How To Holistically Heal Your Endometriosis

How To Holistically Heal Your Endometriosis

If you experience debilitating period pain, pelvic pain, painful sex, bowel or bladder symptoms, persistent bloating or difficulty conceiving, endometriosis may be part of the picture.

Endometriosis is often spoken about as a condition of menstruation, but it is much more complex than having “bad periods.” It is a chronic inflammatory gynaecological condition that can affect pain, digestion, fertility, energy, emotional wellbeing, relationships, work and quality of life.

In Australia, around 1 in 7 women born between 1973 and 1978 were estimated to have been diagnosed with endometriosis by age 44–49. Despite growing awareness, diagnosis can still take years.¹

Understanding what endometriosis is, recognising its many possible symptoms, obtaining the right diagnosis and looking beyond pain alone can help build a more comprehensive approach to treatment.

What Is Endometriosis?

Endometriosis is a chronic inflammatory condition characterised by tissue similar to the endometrium, the tissue lining the inside of the uterus, growing outside the uterus.

Endometriosis may occur on or around the ovaries, fallopian tubes and pelvic lining, as well as the bowel and bladder. More rarely, it can occur beyond the pelvis.

This endometrial-like tissue exists within a hormonally responsive and inflammatory environment. Over time, endometriosis can contribute to inflammation, fibrosis, scarring and adhesions, where tissues or organs that would normally move freely can become bound together.

Importantly, the amount of endometriosis visible does not necessarily correspond with the amount of pain experienced. Someone with relatively limited visible disease may experience severe pain, while another person with more extensive disease may have fewer symptoms.

Endometriosis is therefore not simply a structural problem. Hormonal signalling, inflammation, immune activity and, in some people, changes in how the nervous system processes persistent pain may all contribute to the experience of the condition.

How Common Is Endometriosis?

Endometriosis is common, yet historically under-recognised.

Australian data estimate that around 14%, or approximately 1 in 7, women born between 1973 and 1978 had been diagnosed with endometriosis by age 44–49.¹

Diagnosis is often delayed. Australian estimates suggest an average interval of approximately 6–8 years between the onset of symptoms and diagnosis.¹

Years of unexplained pain can affect education, employment, relationships, exercise, sexual health, fertility and emotional wellbeing. It can also mean years of adapting life around symptoms without understanding why they are occurring.

What Are the Symptoms of Endometriosis?

Endometriosis does not look the same in everyone.

Symptoms may include:

• Severe menstrual pain

• Chronic or recurrent pelvic pain

• Heavy menstrual bleeding

• Pain during or after sexual intercourse

• Pain with bowel movements

• Pain with urination, particularly around menstruation

• Abdominal bloating or swelling

• Constipation, diarrhoea or other digestive disturbances

• Lower back pain

• Fatigue

• Difficulty conceiving or infertility

• Pain at ovulation or at other times of the menstrual cycle

Some people have extensive endometriosis with relatively few symptoms, while others experience debilitating symptoms that significantly interfere with daily life.

Severe menstrual pain that repeatedly stops you from working, studying, exercising, sleeping or participating in ordinary life deserves investigation.

What Causes Endometriosis?

There is currently no single established cause of endometriosis.

Several biological mechanisms have been proposed, and it is increasingly understood as a complex condition involving interactions between genetic susceptibility, hormonal signalling, inflammation, immune function and local tissue biology.

Proposed mechanisms include retrograde menstruation, where menstrual fluid travels backwards through the fallopian tubes into the pelvic cavity; genetic susceptibility; altered immune responses; inflammatory signalling; and cellular changes that allow endometrial-like tissue to establish outside the uterus.

Endometriosis is also an oestrogen-dependent condition, meaning oestrogen influences the growth and activity of endometriotic lesions. This is different from simply describing endometriosis as being caused by “too much oestrogen.”

Environmental exposures, including endocrine-disrupting chemicals, are also being investigated for their possible role, but the science is still developing.

There is unlikely to be one explanation that accounts for every person with endometriosis.

How Is Endometriosis Diagnosed?

Diagnosis begins with listening carefully to symptoms.

Your practitioner may ask about:

• Menstrual pain and bleeding

• Pelvic pain throughout the cycle

• Bowel and bladder symptoms

• Pain during sex

• Fertility

• Family history of endometriosis

• The effect symptoms have on everyday life

Imaging can then play an important role.

A specialised transvaginal ultrasound may identify ovarian endometriomas and some forms of deep endometriosis. MRI may be useful in selected circumstances, particularly when more detailed mapping of disease is required.

Laparoscopy, a keyhole surgical procedure allowing direct visualisation of the pelvis, may still be recommended in particular circumstances and can allow endometriosis to be treated surgically at the same time.

Importantly, contemporary Australian guidance no longer means that everyone with suspected endometriosis must undergo surgery before treatment can begin.

And a normal ultrasound does not necessarily mean endometriosis is absent.

What Else Should Be Investigated?

One of the reasons endometriosis can be complicated is that symptoms may overlap with other conditions.

Depending on the individual, investigation may also need to consider:

• Adenomyosis

• Irritable bowel syndrome

• Inflammatory bowel disease

• Pelvic floor dysfunction

• Bladder pain syndrome

• Fibroids

• Ovarian cysts

• Iron deficiency from heavy bleeding

• Thyroid or other hormonal conditions

• Chronic pelvic pain syndromes

In naturopathic practice, I also look at the broader health picture: digestion and bowel function, nutrient status, dietary intake, sleep, stress, fatigue, inflammatory burden and the menstrual cycle as a whole.

Not because these necessarily cause endometriosis, but because they can profoundly influence how well someone feels while living with it.

The Gut and Endometriosis

The gut deserves attention in someone with endometriosis, particularly when bloating, constipation, diarrhoea or painful bowel movements are part of the picture.

The gut microbiome participates in immune regulation, inflammatory signalling and the metabolism and excretion of hormones, including oestrogens.

But it is important not to assume that every digestive symptom is simply “poor gut health.”

Endometriosis itself can involve or affect tissues surrounding the bowel. Pelvic floor dysfunction, pain sensitisation, medications, dietary restriction and overlapping IBS may also contribute.

My approach is therefore to ask: what is actually happening in this person's gut?

Treatment may involve improving bowel regularity, increasing appropriate fibre and plant diversity, supporting microbial health and investigating persistent digestive symptoms rather than simply adding probiotics or removing increasingly large numbers of foods.

Nutrition and Endometriosis

There is no single scientifically established “endometriosis diet.”

However, a nutrient-dense, predominantly wholefood diet provides a strong foundation for general health and may help support inflammatory balance, bowel function, metabolic health and nutrient status.

I generally focus on:

• Plenty of colourful vegetables and leafy greens

• Herbs and spices

• Quality protein

• Oily fish and other sources of omega-3 fatty acids

• Extra virgin olive oil

• Nuts and seeds

• Legumes and whole grains where tolerated

• Adequate fibre

• Berries and other whole fruits

• Fermented foods where appropriate

At the same time, I look at what may be crowding these foods out: ultra-processed foods, excessive refined carbohydrates, poor-quality fats, excessive alcohol and a diet lacking in diversity.

The aim is not dietary perfection or unnecessary restriction.

It is to nourish the person living with endometriosis.

Nutrient Deficiencies Matter

Heavy menstrual bleeding, restrictive diets, digestive problems and chronic illness can all affect nutritional status.

Depending on symptoms and clinical history, I may investigate:

• Iron and ferritin

• Vitamin B12

• Folate

• Vitamin D

• Zinc

• Magnesium and dietary magnesium intake

Iron deserves particular attention when periods are heavy.

Iron deficiency can contribute to exhaustion, poor exercise tolerance, breathlessness, headaches, restless legs, poor concentration and hair loss, symptoms that can easily become entangled with the fatigue already associated with chronic pain.

Testing first allows supplementation to be targeted rather than guessed.

Supporting the Nervous System and Persistent Pain

Pain begins with biology, but persistent pain can eventually involve much more than the original tissue injury or inflammation.

Repeated pain signalling can change the way the peripheral and central nervous systems process sensory information. This is sometimes referred to as pain sensitisation.

This does not mean the pain is psychological.

It means persistent pain can involve both the tissues and the nervous system processing information from those tissues.

For this reason, comprehensive pain care may include medical treatment alongside pelvic physiotherapy, appropriate movement, sleep support, psychological support and techniques that help reduce persistent physiological arousal.

Breathwork, meditation, gentle movement and somatic practices are not substitutes for treating endometriosis itself. They are tools that may help someone living with persistent pain regulate the wider physiological burden of that pain.

Movement and Endometriosis

Movement should support the body rather than become another demand placed upon it.

Walking, resistance exercise, mobility work, yoga, Pilates and pelvic-floor physiotherapy may all have a place depending on symptoms and capacity.

During severe pain flares, rest or gentler movement may be more appropriate.

At other times, gradually building strength and cardiovascular fitness can support general health, mood, metabolic function, bone health and resilience.

There is no virtue in pushing through debilitating pain.

The goal is sustainable movement that works with the body.

Sleep and Rest

Persistent pain can disturb sleep, while inadequate sleep can increase sensitivity to pain.

This can become a difficult cycle.

A regular sleep-wake rhythm, morning daylight, adequate darkness at night, reducing late stimulants, addressing pain before bedtime and investigating persistent insomnia can therefore form an important part of broader endometriosis care.

Rest also matters beyond sleep.

Living with chronic pain requires energy. Allowing periods of genuine recovery is part of care, not something that has to be earned after everything else has been completed.

Reducing Unnecessary Environmental Exposures

Endocrine-disrupting chemicals are substances capable of interfering with hormonal systems.

Research continues into whether particular environmental exposures influence the development or progression of endometriosis.

At present, this field is evolving, and exposure to a particular chemical cannot be said to be the cause of someone's endometriosis.

Nevertheless, reducing unnecessary exposure to potentially harmful chemicals is a reasonable broader health principle.

Simple changes may include reducing heating food in plastic, choosing fresh whole foods where possible, washing produce, ventilating the home and being more discerning about heavily fragranced personal-care and household products.

The objective is not to live in fear of chemicals.

It is to reduce avoidable exposure where practical.

Supplements and Herbal Medicine

Supplements are not interchangeable, and neither are people with endometriosis.

Depending on the person, nutritional or herbal support may be considered for inflammation, menstrual discomfort, nutrient deficiencies, digestive health, stress physiology or sleep.

Examples sometimes investigated in integrative care include omega-3 fatty acids, magnesium and specific nutrients where deficiency or inadequate intake is identified.

Herbal medicine may also have a place, but the formulation needs to be individualised.

What I prescribe for someone experiencing heavy bleeding, constipation and fatigue may be very different from what I prescribe for someone with diarrhoea, severe cyclical pain and difficulty sleeping.

Herbs and supplements can also interact with medications and may be inappropriate before surgery, during fertility treatment, pregnancy or alongside particular medical conditions.

The supplement should follow the assessment, not the other way around.

Conventional and Medical Treatment

Endometriosis treatment should be individualised according to symptoms, disease location, fertility intentions, treatment preferences and previous response to therapy.

Medical treatment may include:

• NSAIDs and other pain-relieving medications

• Combined hormonal contraceptives

• Progestogen therapies

• GnRH agonists or antagonists in selected circumstances

• Other hormonal therapies

• Multidisciplinary pain management

Surgery may be appropriate for some people, particularly when symptoms remain significant, anatomy is affected, deep disease is suspected, fertility considerations arise or medical treatment has not provided adequate relief.

Laparoscopic surgery may involve excision or other surgical treatment of endometriotic lesions and adhesions.

Fertility support, including assisted reproductive technologies, may also be appropriate where conception is difficult.

There is currently no single treatment that cures endometriosis for everyone. Treatment decisions should therefore be made individually and, ideally, through shared decision-making between the patient and appropriately experienced healthcare practitioners.

Endometriosis Requires Whole-Person Care

One of the difficulties with chronic illness is that healthcare can become divided into parts.

The gynaecologist looks at the pelvis.

The gastroenterologist looks at the bowel.

The physiotherapist looks at the pelvic floor.

The psychologist looks at emotional wellbeing.

The naturopath looks at nutrition, lifestyle and broader physiology.

Yet the person experiencing all of these things has one body.

Endometriosis is precisely the kind of condition that demonstrates why integrated care matters.

For some people, good care may involve a GP, gynaecologist, pelvic-floor physiotherapist, pain specialist, psychologist, dietitian or naturopath working alongside one another.

The question should not be which discipline has the entire answer.

It should be: what does this particular person need?

Ready to Address the Bigger Picture?

If you have endometriosis, or suspect that you might, the first step is not to normalise debilitating pain.

Seek an appropriate clinical assessment.

Understand what is happening in your body.

Then look beyond the diagnosis itself.

What is your menstrual cycle telling you? Are you losing excessive blood? Are you iron deficient? How is your digestion? Are your bowels moving comfortably? Are you sleeping? Are you eating enough nourishing food? Is persistent pain keeping your nervous system on alert? Are you able to move your body? What is the condition costing you emotionally and practically?

These questions do not replace medical diagnosis or treatment.

They widen the lens.

Because treating endometriosis well is not only about treating lesions. It is about caring for the whole person living with endometriosis.

If you would like an individualised naturopathic assessment, you can book a consultation with me to explore your symptoms, menstrual health, nutrition, digestion, nutrient status and broader health picture and develop a treatment plan appropriate for you.

This guide is for educational purposes and does not replace medical advice. Always speak with your healthcare provider before making changes to medication or treatment plans.