Understanding Endometriosis: A Whole-Body Perspective

Written By Jessica Karvelis

By Jessica Karvelis (BHSc Nat) (AdvDip) (CertIV)

For millions of women around the world, endometriosis is more than just “painful periods.” It’s a misunderstood, chronic condition that can affect every part of daily life, from energy levels to fertility and emotional well-being. Despite its prevalence of 1 in every 7 women, many sufferers go years without a proper diagnosis, navigating pain and uncertainty alone. But by understanding what exacerbates endometriosis and how you can support your body via natural therapies, you can reclaim your health and quality of life.

What Is Endometriosis?

Endometriosis is a chronic, inflammatory condition where tissue similar to the uterine lining (the endometrium) grows outside the uterus. These misplaced tissues, called endometrial-like lesions, can implant on the ovaries, fallopian tubes, the lining of the pelvis, and in some cases, even the bowel, bladder, or lungs [1]. These lesions respond to monthly hormonal changes, and which each cycle, they swell, bleed, and inflame surrounding tissues, as the immune system detects them in places they do not belong. This process can lead to pain, scar tissue (adhesions), and organ dysfunction [2].

Common Symptoms
Endometriosis is not just a "bad period." It's a systemic condition that can deeply impact quality of life. Symptoms vary, but often include [1]:

  • Severe menstrual cramps (dysmenorrhea)

  • Ongoing pelvic or lower back pain

  • Pain during sex (dysphasia)

  • Digestive symptoms like bloating, diarrhea, or painful bowel movements (dyschezia), especially during menstruation

  • Heavy or irregular periods

  • Fatigue, migraines, and difficulty concentrating ("brain fog")

  • Difficulty falling pregnant

Every woman’s experience is different, and many suffer in silence for years before receiving a diagnosis.

What Causes Endometriosis?
The exact cause is still unknown, but modern science and naturopathic medicine agree that endometriosis is a multi-factorial disease [3]. The following refers to potential causations of endometriosis:

  1. Retrograde Menstruation: This is an old theory which is in the process of being debunked as a major contributing factor to the development of endometriosis; however, it is still possible that some menstrual tissue flows backward through the fallopian tubes into the pelvic cavity, where it implants and grows [4].

  2. Cellular Transformation (Metaplasia): Certain cells in the pelvis may transform into endometrial-like tissue due to inflammation, genetics, or hormonal triggers, such as low progesterone and high estrogen [3].

  3. Immune System Dysregulation: Your immune system may fail to recognise and clear out misplaced tissue, allowing inflammation to persist [5].

  4. Hormonal Imbalance: Endometriosis is often associated with high local estrogen and low progesterone production, two hormones that play key roles in lesion growth [6].

  5. Trauma: The development of endometriosis may be triggered by trauma via the activation of chronic inflammatory pathways and dysregulation of the immune and endocrine systems [12]. Studies have demonstrated that individuals with a history of childhood or adulthood traumatic experiences, including physical or sexual abuse, are at significantly higher risk of being diagnosed with endometriosis [13].

  6. Environmental Toxins: Exposure to endocrine-disrupting chemicals (e.g., BPA, phthalates, PCBs) can mimic estrogen and worsen hormonal imbalances [14][15].

A Naturopathic Approach: Treating the Whole Person
At Terraflora Naturopathy, we take a holistic, root-cause approach to endometriosis. Rather than just managing symptoms, we explore the deeper drivers of disease, including:

  • Hormone metabolism

  • Liver detoxification

  • Gut health

  • Immune system balance

  • Genetic susceptibility (e.g., MTHFR variants)

  • Environmental toxin load

  • Stress and nervous system regulation

  • Mitochondrial function

Gut Integrity & Methylation Support

Addressing intestinal permeability (commonly known as leaky gut, where the lining of the small intestine becomes damaged, allowing substances such as undigested food particles, toxins, and bacteria to enter the bloodstream) can be supported through targeted nutrients such as glutamine, zinc, and vitamins A and D, which help repair and maintain the intestinal lining. Additionally, addressing underlying dysbiosis (an overgrowth of harmful microbes in the gastrointestinal tract) with appropriate antimicrobial strategies may be beneficial, given the gut’s central role in both immune system activation and estrogen recycling [25][26].

Enhancing estrogen detoxification via phase II methylation (particularly important in individuals with MTHFR polymorphisms), using diindolylmethane (DIM), calcium-D-glucarate, B vitamins and iodine to support hormone metabolism and progesterone synthesis [27][28]. Evidence suggests that impaired methylation pathways and MTHFR C677T variants may increase endometriosis susceptibility [27], while nutrients supporting phase II detoxification may aid hormonal balance.


Healing Through Diet & Lifestyle

Nutrition plays a pivotal role in the management of endometriosis by modulating inflammation, supporting hormonal balance, and enhancing detoxification pathways. A carefully designed diet can help reduce estrogen dominance, improve liver metabolism, and lower oxidative stress, all of which contribute to symptom relief and improved quality of life [8].

A diet emphasising whole, plant-based foods provides essential phytonutrients, antioxidants, and omega-3 fatty acids can help regulate inflammatory and immune responses [9]. Regular consumption of vegetables, fruits, legumes, whole grains, and healthy fats such as those found in flaxseeds, walnuts, and salmon can support hormone balance and reduce systemic inflammation. Additionally, sufficient dietary fibre facilitates the elimination of excess estrogen through the gut, aiding estrogen detoxification and reducing circulating levels that may fuel endometriotic lesion growth [8][9].

Foods that are particularly beneficial are cruciferous vegetables, including broccoli, cauliflower, brussels sprouts, and cabbage, which contain natural compounds such as indole-3-carbinol (I3C) and its active metabolite DIM. These compounds enhance hepatic estrogen metabolism, promoting the conversion of potent estrogens (e.g., estradiol) into less active forms. This process helps mitigate estrogen dominance, a common hormonal feature associated with endometriosis [10]. Cruciferous vegetables also support phase II liver detoxification enzymes, promoting the excretion of hormones and toxins while reducing inflammatory load and oxidative stress.

Elimination of trigger foods can provide symptom improvement by reducing or eliminating inflammatory and hormonally active foods such as gluten, dairy, caffeine, and alcohol [16][17]. These dietary components may increase intestinal permeability, prostaglandin synthesis, and inflammatory cytokine production, potentially worsening pain and bloating [16][17]. Gradual reintroduction allows for the identification of individual sensitivities while minimizing symptom flare-ups.

Key Herbs & Supplements

  • Magnesium glycinate/citrate: Supports uterine muscle relaxation, reduces menstrual cramping, and assists in nervous system regulation [18].

  • Vitamin D & Omega 3: Both play integral roles in immune regulation, antioxidant defence, and reproductive hormone balance, potentially improving inflammatory markers and hormonal harmony in women with endometriosis [22][23].

  • Melatonin: Clinical trial - 10 mg daily for 8 weeks significantly lowered pelvic pain (≈ 39 % reduction), improved sleep, and reduced analgesic use, with no serious adverse events [19].

  • N-Palmitoylethanolamide (PEA): Combination of PEA (400 mg) with trans-polydatin (40 mg), twice daily for 3 months, resulted in significant reduction of pelvic pain and dysmenorrhea. Improvements persisted 30 days post-treatment in a pilot open-label study [20].

  • N-Acetylcysteine (NAC): At 600 mg thrice daily for 3 months (three days per week), NAC reduced dysmenorrhea, dyspareunia, and pelvic pain; decreased NSAID use; reduced ovarian endometrioma size and serum CA-125 levels; and achieved a 75 % spontaneous pregnancy rate in patients desiring fertility [21].

  • Herbal support: Herbs such as turmeric [24], ginger, cramp bark, raspberry leaf, vitex, dandelion root, etc, have been suggested to aliviate symptoms of endometriosis by reducing inflammation, oxidative stress and tonifying the uterus; however, robust clinical evidence is lacking.

Physical and Manual Therapies

To reduce pelvic floor tension, improve mobility, decrease pain, and enhance blood/lymphatic flow.

  • Acupuncture

    • Evidence suggests it may reduce endometriosis-associated pelvic pain, via modulation of pain pathways and inflammation.

    • Often combined with lifestyle or medical therapy.

  • Pelvic floor physiotherapy

    • Focuses on stretching, strengthening, and relaxing pelvic floor muscles.

    • Can address dyspareunia, chronic pelvic pain, and urinary/bowel symptoms.

    • Example techniques: deep breathing, myofascial release, trigger point therapy.

  • Pelvic massage / Myofascial release

    • Gentle internal or external massage to reduce scar tissue adhesions, trigger points, and fascial restrictions.

    • Can improve flexibility, reduce pain, and enhance circulation.

  • Spinal energetics / Somatic therapies

    • Includes therapies like craniosacral therapy or energy-based spinal approaches.

    • May help relieve nervous system dysregulation associated with chronic pelvic pain.

    • Evidence is mostly anecdotal or case series, but many patients report improved pain and relaxation.

  • Yoga and targeted stretching

    • Gentle yoga poses focused on hip, pelvic, and lower back mobility.

    • Supports stress reduction and pelvic floor relaxation.

You’re Not Alone

Living with endometriosis can be isolating and overwhelming, but you do not have to go through it alone. At Terraflora Naturopathy, we are here to listen, to dig deep, and to guide you toward sustainable, natural solutions that honour your body’s wisdom. Whether you are managing pain, exploring fertility options, or simply trying to regain control over your health, naturopathic care offers compassionate, whole-body strategies tailored to you.

References

  1. JAMA Network. (2022). Endometriosis: A review. JAMA. https://jamanetwork.com/journals/jama/article-abstract/2833561

  2. Morotti, M., Vincent, K., Brawn, J., Zondervan, K. T., & Becker, C. M. (2025). Comprehensive review of endometriosis care: Hormonal, inflammatory, and immune mechanisms in pathophysiology. International Journal of Gynecologic Cancer. https://journals.lww.com/greenjournal/fulltext/2025/09000

  3. Viganò, P., Somigliana, E., & Vercellini, P. (2022). New insights in pathogenesis of endometriosis. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9095948

  4. Sampson, J. A. (2023). Systematic review: Retrograde menstruation theory. PubMed. https://pubmed.ncbi.nlm.nih.gov/39055487/

  5. Wu, M., & Ho, H. N. (2006). The estrogen-immune interface in endometriosis. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11720315

  6. Zhang, Y., et al. (2023). Hormonal imbalance-mediated immune inflammation in endometrial decidualization disorder. PubMed. https://pubmed.ncbi.nlm.nih.gov/40628562/

  7. Kim, S., et al. (2014). Association between IL1A locus and endometriosis. PubMed. https://pubmed.ncbi.nlm.nih.gov/25336714/

  8. Healthline. (2025). 8 diet tips to help fight endometriosis. https://www.healthline.com/nutrition/endometriosis-diet-tips

  9. Larsson, S. C., et al. (2023). Dietary factors and risk for endometriosis: Mendelian randomization analysis. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12236032/

  10. Verkerk, R., Schreinemachers, J., & Katan, M. B. (2007). A review of the clinical efficacy and safety of cruciferous vegetable phytochemicals. PubMed. https://pubmed.ncbi.nlm.nih.gov/17605302/

  11. Porpora, M. G., et al. (2023). Efficacy of N-acetylcysteine on endometriosis-related pain, size reduction of ovarian endometriomas, and fertility outcomes. PubMed. https://pubmed.ncbi.nlm.nih.gov/36981595/

  12. Perino A, Vigano’ P, Carinelli S, et al. Trauma and endometriosis. A review. May we explain surgical phenotypes and natural history of the disease? Hum Reprod Update. 2017;23(4):566-575. https://pubmed.ncbi.nlm.nih.gov/28403918/

  13. Koller D, Løkhammer S, Goroshchuk O, et al. Observational and Genetic Analyses of Traumatic Experiences and Endometriosis. JAMA Psychiatry. 2025;82(4):386-394. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2829592

  14. Giannandrea F, Liberati M, Puzzolo D, et al. Environmental Exposure to Non-Persistent Endocrine Disrupting Chemicals and Endometriosis: A Systematic Review. Int J Environ Res Public Health. 2022;19(9):5608. doi:10.3390/ijerph19095608.

  15. Scinicariello F, Mansouri A, Porta M, et al. Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review. Arch Gynecol Obstet. 2021;303:11-33. doi:10.1007/s00404-020-05801-3.

  16. Dietary and Nutritional Interventions for the Management of Endometriosis. Nutrients. 2024;16(23):3988. https://pubmed.ncbi.nlm.nih.gov/39683382/

  17. Sverrisdóttir, U. Á., Hansen, S., & Rudnicki, M. (2022). Impact of diet on pain perception in women with endometriosis: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 271, 245–249. https://doi.org/10.1016/j.ejogrb.2022.02.028

  18. Yaralizadeh M, Najar S, Namjoyan F, Abedi P. Effectiveness of magnesium on menstrual symptoms among dysmenorrheal college students: a randomized controlled trial. Int J Women’s Health Reproduct Sci. 2024;12(2):70‑76. https://ijwhr.net/pdf/pdf_IJWHR_624.pdf

  19. Haghmorad D, Alimoradi S, Kesraei M, et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):775–782. doi:10.1016/j.pain.2013.03.022

  20. Indraccolo U, Barbieri F. Effectiveness of the association micronized N‑palmitoylethanolamide (PEA)‑trans‑polydatin in the treatment of chronic pelvic pain related to endometriosis after laparoscopic assessment: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2011;150(1):76–79. https://pubmed.ncbi.nlm.nih.gov/21601979/

  21. Anastasi, E., Scaramuzzino, S., Viscardi, M. F., Viggiani, V., Piccioni, M. G., Cacciamani, L., … Porpora, M. G. (2023). Efficacy of N‑acetylcysteine on endometriosis‑related pain, size reduction of ovarian endometriomas, and fertility outcomes. International Journal of Environmental Research and Public Health, 20(6), 4686. https://doi.org/10.3390/ijerph20064686

  22. Nazari L, Amiri M, Ranjbar G, et al. Effect of vitamin D supplementation on chronic pelvic pain and antioxidant markers in women with endometriosis: A randomized controlled trial. BMC Complement Med Ther. 2021;21:248. https://pubmed.ncbi.nlm.nih.gov/33508990/

  23. Khorshidi M, Najafian M, Mozafari K, et al. Effect of vitamin D and omega‑3 fatty acids supplementation on dysmenorrhea and quality of life in adolescents: A randomized controlled trial. Am J Clin Nutr. 2020;112(1):229–238. https://academic.oup.com/ajcn/article-abstract/112/1/229/5846052

  24. Maleki M, Eftekhari M, Sadeghi R, et al. Curcumin as adjunctive therapy for endometriosis: Randomized controlled trial. Phytother Res. 2023;37(2):789–798. https://pubmed.ncbi.nlm.nih.gov/40220411/

  25. Moustakli, E., Zagorianakou, N., Makrydimas, S., Oikonomou, E. D., Miltiadous, A., & Makrydimas, G. (2025). The Gut–Endometriosis Axis: Genetic Mechanisms and Public Health Implications. Genes, 16(8), 918. https://doi.org/10.3390/genes16080918

  26. Baușic, A. I. G., Scurtu, F., Manu, A., Matasariu, D. R., & Brătilă, E. (2025). Gut Microbiota Dysbiosis in Endometriosis: A Potential Link to Inflammation and Disease Progression. International Journal of Molecular Sciences, 26(11), 5144. https://doi.org/10.3390/ijms26115144

  27. de Souza, T., et al. (2025). Systematic Review on the DNA Methylation Role in Endometriosis: Current Evidence and Perspectives. Clinical Epigenetics, 17, 32. https://doi.org/10.1186/s13148‑025‑01828‑w

  28. Tosti C, et al. (2024). Dietary and Nutritional Interventions for the Management of Endometriosis. Nutrients, 16(23), 3988. https://doi.org/10.3390/nu16233988

Jessica Karvelis
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