue, and evading immune responses, especially under the influence of hormonal signals.

Both mesenchymal (the basic tissue from which other connective tissues are formed) and haematopoietic stem cells derived from bone marrow play a role in regenerating the endometrium. During the menstrual cycle, these cells proliferate, but if they mistakenly attach to other tissues instead of the uterine lining, they may contribute to the development of endometriosis.

Other theories challenge the idea that endometriosis originates from bone marrow stem cells. Progenitor cells, like stem cells, are able to develop into many different somatic cells, but within narrower boundaries. Circulating epithelial progenitor cells from the endometrium are thought to be a more likely source than bone marrow cells. According to this view, endometriosis begins when a circulating endometrial epithelial progenitor cell forms a gland at the site of the lesion, which then attracts various stromal (connective tissue) progenitor cells. This approach offers a new perspective in understanding the development of endometriosis. [5]

The genetic and epigenetic background of endometriosis plays a major role in the development of the disease. (Epigenetics refers to how environmental and behavioural factors influence the way genes are expressed.) Women with a family history of endometriosis are at higher risk [1], [2]. Specific genes may affect the body’s estrogen regulation, thereby contributing to the disease. In addition, fetal exposure to endocrine-disrupting chemicals—such as dioxins and phthalates—may increase susceptibility. [1]

Mutations in tumour-associated genes, such as KRAS, are frequently found in various forms of endometriosis. While these mutations usually do not cause cancer on their own, some—like KRAS mutations—may promote the survival of endometrial tissue at abnormal sites and make it more resistant to progesterone therapy. [20]

Although uterine (normally located) and ectopic (abnormally located) endometrial tissues share genetic similarities, they differ in their epigenetic profiles, particularly in DNA methylation patterns. These differences affect genes involved in immune function, inflammation, cell adhesion, and hormone signalling. In addition, microRNAs (miRNAs)—small molecules that regulate gene expression—are also altered in endometriosis, influencing processes such as cell survival, differentiation, and migration.

Advancements in understanding the genetic and epigenetic mechanisms of endometriosis may lead to the development of new therapeutic strategies [20]. However, it’s essential to remember that genes are not destiny. Through comprehensive treatments, a healthy diet, and lifestyle changes, we can reduce toxic load, support detoxification, and positively influence gene expression. [1]

Can endometriosis be treated?

Conventional medicine tools for the treatment of endometriosis

When creating a treatment plan for endometriosis, healthcare providers consider several factors: the severity of the disease, the patient’s age, desire for future pregnancy, and the intensity of symptoms—particularly pain [3]. Conventional treatment strategies focus primarily on pain management and improving fertility, using a combination of medications and surgical options. While many patients experience symptom relief after surgery, this is often temporary, with symptoms returning within a few years. Hormonal treatments may also come with unpleasant side effects.

In some cases, symptoms improve spontaneously—particularly after menopause, during pregnancy, or while breastfeeding. However, most patients require ongoing treatment to manage their condition [1], [21]. To achieve the best outcomes, combining multiple therapeutic approaches as early as possible is recommended. [3]

Pain management is a key element in treating endometriosis. Doctors frequently recommend non-steroidal anti-inflammatory drugs, which are effective in relieving painful menstrual cramps. However, these medications only alleviate symptoms and do not address the root cause. [3], [6]

Pharmacological treatments aim to relieve pain, prevent disease progression, and, in some cases, support fertility. Most of these approaches involve hormone regulation.

Options include: Combined hormonal contraceptives (pills, injections, patches, or vaginal rings): These reduce endometriosis-related hormones and help relieve menstrual pain. Continuous use for at least one year is often necessary to achieve sustained symptom relief. Gonadotropin-releasing hormone (GnRH) agonists: These block the menstrual cycle and reduce estrogen levels, shrinking endometriotic tissue by inducing a temporary, reversible menopause. To manage side effects like hot flashes, weight gain, vaginal dryness, or osteoporosis, low-dose estrogen or progestin may be added. Progestins (synthetic versions of progesterone): These stop menstruation and limit the growth of endometriosis tissue. Delivery options include intrauterine devices, injections, or progestin-only pills. Aromatase inhibitors: These lower estrogen levels and are typically combined with progestins or combined contraceptives. [3], [6]

While hormone therapies can be effective, symptoms often return after treatment is stopped. Moreover, these medications are not recommended during pregnancy or for women trying to conceive. It’s essential to be aware of potential side effects and seek ways to reduce them during treatment. [1], [3]

For women with endometriosis-related infertility, reproductive endocrinologists may recommend treatments to stimulate the ovaries, or in vitro fertilisation (IVF). [6]

Conservative surgery—which removes endometriotic lesions without damaging reproductive organs—can improve both fertility and pain. Laparoscopic surgery, which requires only small incisions, is often used to excise endometrial tissue, followed by hormone therapy to enhance fertility outcomes [6]. Robot-assisted laparoscopy is especially helpful in treating deeply infiltrating endometriosis, though it may increase the risk of complications affecting the gastrointestinal, urinary, or reproductive systems [22]. Some patients may require multiple surgeries, which can result in nerve damage and increased pain sensitivity over time. [1]

More radical surgical options—such as hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries)—are usually reserved for cases where other treatments have failed. These procedures are generally recommended when patients suffer from severe pelvic pain, infertility, or large ovarian cysts [22]. However, removing the uterus and/or ovaries leads to premature menopause, which carries long-term risks, such as increased likelihood of cardiovascular and metabolic diseases. [6]

The cornerstone of conventional medical treatment is for patients to work with a trusted physician—and, if needed, to seek a second opinion—to fully understand all available options, including benefits and side effects. [6]

Tools of functional medicine in the treatment of endometriosis

Endometriosis is characterised by chronic inflammation, elevated estrogen activity, and immune dysfunction. The functional medicine approach aims to address these root causes by using targeted dietary and lifestyle interventionsto reduce inflammation and support healthy hormone metabolism, ultimately helping to relieve symptoms and improve quality of life. [23]

Treatment of endometriosis

Figure 3. Tools of functional medicine in the treatment of endometriosis

Nutrition and supplementation for endometriosis

Useful foods and diets

An anti-inflammatory diet plays a crucial role in managing endometriosis. To help relieve symptoms, it’s important to eliminate inflammatory, ultra-processed foods and focus on fresh, whole foods. This supports gut healing, helps rebalance the microbiome, and reduces systemic inflammation. [1]

Foods that reduce inflammation include fruits, vegetables, and sources of omega-3 fatty acids such as fish, eggs, nuts, and seeds (e.g., flaxseed) [23]. In addition to their anti-inflammatory properties, fruits and vegetables are rich in fibre, which supports healthy bowel movements and plays a key role in the detoxification process [1]. Certain plant compounds are especially beneficial: carotenoids and flavonoids found in dark green vegetables (e.g., kale, spinach, pak choy, watercress, broccoli, chard); beta-carotene found in orange and yellow vegetables and fruits (e.g., carrots, peppers, mangoes). Bromelain, which is also an anti-inflammatory enzyme, is found in pineapple [23].  Incorporating these foods into a Mediterranean-style diet—rich in vegetables, healthy fats, and whole foods—can help alleviate symptoms and improve overall quality of life [2], [24]. Additional gut-supportive options include bone broth, collagen, and fermented foods, which help maintain intestinal lining integrity. [1]

Maintaining hormonal balance is equally important, as high estrogen levels can worsen symptoms. Supporting liver and bowel function is key to clearing excess estrogen from the body. Foods high in fibre, including cruciferous vegetables (e.g. broccoli, Brussels sprouts, cabbage), beetroot, watercress, and artichokes, help metabolise estrogen. In particular, indole-3-carbinol, found in cruciferous vegetables, aids in binding and eliminating excess estrogen [1]. Phytoestrogens—plant compounds found in flaxseed, apples, and chickpeas—may help balance estrogen levels by exerting anti-estrogenic effects, although the role of soy remains debated. [23]

A low-glycaemic diet is also recommended, as high insulin levels can drive inflammation. Including sufficient protein and healthy fats (such as oily fish, eggs, and flaxseed) supports stable blood sugar and provides nutrients like vitamin D, which helps improve immune tolerance—a key factor in addressing the root causes of endometriosis. [23]

Finally, it’s worth noting that meat from organically raised, pasture-fed animals and wild game tends to contain higher levels of omega-3 fatty acids than that of conventionally farmed livestock. Choosing organic produce whenever possible also helps reduce exposure to xenoestrogens, which can interfere with hormonal balance. [23]

Foods to avoid

Reducing or eliminating inflammatory foods is just as important as incorporating beneficial ones. This supports a healthy gut microbiome, helps control chronic inflammation, and contributes to better hormonal balance. [2]

Foods to avoid or limit include: those high in sugar, trans fats, and omega-6 fatty acids; refined carbohydrates (e.g., white bread, pasta, cakes, biscuits); processed and fried foods; factory-farmed meat; caffeine; and alcohol. [1–2], [23]

In addition, some individuals may benefit from an elimination diet, which involves temporarily removing certain foods to identify sensitivities or intolerances. In the context of endometriosis, it is especially worth considering the elimination of dairy products and gluten, as these can contribute to inflammation and immune dysfunction in susceptible individuals. [1–2], [23]

Dietary supplementation

A variety of evidence-based supplements and herbs can help alleviate symptoms of endometriosis by reducing inflammation, supporting hormone balance, and promoting tissue repair. [2]

Anti-inflammatory herbs and active compounds:

  • Ginger
  • Cinnamon
  • Cloves
  • Green tea
  • Turmeric (curcumin)
  • Rosemary (carnosol)
  • Chilli pepper (capsaicin)
  • Berries such as blueberries, cranberries, and grapes (resveratrol, pterostilbene)
  • Frankincense (boswellia) [1]
  • Pine bark extract (pycnogenol): One study found that women who took 60 mg daily for 48 weeks experienced a gradual but steady reduction in symptoms. [23]
  • Chaste tree (Vitex) is another traditional herb that may help regulate the menstrual cycle and hormonal balance. [2]
  • The immune-boosting flavonoid quercetin—found naturally in apples, berries, vegetables, broccoli, cauliflower, cabbage, Brussels sprouts, olive oil, capers, and onions—is also worth highlighting. [1], [23]
  • Modified citrus pectin (MCP)—a soluble fibre derived from citrus peels—can block galectin-3, a protein involved in fibrosis and inflammation. MCP also acts as a gentle chelator (binding toxins and heavy metals) and a prebiotic, promoting beneficial gut bacteria growth.
  • Liver-supporting supplements are crucial for healthy hormone metabolism and detoxification. Examples include: milk thistle – traditionally used to protect the liver from toxin-induced damage, including that caused by heavy metals; N-acetylcysteine (NAC) – an antioxidant that reduces tissue damage and inflammation; as well as alpha-lipoic acid (ALA) and glutathione – powerful antioxidants that support detoxification and immune function. One study showed that three months of NAC supplementation significantly reduced cyst size and pain in women with endometriosis. [1–2]
  • Lastly, probiotics and prebiotics help maintain a healthy gut microbiome: Probiotics are beneficial live bacteria that help restore gut microbiome balance. Prebiotics are dietary fibres that feed and support these good bacteria.

Dietary supplement

Effects

Natural sources

Vitamin D

It has anti-inflammatory and immunomodulatory properties. Adequate levels may help control the survival and growth of endometrial tissues, regulate hormonal balance, and its supplementation may reduce endometriosis-related pain and improve quality of life.

Sunlight, fatty fish, egg yolks, liver, and certain mushrooms.

Vitamin A

It plays an important role in the health of the digestive system, reproductive organs, and the pelvic mucosa, and supports efficient estrogen metabolism. Beta-carotene is a precursor of vitamin A. Its proper function also depends on adequate levels of vitamins D and K.

Orange and yellow vegetables and fruits, dark leafy greens, eggs, and liver.

Vitamin C

It enhances cellular immunity and supports the barrier function of mucosal tissues, making it essential for maintaining healthy tissue function in both the gut and the pelvic region.

Light-colored fresh vegetables and fruits, as well as dark leafy greens.

Vitamin E

Women with endometriosis tend to have lower levels of this antioxidant, which may contribute to increased inflammation and excessive growth of endometrial tissue.

Nuts and seeds—especially sunflower seeds, pine nuts, almonds, and hazelnuts—as well as avocado, spinach, and olive oil.

B vitamins

In addition to supporting the conversion of essential fatty acids into their beneficial, anti-inflammatory forms, B vitamins are also essential for efficient estrogen metabolism in the liver. Vitamin B6, in particular, has been shown to reduce the intensity and duration of menstrual pain.

Meat and fish, organ meats, eggs, legumes, beans, red lentils, Brussels sprouts, spinach, lettuce, beets, radishes, flaxseeds, and sunflower seeds.

Essential Fatty Acids

These are indispensable for healthy hormonal function. It is important to maintain a proper balance between omega-3 and omega-6 fatty acids—ideally in a ratio of about 1:1 to 1:4. Zinc and vitamin B6 are also necessary for their metabolism and for their conversion into beneficial prostaglandins. These are lipid molecules with anti-inflammatory, hormone-like effects in the body.

Good sources include oily fish such as sardines, salmon, mackerel, herring, and trout.

Magnesium

Magnesium supports liver detoxification, promoting the elimination of excess estrogen and supporting immune function.

Brazil nuts, eggs, sunflower seeds, liver, fish, and chia seeds.
Iodine Iodine has anti-inflammatory properties, supports hormonal balance (including the reduction of estrogen dominance), and contributes to immune system function. Seaweeds and algae, fish and other seafood, eggs, and iodized salt.

Table 1. Essential vitamins and nutrients for women with endometriosis [23]

Overall, adopting an appropriate diet combined with targeted nutritional supplements offers promising potential for managing endometriosis—particularly when guided by a qualified specialist. This integrative approach can support the restoration of hormonal balance and help alleviate symptoms. Various dietary strategies, including vitamin supplementation (e.g. vitamins D, A, C, and E), omega-3 fatty acids, turmeric, and therapeutic diets such as the Mediterranean or low FODMAP diets, have been shown to positively influence the course of the disease. [4]

Minimising environmental toxicity in endometriosis

Xenoestrogens are synthetic or environmental chemicals that mimic estrogen in the body. By disrupting hormonal balance, they can contribute to estrogen dominance—a key driver of endometriosis. Many xenoestrogens are found in plastics. To reduce exposure: Avoid foods wrapped in soft plastic film or stored in plastic containers. Do not microwave food in plastic, as heat can release more of these chemicals into your food [1]. Canned foods often contain BPA in their lining, another xenoestrogen linked to reproductive issues. Phthalates, found in many plastics, also disrupt endocrine function. Switching to glass containers and bottles, using a home water filter, and opting for reusable BPA-free or stainless steel water bottles are practical steps to limit exposure [23]. Home furnishings and materials—such as adhesives used in carpets or furniture—can also release harmful chemicals, so it’s wise to consider non-toxic alternatives when possible.

Food sources matter too. Commercial meat and dairy often contain growth hormones, which may interfere with the body’s natural hormone balance. Choosing grass-fed, free-range, and organic products helps minimise intake of these added hormones. Likewise, pesticides and insecticides used in conventional agriculture can affect hormone function, making organic produce a safer choice. To make the best choices, it is important to be aware of the most commonly contaminated foods and plan your shopping accordingly. [23]

Finally, personal care products also play a role. Many shampoos, soaps, detergents, and cosmetics contain parabensand phenoxyethanol, which can be absorbed directly through the skin and bypass the liver’s detoxification system. Choosing skincare and household products made from natural ingredients can significantly reduce this exposure. [23]

Move to manage endometriosis

Physical activity supports the immune system, which plays a key role in the development and progression of endometriosis. Exercise can also help regulate hormone levels, reduce chronic pain, improve sleep, manage stress, and lower systemic inflammation—all important aspects of endometriosis management. [4]

However, is this supported by scientific evidence? Two systematic reviews have explored the connection between exercise and endometriosis. While some studies show a protective effect or pain reduction, others have found no significant impact. These mixed results suggest that more research is needed to identify effective exercise programmes tailored to individuals with endometriosis. [4]

It’s also important to recognise that excessive or inappropriate exercise can disrupt hormonal balance, so finding the right type, intensity, and duration of activity is key [25]. Gentle forms of movement, such as yoga, Pilates, walking, and tai chi, can help reduce inflammation and stimulate the release of endorphins, the body’s natural pain-relieving hormones. Exercise also supports lymphatic circulation, which helps the body eliminate excess estrogen. Moderate aerobic activity can enhance serotonin levels and overall well-being, but overexertion may act as a barrier to healing in some cases [22]. On days when energy levels are higher, it may be beneficial to choose short, high-intensity workouts—such as HIIT (High-Intensity Interval Training)—instead of long, strenuous cardio sessions. This helps maintain the benefits of exercise without overstimulating the stress response. Excessive and prolonged exercise can increase inflammation and raise cortisol levels, potentially leading to hormonal imbalances. [23]

The role of sleep improvement in endometriosis

Women with endometriosis often experience poorer sleep quality compared to those without the condition. Disrupted sleep may be linked to pelvic pain, painful bladder syndrome, and other symptoms that negatively affect quality of life and mood. Studies have shown that women with endometriosis also tend to have lower pressure pain thresholds in the diaphragm and abdomen—an indication of increased central sensitivity often associated with disturbed sleep. [4]

Even mild but regular sleep deprivation (less than 7–8 hours per night) can increase stress levels, reduce pain tolerance, and amplify symptoms. This can create a vicious cycle, where poor sleep worsens symptoms, and symptoms disrupt sleep—ultimately contributing to chronic pain and fatigue. [23]

To support healthy sleep: Stick to a consistent bedtime and wake-up schedule. Avoid digital screens before bed, as blue light can interfere with melatonin production. Engage in calming pre-sleep routines, such as a warm bath or herbal tea. Prioritising sleep hygiene can help restore hormonal balance, reduce inflammation, and improve emotional and physical resilience. [23]

Stress management for endometriosis

Endometriosis is not only a physical condition—it’s also linked to chronic emotional stress. Persistent stress can weaken immune function, particularly the activity of natural killer (NK) cells, which play a role in controlling endometrial lesions. Stress also contributes to hormonal imbalances, affecting estrogen and progesterone levels and worsening symptoms [1]. Animal studies have confirmed that stress can lead to increased lesion size, reinforcing the importance of stress reduction as part of symptom management. [1]

Effective stress management techniques include: breathing exercises, mindfulness meditation, guided imagery – a visualization technique for calming the nervous system, and mind-body therapies, such as cognitive behavioural therapy (CBT) or biofeedback, also show promise for people with endometriosis. [1], [23–24]

Stress relief doesn’t always require structured techniques. Sometimes, it can be as simple as: meeting a close friend, going for a walk in nature, listening to music, or enjoying a good book. These small acts of self-care can have a meaningful impact on pain perception, inflammation, and emotional well-being. [23]

Other therapies for endometriosis

In addition to medical and lifestyle interventions, a range of complementary therapies can support women in managing endometriosis-related pain and improving daily quality of life. Acupuncture has shown promising results. In one study conducted by Harvard Medical School, participants experienced a 62% reduction in pain after just four weeks of acupuncture treatment [23]. Chiropractic care, focusing on the spine and surrounding soft tissues, may also be beneficial, particularly when combined with manual therapies like massage and pelvic floor physiotherapy. These approaches can help reduce stress, improve circulation, and ease pelvic pain. Electro-physical therapies, such as: Transcutaneous electrical nerve stimulation (TENS), Neuromuscular electrical stimulation (NMES) can also provide pain relief and enhance the effectiveness of other treatments. These complementary therapies offer more than just symptom control—they can empower women with endometriosis to take an active role in their healing journey and reclaim quality of life. [2], [24]

Endometriosis presents uniquely in each woman, affecting multiple systems in complex ways. The most effective treatment approach is one that’s individualised, reflecting a woman’s life goals, health status, and the specific impact of the disease on her well-being. The functional medicine model honours this individuality by considering each patient’s biochemistry, lifestyle, and environmental exposures. It offers personalized recommendations that support hormonal balance, reduce pain and inflammation, and promote long-term healing and resilience.

Do you suffer from endometriosis?

Examining the composition of the gut microbiome can help uncover the underlying root causes behind the symptoms.

References

[1] ‘A Functional-Medicine Approach to Endometriosis’, Experience Life, Sep. 21, 2023 https://experiencelife.lifetime.life/article/a-functional-medicine-approach-to-endometriosis/

[2] H. Yoshimura, ‘Functional Medicine Approaches to Endometriosis: Managing Pain and Improving Quality of Life’, Rupa Health, Mar. 16, 2023 https://www.rupahealth.com/post/integrative-approaches-to-endometriosis

[3] ‘What Is Endometriosis?’, Cleveland Clinic https://my.clevelandclinic.org/health/diseases/10857-endometriosis

[4] ‘Endometriosis: Root Causes & Lifestyle Interventions’, The Institute for Functional Medicine https://www.ifm.org/news-insights/endometriosis-root-causes-lifestyle-interventions/

[5] Y. Wang, K. Nicholes, and I.-M. Shih, ‘The Origin and Pathogenesis of Endometriosis’, Annu. Rev. Pathol. Mech. Dis., vol. 15, no. Volume 15, 2020, pp. 71–95, Jan. 2020, DOI: https://doi.org/10.1146/annurev-pathmechdis-012419-032654

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Table of contents

Endometriosis affects nearly 10% of women of reproductive age worldwide and often takes up to 10 years to be diagnosed. It is a complex disorder involving the growth of extrauterine tissue similar to the lining of the uterus. It can cause chronic pain, inflammation, and, in some cases, infertility. Recognition is complicated by the diversity of symptoms.

The causes and development of endometriosis are not fully understood. Its onset has been linked to hormonal imbalances, environmental factors, lifestyle (diet, sleep, stress), and genetic predisposition. More recently, it has increasingly been recognized as an immune and inflammatory disorder, exacerbated by cyclical hormonal changes and exposure to environmental toxins.

Conventional treatments, such as surgery and hormone therapy, often fail to produce satisfactory results, leading some affected women to turn to an integrative approach. In this model, practitioners offer support by addressing nutrition, supplementation, and lifestyle while considering the person as a whole. Complementing conventional medicine with these tools can help improve quality of life and alleviate the physical and emotional challenges of the condition.

What is endometriosis?

Endometriosis is a chronic gynaecological condition in which tissue similar to the lining of the uterus grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. Less commonly, this tissue may also be found outside the pelvic region, such as in the chest. It is hormonally sensitive and may bleed and become inflamed during the menstrual cycle, leading to pain, scarring, and adhesions in surrounding tissues and organs [1–3]. Essentially, this is an estrogen-dependent inflammatory process. [4]

Diagnosis is typically based on symptoms and medical history, but definitive confirmation often requires laparoscopic examination [3]. Treatments include drug therapy to restore hormonal balance, surgical interventions to remove endometriotic tissue, and complementary approaches addressing nutrition and lifestyle. The most effective treatment strategies often combine these methods to enhance quality of life and reduce complications. [2]

Types of endometriosis

Endometriosis can be classified into three main types based on the location and depth of tissue growth: Superficial endometriosis – appears on the surface of the peritoneum or on the outer surfaces of organs. Deep infiltrating endometriosis – lesions that can invade the intestines, bladder, or muscular layers of other organs, often causing severe pain and additional symptoms. Ovarian endometriosis – characterised by the formation of large cysts on the ovaries, known as endometriomas, which are often associated with infertility and a higher risk of ovarian cancer.

These types differ in clinical presentation and treatment. Superficial endometriosis is generally associated with milder symptoms, whereas deep infiltrating types often lead to significant pain and gastrointestinal symptoms that may require surgical intervention. [5]

Types of endometriosis

Figure 1. Types of endometriosis

Risk factors and comorbidity of endometriosis

Several factors may increase the risk of developing endometriosis, including a family history of the condition, menstrual cycles shorter than 27 days, prolonged menstruation (lasting more than five days), extended exposure to estrogen, childlessness, low body mass index, and Asian ancestry. [3], [5]

Endometriosis is frequently associated with other gynaecological conditions such as ovarian cysts or Asherman’s syndrome (characterised by uterine adhesions), as well as gastrointestinal disorders like irritable bowel syndrome (IBS) [6–7]. It may also co-occur with systemic issues including infections, allergies, autoimmune diseases, psychiatric conditions, and certain cancers, such as ovarian and breast cancer. Although the underlying reasons for these comorbidities are not yet fully understood, the spread of inflammatory cytokines, microRNAs, and stem cells may contribute. [5]

Symptoms of endometriosis

The severity of symptoms varies greatly and does not necessarily reflect the extent of the condition. Small lesions may cause intense symptoms, while extensive tissue growth might result in mild or no symptoms at all. [2–3], [6]

More common symptoms include:

  • Pelvic pain
  • Premenstrual cramping
  • Painful and prolonged menstruation
  • Heavy bleeding
  • Pain during or after intercourse
  • Difficulty conceiving

Less commonly known symptoms include:

  • Gastrointestinal issues (e.g., bloating, nausea, diarrhoea)
  • Painful bowel movements or urination (especially during menstruation)
  • Lower back pain
  • Painful ovulation
  • Interstitial cystitis (painful bladder syndrome)
  • Chronic fatigue or pain
  • Depression and anxiety

How is endometriosis diagnosed?

The diagnostic process for endometriosis typically begins with a review of symptoms and medical history during a consultation with a gynaecologist, especially when the patient presents with pelvic pain or menstrual issues. The physician then performs a physical pelvic examination to palpate the area and identify any tenderness or abnormalities.This is usually followed by an abdominal and/or transvaginal ultrasound, which provides imaging of the reproductive organs and can help detect endometriomas. In some cases, magnetic resonance imaging (MRI) is used to obtain more detailed insights into the location and extent of the lesions. While MRI is useful in visualising endometriotic tissue, laparoscopy remains the gold standard for diagnosis, as it allows for direct visualisation and biopsy of the suspected areas. During laparoscopy, surgeons can also carry out immediate treatment interventions if needed [3], [6]. Endometriosis may also be discovered incidentally, since not all cases present with noticeable symptoms.

In addition to conventional diagnostic tools, functional medicine recommends further laboratory testing to gain a more comprehensive understanding of the condition. These are explored in the following section. [2]

The development of endometriosis

Throughout evolution, multicellular organisms have developed three fundamental principles for tissue organisation: repairing DNA damage caused by internal or external factors, responding to external signals for cell division, and maintaining strict adherence to their genetically assigned location. Endometriosis appears to defy the third principle. Whether influenced by internal or environmental triggers, endometrial-like cells have lost their ability to remain in their designated place within the uterus [5]. Two leading theories attempt to explain the ‘migration’ of these cells: retrograde menstruation and extrauterine stem cell activity. However, neither theory fully accounts for all the clinical and pathological characteristics of the condition. [5]

The precise causes and mechanisms behind the development of endometriosis remain unclear, with ongoing research exploring various contributing factors including hormonal imbalances, genetic predisposition, environmental influences, and lifestyle factors such as diet, sleep, and stress [2]. Furthermore, endometriosis is increasingly recognised as an immune and inflammatory disorder, aggravated by cyclical hormonal shifts and environmental toxins.

Understanding the complex and multifactorial nature of endometriosis is essential for developing effective treatments and improving patients’ quality of life.

Factors associated with the development of endometriosis

Figure 2. Factors associated with the development of endometriosis

Factors associated with the development of endometriosis

Endometriosis is a chronic inflammatory gynaecological condition marked by local inflammation and immune dysfunction. Inflammation occurs as a result of bleeding and tissue damage during menstruation—since endometriotic tissue cannot shed and exit the body like the normal uterine lining. [5]

Endometriotic lesions and peritoneal fluid show increased levels of inflammatory mediators and cytokines, prostaglandins, metalloproteinases, adhesion molecules, and reactive oxygen and nitrogen species, all of which contribute to persistent inflammation [5], [8]. Several types of immune cells also accumulate in the affected area. These include increased and functionally altered macrophages, T- and B-lymphocytes, and reduced natural killer (NK) cells. Thus, immune system dysregulation contributes to the development of endometriosis, as certain immune cells fail to function effectively in eliminating abnormal cells. [2], [8]. A key contributor may be galectin-3, a protein that regulates immune responses. Galectin-3 levels are elevated in the peritoneal fluid of women with endometriosis. It inhibits NK cell function and increases endometrial cell adhesion, promoting scarring, fibrosis, and chronic inflammation. Targeting galectin-3 could offer a novel therapeutic strategy. [1]

Endometriosis resembles a chronic wound that never heals. A major factor in this process is the activation of the NF-κB pathway, a nuclear transcription factor triggered by inflammatory mediators and oxidative stress. It regulates genes responsible for inflammation, and its activation further stimulates the production of inflammatory compounds. Estrogen enhances NF-κB activity, which may worsen hormonal imbalance and intensify symptoms. [5]

At the same time, regulation of pro-inflammatory cytokines and certain immunosuppressive mechanisms may improve the inflammatory response. IL-10, for example, is an anti-inflammatory cytokine that can inhibit the production of proinflammatory cytokines, thereby attenuating responses. Anti-inflammatory cytokines also affect T-cell function, particularly regulatory T-cells, which can help maintain immune balance. The PD-1/PD-L1 pathway is a key immunosuppressive mechanism responsible for inhibiting T cell function. Its activation may contribute to the maintenance of an inflammatory environment by preventing immune cells from functioning efficiently, so inhibiting the pathway may be another promising option for the treatment of endometriosis. [5]

Monitoring specific inflammatory markers, such as hs-CRP, can help assess inflammation levels and track the effectiveness of anti-inflammatory interventions. [2]

Women with endometriosis often exhibit elevated estrogen levels, which stimulate the growth of endometrial tissue outside the uterus. Progesterone, a hormone that normally has anti-inflammatory effects, may be less effective in these women due to progesterone resistance. As a result, endometrial tissue fails to respond appropriately, allowing abnormal growth to continue. These hormonal imbalances can also disrupt the menstrual cycle and contribute to fertility issues. [2], [9]

This imbalance is typically characterised by reduced progesterone receptor (PR) activity and increased estrogen receptor (ER) activity. When PR activity is insufficient, it cannot counteract the pro-inflammatory effects of estrogen, sustaining the disease and complicating treatment. Additionally, women with endometriosis often have increased aromatase activity—an enzyme responsible for estrogen synthesis—leading to further local estrogen production and inflammation. [5]

Because endometrial tissue can produce its own estrogen, conventional hormonal therapies such as contraceptives or GnRH agonists, which aim to reduce estrogen and increase progesterone, don’t always yield the desired results and can come with side effects (e.g., osteoporosis) [1], [5], [10]. To improve treatment outcomes, restoring hormonal balance is crucial. In functional medicine, hormone balance is a key focus. This includes investigating hormone metabolism and detoxification, as well as evaluating the impact of chronic stress and environmental toxins on the hormonal system. [1]

A comprehensive hormone analysis can help tailor treatments to the individual by assessing hormone levels and their metabolites. These tests can guide personalised strategies that reduce inflammation, regulate hormone function, and support overall health. [2]

Many experts agree that retrograde menstruation may play a significant role in the development of endometriosis. In this process, menstrual blood containing live endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of exiting through the cervix and vagina. These cells can then attach to the surfaces of other organs and, under the influence of estrogen during the menstrual cycle, begin to bleed and inflame, causing pain. [9]

Although retrograde menstruation occurs in most women, only a small percentage develop endometriosis. This is likely due to immune system deficiencies that prevent effective clearance of these abnormal cells from the pelvic region [1]. Hormonal imbalances—especially progesterone resistance—also create an environment where these cells can implant, grow, and proliferate. Other contributing mechanisms may include cellular metaplasia (in which peritoneal cells transform into endometrial-like cells) or lymphatic and vascular metastasis (spread of endometrial cells through the lymphatic system or bloodstream) [4]. The retrograde menstruation theory is also closely linked with uterine outflow obstructions—such as cervical stenosis or fibroids—which can increase the risk of retrograde flow. [5]

However, it is important to note that this theory alone cannot fully explain all forms of endometriosis. For example, deeply infiltrating endometriosis, which affects the deeper layers of organ structures, behaves more like cancer metastasis than superficial implantation. Likewise, cases where endometriosis appears in remote areas like the thoracic cavity or brain are not fully explained by retrograde menstruation. [5]

Composition of the microbiome

The gut microbiome is a complex, dynamic ecosystem consisting of bacteria, archaea, fungi, and viruses. It plays a critical role in human health by supporting nutrient absorption, regulating immune responses, and maintaining gut barrier function. [11]

In women with endometriosis, notable alterations in the gut microbiome—known as dysbiosis—have been observed. This imbalance can contribute to disease progression. Specifically, women with endometriosis often show reduced microbial diversity and lower levels of beneficial Lactobacillus species [1], [11–12]. Moreover, both genital and gastrointestinal samples frequently reveal higher proportions of potentially pathogenic bacteria. [12]

According to the bacterial contamination theory, menstrual blood in endometriosis may be heavily contaminated with Escherichia coli, which releases lipopolysaccharide (LPS) endotoxins. These endotoxins can trigger pro-inflammatory responses in the pelvic cavity, potentially promoting endometriosis progression [13–14]. Other pathogens that may be involved include Gardnerella, α-Streptococcus, Enterococcus, and strains from the Proteobacteria and Enterobacteriaceae families [15–16]. Additionally, GnRH agonist hormone therapy may worsen bacterial colonisation, increasing the risk of endometritis—infectious inflammation of the uterine lining. [13]

One particularly important aspect of the microbiome’s role in endometriosis is the estrobolome—a subset of gut bacteria capable of metabolising estrogen. These microbes produce β-glucuronidase, an enzyme that deconjugates estrogen, increasing levels of circulating free estrogen, which in turn can worsen endometriosis symptoms [11–12]. Notably, Escherichia species are among the bacteria that encode this enzyme. [16]

Although the precise relationship between the microbiome and endometriosis is still being investigated, it is clear that microbial imbalances in the gut and reproductive tract may influence disease development and severity. Modulating the microbiome—through probiotics, eradication of harmful strains, or dietary interventions—offers a promising treatment strategy. For instance, specific strains like Lactobacillus gasseri have shown potential in reducing endometriosis-related pain [12]. Comprehensive faecal genomic analysis can support personalised treatment strategies by identifying microbial imbalances and guiding targeted restoration of gut microbiome, ultimately helping to relieve symptoms and improve overall well-being. [2], [11]

Do you suffer from endometriosis?

Examining the composition of the gut microbiome can help uncover the underlying root causes behind the symptoms.

A variety of environmental factors may contribute to the development of endometriosis—most notably environmental toxins, heavy metals, phthalates, pesticides, and other industrial chemicals [9], [17]. These substances are classified as endocrine disruptors, meaning they can interfere with hormonal balance. Common sources include food packaging, personal care products, cosmetics, and plastic bottles. [1], [9]

Studies have found elevated levels of phthalates and bisphenol A (BPA) in the blood of women with endometriosis. BPA closely resembles estrogen in structure, but it is more persistent in the body and can disrupt estrogen signalling, worsening symptoms. [1]

Other environmental toxins, such as dioxins, organochlorine pesticides, and polychlorinated biphenyls, have been linked to hormonal imbalances and chronic inflammation [18]. Furthermore, air pollution, particularly fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs), may increase the risk of endometriosis by promoting inflammation and oxidative stress. [2]

Reducing exposure to these harmful substances is crucial for protecting reproductive health. This includes implementing strict environmental regulations, adopting sustainable practices, improving waste management, and raising public awareness. From a functional medicine perspective, lab testing for heavy metals and other toxins can help assess individual exposure levels. Identifying and addressing these environmental risk factors is a valuable component in the holistic management of endometriosis. [2]

Diet and lifestyle habits play a crucial role in the development, progression, and management of endometriosis. Certain dietary choices—such as consuming red meat, processed foods, and saturated fats—may increase the risk of the condition. In contrast, diets rich in fruits, vegetables, and omega-3 fatty acids are associated with a reduced risk. Incorporating anti-inflammatory foods into the diet can help manage chronic inflammation [2]. Diet also influences the estrobolome and the overall gut microbiome. The intake of phytoestrogens (plant compounds that can have estrogen-like or anti-estrogenic effects) impacts both gut health and estrogen-related disease risk. Depending on their source, phytoestrogens may be either protective or harmful, affecting the likelihood of developing hormone-related conditions [11]. Dietary suggestions are given below under treatment options.

In addition to diet, exercise and stress management are key lifestyle factors. Regular physical activity is associated with a lower risk of developing endometriosis, as it helps reduce inflammation. On the other hand, chronic stress can weaken the immune system and disrupt hormonal balance, potentially worsening symptoms by encouraging endometrial tissue growth [2]. Chronic stress and pain can also lead to central sensitisation, a condition in which the central nervous system becomes hypersensitive to pain, making everyday stimuli feel painful and compounding symptom management challenges [1]. Similarly, sleep deprivation or poor-quality sleep is a risk factor for endometriosis and may intensify pain and inflammation. [19]

In summary, dietary patterns and lifestyle factors significantly influence the course of endometriosis. For those affected, adopting supportive dietary and lifestyle habits can be a powerful way to alleviate symptoms and enhance overall well-being.

Stem cell-based theories of endometriosis suggest that the condition may arise from the activity of stem cells originating from either the endometrium or the bone marrow. Endometrial stem cells are capable of adhering to sites outside the uterus, infiltrating tissue, and evading immune responses, especially under the influence of hormonal signals.

Both mesenchymal (the basic tissue from which other connective tissues are formed) and haematopoietic stem cells derived from bone marrow play a role in regenerating the endometrium. During the menstrual cycle, these cells proliferate, but if they mistakenly attach to other tissues instead of the uterine lining, they may contribute to the development of endometriosis.

Other theories challenge the idea that endometriosis originates from bone marrow stem cells. Progenitor cells, like stem cells, are able to develop into many different somatic cells, but within narrower boundaries. Circulating epithelial progenitor cells from the endometrium are thought to be a more likely source than bone marrow cells. According to this view, endometriosis begins when a circulating endometrial epithelial progenitor cell forms a gland at the site of the lesion, which then attracts various stromal (connective tissue) progenitor cells. This approach offers a new perspective in understanding the development of endometriosis. [5]

The genetic and epigenetic background of endometriosis plays a major role in the development of the disease. (Epigenetics refers to how environmental and behavioural factors influence the way genes are expressed.) Women with a family history of endometriosis are at higher risk [1], [2]. Specific genes may affect the body’s estrogen regulation, thereby contributing to the disease. In addition, fetal exposure to endocrine-disrupting chemicals—such as dioxins and phthalates—may increase susceptibility. [1]

Mutations in tumour-associated genes, such as KRAS, are frequently found in various forms of endometriosis. While these mutations usually do not cause cancer on their own, some—like KRAS mutations—may promote the survival of endometrial tissue at abnormal sites and make it more resistant to progesterone therapy. [20]

Although uterine (normally located) and ectopic (abnormally located) endometrial tissues share genetic similarities, they differ in their epigenetic profiles, particularly in DNA methylation patterns. These differences affect genes involved in immune function, inflammation, cell adhesion, and hormone signalling. In addition, microRNAs (miRNAs)—small molecules that regulate gene expression—are also altered in endometriosis, influencing processes such as cell survival, differentiation, and migration.

Advancements in understanding the genetic and epigenetic mechanisms of endometriosis may lead to the development of new therapeutic strategies [20]. However, it’s essential to remember that genes are not destiny. Through comprehensive treatments, a healthy diet, and lifestyle changes, we can reduce toxic load, support detoxification, and positively influence gene expression. [1]

Can endometriosis be treated?

Conventional medicine tools for the treatment of endometriosis

When creating a treatment plan for endometriosis, healthcare providers consider several factors: the severity of the disease, the patient’s age, desire for future pregnancy, and the intensity of symptoms—particularly pain [3]. Conventional treatment strategies focus primarily on pain management and improving fertility, using a combination of medications and surgical options. While many patients experience symptom relief after surgery, this is often temporary, with symptoms returning within a few years. Hormonal treatments may also come with unpleasant side effects.

In some cases, symptoms improve spontaneously—particularly after menopause, during pregnancy, or while breastfeeding. However, most patients require ongoing treatment to manage their condition [1], [21]. To achieve the best outcomes, combining multiple therapeutic approaches as early as possible is recommended. [3]

Pain management is a key element in treating endometriosis. Doctors frequently recommend non-steroidal anti-inflammatory drugs, which are effective in relieving painful menstrual cramps. However, these medications only alleviate symptoms and do not address the root cause. [3], [6]

Pharmacological treatments aim to relieve pain, prevent disease progression, and, in some cases, support fertility. Most of these approaches involve hormone regulation.

Options include: Combined hormonal contraceptives (pills, injections, patches, or vaginal rings): These reduce endometriosis-related hormones and help relieve menstrual pain. Continuous use for at least one year is often necessary to achieve sustained symptom relief. Gonadotropin-releasing hormone (GnRH) agonists: These block the menstrual cycle and reduce estrogen levels, shrinking endometriotic tissue by inducing a temporary, reversible menopause. To manage side effects like hot flashes, weight gain, vaginal dryness, or osteoporosis, low-dose estrogen or progestin may be added. Progestins (synthetic versions of progesterone): These stop menstruation and limit the growth of endometriosis tissue. Delivery options include intrauterine devices, injections, or progestin-only pills. Aromatase inhibitors: These lower estrogen levels and are typically combined with progestins or combined contraceptives. [3], [6]

While hormone therapies can be effective, symptoms often return after treatment is stopped. Moreover, these medications are not recommended during pregnancy or for women trying to conceive. It’s essential to be aware of potential side effects and seek ways to reduce them during treatment. [1], [3]

For women with endometriosis-related infertility, reproductive endocrinologists may recommend treatments to stimulate the ovaries, or in vitro fertilisation (IVF). [6]

Conservative surgery—which removes endometriotic lesions without damaging reproductive organs—can improve both fertility and pain. Laparoscopic surgery, which requires only small incisions, is often used to excise endometrial tissue, followed by hormone therapy to enhance fertility outcomes [6]. Robot-assisted laparoscopy is especially helpful in treating deeply infiltrating endometriosis, though it may increase the risk of complications affecting the gastrointestinal, urinary, or reproductive systems [22]. Some patients may require multiple surgeries, which can result in nerve damage and increased pain sensitivity over time. [1]

More radical surgical options—such as hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries)—are usually reserved for cases where other treatments have failed. These procedures are generally recommended when patients suffer from severe pelvic pain, infertility, or large ovarian cysts [22]. However, removing the uterus and/or ovaries leads to premature menopause, which carries long-term risks, such as increased likelihood of cardiovascular and metabolic diseases. [6]

The cornerstone of conventional medical treatment is for patients to work with a trusted physician—and, if needed, to seek a second opinion—to fully understand all available options, including benefits and side effects. [6]

Tools of functional medicine in the treatment of endometriosis

Endometriosis is characterised by chronic inflammation, elevated estrogen activity, and immune dysfunction. The functional medicine approach aims to address these root causes by using targeted dietary and lifestyle interventionsto reduce inflammation and support healthy hormone metabolism, ultimately helping to relieve symptoms and improve quality of life. [23]

Treatment of endometriosis

Figure 3. Tools of functional medicine in the treatment of endometriosis

Nutrition and supplementation for endometriosis

Useful foods and diets

An anti-inflammatory diet plays a crucial role in managing endometriosis. To help relieve symptoms, it’s important to eliminate inflammatory, ultra-processed foods and focus on fresh, whole foods. This supports gut healing, helps rebalance the microbiome, and reduces systemic inflammation. [1]

Foods that reduce inflammation include fruits, vegetables, and sources of omega-3 fatty acids such as fish, eggs, nuts, and seeds (e.g., flaxseed) [23]. In addition to their anti-inflammatory properties, fruits and vegetables are rich in fibre, which supports healthy bowel movements and plays a key role in the detoxification process [1]. Certain plant compounds are especially beneficial: carotenoids and flavonoids found in dark green vegetables (e.g., kale, spinach, pak choy, watercress, broccoli, chard); beta-carotene found in orange and yellow vegetables and fruits (e.g., carrots, peppers, mangoes). Bromelain, which is also an anti-inflammatory enzyme, is found in pineapple [23].  Incorporating these foods into a Mediterranean-style diet—rich in vegetables, healthy fats, and whole foods—can help alleviate symptoms and improve overall quality of life [2], [24]. Additional gut-supportive options include bone broth, collagen, and fermented foods, which help maintain intestinal lining integrity. [1]

Maintaining hormonal balance is equally important, as high estrogen levels can worsen symptoms. Supporting liver and bowel function is key to clearing excess estrogen from the body. Foods high in fibre, including cruciferous vegetables (e.g. broccoli, Brussels sprouts, cabbage), beetroot, watercress, and artichokes, help metabolise estrogen. In particular, indole-3-carbinol, found in cruciferous vegetables, aids in binding and eliminating excess estrogen [1]. Phytoestrogens—plant compounds found in flaxseed, apples, and chickpeas—may help balance estrogen levels by exerting anti-estrogenic effects, although the role of soy remains debated. [23]

A low-glycaemic diet is also recommended, as high insulin levels can drive inflammation. Including sufficient protein and healthy fats (such as oily fish, eggs, and flaxseed) supports stable blood sugar and provides nutrients like vitamin D, which helps improve immune tolerance—a key factor in addressing the root causes of endometriosis. [23]

Finally, it’s worth noting that meat from organically raised, pasture-fed animals and wild game tends to contain higher levels of omega-3 fatty acids than that of conventionally farmed livestock. Choosing organic produce whenever possible also helps reduce exposure to xenoestrogens, which can interfere with hormonal balance. [23]

Foods to avoid

Reducing or eliminating inflammatory foods is just as important as incorporating beneficial ones. This supports a healthy gut microbiome, helps control chronic inflammation, and contributes to better hormonal balance. [2]

Foods to avoid or limit include: those high in sugar, trans fats, and omega-6 fatty acids; refined carbohydrates (e.g., white bread, pasta, cakes, biscuits); processed and fried foods; factory-farmed meat; caffeine; and alcohol. [1–2], [23]

In addition, some individuals may benefit from an elimination diet, which involves temporarily removing certain foods to identify sensitivities or intolerances. In the context of endometriosis, it is especially worth considering the elimination of dairy products and gluten, as these can contribute to inflammation and immune dysfunction in susceptible individuals. [1–2], [23]

Dietary supplementation

A variety of evidence-based supplements and herbs can help alleviate symptoms of endometriosis by reducing inflammation, supporting hormone balance, and promoting tissue repair. [2]

Anti-inflammatory herbs and active compounds:

  • Ginger
  • Cinnamon
  • Cloves
  • Green tea
  • Turmeric (curcumin)
  • Rosemary (carnosol)
  • Chilli pepper (capsaicin)
  • Berries such as blueberries, cranberries, and grapes (resveratrol, pterostilbene)
  • Frankincense (boswellia) [1]
  • Pine bark extract (pycnogenol): One study found that women who took 60 mg daily for 48 weeks experienced a gradual but steady reduction in symptoms. [23]
  • Chaste tree (Vitex) is another traditional herb that may help regulate the menstrual cycle and hormonal balance. [2]
  • The immune-boosting flavonoid quercetin—found naturally in apples, berries, vegetables, broccoli, cauliflower, cabbage, Brussels sprouts, olive oil, capers, and onions—is also worth highlighting. [1], [23]
  • Modified citrus pectin (MCP)—a soluble fibre derived from citrus peels—can block galectin-3, a protein involved in fibrosis and inflammation. MCP also acts as a gentle chelator (binding toxins and heavy metals) and a prebiotic, promoting beneficial gut bacteria growth.
  • Liver-supporting supplements are crucial for healthy hormone metabolism and detoxification. Examples include: milk thistle – traditionally used to protect the liver from toxin-induced damage, including that caused by heavy metals; N-acetylcysteine (NAC) – an antioxidant that reduces tissue damage and inflammation; as well as alpha-lipoic acid (ALA) and glutathione – powerful antioxidants that support detoxification and immune function. One study showed that three months of NAC supplementation significantly reduced cyst size and pain in women with endometriosis. [1–2]
  • Lastly, probiotics and prebiotics help maintain a healthy gut microbiome: Probiotics are beneficial live bacteria that help restore gut microbiome balance. Prebiotics are dietary fibres that feed and support these good bacteria.

Dietary supplement

Effects

Natural sources

Vitamin D

It has anti-inflammatory and immunomodulatory properties. Adequate levels may help control the survival and growth of endometrial tissues, regulate hormonal balance, and its supplementation may reduce endometriosis-related pain and improve quality of life.

Sunlight, fatty fish, egg yolks, liver, and certain mushrooms.

Vitamin A

It plays an important role in the health of the digestive system, reproductive organs, and the pelvic mucosa, and supports efficient estrogen metabolism. Beta-carotene is a precursor of vitamin A. Its proper function also depends on adequate levels of vitamins D and K.

Orange and yellow vegetables and fruits, dark leafy greens, eggs, and liver.

Vitamin C

It enhances cellular immunity and supports the barrier function of mucosal tissues, making it essential for maintaining healthy tissue function in both the gut and the pelvic region.

Light-colored fresh vegetables and fruits, as well as dark leafy greens.

Vitamin E

Women with endometriosis tend to have lower levels of this antioxidant, which may contribute to increased inflammation and excessive growth of endometrial tissue.

Nuts and seeds—especially sunflower seeds, pine nuts, almonds, and hazelnuts—as well as avocado, spinach, and olive oil.

B vitamins

In addition to supporting the conversion of essential fatty acids into their beneficial, anti-inflammatory forms, B vitamins are also essential for efficient estrogen metabolism in the liver. Vitamin B6, in particular, has been shown to reduce the intensity and duration of menstrual pain.

Meat and fish, organ meats, eggs, legumes, beans, red lentils, Brussels sprouts, spinach, lettuce, beets, radishes, flaxseeds, and sunflower seeds.

Essential Fatty Acids

These are indispensable for healthy hormonal function. It is important to maintain a proper balance between omega-3 and omega-6 fatty acids—ideally in a ratio of about 1:1 to 1:4. Zinc and vitamin B6 are also necessary for their metabolism and for their conversion into beneficial prostaglandins. These are lipid molecules with anti-inflammatory, hormone-like effects in the body.

Good sources include oily fish such as sardines, salmon, mackerel, herring, and trout.

Magnesium

Magnesium supports liver detoxification, promoting the elimination of excess estrogen and supporting immune function.

Brazil nuts, eggs, sunflower seeds, liver, fish, and chia seeds.
Iodine Iodine has anti-inflammatory properties, supports hormonal balance (including the reduction of estrogen dominance), and contributes to immune system function. Seaweeds and algae, fish and other seafood, eggs, and iodized salt.

Table 1. Essential vitamins and nutrients for women with endometriosis [23]

Overall, adopting an appropriate diet combined with targeted nutritional supplements offers promising potential for managing endometriosis—particularly when guided by a qualified specialist. This integrative approach can support the restoration of hormonal balance and help alleviate symptoms. Various dietary strategies, including vitamin supplementation (e.g. vitamins D, A, C, and E), omega-3 fatty acids, turmeric, and therapeutic diets such as the Mediterranean or low FODMAP diets, have been shown to positively influence the course of the disease. [4]

Minimising environmental toxicity in endometriosis

Xenoestrogens are synthetic or environmental chemicals that mimic estrogen in the body. By disrupting hormonal balance, they can contribute to estrogen dominance—a key driver of endometriosis. Many xenoestrogens are found in plastics. To reduce exposure: Avoid foods wrapped in soft plastic film or stored in plastic containers. Do not microwave food in plastic, as heat can release more of these chemicals into your food [1]. Canned foods often contain BPA in their lining, another xenoestrogen linked to reproductive issues. Phthalates, found in many plastics, also disrupt endocrine function. Switching to glass containers and bottles, using a home water filter, and opting for reusable BPA-free or stainless steel water bottles are practical steps to limit exposure [23]. Home furnishings and materials—such as adhesives used in carpets or furniture—can also release harmful chemicals, so it’s wise to consider non-toxic alternatives when possible.

Food sources matter too. Commercial meat and dairy often contain growth hormones, which may interfere with the body’s natural hormone balance. Choosing grass-fed, free-range, and organic products helps minimise intake of these added hormones. Likewise, pesticides and insecticides used in conventional agriculture can affect hormone function, making organic produce a safer choice. To make the best choices, it is important to be aware of the most commonly contaminated foods and plan your shopping accordingly. [23]

Finally, personal care products also play a role. Many shampoos, soaps, detergents, and cosmetics contain parabensand phenoxyethanol, which can be absorbed directly through the skin and bypass the liver’s detoxification system. Choosing skincare and household products made from natural ingredients can significantly reduce this exposure. [23]

Move to manage endometriosis

Physical activity supports the immune system, which plays a key role in the development and progression of endometriosis. Exercise can also help regulate hormone levels, reduce chronic pain, improve sleep, manage stress, and lower systemic inflammation—all important aspects of endometriosis management. [4]

However, is this supported by scientific evidence? Two systematic reviews have explored the connection between exercise and endometriosis. While some studies show a protective effect or pain reduction, others have found no significant impact. These mixed results suggest that more research is needed to identify effective exercise programmes tailored to individuals with endometriosis. [4]

It’s also important to recognise that excessive or inappropriate exercise can disrupt hormonal balance, so finding the right type, intensity, and duration of activity is key [25]. Gentle forms of movement, such as yoga, Pilates, walking, and tai chi, can help reduce inflammation and stimulate the release of endorphins, the body’s natural pain-relieving hormones. Exercise also supports lymphatic circulation, which helps the body eliminate excess estrogen. Moderate aerobic activity can enhance serotonin levels and overall well-being, but overexertion may act as a barrier to healing in some cases [22]. On days when energy levels are higher, it may be beneficial to choose short, high-intensity workouts—such as HIIT (High-Intensity Interval Training)—instead of long, strenuous cardio sessions. This helps maintain the benefits of exercise without overstimulating the stress response. Excessive and prolonged exercise can increase inflammation and raise cortisol levels, potentially leading to hormonal imbalances. [23]

The role of sleep improvement in endometriosis

Women with endometriosis often experience poorer sleep quality compared to those without the condition. Disrupted sleep may be linked to pelvic pain, painful bladder syndrome, and other symptoms that negatively affect quality of life and mood. Studies have shown that women with endometriosis also tend to have lower pressure pain thresholds in the diaphragm and abdomen—an indication of increased central sensitivity often associated with disturbed sleep. [4]

Even mild but regular sleep deprivation (less than 7–8 hours per night) can increase stress levels, reduce pain tolerance, and amplify symptoms. This can create a vicious cycle, where poor sleep worsens symptoms, and symptoms disrupt sleep—ultimately contributing to chronic pain and fatigue. [23]

To support healthy sleep: Stick to a consistent bedtime and wake-up schedule. Avoid digital screens before bed, as blue light can interfere with melatonin production. Engage in calming pre-sleep routines, such as a warm bath or herbal tea. Prioritising sleep hygiene can help restore hormonal balance, reduce inflammation, and improve emotional and physical resilience. [23]

Stress management for endometriosis

Endometriosis is not only a physical condition—it’s also linked to chronic emotional stress. Persistent stress can weaken immune function, particularly the activity of natural killer (NK) cells, which play a role in controlling endometrial lesions. Stress also contributes to hormonal imbalances, affecting estrogen and progesterone levels and worsening symptoms [1]. Animal studies have confirmed that stress can lead to increased lesion size, reinforcing the importance of stress reduction as part of symptom management. [1]

Effective stress management techniques include: breathing exercises, mindfulness meditation, guided imagery – a visualization technique for calming the nervous system, and mind-body therapies, such as cognitive behavioural therapy (CBT) or biofeedback, also show promise for people with endometriosis. [1], [23–24]

Stress relief doesn’t always require structured techniques. Sometimes, it can be as simple as: meeting a close friend, going for a walk in nature, listening to music, or enjoying a good book. These small acts of self-care can have a meaningful impact on pain perception, inflammation, and emotional well-being. [23]

Other therapies for endometriosis

In addition to medical and lifestyle interventions, a range of complementary therapies can support women in managing endometriosis-related pain and improving daily quality of life. Acupuncture has shown promising results. In one study conducted by Harvard Medical School, participants experienced a 62% reduction in pain after just four weeks of acupuncture treatment [23]. Chiropractic care, focusing on the spine and surrounding soft tissues, may also be beneficial, particularly when combined with manual therapies like massage and pelvic floor physiotherapy. These approaches can help reduce stress, improve circulation, and ease pelvic pain. Electro-physical therapies, such as: Transcutaneous electrical nerve stimulation (TENS), Neuromuscular electrical stimulation (NMES) can also provide pain relief and enhance the effectiveness of other treatments. These complementary therapies offer more than just symptom control—they can empower women with endometriosis to take an active role in their healing journey and reclaim quality of life. [2], [24]

Endometriosis presents uniquely in each woman, affecting multiple systems in complex ways. The most effective treatment approach is one that’s individualised, reflecting a woman’s life goals, health status, and the specific impact of the disease on her well-being. The functional medicine model honours this individuality by considering each patient’s biochemistry, lifestyle, and environmental exposures. It offers personalized recommendations that support hormonal balance, reduce pain and inflammation, and promote long-term healing and resilience.

Do you suffer from endometriosis?

Examining the composition of the gut microbiome can help uncover the underlying root causes behind the symptoms.

References

[1] ‘A Functional-Medicine Approach to Endometriosis’, Experience Life, Sep. 21, 2023 https://experiencelife.lifetime.life/article/a-functional-medicine-approach-to-endometriosis/

[2] H. Yoshimura, ‘Functional Medicine Approaches to Endometriosis: Managing Pain and Improving Quality of Life’, Rupa Health, Mar. 16, 2023 https://www.rupahealth.com/post/integrative-approaches-to-endometriosis

[3] ‘What Is Endometriosis?’, Cleveland Clinic https://my.clevelandclinic.org/health/diseases/10857-endometriosis

[4] ‘Endometriosis: Root Causes & Lifestyle Interventions’, The Institute for Functional Medicine https://www.ifm.org/news-insights/endometriosis-root-causes-lifestyle-interventions/

[5] Y. Wang, K. Nicholes, and I.-M. Shih, ‘The Origin and Pathogenesis of Endometriosis’, Annu. Rev. Pathol. Mech. Dis., vol. 15, no. Volume 15, 2020, pp. 71–95, Jan. 2020, DOI: https://doi.org/10.1146/annurev-pathmechdis-012419-032654

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Published On: July 15th, 2025 / Categories: Uncategorized / Tags: /

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