Endometriosis: Symptoms, Causes, Treatments, and Natural Approaches

Endometriosis is a chronic inflammatory condition that affects about 10 percent of women of reproductive age. It is present in up to 80 percent of pelvic pain cases and 63 percent of unexplained infertility in women. The condition occurs when tissue similar to the uterine lining grows outside the uterus, causing severe pain and other debilitating symptoms.

Diagnosing endometriosis is often delayed, sometimes by as much as 12 years after symptoms begin. This is due to factors like the normalization of menstrual pain, the need for invasive diagnostic surgery, limited understanding of the condition’s complexity, and frequent misdiagnoses.

Conventional treatments often fall short because they do not address the whole-body nature of endometriosis. Effective management requires an integrated, personalized approach.

Endometriosis can cause a variety of symptoms that significantly impact quality of life and daily activities. Interestingly, the severity of symptoms does not always match the extent of the disease. Some women with severe endometriosis may have minimal symptoms, while others with mild endometriosis may experience intense pain. Others may have no symptoms and only discover they have endometriosis when seeking help for fertility issues.

The primary symptoms are:

• Chronic pelvic or lower abdominal pain: Often the most prominent symptom leading women to seek medical care. This pain may be constant or cyclical and is often worse during menstruation.
• Painful periods (dysmenorrhea): Severe menstrual cramps that may begin before and extend several days into the menstrual period
• Back pain: Lower back pain is common, often occurring along with pelvic pain or menstruation.
• Heavy or irregular periods: Heavier than normal menstrual flow, bleeding between periods, or more frequent cycles
• Pain with sex: Deep pain during or after sexual intercourse
• Urinary symptoms: Pain with bladder filling or urination, or increased urinary frequency, especially during menstruation
• Painful bowel movements: Discomfort or pain during bowel movements, often with diarrhea, constipation, or bloating, especially during menstruation
• Fatigue: Chronic fatigue, often worse during menstruation
• Infertility: Affects 20 to 30 percent of all women with infertility

Many of these symptoms can also be associated with other conditions, which need to be ruled out for a proper diagnosis. Early detection and treatment may help manage symptoms, prevent disease progression, and preserve fertility.

The exact causes of endometriosis are not well understood, but research suggests it involves a combination of genetic, hormonal, immune, and environmental factors, with immune dysfunction playing a key role. Multiple theories explain how endometriosis begins and progresses, but no single explanation covers all cases. The causes likely vary from person to person.

As research advances, several leading theories have emerged to explain the development of endometriosis.

Origins of Endometrial-like Cells

Endometriosis may begin when cells similar to those lining the uterus (endometrium) appear outside the uterus. These cells can be found in various locations, such as the ovaries, fallopian tubes, pelvic cavity, bladder, digestive tract, and, in rare cases, even the spleen and central nervous system. Theories on how these cells appear outside the uterus include:

• Being present at birth—occurring during fetal development
• Retrograde menstruation—occurs when menstrual blood flows backward into the pelvic cavity, carrying endometrial cells with it. This process is not unusual and happens in 90 percent of women.
• Spreading—through the lymphatic system or blood vessels
• Metaplasia—a process where cells change and become endometrial-like cells outside the uterus.

Hormones and Immune Dysfunction in Lesion Formation

In many cases, endometrial-like cells do not develop into endometriosis. When they do, factors may trigger the immune system, leading to chronic inflammation and abnormal immune function.

Normally, the immune system would remove these misplaced cells, but in endometriosis, it malfunctions and activates them instead. Driven by estrogen, the immune system helps the cells stick to tissues and grow by forming their own blood supply and nerve connections.

These cells form lesions, which may appear as superficial implants, ovarian cysts, or deep infiltrating disease. The lesions bleed during the menstrual cycle, but unlike in the uterus, there is no way for the blood to leave the body. The lesions also produce their own estrogen and inflammatory substances while becoming resistant to progesterone, which would normally limit their growth.

As a result, the combination of excess estrogen and progesterone resistance creates a cycle of inflammation and oxidative stress, leading to more tissue damage and lesion growth.

Pain and Nervous System Remodeling

Lesions are not the only cause of pain in endometriosis. Evidence suggests that endometriosis can lead to changes in both the peripheral and central nervous systems. This makes nerves more sensitive to stimuli, causing exaggerated pain and inflammation.

These changes may explain why some women still experience pain after lesions are surgically removed. Endometriosis often coexists with other conditions, involving sensory dysfunction, such as interstitial cystitis (found in 70 to 80 percent of cases), irritable bowel syndrome (50 to 70 percent), and overactive bladder syndrome.

Painful Periods and Infertility in Endometriosis

Endometriosis can cause painful periods and infertility in several ways:

1. Chronic inflammation: Pelvic lesions cause inflammation that leads to cramping and pain during menstruation.
2. Disruption of reproductive processes: Inflammation can affect egg development, ovulation, and fertilization.
3. Structural changes: Lesions and scar tissue can change the structure of pelvic organs, blocking fallopian tubes or hindering egg movement.
4. Hormonal imbalances and pain-inducing chemicals: Endometriosis can cause hormonal imbalances and release chemicals like prostaglandins, which intensify period pain and interfere with embryo implantation in the uterus.

The Role of Microbiomes in Endometriosis

People with endometriosis often have different microbiome profiles compared to those without the condition. Research suggests that changes in the microbiomes of the gut, vagina, and abdominal lining (peritoneal cavity), along with an unhealthy microbial balance (dysbiosis), may play a key role in endometriosis.

These changes are linked to inflammation and altered immune responses, contributing to pain and other symptoms. The gut microbiome influences estrogen metabolism, and estrogen levels can also affect the microbiome’s composition. This relationship may be bidirectional, with each worsening the other. Additional research might clarify these connections.

Genetic and Epigenetic Factors

Genetic factors may predispose individuals to endometriosis, but genes can be turned on or off by epigenetic changes—modifications in gene expression that do not change the DNA sequence. Both genetic and epigenetic factors affect the body’s response to hormones, inflammation, and other processes involved in endometriosis. Notably, epigenetic changes are reversible and can be influenced by environmental and lifestyle factors such as diet, stress, and physical activity. This offers a promising path for managing the condition through targeted lifestyle changes.

Endocrine-Disrupting Chemicals (EDCs)

EDCs can mimic or interfere with hormones and have been linked to endometriosis. EDCs disrupt hormone production, metabolism, and excretion, leading to imbalances that promote inflammation, oxidative stress, and changes in immune function. Research suggests that daughters of women exposed to EDCs during pregnancy may have a higher risk of developing endometriosis.

Several chemicals associated with endometriosis include:

• Dioxins: Found in fatty foods such as meat, dairy, and fish, industrial sites, and smoke from burning plastics or treated wood, these persistent organic pollutants are linked to an increased risk of endometriosis.
• Organochlorines: Used in pesticides, some, but not all, studies link organochlorines to endometriosis. Organochlorines are found in contaminated soil, water, and fatty foods.
• Phthalates: Used in plastics, food packaging, vinyl flooring, cosmetics, personal care products, and some toys. Some studies link phthalates to endometriosis though results vary.
• Bisphenol A (BPA): A plastic component with estrogen-like properties, BPA is found in food containers, can linings, dental sealants, and cash register receipts.

Endometriosis is classified into three types based on lesion development and location:

1. Superficial peritoneal endometriosis: Lesions form on the pelvic peritoneum (the thin lining inside the pelvis) and account for 15 to 50 percent of cases.
2. Ovarian endometrioma: Ovarian cysts present in 2 to 10 percent of cases and 50 percent of those with infertility.
3. Deep infiltrating endometriosis: Lesions grow into tissues and organs behind the abdominal lining, such as the vagina, bladder, and bowel. This type occurs in 20 percent of cases, with bowel involvement in 5 to 12 percent.

About 20 percent of cases do not fit these categories, including rare instances outside the pelvis.

After diagnosis, endometriosis can be classified into one of four stages determined by the severity of lesions. These stages vary depending on the organization proposing the classifications. The stages proposed by the American Fertility Association (AFS) and the American Society for Reproductive Medicine (ASRM) are:

• Stage I: mild (AFS) or minimal (ASRM)
• Stage II: moderate (AFS) or mild (ASRM)
• Stage III: severe (AFS) or moderate (ASRM)
• Stage IV: extensive (AFS) or severe (ASRM)

Enzian classifications further classify deep infiltrating endometriosis.

The following factors increase the likelihood of developing endometriosis:

• Sex: Endometriosis primarily affects females or those born female with intact female reproductive organs. Rare cases have been reported in men, possibly due to residual tissue from fetal development.
• Age: The highest risk is in women aged 25 to 45, though it can also occur in 2 to 5 percent of postmenopausal women, adolescents after menstruation begins, and rarely, in girls before their first period.
• Menstrual and reproductive history: Early onset of periods and short menstrual cycles increase risk, likely due to higher circulating estrogens. Having given birth and using oral contraceptives are linked to a lower risk.
• Ethnicity: Endometriosis may be more common in women of Asian descent and less common in women of African and Hispanic descent, though further research is needed to confirm whether these differences are biological, due to sociocultural factors, or access to health care.
• Family history: Having a first-degree relative with endometriosis increases a woman’s risk up to sevenfold.
• Omega-6 fatty acids: Inflammatory omega-6 fatty acids may increase risk. Conversely, higher intake of omega-3 fatty acids is associated with reduced risk, likely due to anti-inflammatory effects.
• Body mass index (BMI): Some studies suggest both high BMI (over 30) and low BMI may increase the risk. Obese women often report more severe menstrual pain, possibly because body fat produces estrogen and inflammation-causing substances.
• Alcohol: Research shows mixed findings, with some studies indicating increased risk and others showing no effect. A higher risk is noted with more than three drinks per week, possibly due to alcohol’s impact on estrogen levels and inflammation.
• Caffeine: Studies on caffeine’s effects on endometriosis are also mixed. Some show no effect, while one suggests a potential link, particularly with coffee intake above 300 milligrams of caffeine per day, which is 16 ounces for some brands.
• Regular exercise: Findings vary depending on the type of exercise. However, doing aerobic exercise three or more times a week and strength training twice a week may lower the risk of endometriosis by 40 to 80 percent.
• Prolonged sitting: Long periods of sitting are associated with an increased risk.
• Night work: Working rotating night shifts for five years or more raises risk.
• Abuse: Those who have experienced physical and sexual abuse are more likely to develop endometriosis.

Diagnosing endometriosis is challenging because its symptoms can mimic other conditions, often leading to delays. Initial steps typically include a physical examination, manual palpation, and a detailed patient and family history to determine if further investigation is needed.

Doctors usually order basic blood tests, such as a complete blood count with differential, to rule out other conditions and check for anemia, which is common in women with heavy menstrual bleeding.

Despite research on inflammatory and immune markers and the microbiome, no biomarkers have been approved to diagnose endometriosis. Imaging tests like ultrasound and MRI cannot reliably detect small or superficial lesions, so a definitive diagnosis requires microscopic evaluation of a biopsy obtained surgically.

The most common diagnostic method is laparoscopic surgery, which uses small incisions and a camera to examine and take tissue samples. In more complex cases, open surgery (laparotomy) with a larger incision may be needed to reach the pelvic organs.

Functional Medicine Testing

Functional medicine practitioners often use a whole-body approach with additional tests to identify underlying causes and contributing factors. These tests are helpful for developing personalized treatment plans. Not all tests will be necessary for every case—selection depends on individual symptoms, history, and suspected triggers.

Potential tests include:

• Environmental toxicity screen: Detects toxins or endocrine disruptors that may cause hormonal imbalances or inflammation.
• Heavy metals assessment: Identifies toxic metal accumulation that could affect immune function and health.
• Small intestinal bacterial overgrowth (SIBO) breath test: Ordered if gastrointestinal symptoms are present, given the link between irritable bowel syndrome (IBS), SIBO, and endometriosis.
• Comprehensive stool analysis: Provides detailed information about gut health, including microbial composition, parasites, and markers for digestion, inflammation, and intestinal permeability.
• Vaginal microbiome assessment: Evaluates vaginal microbial composition or pH levels to identify dysbiosis. Vaginal pH of 4.5 or above may indicate an issue.
• Hormone and metabolites panel: Assesses hormonal imbalances and estrogen metabolites to understand estrogen processing.
• Inflammatory markers tests: Tests like C-reactive protein and Galectin-3 evaluate inflammation and scarring risks.
• Other possible tests: May include food allergy and sensitivity panels, celiac and gluten sensitivity evaluation, nutrient levels, and omega fatty acids.

Some symptoms of endometriosis are also complications, but if left untreated, the condition can lead to:

• Decreased quality of life, affecting social, emotional, and sexual well-being
• Anatomical abnormalities from adhesions
• Organ dysfunction (e.g., bowel or bladder)
• Infertility or subfertility
• Ovarian cancer (associated with ovarian endometriomas)
• Reduced work productivity and physical activity
• Poor sleep quality
• Pregnancy complications, such as miscarriage, preterm birth, bleeding, placental issues, fetal growth restriction, high blood pressure, and cesarean delivery.

Women with endometriosis have a higher risk of certain autoimmune disorders, such as autoimmune thyroid disorders, lupus, celiac disease, Sjögren’s syndrome, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Addison’s disease. The reason for this is unknown, but it may be due to general immune system dysfunction.

Conventional treatments for endometriosis focus on symptom control but may not always be effective or suitable for pregnancy. While surgery and hormone therapies can relieve pain, they rarely eliminate it or address the disease’s underlying causes. Pain relief lasts longer than six months for only 40 to 70 percent of those with chronic pelvic pain.

Surgery can increase pregnancy rates by up to 60 percent in cases of infertility, but it does not stop endometriosis from progressing. The condition returns in 20 to 30 percent of individuals within five years, and about 36 percent require additional surgeries. Endometriosis can also come back after a hysterectomy.

Comprehensive care should be personalized and involve a multidisciplinary team.

Conventional treatments include:

1. Hormonal Treatments

• Gonadotropin-releasing hormone (GnRH) analogs and antagonists: Induce a low-estrogen state to alleviate symptoms
• Aromatase inhibitors: Lower estrogen levels
• Oral contraceptives: Regulate hormones to reduce pain and bleeding
• Progestins (dienogest, norethindrone acetate, medroxyprogesterone): Synthetic progesterone to reduce pain and slow endometriosis growth.

Potential side effects include: Decreased bone density, mood changes, breast atrophy, hot flashes, vaginal dryness, and with long-term use, central obesity, hyperlipidemia, and increased cardiovascular risk.

2. Pain Relievers

• Non-steroidal anti-inflammatory drugs (NSAIDs): Manage pain and inflammation
• Acetaminophen: Pain relief
• Opioids: Severe pain management

Potential side effects include: Gastrointestinal issues, constipation, addiction risk, liver toxicity.

3. Surgical Treatments

• Laparoscopic excision: Removes entire lesions, including deeper tissue, for better long-term results. Limited access to skilled surgeons and insurance coverage can be challenging.
• Laparoscopic ablation: Destroys lesions using heat or laser.
• Hysterectomy: Removes part or all of the uterus, sometimes including ovaries.

Potential side effects include: Surgical complications, risk of early menopause (if ovaries are removed), adhesion formation, and reduced ovarian egg supply after repeat surgeries.

Integrative Treatments

Integrative treatments offer holistic options that may complement or serve as alternatives to conventional medical care. These include:

• Traditional Chinese medicine (TCM): Small studies suggest TCM, including herbal medicine, acupuncture, enemas, and external applications, can achieve effectiveness rates of 90 percent or higher in relieving symptoms like dysmenorrhea and infertility. Some herbal treatments promote lesion regression with few side effects and long-lasting benefits by enhancing blood circulation and removing stasis.
• Transcutaneous electrical nerve stimulation (TENS): Uses electrical stimulation on the skin to relieve pain. Evidence suggests it may reduce chronic pelvic pain and pain during intercourse, improving quality of life. TENS is considered safe with minimal side effects when used properly.
• Cannabis: Some women with endometriosis and researchers report cannabis is effective for pain relief due to its anti-inflammatory and analgesic properties. Research on its long-term use and overall effectiveness is ongoing.
• Low dose naltrexone (LDN): Originally used to treat addiction, LDN at lower doses is recognized for its potential as an immunomodulator, anti-inflammatory, and pain reliever. While specific research on endometriosis is lacking, its ability to regulate immune function in other conditions suggests it could be a helpful treatment, warranting further study.

Emerging Treatments

Some promising treatments are under investigation but not yet FDA-approved, including:

• Immunomodulators: Target immune system components like macrophages, NK cells, and T cell responses, but human trial benefits are limited so far.
• Anti-angiogenic agents: Aim to prevent new blood vessel growth to reduce lesion development and spread.

Endometriosis imposes significant emotional, mental, and financial burdens, often leading to depression and anxiety. Many people with endometriosis face limitations in work, social activities, and sexual function, with 50 to 56 percent reporting negative impacts on relationships. Addressing these aspects is essential for comprehensive care.

Chronic pain is closely linked to mental health difficulties. Negative thought patterns, such as worrying about pain or fearing it will worsen, can intensify it. Conversely, a positive mindset, mindfulness meditation, and body scan exercises can help change the way people experience pain.

Mind-body practices, like yoga and meditation, can improve the quality of life and well-being of women with endometriosis. Some women feel insecure about their bodies due to symptoms or treatments, which can lead to disordered eating. Hatha yoga specifically can help boost self-image, potentially reducing the risk of disordered eating.

Regular exercise also provides benefits by releasing endorphins, reducing pain sensitivity, and helping the brain form new connections to better manage pain. These strategies can reduce pain intensity, improve pain tolerance, and help with coping, leading to a better quality of life. Counseling and online support groups can also offer emotional support, although support groups should not replace medical advice.

Research supports several natural approaches to managing endometriosis, but not every strategy will work for everyone because of different triggers and the complex nature of the condition. Often, a combination of approaches is needed for effective management. The strategies listed here are based on current peer-reviewed research, but there may be other helpful options not included.

The first step is to remove triggers, such as inflammatory factors, environmental toxins, food sensitivities, infections, overgrowths, and nutritional deficiencies. Next, focus on creating a balanced internal environment that supports the body’s natural healing processes. The following strategies can help achieve this balance:

Dietary Foundations for Managing Endometriosis

Nutrition influences inflammation, antioxidant levels, and hormone balance. Thus, eating the right foods can help reduce symptoms and support healing. Consider these key dietary factors:

• Fiber: Aim for at least 25 grams daily to help reduce circulating estrogen levels and feed beneficial gut bacteria. Sources include vegetables, fruits, legumes, and whole grains.
• Fat: Limit trans fats and conventionally raised red meat; increase omega-3 fatty acids from fish and plant sources such as flaxseeds, chia seeds, and walnuts.
• Gluten: Consider gluten elimination as it can increase intestinal permeability. Although studies on endometriosis are conflicting, one study found that 75 percent of women with endometriosis reported less pain after removing gluten.
• Macronutrient balance: Eat balanced meals with complex carbohydrates, lean proteins, and healthy fats to help stabilize blood sugar levels. Metabolic syndrome, which includes high blood sugar, is linked to endometriosis and may worsen inflammation and hormonal imbalances.
• Anti-inflammatory foods: Include turmeric, ginger, berries, leafy greens, fatty fish like salmon, nuts (especially walnuts), and olive oil to help reduce inflammation.
• Antioxidants: Prioritize antioxidant-rich foods to counter oxidative stress. Colorful fruits and vegetables offer antioxidant benefits as well as essential fiber and anti-inflammatory polyphenols. Good sources include citrus fruits, berries, leafy greens, nuts, and seeds.
• Cruciferous vegetables: Vegetables like broccoli, cauliflower, Brussels sprouts, and kale, contain indole-3-carbinol, which supports detoxification and a healthier balance of estrogens in the body. They also provide sulforaphane, which helps reduce inflammation and supports cellular health.

Targeted Elimination Diets

Several specialized diets may help manage endometriosis symptoms by identifying food sensitivities, reducing inflammation, or easing digestive issues. Due to their restrictive nature, these diets are not meant for long-term use. Professional guidance is recommended to ensure they are safe and balanced. The following diets may be beneficial:

• Elimination diet: This approach involves removing common inflammatory foods like dairy, gluten, soy, eggs, and red meat for a period of time, typically four to six weeks. Foods are then reintroduced one at a time while watching for symptoms. This can help identify individual food sensitivities that may be exacerbating endometriosis symptoms.
• Low-FODMAP diet: FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These fermentable carbohydrates can cause digestive symptoms. Examples of high-FODMAP foods include wheat, dairy, onions, and beans. For women with endometriosis who also have IBS, a low-FODMAP diet may help reduce bloating, gas, and abdominal pain. The diet involves avoiding high-FODMAP foods for several weeks, then slowly reintroducing them to identify triggers.
• Autoimmune protocol (AIP) diet: A stricter form of the Paleo diet, the AIP diet aims to reduce inflammation and support gut health by cutting out grains, legumes, dairy, eggs, nightshades, nuts, seeds, and processed foods. While not specifically studied for endometriosis, it has been shown to reduce inflammation and modulate the immune system in women with Hashimoto’s and to reduce inflammation and achieve remission in inflammatory bowel disease.

While a nutritious diet is essential, optimizing digestion and absorption is equally crucial. Even the healthiest diet may not work if the body cannot properly break down and absorb nutrients. Stress, medications, and gut health issues can disrupt digestion, while adequate stomach acid and digestive enzymes are necessary for nutrient absorption. Thus, supporting gut health is key to managing endometriosis through diet.

Gut Health, Immunity, and Inflammation Management

A healthy gut is essential for managing endometriosis. The gut microbiome affects immune function, hormone regulation, and even brain health through the gut-brain axis. The gut lining serves as a barrier to keep harmful substances from entering the bloodstream and causing inflammation. When this barrier becomes “leaky” or damaged, it can worsen endometriosis symptoms and allow harmful bacteria or toxins to enter the bloodstream.

To support gut healing, maintain a strong intestinal barrier, and promote a healthy microbiome, consider these strategies:

1. L-glutamine-rich foods: Spinach, cabbage, and grass-fed beef
2. Zinc sources: Oysters, beef, pumpkin seeds, and lentils
3. Omega-3 fatty acids: Fatty fish (salmon, sardines), chia seeds, and walnuts
4. Fermented foods: Sauerkraut, kimchi, and kefir to enhance microbiome diversity
5. Prebiotic foods: Garlic, onions, asparagus, and bananas to nourish beneficial gut bacteria

Probiotic supplements may also help. It is best to work with a professional to choose probiotic strains based on strain-specific effects and stool analysis, with periodic adjustments.

Red Meat

Higher red meat intake has been linked to an increased risk of endometriosis, but studies do not distinguish between conventional, grain-fed meat and organic, grass-fed options. Both types of red meat contain heme iron, which can promote oxidative stress. Conventional red meat may have an increased risk because it contains growth hormones and more omega-6 fatty acids, which can lead to hormonal imbalances and inflammation. Organic, grass-fed beef, with no added hormones, a better balance of omega-6 to omega-3 fatty acid ratio, and more antioxidants, may pose less risk.

Red meat provides essential nutrients like iron, zinc, and selenium, which are often deficient in those with endometriosis. For a balanced approach, consider choosing organic, grass-fed, and grass-finished options. Consult a nutrition professional for personalized advice based on individual needs.

Supplements

While a balanced diet should be the main source of nutrients, supplements may be necessary to address specific deficiencies that can affect the progression and symptoms of endometriosis. The most common deficiencies in women with endometriosis are vitamins B6 and B12, folate, magnesium, iron, zinc, and selenium. Nutrient testing can help determine individual needs.

The following supplements may help relieve pain, reduce inflammation, manage lesions, or support the natural breakdown of abnormal cells (apoptosis), which is particularly beneficial for endometriosis:

• Resveratrol
• Epigallocatechin-3-gallate (EGCG)
• Curcumin
• Extracts of Pueraria (kudzu flower), black garlic, Calligonum comosum, and Uncaria tomentosa (cat’s claw)
• Melatonin
• Modified citrus pectin

Key Lifestyle Strategies for Managing Endometriosis

The following lifestyle strategies can help manage endometriosis and improve overall well-being:

• Exercise: Regular exercise such as walking, yoga, and strength training, can reduce inflammation, insulin resistance, and pain related to endometriosis. Frequency and consistency are key for therapeutic benefits. Moderate exercise is recommended because high-intensity exercise may be linked to reproductive disorders.
• Stress: Stress can worsen endometriosis symptoms by suppressing immune function, increasing inflammation, and disrupting hormonal balance, which can lead to more severe lesions. Reducing stress can help ease pain and support healing.
• Sleep: Circadian rhythms regulate hormones affecting sleep, immune function, and inflammation. Poor sleep disrupts these rhythms, causing hormonal imbalances and increased inflammation. Keeping a regular sleep schedule, getting natural light, and limiting blue light exposure can support healthy rhythms.

A 2007 study found that women with endometriosis incurred an average of $12,118 in direct medical costs and $15,737 in indirect costs per year, with expenses highest in the first year and when surgery is needed. Given that medical costs have risen faster than inflation every year, these expenses are likely much higher today—and they may not even account for the costs of alternative treatments. Beyond the financial burden, the mental and emotional toll of living with endometriosis is immense. Together, these challenges highlight the urgent need for prevention.

While you may not be able to completely prevent endometriosis, certain lifestyle changes can help manage inflammation, oxidative stress, and estrogen levels. These changes might reduce the risk and ease symptoms. They could also affect gene expression, impacting your health and possibly the health of future generations.

Here are some strategies that may help reduce your risk:

1. Exercise regularly to maintain a healthy weight, manage pain, and balance estrogen levels.
2. Follow the dietary principles discussed in the natural approaches section to manage inflammation and balance hormones.
3. Maintain a healthy gut lining and microbiome to support immune function and reduce inflammation.
4. Limit or avoid alcohol and caffeine to help lower estrogen production.
5. Choose organic foods when possible and use chemical-free cleaning products and personal care items to reduce toxic exposures.
6. Use glass or stainless steel containers for food storage, avoid heating food in plastic containers, and avoid non-stick cookware to minimize exposure to harmful chemicals.
7. Consider professional counseling if you have a history of trauma, such as physical or sexual abuse.
8. Practice at least ten minutes of deep breathing daily to help reset the stress response.
9. Regularly engage in activities that bring joy and relaxation to support overall health and resilience.