Treatment for Endometriosis: Are Pain Meds My Only Option?

If you or someone you know is living with endometriosis, you probably know of the most common symptom … pain, a lot of it. It might feel instinctual or convenient to pop pain meds to provide some relief, but we know this choice is not sustainable nor always safe for a life-long condition. It leaves you thinking… if not pain meds then what else? Before we dive into alternative treatment options, we first have to understand what endometriosis is!

A woman’s uterus is lined with a unique type of tissue, called endometrial tissue or endometrium. Every month, the body signals the growth of a new endometrium to prepare for potential pregnancy or fertilized egg. The unfertilized egg is released each month by the ovaries.

What causes this monthly cycle? Hormones or chemical messengers signal this growth and release of eggs. If pregnancy or fertilization occurs, then the endometrium thickens and the egg will implant into the strong endometrium. If pregnancy does not occur, the tissue and the unfertilized egg will break down, exit the body, and a new endometrium will grow next month. This is your period or menstrual cycle!

Now, keep this cycle in mind as we think about endometriosis…

What the heck is Endometriosis?

Endometriosis is an inflammatory condition that occurs when the special, endometrial tissue grows outside of the uterus. Remember, that tissue is only supposed to be inside of the uterus. Even though it is in the wrong location, it still is endometrial tissue and still responds to hormones. These hormones still signal the growth and shedding every month. However, when endometrial tissue outside the uterus is broken-down it has nowhere to exit the body which causes a buildup of blood and tissues between your organs, especially organs in the pelvic & abdominal areas. This leads to inflammation, organ damage, painful cysts, and many other health complications. 

The most common symptoms of endometriosis are intense pain and infertility. This pain can be experienced in the abdominal, back, pelvis, and even distant sites like the shoulder blades. Women often experience this pain during the monthly menstrual cycle, intercourse, bowel movements, and even urination. It often disrupts day-to-day activities, relationships, and a woman’s overall well-being. Yet, there is a mark of shame or stigma surrounding the condition.

Employers, family, friends, and doctors often question or doubt the severity of endometriosis and this pain. People without the condition frequently associate endometriosis pain with “common period cramps”. Most women know all too well the pain from these normal cramps. When you think about it, the pain from common period cramps occurs even when tissue is in the correct location, inside the uterus. With endometriosis, the tissue is in the wrong location, so the pain is unimaginable for those who do not experience it!

Minimizing a woman’s endo pain also minimizes her confidence to ask for help. This contributes to a concerning delay in diagnosis and a dependence on pain medications. Even after diagnosis and learning that there is no cure-all solution that will wipe away endo 100%, endo patients may ask … Are pain meds really my only option?

Good news – pain meds are certainly not the only option!! There are numerous options to take control of your endometriosis. These options don’t have to include only conventional medicine approaches like medications or surgery. There’s so much more than that! Now let’s discuss different medical approaches: Conventional, integrative, and functional. When looking to treat your endo, you do not have to choose one approach. In fact, a combination of the three often leads to the best results!

Typical Medical Treatment Options

Conventional or Western medicine is a common medical approach used in the US and Europe. It uses data based on research on large populations to address and diagnose health conditions. It focuses on treating symptoms by using medications and surgeries.

Pain meds are commonly recommended to address abdominal or pelvic discomfort experienced by endo patients. This is because endometriosis is an inflammatory condition so nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can provide relief. However, like all medications, there are side effects. Pain meds often result in GI issues like bloating, gas, nausea, diarrhea, constipation, ulcers, stomach inflammation, and stomach pain. It is also well-known that chronic use of NSAID pain medications like Ibuprofen or Advil causes gut damage over time. These side effects are even more drastic when taken long-term or at high doses which can include liver and kidney toxicity. This is why alternative options or a combination of treatments are far more beneficial to treating your endo (1).

Surgery can be a good choice for patients who have more advanced cases of endo or extreme pain that has not been reduced with other treatments. It will remove endometrial tissue that is on the outside of the uterus (remember, the outside is the wrong location!) to prevent the spread of tissue or restore function to organs. The surgeon can also remove any scar tissue that has built up in an area and has caused inflammation or pain. Laparoscopic surgery is the most common type of surgery for endo. This scary term simply means your surgeon will perform a small cut and insert a laparoscope, a small viewing instrument. They will use other tools to remove the tissue buildup or endometrial tissue (2). Patients often ask if surgery is a permanent long-term solution. It’s important to note that it is not. Endometriosis is a chronic condition and the endometrial tissue will keep trying to grow back. Surgery can be a helpful “reset” to the endometriosis. But it is crucial to follow-up surgery with a long-term remission plan that will help you keep the endometriosis under control & prevent it from coming back as aggressively. We’ll discuss what that looks like below!

Hormone-containing medications, such as birth control, are also common, conventional ways to treat endo. In this blog, we will be focusing on functional and integrative medicine treatments but click here for more information on birth control options.

Natural Remedies for Endometriosis

Functional and integrative medicine are quite different from conventional medicine and can be overlooked by many practices. Often, conventional medicine only attempts to reduce symptoms in order to treat a condition. While functional & integrative medicine also seeks to reduce symptoms, they do so in a holistic and root-cause approach. Together, integrative and functional medicine are a dynamic duo for managing complex chronic diseases like endometriosis. They investigate an individual’s unique features like lifestyle, habits, diet, culture, emotional well-being, genetics, environmental toxins, and more to understand why an individual experiences endo symptoms in a particular way.

Approaching endo with nuance in this manner is so important because each woman’s endo is different. One woman’s endo may be fueled more by her stress and lack of sleep, whereas another woman’s endo may be fueled more by the lack of fiber and anti-inflammatory nutrients she’s not getting. Combining this holistic approach with conventional medicine when needed often leads to the best results. In fact, we see it often with our patients. We often combine a multidisciplinary approach to endo care by combining integrative, functional, and conventional medicine approaches to tackle endo from different angles. These disciplines are meant to complement each other, it doesn’t have to be only one or the other. For example, we have seen patients experience the most relief by following an anti-inflammatory diet and herbal supplements after laparoscopic surgery to maintain the benefits of the surgery for a longer time.

What are herbal supplements and an anti-inflammatory diet? How do they help endo? Nutrition is just one aspect of integrative, functional medicine, but it is a crucial foundation. Without it, it’s like building a house without pillars… it will eventually crumble. So, let’s jump into it!

Endometriosis Diet: Does Food Really Matter?

Remember, when endometrial tissue sheds and bleeds outside the uterus it causes inflammation and scar tissue formation. The body’s response to this inflammation and scar tissue can lead to pain and many other chronic issues. It’s basically like internally bleeding every month – of course, your body is not going to be happy! Every time your body has internal bleeding from endometriosis, your body is left with a mess of blood and extra tissue between your organs that it has to clean up. Specific foods and lifestyle changes help the body clean up this mess quickly so your body has less inflammation and pain overall. However, there are also some foods and habits that add to the mess or slow down the cleanup.

Think about when you shatter a glass … the fastest way to clean it up is probably with a vacuum. Some food/lifestyle choices are like a vacuum while other lifestyle choices are like cleaning glass with your hands! The second option is unsafe, requires much more time, and never quite gets every piece. Same thing for endometriosis… without the proper foods and changes, the body is fighting an impossible battle. It does not have enough time and energy to clean up the mess before the next monthly cycle comes around and adds even more blood! So, understanding which foods and habits to follow is crucial.

In a past blog, The 6 Root Causes Behind Your Endometriosis Symptoms, we nailed down the key principles of an anti-inflammatory endometriosis diet plan. These are the 5 most important takeaways from that blog to aim for …

1. Increasing the intake of omega 3 fatty acids and lower omega 6 fatty acids intake to decrease inflammation. What the heck are omega-3’s and how do I make sure I get enough? Click here!
2. Eating a variety of herbs and spices which are packed with anti-inflammatory nutrients. Cinnamon, oregano, or what? Help! Click here for guidance!
3. Stabilizing your blood sugar by eating at consistent times and balancing food groups. How is blood sugar important for endo? Within a few pages of our blood sugar balance eBook, it will all make sense!
4. Avoiding caffeine and alcohol. 
5. Increasing dietary fiber to 35 – 40 grams each day. Not sure how to do that? You can access the eBook we use with all our patients to reach their fiber goals here!

Conventional medicine often ignores science-supported herbs and supplements, but we take great care to combine herbal medicine and nutrition medicine, alongside conventional medicine – because that’s what helps patients best. They are far more than leaves and potions – this stuff can transform the presence of endo in your life! Unlike many medications, herbal remedies are naturally incorporated into your life without all the side effects and high risks (when used correctly of course).

Some of the top herbs and supplements for endo include …

1. Melatonin
   • While most people think of sleep when considering melatonin, it is actually very effective in reducing pain as well! It is a hormone that regulates sleep but also has anti-inflammatory, antioxidant, and pain-relieving properties. A clinical trial investigated the impact of melatonin compared to a placebo with forty endometriosis patients. They discovered that the group that took melatonin had significantly lower pain! Specifically, the study showed that “melatonin at 10 mg/day reduces endometriosis-associated chronic pelvic pain, including a reduction in pelvic pain, pelvic pain during menses, pain during vaginal penetration, pain during urination and pain during defecation that is statistically and clinically significant” (3). Getting a good night’s rest is an added bonus!
2. N- acetylcysteine (NAC)
   • NAC is a nutrient that increases the production of an important detoxifier, glutathione, which helps you clear your estrogen more effectively. Remember, estrogen is responsible for the growth and shedding of endometrial tissue which results in inflammation and painful symptoms. Glutathione is also the body’s vacuum cleaner, it helps to “clean out” inflammation and damaged cells, and improves positive pregnancy outcomes too. In one study, 75% of women taking NAC got pregnant and the remaining 25% achieved pregnancy through IVF (4)! Taking a supplement of 1800 mg/day can ease painful symptoms and increase your fertility chances!
3. Pycnogenol
   • Pycnogenol is a very safe herbal supplement made from the bark of the French maritime pine tree. Research has shown a significant reduction in pain as well as lesions caused by endometriosis. One study found that, after four weeks on pycnogenol, patients slowly but steadily reported reducing symptoms like menstrual cramps and pain. However, keep in mind that it may take several months to feel differences so it may help to combine it with other treatments as you wait (5). We recommend that our patients take 30mg twice a day, or if that’s hard to remember 60 mg once a day.
4. Vitamin B6
   • Vitamin B6 is an essential vitamin that is important in metabolism, brain development, hormone production, and a healthy immune system. It is also essential in the metabolism and detoxification of estrogen out of the body through urine or stool. Remember, high estrogen levels can contribute to the progression of endometriosis and painful symptoms so it is also important to help improve estrogen clearance. But it’s also important to note that when we say high estrogen, we don’t mean that you will necessarily have high estrogen levels in your lab tests. Some women with endo do, but more often than not women have other estrogens from environmental toxins and chemicals circulating around causing damage and wreaking havoc on the body. Those chemical estrogens are called xenoestrogens and are found in chemical cleaning products, perfumes, makeup, and many other household items unfortunately. To understand more about how to eliminate these xenoestrogens, check out our blog Unseen Threats: The Impact of Everyday Chemicals on Your Hormone Health. What’s especially problematic is the longer estrogen or xenoestrogens linger around the more endometrial tissue growth can happen. B6 supports the liver by helping it to “de-activate” those estrogens & toxins and sends it off to the intestine to be removed with your daily bowel movement. This helps to clean up the mess caused by endo (6). You only need to take about 50mg each day!
   • If you aren’t having daily bowel movements, that’s a problem! You deinifely need to have daily well formed bowel movements before ramping up liver detoxification, because the liver relies on your gut to remove the waste, if your gut can’t remove that waste then it’ll just build up!
5. Omega 3 Supplements
   • Remember, omega-3s have amazing anti-inflammatory properties! They help clean the mess of tissue and blood that endo causes. Although you can increase your omega-3 intake through food sources, endometriosis causes so much inflammation that you need more omega-3s than you can realistically get from foods. Taking a supplement with about 2000-3000 mg/day, will do the trick!
6. Devil’s Claw
   • Even though the name sounds terrifying, we promise that this herb, native to South Africa, actually has a really safe profile! Clinical research shows that taking extracts of devil’s claw can significantly decrease low back pain and be just as effective as anti-inflammatory drugs but without all the gut-related side effects (7). So if you tend to have endo back pain, this herb, can be a great option. We recommend our patients take 400mg 3-4x/day or, if that’s too difficult to remember, then do 800mg 2x/day.
7. Turmeric
   • Turmeric is a traditional Indian spice that downregulates inflammation and stress in endometriosis. According to Kamal et al., several studies “reported the positive effects of curcumin in alleviating endometriosis through anti-inflammatory, anti-proliferative, anti-angiogenic and pro-apoptotic mechanisms” (8). Not only does it transform a meal into something amazing but also can transform your life with endo. Only about 1.5 tsp (2000mg/day) a day is needed but more can be used for extra inflammation support. Turmeric is actually best used in the original powder form, rather than capsules.
8. Other
   • There are several other herbs and botanicals that aid your symptoms. Check out our free eBook, Calm the Cramps, to explore the amazing benefits of cramp bark, ginger root, and black cohosh!

Careful! Don’t Risk Your Health with Low-Quality Supplements

When buying supplements, quality matters! Many supplements on the market are questionable, with some even being adulterated. For instance, did you know that turmeric is sometimes substituted with orange-dyed powder? This is why we’re very selective about where our patients purchase their supplements.

One source we recommend is Fullscript. Fullscript is a trusted portal that provides high-quality supplements that undergo frequent quality testing. Fullscript ensures all products are batch-tested, and questionable sellers aren’t allowed on their platform. Access is also secure; only those with a practitioner-provided link, like the one we’ve shared below, can purchase. This helps ensure you’re getting quality supplements through a verified source. And a bonus when using the Fullscript link below, you’ll get an exclusive 20% discount on all supplements! There are many affordable, top-quality brands like Now Foods and more, so you can prioritize your health without breaking the bank. Just click here to get started.

Unfortunately, Fullscript is only accessible for US-based individuals. If you don’t live in the United States & can’t access Fullscript, you can purchase many of the same supplements off of iHerb. Just click on the Fullscript protocol here so that you can see which brands are best to buy.

Keep in mind that these dietary changes & supplements should be done with guidance from a registered dietitian or healthcare provider for your safety. We always help our patients navigate those combinations safely.  If you’re on any other medications, please never combine them with supplements without consulting with an experienced provider.

Phew! That was a lot of information we covered, and this is only the tip of the iceberg. Endometriosis is a complex condition, and it often requires a lot of customization to get the treatment just right. We often select from hundreds of herbs and dozens of nutritional approaches when treating endo, because no one woman’s endo is the same. In addition, the options we mentioned in this blog are safe for most people, there are many other herbs we love to use but didn’t include in here because they require more nuanced dosing and precise usage. That’s why getting that personalized approach from a healthcare provider trained in endometriosis care is crucial to managing endo effectively in the long term. If you’re ready to take that next step in personalizing your endo care we’re happy to help, head to our services page here.

For more information about signs and symptoms, diagnosis, and stigma, please read An End to Endo Stigma: Endometriosis, Symptoms, and Diagnosis.