Endometriosis is a progressive and chronic condition in which endometrial tissue (the inner
lining of the uterus that is shed each month during menses) is found outside of the uterus and
implanted within the pelvic cavity.
Endometriosis is believed to affect as many as 10% of all women in the United States and is
the third leading cause of gynecologic hospitalization and a leading cause of
hysterectomy.1 Although many theories exist, the cause of endometriosis is unclear.
However, there does appear to be a genetic link—women who have a mother or sister with
endometriosis are more likely to develop this condition.
Checklist for
Endometriosis
What are the symptoms of endometriosis?
Women with endometriosis may have symptoms including pain before and during menstrual
periods, pain with sexual intercourse, abdominal bloating, pain during urination or bowel
movements, pelvic tenderness, premenstrual spotting, abnormally heavy or long menstrual
periods, rectal bleeding during menstrual periods, and an inability to become pregnant.
Medical treatments
Over the counter drugs for inflamation, such as aspirin
(Bayer®, Ecotrin®, Bufferin®), ibuprofen
(Motrin®, Advil®), and naproxen (Aleve®),
might be beneficial.
Prescription drug treatment focuses on controlling inflammation and reducing estrogen and
progesterone blood levels. Prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®), naproxen (Anaprox®,
Naprosyn®), indomethacin (Indocin®), ketoprofen (Orudis®), and
diclofenac (Voltaren®), help control inflamation. Oral birth control pills (Ortho-Novum®, Mircette®,
Loestrin®, Triphasil®), antiestrogens such as danocrine (Danazol®), progestins
including progesterone (Prometrium®) and
medroxyprogesterone (Provera®), and gonadotropin-releasing hormones, such as
leuprolide (Lupron®) and goserelin (Zoladex®), are prescribed to affect hormone
levels.
Surgical treatments, such as removal of the endometrial areas, ovaries, or uterus may also
be recommended.
Dietary changes that may be helpful
There has been no research investigating the effect of any specific diet in women with
endometriosis. Preliminary research suggests that women who consume more than 5 grams of caffeine per month (about 1.5 cups of coffee a day) are more likely to have
endometriosis.2 No study has investigated whether avoiding caffeine improves the
symptoms of endometriosis.
Lifestyle changes that may be helpful
Preliminary studies suggest that women who exercise two to four hours per week have less
risk of developing endometriosis.3 4 However, the benefit seems to be
limited to those women who participate in vigorous exercise, such as jogging or other
activities that raise the heart rate. Whether exercise will reduce the symptoms of existing
endometriosis is unknown.
Nutritional supplements that may be helpful
There have been no human studies examining the effect of specific nutrients on
endometriosis. Animal research suggests that fish oils may
reduce the severity of endometriosis,5 6 and fish oils have been shown
to improve symptoms of dysmenorrhea (painful
menstruation),7 which may be caused by endometriosis. Therefore, while no specific
research has been done on the effects of fish oils in women with endometriosis, some health
practitioners recommend several grams of fish oil per day for this condition.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Vitex is recommended either alone or in combination with
other herbs, such as dandelion root, prickly ash, and
motherwort, by some doctors to treat the symptoms of endometriosis.8
9 Although vitex affects hormones that in turn affect the severity of
endometriosis,10 and it may be effective for
premenstrual syndrome,11 no research has tested the effect of vitex
supplementation on women with endometriosis. Similarly, no other botanical medicines have been
scientifically researched for treating this disease.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
According to preliminary reports, regular meetings with other endometriosis sufferers may
help women with endometriosis learn about the disease and cope better with the many
psychological and emotional issues that often accompany this condition.12 One
preliminary study found that women who had the opportunity to speak with other women with
endometriosis, as well as to meet with their physician, had a higher satisfaction with their
overall care.13
Acupuncture has been reported anecdotally to help
control the pain associated with some cases of endometriosis,14 but no controlled
studies have confirmed this claim. One small, preliminary study found that auricular
acupuncture (acupuncture of the ear) was as effective as hormone therapy in treating
infertility due to endometriosis.15
References
1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet
Gynecol Clin North Am 1997;24:235–58 [review].
2. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female
infertility to consumption of caffeinated beverages. Am J Epidemiol
1993;137:1353–60.
3. Cramer DW, Wilson E, Stillman RJ, et al. The relation of endometriosis
to menstrual characteristics, smoking, and exercise. JAMA 1986;255:1904–8.
4. Signorello LB, Harlow BL, Cramer DW, et al. Epidemiologic determinants
of endometriosis: a hospital-based case-control study. Ann Epidemiol
1997;7:267–74.
5. Yano Y. Effect of dietary supplementation with eicosapentaenoic acid
on surgically induced endometriosis in the rabbit. Nippon Sanka Fujinka Gakkai Zasshi
1992 Mar;44(3):282–8 [in Japanese].
6. Covens AL, Christopher P, Casper RF. The effect of dietary
supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit.
Fertil Steril 1988;49:698–703.
7. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with
omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J
Obstet Gynecol 1996;174:1335–8.
8. Batchelder HJ, Hudson T, Lewin A, et al. Therapeutic approaches to
endometriosis. The Protocol Journal of Botanical Medicine
1996;Spring:25–60.
9. Hudson T. Women’s Encyclopedia of Natural Medicine. Los
Angeles: Keats Publishing, 1999:79–88.
10. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit
prolactin secretion of rat pituitary cells. Horm Metab Res 1993;25:253–5.
11. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual
tension syndrome with Vitex agnus-castus. Controlled, double-blind study versus pyridoxine.
Phytomedicine 1997;4:183–9.
12. Whitney ML. Importance of lay organizations for coping with
endometriosis. J Reprod Med 1998;43(3 Suppl):331–4.
13. Wingfield MB, Wood C, Henderson LS, Wood RM. Treatment of
endometriosis involving a self-help group positively affects patients’ perception of
care. J Psychosom Obstet Gynaecol 1997;18:255–8.
14. Maciocia, G. Obstetrics and Gynecology in Chinese Medicine.
New York: Churchill Livingstone, 1998:691–733.
15. Gerhard I, Postneek F. Auricular acupuncture in the treatment of
female infertility. Gynecol Endocrinol 1992;6:171–81.
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