Overcome Endometriosis: Ease Pain And Improve Fertility

What is Endometriosis?

Endo is a condition with uterine lining-like tissue lodged somewhere within the abdominal cavity.  This tissue is sensitive to hormonal changes.  It grows in response to increases in estrogen levels, just as the uterine lining does.  This growing tissue causes pressure on surrounding tissues and nerves, leading to intense pain.  Sometimes, the pain is present throughout a woman’s cycle, not just at menstruation.  In some women, the pain is both excruciating and debilitating.

Endometriosis Staging: What Your Diagnosis Actually Means

Endometriosis is classified into four stages by the American Society for Reproductive Medicine (ASRM), based on the location, extent, and depth of endometrial implants, the presence and severity of adhesions, and the involvement of the ovaries.

Stage I – Minimal

Small, superficial implants on the pelvic lining or organs, no significant adhesions. Pain can still be severe at this stage. The stage does not correlate reliably with pain intensity.

Stage II – Mild

Deeper implants, slightly more widespread, still without significant scarring or adhesions.

Stage III – Moderate

Multiple deep implants, small endometriomas (cysts) on one or both ovaries, and filmy adhesions – bands of scar tissue that begin to distort the pelvic anatomy.

Stage IV – Severe

Many deep implants, large endometriomas, and dense adhesions that can significantly distort the fallopian tubes, ovaries, and surrounding structures. This stage has the most direct impact on fertility.

A critical point most patients don’t hear: The stage of your endometriosis does not predict your level of pain, and it does not predict fertility outcomes on its own. Women with Stage I endometriosis can have debilitating pain and significant difficulty conceiving, while some women with Stage IV are diagnosed incidentally during surgery for an unrelated issue and report minimal symptoms. What staging tells you is the anatomical extent of disease. It does not tell you why you have it, what is driving it hormonally, or what will stop it from progressing or recurring.

What are the Symptoms of Endometriosis?

Endometriosis symptoms include:

1. Intense abdominal pain that worsens before and/or during menstruation.  Women with endo often have to take painkillers during their periods.  Even then, they experience incapacitating pain. Menstrual cramps of any severity may indicate mild, moderate or severe endometriosis.
2. Rectal or bladder pain that is worse around menstruation.
3. Bladder irritability. The symptoms are sometimes similar to a bladder infection, but they keep recurring despite antibiotic treatment.
4. Infertility.  In some instances, endometriosis blocks the fallopian tubes. If this happens, IVF is necessary for conception.  That’s why IVF was initially invented.  Endo causes other problems with fertility as well.  If the tubes are not blocked, these other issues can be overcome with natural treatment.

What Causes Endometriosis?

There are many theories as to why this tissue is outside of the uterus:

• Dioxin.  Research on monkeys exposed to dioxin, a pollutant, shows increased endometriosis. A study by the Environmental Protection Agency found that exposure to dioxin from bleached products such as sanitary napkins and tampons was insignificant.  More concerning is the exposure to dioxin through consumption of beef and dairy products.
• Retrograde flow.  Retrograde flow is menstrual blood flowing the wrong way.  That is, rather than going down and out of the uterus through the cervix, menstrual tissue goes up and out through the fallopian tubes. Gravity could assist this, so headstands or yoga during heavy menstruation are not recommended. Retrograde menstrual flow occurs in approximately 90% of all women.  So, this theory alone isn’t enough to explain why some women have endometriosis, and others don’t.
• Overly active uterine lining cells.  An enzyme called telomerase is excessively active in women with endo.
• Autoimmune.  More recent theories suggest that endometriosis is an autoimmune disorder. Endo patients have high levels of circulating anti-endometrial antibodies. This seems like a chicken-and-egg situation.  Are the antibodies present because of the endometriosis, or are they causing it?  If endometrial tissue is in the abdominal cavity where it does not belong, the immune system targets it as foreign and creates antibodies against it.  We would expect this with tissue, which is where it shouldn’t be.
• Coelomic metaplasia.  This theory states that the cells that line your abdomen change into uterine lining cells.  The theory arises because endometriosis is found in fetuses and men.  Estrogen dominance is a likely contributor to this.
• Estrogen Dominance means an imbalance between estrogen and other hormones, like progesterone, that help balance it.

Which hormones are involved in endometriosis? How can you tell?

To confirm what the exact hormone imbalance is that is causing or contributing to your endo, there are several testing/information-gathering options:

1. Conventional hormone blood tests. Be aware that these tests must be performed at specific points of your menstrual cycle to interpret them and determine whether your levels are optimal. The second thing to be aware of is that laboratory ranges for hormones are notoriously broad and not based on what is optimal. Women will fall within these ranges even when there are apparent signs of hormone imbalance. Your tests need to be interpreted by a naturopathic doctor like myself, who will not rely on conventional ranges but instead on ranges based on optimal hormonal balance.
2. DUTCH testing. DUTCH testing is dried urine testing for hormones, such as estrogen and its metabolites. Metabolites tell us how your body deals with your hormones. This is particularly important concerning estrogen and how your liver breaks it down and excretes it.
3. Basal Body Temperature charting. Checking your temperature first thing in the morning and logging it in an app helps us identify whether you are ovulating, when you are ovulating, and what your hormones are like before and after ovulation.

Natural Treatment for Endometriosis

My naturopathic treatment plan for endometriosis includes:

1. Preventing the escape of uterine tissue from the uterus
2. Helping your body to remove endo tissue that is already in your abdomen
3. Relieving your pain
4. Reducing excess estrogen
5. Aiding liver detoxification of hormones and hormone-mimicking pollutants (not with the kits from the health food store!)
6. Ensuring intestinal health so that toxin excretion is efficient

Preventing Uterine Tissue from Escaping the Uterus

• Avoid inversions or headstands during heavy menstrual flow
• Reduce dioxin intake from beef and dairy consumption
• Reduce telomerase activity by increasing melatonin
• Address autoimmunity if it’s present
• Balance estrogen and progesterone to resolve estrogen dominance

Remove Abnormal Tissue

Your immune system is responsible for identifying and removing this foreign tissue.  Acupuncture helps to stimulate immune system activity in your abdomen.  This enhances the clean-up of this endo tissue.

Your diet either improves or inhibits your immune system.  We optimize your diet to help your immune system work better.  Immune-boosting herbs can also help you eliminate this abnormal tissue.

Pain Relief

Acupuncture works amazingly well to relieve pain. Research proves it is effective for this type of pain.

Why Endometriosis Keeps Coming Back: The Estrogen Connection

The single most important thing to understand about endometriosis is that it is an estrogen-dependent disease. Removing implants surgically does not change the hormonal environment that allowed them to grow in the first place. Without addressing that environment, recurrence is not a matter of if; it is a matter of when.

Here is the mechanism, and why it matters clinically:

Aromatase and local estrogen production in ectopic tissue

In healthy tissue, estrogen is produced primarily by the ovaries and, to a lesser extent, by adipose (fat) tissue and the adrenal glands. Endometrial implants, the tissue growing outside the uterus, behave differently. Research has shown that ectopic endometrial tissue overexpresses aromatase (CYP19A1), the enzyme responsible for converting androgens into estrogen. This means the implants are not simply responding to circulating estrogen – they are manufacturing their own local estrogen supply.

This creates a self-reinforcing cycle or snowball effect:

1. Aromatase in the implants converts local androgens to estradiol
2. Elevated local estradiol stimulates inflammatory prostaglandin E2 (PGE2) production
3. PGE2 is both pro-inflammatory and a potent stimulator of aromatase activity
4. More aromatase → more local estrogen → more PGE2 → more growth and inflammation

At the same time, endometriotic tissue shows reduced expression of 17β-hydroxysteroid dehydrogenase type 2 (17β-HSD2). This enzyme inactivates estradiol by converting it to the weaker estrone. So not only are the implants producing excess estrogen locally, but they are also less able to deactivate it.

Progesterone resistance compounds the problem

Women with endometriosis commonly exhibit progesterone resistance, a reduced cellular response to progesterone even when circulating levels are adequate. Progesterone normally suppresses aromatase activity and stimulates 17β-HSD2. When cells stop responding properly to progesterone, both of these protective effects are lost, further amplifying local estrogen activity.

This is why simply testing serum estradiol and progesterone often misses the picture entirely. Circulating levels can look reasonable while local tissue is operating in a state of significant estrogen excess. I would still measure serum levels of these hormones, with the understanding that they reveal only part of the picture.

Systemic estrogen dominance

Beyond the tissue-level mechanisms, most women with endometriosis also carry a broader pattern of estrogen dominance, elevated estrogen relative to progesterone at the systemic level. Contributing factors include impaired liver detoxification of estrogen metabolites, gut dysbiosis (which allows reabsorption of excreted estrogens via beta-glucuronidase activity), xenoestrogen exposure from plastics, pesticides, and personal care products, and insulin dysregulation, which drives aromatase activity in adipose tissue.

Addressing estrogen dominance systemically, through liver support, gut health, dietary change, and hormone-specific nutraceuticals, is as important as any local treatment strategy. You can read more about how I assess and treat estrogen dominance here.

Liver Detoxification

It’s your liver’s job (among 200 others) to detoxify chemicals, toxins, and excess hormones.  This prepares them for elimination. Only once your liver fully processes these substances are they removed from your body.  If your liver is overwhelmed or undernourished, these toxins build up in your system.  Many natural substances aid liver detoxification. For example, vitamins B6 and B12, magnesium, glucarate, I3C, and 5MTHF help your liver remove estrogen.

Intestinal Health

Once your liver processes toxins, they get excreted through your bowels.  Antibiotics or unhealthy diets lead to an unhealthy digestive tract.  These cause the overgrowth of harmful bacteria or yeast.  An enzyme (beta-glucuronidase) from certain bacteria allows these toxins to be recycled rather than removed.   Gut cleanse kits often do little to correct intestinal bacteria and improve intestinal health.  Most only stimulate bowel movements with laxative herbs and/or fibre supplements.  Correcting your gut bacteria requires a generally healthy lifestyle and:

• removing food sensitivities
• taking something to kill off the nasty bugs
• using something to restore the good bugs and
• taking something to repair your gut wall.

Benefits of Natural Treatment for Endometriosis

1. Addresses the underlying cause of endometriosis.  This provides a longer-term solution.
2. Prevents recurrence of endometriosis. Estimated recurrence rates after surgery range from 30% to 40% within 5 years.  Many women experience a recurrence within 1-1.5 years.
3. Shrinks existing cysts and reduces pain.
4. Avoids the side effects of drugs.
5. Provides better overall health and hormone balance.
6. Improves fertility.  Sometimes, endo impairs fertility by blocking the ovary from releasing an egg or blocking the opening of the fallopian tube.  If the tube is blocked, the egg can’t reach the sperm for fertilization.  If you have blocked tubes, you will require IVF treatment to conceive. The condition also makes the lining of the uterus less receptive to implantation.  Naturopathic treatment helps the latter source of endometriosis-related infertility.

Surgery vs. Naturopathic Treatment for Endometriosis

If you have had a laparoscopy and your endometriosis has returned, or if you are weighing whether to proceed with surgery, this is what the evidence shows and what I think you deserve to hear plainly.

What surgery does well

Laparoscopic excision or ablation of endometrial implants is effective for confirming the diagnosis, staging the disease, removing visible implants, draining or removing endometriomas, releasing adhesions that distort pelvic anatomy, and providing meaningful short- to medium-term pain relief.

For women with fallopian tube blockage due to severe adhesions, surgery may be a necessary step toward fertility. For women in severe pain whose quality of life is significantly impaired, surgery can provide relief that allows other interventions to take effect.

What surgery does not do

Surgery removes existing implants. It does not modify the aromatase overexpression, progesterone resistance, immune dysregulation, liver detoxification capacity, gut microbiome composition, or xenoestrogen burden that drove the disease in the first place. Once those underlying drivers remain unchanged, new implants develop.

The recurrence data reflects this clearly. Recurrence rates after laparoscopic surgery range from 20-40% within two years and up to 50% within five years, depending on the study and definition of recurrence used. For women who have had multiple surgeries, recurrence tends to happen faster each time, and each procedure carries its own risks – adhesion formation, damage to surrounding structures, and reduced ovarian reserve if endometriomas are removed from the ovaries each time.

Where naturopathic treatment for endo fits

Naturopathic treatment addresses the hormonal, immune, and environmental drivers of endometriosis, that is, the root cause layer that surgery leaves untouched. This is not a claim that natural treatment will remove existing implants. It is a claim, supported by the mechanisms described above, that reducing the estrogenic stimulus driving implant growth, supporting immune-mediated clearance of ectopic tissue, and correcting the systemic environment gives you the best chance of long-term remission rather than recurrence.

For women who have had surgery, naturopathic treatment is best understood as the necessary second step, addressing what the surgery could not. For women earlier in their diagnosis, it can meaningfully reduce progression and symptom severity while preserving fertility and avoiding the cumulative risks of repeated procedures.

The two approaches are not mutually exclusive. They address different layers of the same disease.

Endometriosis and Fertility: What You Need to Know

Endometriosis is one of the leading causes of female infertility, implicated in 30-50% of women who have difficulty conceiving. The mechanisms are multiple and not limited to the fallopian tube blockage that most patients are told about.

How endometriosis impairs fertility

Anatomical distortion

Adhesions can displace or compress the fallopian tubes and ovaries, preventing the egg from being captured after ovulation or from travelling to meet sperm. When tubes are fully blocked, IVF is required for conception. This limitation is anatomical and not resolved by medical or naturopathic treatment alone.

Ovarian endometriomas

Endometriotic cysts on the ovaries (endometriomas) are associated with reduced ovarian reserve. Research suggests the cyst itself, and particularly surgical removal of the cyst wall, can damage the surrounding ovarian tissue and reduce the pool of available follicles. Women with endometriomas should have their ovarian reserve assessed (AMH, antral follicle count) before proceeding with any intervention.

Inflammatory pelvic environment

Even without anatomical obstruction, peritoneal fluid from women with endometriosis has elevated levels of pro-inflammatory cytokines, activated macrophages, and reactive oxygen species. This environment is toxic to sperm motility, egg quality, and early embryo development. Women with endometriosis who have open tubes and appear anatomically normal can still have significantly impaired fertility due to this inflammatory environment.

Impaired implantation

Endometriosis alters the endometrial receptivity window, the narrow period during which the uterine lining is prepared to receive an embryo. Progesterone resistance, which is a hallmark of endometriosis, directly impairs the changes the endometrium needs to undergo for successful implantation. This is why some women with endometriosis experience repeated implantation failure even with IVF.

Egg quality

Oxidative stress from chronic pelvic inflammation negatively affects oocyte quality and maturation. This is particularly relevant in older women with endometriosis, where the combination of age-related decline and oxidative damage creates a compounding effect on egg quality.

What naturopathic treatment addresses in the fertility context

The anatomical consequences of severe endometriosis, adhesions, scar tissue, blocked tubes, and large endometriomas significantly distorting anatomy require surgical assessment and, in some cases, intervention. I am direct about this with patients.

What naturopathic treatment addresses is the layer beneath the anatomy: reducing peritoneal inflammation, improving egg quality through antioxidant support, restoring progesterone sensitivity to improve implantation, optimizing the endometrial environment, and correcting the systemic hormonal drivers that impair every stage of the reproductive process.

For women with endometriosis who are trying to conceive, the best approach is integrative treatment.

If endometriosis-related infertility is your primary concern, you can read more about how I approach fertility and conception from a naturopathic perspective.

For help with this or any other health problem, book an appointment here or call the office at 416-481-0222 for more information.

Authored by Dr. Pamela Frank, BSc(Hons), ND

Dr. Pamela Frank has been in practice as a naturopathic doctor for over 26 years. Since 1999, she has earned acclaim as a leading naturopath in Toronto, amassing multiple awards.

Dr. Pamela has a special interest in addressing hormone-related complexities, including but not limited to PCOS, endometriosis, acne, hair loss, weight management, thyroid issues, and fertility.

Residing in Toronto with her family and loyal companion, Dolly the rescue dog, Dr. Pamela seamlessly combines her professional commitment with a diverse range of interests.

Beyond her clinical endeavours, she actively engages in kickboxing, leadership roles within Scout Groups, yoga practice, podcasting, and outdoor pursuits such as backcountry camping.

Dr. Pamela’s comprehensive approach reflects not only her dedication to optimal health but also her passion for continual personal and professional growth.

Endometriosis and Natural Treatment Research

Breastfeeding:

Farland LV, et al. History of breastfeeding and risk of incident endometriosis: a prospective cohort study. BMJ. 2017; 358:j3778.
Breastfeeding is inversely associated with the risk of endometriosis, that is, increased breastfeeding equals lower risk.

Chinese Herbal Medicine:

Flower A, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews. 2012; DOI: 10.1002/14651858.CD006568
Two small studies in this systematic review suggest that Chinese herbal medicine is equally effective compared to gestrinone and possibly more effective than danazol in relieving endometriosis-related pain.

Teenage girls who are too skinny are more likely to develop the painful reproductive disorder endometriosis than their heavier peers, research shows. Source: Queensland Institute of Medical Research

Did you know that endometriosis problems can continue even after a hysterectomy?

August 5, 2008

Scientists have identified an enzyme abnormality that may be the cause of endometriosis

Women who have endo express an enzyme called telomerase in both the early and late stages of the menstrual cycle.  It is normal to express this enzyme only in the early stages of the cycle.  As a result, the lining of the womb is more hostile to early pregnancy.  The cells that are shed at this late stage in the menstrual cycle are more ‘aggressive’.  They are more able to survive and implant outside the uterus. To read more click here – http://www.liv.ac.uk/news/press_releases/2008/08/endometriosis.htm

The good news is that there are natural ways to suppress telomerase activity.

October 1, 2009

Aromatase inhibitors improve pain control in endo

Pharmaceutical aromatase inhibitors cause uncomfortable side effects about half the time.  Women tolerate natural aromatase inhibitors much better.

Resveratrol:

Supplementation with resveratrol as well as an oral contraceptive significantly improved and even resolved painful periods and pelvic pain in endometriosis patients.

Source: Int J Womens Health. 2012;4:543-9. Epub 2012 Oct 10

Vitamin D:

Low vitamin D status is associated with impaired fertility, endometriosis and PCOS.

Source: International Journal of Women’s Health, Volume 3, Pages 25-35, 2011

N-acetyl cysteine (NAC):

Supplementation with N-acetyl cysteine decreased cyst mean diameter, compared to a significant increase in untreated patients.

Source: Evid Based Complement Alternat Med. 2013;2013:240702.

Stem cells:

Identification of stem cells in the endometrium suggests that they are involved in the development of endometriosis.  Source: Histol Histopathol. 2012 Jan;27(1):23-9.

PCBs:

In women aged 20-40, the sum of all polychlorinated biphenyl (PCB) substances was 1.6 times higher in the women diagnosed with endometriosis than in controls. Source: Environ Health Perspect. 2006 July; 114(7): A404.

Hormones:

Loss of progesterone signaling in the endometrium is part of the development of endometriosis. Progesterone resistance is common in endometriosis patients. Source: Semin Reprod Med. 2010 Jan;28(1):36-43. Epub 2010 Jan 26.

Dioxin:

Dioxin, an environmental contaminant, is largely thought to play a part in the etiology of endometriosis.  Source: Environ Health Perspect. 2002 July; 110(7): 629–634.

In a study of infertile women with endometriosis, 8 individuals with endometriosis were dioxin positive compared to 1 woman in the control group.  This suggests a link between dioxin exposure and endometriosis. Source: Hum Reprod. 1997 Feb;12(2):373-5.

Immune Response:

Inadequate immune and neuroendocrine responses are thought to play a part in the pathophysiology of endometriosis.  Source: Semin Immunopathol. 2007 June; 29(2): 193–210.

Iron:

Iron overload was observed in the peritoneal fluid, endometriotic lesions, peritoneum and macrophages of endometriosis patients.  This suggests that iron is a contributing factor in the development of endometriosis. Source: Mol Hum Reprod. 2008 Jul;14(7):377-85. Epub 2008 May 28.

Immune system:

Endometriosis development is facilitated by the quantity and quality of endometrial cells in the abdominal fluid.  It is associated with increased inflammatory activity. Source: Reprod Biol Endocrinol. 2003; 1: 123.

Pollutants:

The level of exposure to polybrominated biphenyls (PBBs) did not increase the risk of endometriosis. But, higher levels of polychlorinated biphenyls (PCBs) exposure did. Source: Ann Epidemiol. 2007 July; 17(7): 503–510.

Polychlorinated biphenyls (PCBs) are not associated with endometriosis risk. Source: Environ Health Perspect. 2010 September; 118(9): 1280–1285.

Exposure to environmental pollutants, particularly dioxins and polychlorinated biphenyls, increases the risk of endometriosis in women. Source: Environ Health Perspect. 2009 July; 117(7): 1070–1075.

Inflammation:

Exposure to environmental toxins induces an inflammatory-like endometrial response that may advance the development of endometriosis. Source: Fertil Steril. 2008 May; 89(5 Suppl): 1287–1298.

Phytochemicals:

The phytochemicals Diindolylmethane (DIM), its precursor Indole-3-carbinol (I3C), and cogener, 2-(Indol-3-ylmethyl)-3,3’diindolylmethane (LTR-1) prevent or reduce symptoms of mastalgia and endometriosis. Source: United States Patent 7,384,972; June 10, 2008

N-acetyl cysteine:

Supplementation with N-acetyl cysteine decreases cyst mean diameter, compared to a significant increase in untreated patients. Source: Evid Based Complement Alternat Med. 2013;2013:240702.

Acupuncture for Endometriosis

A systematic review and meta-analysis of 10 studies looked at the effectiveness of acupuncture and endometriosis. Although lacking a blinded RCT, a reduction in pain, as well as CA-125 levels, are associated with acupuncture treatment. Source: Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.PLoS One. 2017 Oct 27;12(10):e0186616.

Aromatase overexpression, local estrogen production, and the PGE2 feedback loop in ectopic tissue: Bulun SE, Zeitoun KM, Takayama K, Sasano H. Estrogen biosynthesis in endometriosis: molecular basis and clinical relevance. J Mol Endocrinol. 2000 Aug;25(1):35-42. doi: 10.1677/jme.0.0250035. PMID: 10915216.

Progesterone resistance in endometriosis impairs decidualization, implantation, and drives the proinflammatory phenotype: Bulun SE, Cheng YH, Yin P, Imir G, Utsunomiya H, Attar E, Innes J, Julie Kim J. Progesterone resistance in endometriosis: link to failure to metabolize estradiol. Mol Cell Endocrinol. 2006 Mar 27;248(1-2):94-103. doi: 10.1016/j.mce.2005.11.041. Epub 2006 Jan 10. PMID: 16406281.

Surgical recurrence rates after laparoscopic excision – pooled analysis placing 5-year recurrence at 40–50%
Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009 Jul-Aug;15(4):441-61. doi: 10.1093/humupd/dmp007. Epub 2009 Mar 11. PMID: 19279046.

Peritoneal inflammatory environment – elevated ROS, cytokines, and macrophage activity impairing sperm, oocyte, and embryo quality:
Thiruchelvam U, Wingfield M, O’Farrelly C. Natural Killer Cells: Key Players in Endometriosis. Am J Reprod Immunol. 2015 Oct;74(4):291-301. doi: 10.1111/aji.12408. Epub 2015 Jun 24. PMID: 26104509.

Stilley JA, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res. 2012 Sep;349(3):849-62. doi: 10.1007/s00441-011-1309-0. PMID: 22298022; PMCID: PMC3429772.

Progesterone resistance, impaired endometrial receptivity, and the molecular mechanism of implantation failure in endometriosis:
Lessey, Bruce & Young, Steven. (2014). Homeostasis Imbalance in the Endometrium of Women with Implantation Defects: The Role of Estrogen and Progesterone. Seminars in Reproductive Medicine. 32. 365-75. 10.1055/s-0034-1376355.

DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested on this website.