Endometriosis:

A Holistic Approach

Whitney Staeb

Ohlone Herbal Apprenticeship

October 11, 2016

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I. Introduction
There are many problems in our society surrounding the oppressive notions that attempt to box people into the
narrow definitions of gender and while I do not aim to discuss these in this report, I acknowledge these issues. It is
especially relevant to note this in the case of endometriosis as it is a gendered disease commonly thought to only
affect “women,” which is simply not true. This leads to a highly exclusionary community of people who leave out
transgender individuals and in rare cases, men, who also experience endometriosis and often have an even tougher
time getting the diagnosis and treatment they need.

Endometriosis is an estrogen dependent chronic inflammatory disease in which tissue

similar to that found in the lining of the uterus grows outside of the uterus. This lining, known as
the endometrium, is the soft and spongy inner layer of the uterus. Throughout the menstrual
cycle hormones are released to stimulate the growth of the endometrium in order to prepare for a
potential pregnancy. These hormones also stimulate the ripening of an ovarian follicle (sac-like
structures that contain eggs), to release an egg to be transported through the fallopian tube and
into the uterus, which becomes spongy and well nourished with blood. If the eggs is not fertilized
within about twenty-four hours of being in the uterus, the endometrial lining will begin to
breakdown and shed to be passed down through the vagina during menses [1].

In the case of endometriosis, the extrauterine tissue found growing outside of the uterus
contains glands and stroma similar to that of the endometrium and responds to hormonal stimuli
in a similar manner. When hormones cause the uterus to shed its endometrial lining, endometrial
tissue outside of the uterus will also breakdown and shed but instead of leaving the body during
menses, there is no way for it to exit the body and must therefore be absorbed by the surrounding
tissue. The process of absorption is slow and can be painful as blood easily accumulates in
cavities of the body and can cause inflammation of the surrounding tissue. This can lead to the
formation of scar tissue and can impair the function of the part of the body in which the tissue is
growing.

Growths of endometrial cells outside of the uterus occur most commonly in the deep
pelvic peritoneal cavity, also known as the cul-de-sac (the cavity between the rectum and the
posterior wall of the uterus in the female body). They also occur in or on the ovaries, the
fallopian tubes, the urinary bladder, the pelvic floor, the peritoneum (the membrane lining the
walls of the abdominal cavity, and the bowel. In rare cases, endometriosis can appear outside of
the pelvis in the diaphragm, the pericardium, the tissue of the lungs, and even in the brain [2][3].
The growth of this tissue can cause inflammation, blockages, and various problems in the area
they are growing in or near. After time, the extrauterine endometrial tissue can grow larger and
spread to other areas forming localized scar tissue and adhesions attaching to pelvic organs and
binding them together. Endometriosis can cause the formation of cysts, often containing oxidized
blood. These cysts appear in the ovaries and are referred to as “chocolate” cysts as the inner fluid
resembles chocolate syrup. If ruptured, they can cause horrible pain.

Endometriosis affects 6-10% of reproductive age women and approximately 35-50% of

adult and adolescent women with pelvic pain and infertility [5]. This means roughly that 1 in 10
women of reproductive age (usually between the ages of 15-49) are affected by endometriosis
and it can start as early as menarche. In some cases it is a mild condition that can resolve on its

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own. Menopause may or may not resolve symptoms depending on if the person has scar tissue or
adhesions from either the disease and/or surgery. While endometriosis symptoms can sometimes
be relieved by drugs and/or surgery, there is no cure and most of the drugs prescribed cannot or
will not be used long-term due to side-effects.

II. Symptoms and Long Term Effects

Endometriosis is notoriously hard to diagnose as there are no pathogenic symptoms of the
disease. While some individuals have severe symptoms and pain, others could have little to none.
Many discover they have the disease when they are unable to become pregnant or thorough a
procedure done for another reason. The type and severity of symptoms are usually related to the
location of the extrauterine tissue rather than how much of it there is. Approximately 75% of
those with endometriosis experience pelvic pain and/or pain associated with their menstrual
cycle and therefore it is a key symptom of the condition. The pain can occur: immediately before
and during one’s period, during or after sex, in the abdomen, back, or pelvis, with bowel
movements or gas, and/or during ovulation.

Bleeding is another symptom of endometriosis and affects the cycle in the form of: heavy
bleeding during the period with or without clotting, irregular bleeding or bleeding longer than
usual, and/or spotting in between cycles.

Symptoms of endometriosis can also affect other aspects of the body and its functions
including: bleeding from the bowels or bladder, switching between constipation and diarrhea, an
urge to urinate more frequently than is typical for that person, and/or bloating in the abdomen
with or without pain during the time of the period [6].

Given to the relationship between endometriosis and the hormonal cycle, many
individuals find that pregnancy can relieve the symptoms due to interruptions in the hormonal
cycle. In some cases the relief is presumably permanent and symptoms subside entirely but in
other cases, once the hormonal cycles return to normal the symptoms of endometriosis return as
well.

While benign and rarely life threatening, endometriosis can lead to other long term health
problems. Issues surrounding gender mixed with the complexity of endometriosis lead to the rise
of commonly held myths and misconceptions that cause the disease to often go undiagnosed and
untreated. Those living with endometriosis often experience a severe impact on their physical,
mental, and social well-being that can affect every aspect of their lives. Still today pain
associated with the menstrual cycle is a taboo subject carrying old beliefs from days past when
“women’s problems” were viewed as nothing more than hysterias due to the preconceived
notions of their “delicate and unstable” physical and mental constitutions. Far too often doctors
are reluctant to address symptoms of endometriosis and disregard the symptoms as “part of a
normal cycle” and women are told that the pain they experience every month is a just part of

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being a woman, that it is all in their head, or that they have a low pain tolerance1[7]. This leads to
the disease often going untreated and manifesting as more serious issues, including the
development of cysts, infertility, breast and ovarian cancers, as well as long term physical and
psychological effects on their daily lives.

III. Theories on Cause and Risk Factors

There is no widely acknowledged cause of endometriosis and although theories of
various causes are prevalent, none of them effectively explain all of the factors involved in the
development of the disease. There is general consensus between researchers studying
endometriosis that it is exacerbated by the presence of estrogen and consequently most of the
allopathic treatments attempting to target endometriosis strive to modulate estrogen production
in the body in an attempt to relieve symptoms. This approach does not get to the root of the
disease, nor does it take into account the individual person and their constitution, and therefore
can only go so far.

Retrograde Menstruation
The retrograde menstruation theory, developed in the 1920s by Dr. John Sampson,
suggests that menstrual fluid flows backward up into the fallopian tubes moving into the pelvic
cavity where endometrial cells implant and grow. While this theory can explain a potential cause
of the disease, it has not been proven. This theory is challenged given research concluding that
76-90% of menstruating women have retrograde flow. It is further challenged in the presence of
cases where endometriosis has developed in women who have had a hysterectomy or tubal
ligation. There have even been rare cases in which men who are treated with estrogen following
prostate surgery have also developed endometriosis [9].

Environmental Factors
Although not often discussed in-depth as contributing factors to endometriosis,
environmental factors have been shown to correlate with the disease in multiple studies. One
specific factor is the prevalence of dioxin, a strong teratogen and carcinogen found in the
environment as a byproduct of pesticides, herbicides, the bleaching of paper pulp, and smelting.
Dioxins include a broad range of chemicals including polychlorinated dibenzo dioxins (PCDDs),
polychlorinated dibenzo furans (PCDFs) and, polychlorinated biphenyls (PCBs). Dioxins are
used in the bleaching of tampons and sanitary pads including those that use “chemical-free
bleaching” as these still use chlorine dioxide as the primary bleaching agent. Unless these items
are certified organic, there is still the potential for trace amounts of dioxins [12].

In one study researching dioxin concentrations in individuals with endometriosis, there

was found to be an increased rate of the toxin in those with the disease. Forty-four infertile
women with endometriosis and thirty-five age matched women with tubal infertility were tested

1 A normal menstrual cycle is defined as occurring every 25-35 days and should be consistent in length
and not fluctuate month to month. Menstrual blood should be bright red in color and not dark red, brown,
or clotty. PMS and/or pain is not a normal part of the menstrual cycle and cramping should not be a
regular part of menses. Any of these symptoms could be a sign of a hormonal imbalance or a condition,
like endometriosis, that needs to be acknowledged and dealt with. The monthly period can be understood
as a monthly report card of the health of the body.

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for levels of dioxins in their blood. The results concluded that eight women, or 18%, with
endometriosis had blood levels of dioxin, compared to one woman, only 1%, in the control group
without endometriosis. This study describes the relationship between dioxin and the reproductive
system as a result of the chemical’s ability to alter estrogen, progesterone, and prolactin receptor
activities as well as inhibit T lymphocyte function. Dioxin is also able to mimic estrogen by
interacting with estrogen receptors. Given the notion that the etiology of endometriosis is highly
complex, the presence of dioxin could indicate an affected immune system, or an imbalance of
hormones. Although this study did not find a correlation between the severity of endometriosis
and dioxin levels in the blood, it is one of many linking the disease to dioxin positive individuals
[11].

Hormones
Within many theories discussing the potential etiology of endometriosis, hormonal
imbalance is an underlying factor that itself can be caused by a number of factors. As an estrogen
dependent disease, hormone levels play a critical role in the scope of the disease. Estrogen is
responsible for cell growth and therefore the proliferation of the endometrium and excess
estrogen can lead to abnormal cell growth. Connected with the theory of environmental factors
being a potential cause for the disease, humans are surrounded by an increasing number of
excess estrogens as a result of industrial, agricultural, and chemical companies pouring them
into the environment. Much of this excess estrogen comes from xenoestrogens, a xenohormone
that is able to mimic estrogen in the body. Xenoestrogens are a category of Endocrine Disrupting
Compounds (EDCs) which are able to disrupt communication between the endocrine system and
the organs producing hormones in the body. This results in what is known as estrogen dominance
and is being observed in the rise of various estrogenic symptoms displayed in people of all ages
and genders [13]. Given these factors it is no wonder there are increasing rates of endometriosis
in not only women of reproductive age but also in very young girls. Before 1921, there were only
twenty-one cases reported of the disease in medical literature [14]. This number has been steadily
rising since World War II and today has now risen to one in ten women of reproductive age
developing the disease.

Immune Disfunction and Stress Factors

Another proposed theory of the etiology of endometriosis is a defective or malfunctioning
immune system, as in the cause of autoimmunity. Some studies have observed autoimmune
disease to be more common in individuals with endometriosis. In these examples, women with
endometriosis were found to have a higher concentration of activated macrophages, decreased
cellular immunity, and repressed natural killer cell function [3]. The role of the immune system
in the etiology of endometriosis may also be linked to oxidative stress and could pair
immunological factors with inflammatory factors. One study presented evidence of the
relationship between stress and endometriosis and showed an increase in mast cells that
contribute to an abnormal immune response, similar to other inflammatory diseases [23].

Sexual Abuse
Sexual abuse comes up often in the discussion of endometriosis and given the staggering
statistics that 1 in 5 women will be sexually abused in their lifetime and 1 in 10 women has
endometriosis, a potential relationship between the two can be posited [22]. Sexual abuse
undoubtedly causes stress and inflammation manifested in the body both physically and

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psychologically. Given that endometriosis is an inflammatory disease and stress has been studied
and proven to exacerbate inflammation in the body, it can be theorized that sexual trauma could
play a role in the development and severity of the disease. However, the sexual abuse theory
often leads to misconceptions within the medical community concerning endometriosis and the
consequent dismissal of the disease and its very real symptoms. These misconceptions can lead
to victim blaming and a misunderstanding of the disease. While it is important to highlight the
potential relationship between the disease and sexual abuse, it must be approached with care.

Genetic Predisposition
It is estimated that those who have a close family member with endometriosis are 7-10
times more likely to develop the disease [6]. In cases where this has been studied, it was also
found that in the presence of a hereditary link the disease can worsen in the following generation.
One study identified DNA variations that can predispose certain individuals to endometriosis.
They concluded that “moderate-to-severe endometriosis is significantly more genetically driven
than minimal-to-mild disease” [10]. This study was done on women of European ancestry and
thus can potentially only speak to cases of a similar ancestry.

Role of the Lymphatic System

In more severe cases of endometriosis in which endometrial cells travel to distant places
in the body such as the lungs or brain, is it theorized that the lymphatic system plays a role.
These cells may be able to travel through the lymphatic system or through blood vessels and end
up in other parts of the body [9].

Metaplasia
Some researchers believe endometriosis to be the result of metaplasia, the abnormal
change in tissue, and in the case of endometriosis, the abnormal transformation of extrauterine
cells into endometrial cells. This transformation is thought to either be stimulated by hormonal or
immunological factors, or to have originated in the embryonic stage during which the uterus is
first forming. In some cases of the latter, adult cells may retain their ability to transform into
endometrial cells later in life [3].

Other Theories
Endometriosis is closely linked to other conditions including candidiasis and interstitial
cystitis. Considered the “evil twins” of chronic pelvic pain syndrome, endometriosis and
interstitial cystitis often accompany one another, yet both are commonly under diagnosed [24].
It has also been observed that women with endometriosis have higher instances of candidiasis
than those who do not. This is important as candida overgrowth can cause micro-perforations in
the uterus which can give extrauterine endometrial cells more places to grow [17].

In Traditional Chinese Medicine, endometriosis is considered a blood stasis syndrome

resulting in the formation of endometriotic lesions caused by a number of factors affecting the
reproductive system. Many herbalists and other holistic health care practitioners consider the
disease to be multifactorial in nature and as such cannot always be treated in the same manner
but requires individual treatment plans.

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IV. Diagnosis and Treatment
The primary method to diagnosing endometriosis is through a laparoscopy, a procedure in
which a lighted instrument, called a laparoscope, is inserted into the abdominal cavity via a small
incision near the belly button in order to view the pelvic organs. Diagnosis and removal of
endometrial tissue can take place during the same procedure. The removed tissue is then sent to a
lab for biopsy in order to confirm the presence of endometriosis. Doctors can speculate on the
presence of endometriosis through pelvic exams or ultrasounds however, these methods are
primarily able to determine the presence of cysts which may or may not be related to any
indication of endometriosis.

There are currently no methods used capable of predicting the future prognosis of the
disease stage from an initial surgical diagnosis [4]. The laparoscopic method of both diagnosis
and treatment and the subsequent result is highly dependent upon the skill and experience of the
surgeon. The procedure can relieve symptoms of the disease for a time period, depending on how
much tissue is removed and/or left behind, however it will not cure what is causing the disease.

In the allopathic field of study, endometriosis is primarily treated through hormonal drug
therapies. Because the disease is exacerbated by estrogen hormonal treatments are used as an
attempt to control estrogen production in the body through the suppression of a monthly period.
The medications also aim to shrink the endometrium as well as the lesions from the disease.
None of the medications come without side effects nor do they cure the cause of the disease,
instead they are only able to alleviate pain and other symptoms, sometimes for only a period of
time.

Birth Control Pill

The oral contraceptive pill is the primary treatment method. There are many different
types of contraceptive pills each containing a varying combination of synthetic estrogen and
progesterone. These drugs artificially alter the body’s natural hormones preventing ovulation and
therefore menstruation while attempting to inhibit the growth of endometrial implants. This
treatment method is inexpensive and while it can be taken for a number of years, it does not
come without side effects those of which some women may experience more severely than
others. Irregular vaginal bleeding, nausea, depression, weight gain, and headaches are all
common side effects that may be experienced within a short time of taking the pill. Studies done
on the long term side effects of taking birth control pills have found an increased risk of breast
and cervical cancers as well as Human Papilloma Virus (HPV). Problems with the heart and
circulation leading to an increased risk of stroke, heart attack, and blood clotting have also been
observed, especially in those who smoke or have smoked. Other side effects consist of severe
abdominal pain, chest pain, visual disturbances, and severe pain or swelling in the legs [15].

Progesterone and Progestin

Progestins are a group of drugs designed to mimic the female hormone progesterone in
the body. These can be taken as a pill, via an injection, or through an intrauterine device and
work to reduce a woman’s period or stop it entirely. Although it is not clearly understood how
these medications relieve symptoms of endometriosis, it is believed progestins work by
somehow suppressing the growth of endometrial implants and causing them to eventually waste
away while reducing inflammation in the pelvic cavity caused by the disease. They have been

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found to control symptoms of pain in three out of four women but were not found to relieve
symptoms entirely. Usually progestin treatments are used in lengths of three to six months,
although some treatments are used for longer, and repeat treatments are common. The
levonorgesterel intrauterine system, commonly known as the Mirena coil, is a small plastic T-
shaped intrauterine device that contains progestogen, a synthetic form of progesterone, that is
released into the uterus over a period of five years. As well as progesterone related side effects,
the Mirena IUD poses other potential risks including the development of ovarian cysts. The side
effects from taking progestins vary from drug to drug and are common as most women tend to
experience at least one or two side effects, if not more. Some primary side effects include: acne,
bloating, breast tenderness, bleeding between periods, depression, dizziness, fluid retention,
headaches, fatigue, mood swings, nausea, prolonged bleeding, vomiting, and weight gain [16].

Other Hormonal Treatments

GnRh-agonists are a group of drugs containing a modified version of gonadotropin
releasing hormone that acts on the hypothalamus-pituitary-axis to control hormone release.
These medications act to stop estrogen production in order to deprive endometrial lesions of the
hormone and come in the form of injections—monthly or daily—and nasal sprays. Side effects
of GnRh-agonists are common, many women finding them too severe. Due to the depleted levels
of estrogen these drugs cause the body to go into a false menopause. Along with common
symptoms of menopause such as hot flashes, other side effects include insomnia, headaches,
mood swings, vaginal dryness, depression, acne, decreased libido, and muscle pains [16].

Danazol is one of the least common medical treatments employed for endometriosis. It is
a synthetic androgen (male hormone) that works by creating a hormonal environment in the body
in which menstruation does not occur. Estrogen levels drop as androgen levels rise. While being
able to effectively treat some symptoms of endometriosis for a period of time, many women
discontinue treatment due to the side effects which include increased body hair and acne as well
as weight gain [16].

Due to the multitude of side effects accompanying hormonal treatments, these medication
are limited in use especially in adolescents with the disease.

Surgical Treatment
In more rare cases, a major abdominal procedure called a laparotomy may be performed
to remove endometrial lesions. During a laparotomy, a hysterectomy, the removal of the uterus,
may also be performed. If the surgeon believes the endometriosis to be severe enough, they may
remove the ovaries and fallopian tubes as well as the uterus. This is called a total hysterectomy
and bilateral salpingo-oophorectomy. There is a fifteen percent chance that endometrial lesions
will come back in women who have had this procedure [18].

There are no medications that can be taken indefinitely as they all possess a wide variety
and severity of side effects and risk factors. The prescribed drug therapies are unreliable and
provide no consistent relief without side effects.

V. Holistic Approach to the Treatment of Endometriosis

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 Like the disease itself, the holistic approach to treating endometriosis is complex and can
require not only herbal medicine but also diet and lifestyle changes in order to not only relieve
symptoms but also attack the root of what is potentially causing the disease. It is necessary to
take into account the immune system and inflammation, hormonal regulation, exposure to and
detoxification from toxins, diet and nutrition, lifestyle, and the individual person’s emotional and
psychological state and coping mechanisms for dealing with the disease. Herbal medicine can
not only be used complimentarily to the medical treatment of the disease but can also be used as
a safe alternative to the drugs in order to help resolve the outstanding issues causing the disease.
Without continually disrupting hormonal functions and suppressing the body’s normal cycles, as
the drugs set out to do, a comprehensive herbal treatment plan can address not only the
symptoms of pain, but can also reduce inflammation, improve overall immune health, help the
body process and rid itself of harmful environmental toxins, as well as reduce the emotional and
physiological side effects that often accompany the disease including stress and depression.

While this paper does not go into detail about the comprehensive approach to
endometriosis that Chinese Medicine has been researching and practicing for centuries, it cannot
be overlooked. The treatment of the disease with Chinese Medicine contains many complex
formulas for stagnant blood that contain herbs with primarily anti-inflammatory, anti-
proliferative, and pain-reducing properties. Many of these herbs are used synergistically,
meaning that two or more herbs used together are able to interact with and enhance the effects of
each other. Chinese Medicine offers a number of formulas that have been used successfully in
treating endometriosis. While there have been many studies done on their efficacy not many
randomized control trials can be found in the english literature 2.

Complementary Approach
While pain can sometimes be managed through the use of drugs and/or surgery,
sometimes symptoms persist. Antispasmodic, analgesic, and anti-inflammatory herbs can be used
to manage symptoms of pain and include but are not limited to: Cramp Bark (Viburnum opulus),
Black Haw (Viburnum prunifolium), Black Cohosh (Actaea racemosa), Dong Quai (Angelica
sinensis), and California Poppy (Eschscholzia californica). Stronger anodynes such as Jamaican
Dogwood (Piscidia piscipula), Silk Tassel (Garrya elliptica), and Corydalis (Corydalis ambigua)
can be used in more severe symptoms of pain but should be used only under the supervision of
an herbalist and in small doses. Other herbs to take to support the body and help balance
hormones while on medications and/or after surgery are: Raspberry Leaf (Rubus idaeus), Nettles
(Urtica dioica), Violet (Viola spp), and Red Clover (Trifolium pratense). Complementary therapy
with the use of herbal medicine as well as diet and lifestyle improvements can help manage
symptoms of the disease as well as side effects from the medications.

Alternative Holistic Approach

Endometriosis requires a complex herbal treatment strategy that can involve many
months of therapy and various formulas to be taken acutely, long term, and/or cyclicly. Each

2 Currently, a randomized controlled trial is being done studying the use of TCM in reducing endometrial
related pain as effectively as some hormonal therapies without the pseudo-menopausal side effects that
follow GnRH-a therapy [19].

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formula given should be dependent upon the individual case and that person’s constitution,
lifestyle, diet, and symptomatology. Important herbal actions include:

Analgesics/Anodynes: pain relief

Anti-inflammatories: pain relief
Anti-spasmodics: pain relief
Sedatives: pain relief

Emmenagogues: help regulate cycle

Uterine Tonics: tonify the uterus and reproductive

system

Anti-proliferatives: inhibit proliferation of harmful cells

Hepatics: hormonal regulation by improvement

of healthy hepatic function and
hormonal metabolism by the liver

Hormonagogue: regulate and balance hormones

Lymphatics: relieve stagnation, improve

lymphatic circulation (specifically in
pelvic region)

Immune modulators: improve immune function and

promote healing

Adaptogens: help body adapt to stressors and

manage emotional symptoms

Nervines: stress relief

Herbs
Vitex (Vitex agnus-castus): hormonagogue, emmenagogue, uterine tonic. Vitex is specifically
indicated for endometriosis as well as other hormone related conditions of the female
reproductive system. Vitex works on the pituitary rather than directly on the ovaries and helps
modulate and normalize hormones. It should not be taken with contraceptives.

Black Cohosh (Actaea racemosa): anti-spasmodic, anti-inflammatory, emmenagogue, nervine.

Black cohosh is a phytoestrogen and can help normalize levels of estrogen and progesterone. It
can help relieve cramping and pain associated with endometriosis and help with the stress and
emotional issues the disease can induce.

Dong Quai (Angelica sinensis): anti-inflammatory, emmenagogue, anti-proliferative. Dong Quai

is a female reproductive system tonic and female hormone normalizer that will lower estrogen if

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it is too high, as in the case of endometriosis. It is a well known herb for helping to increase
fertility.

White Peony (Paeonia lactiflora): antispasmodic, emmenagogue, nervine. White Peony helps to
treat blood stagnation in the pelvis and relax the uterus. It contains constituents that help to
strengthen the immune system in fighting against inflammation that could cause the endometrial
implants and adhesions. Some studies have shown that when combined with Licorice Root
(Glycyrrhiza glabra), the uterine relaxing effect and subsequent reduction in menstrual pain is
increased [25].

Licorice (Glycyrrhiza glabra): anti-proliferative, anti-inflammatory. Licorice contains

isoflavones that help regulate estrogen and progesterone levels. It is phyto-estrogenic and
therefore able to raise or lower levels of estrogen. It should be avoided in high blood pressure.

Yarrow (Achillea millefolium): analgesic, anti-inflammatory, antispasmodic, emmenagogue,

alterative. Yarrow is a powerful blood regulating herb indicated for menstrual issues including
dysmenorrhea and menorrhagia that can accompany endometriosis. It can help tone the uterus
and promote a more regular flow, as well as relieve blood stagnation and relax the uterus. In
addition,Yarrow aids the liver in metabolizing hormones.

Lady’s Mantle (Alchemilla vulgaris): emmenagogue, uterine tonic, astringent. Lady’s Mantle is a
specific for menorrhagia and the menstrual cramping associated with endometriosis. It is
considered by some herbalists to be a supreme uterine tonic. As an emmenagogue it can be used
to promote regular menstrual flow but can also act as a uterine astringent.

Wild Yam (Dioscorea villosus): antispasmodic, anti-inflammatory, analgesic, hepatic, nervine

relaxant, hormone balancing. Wild Yam can ease dysmenorrhea and relieve ovarian and uterine
pains. It is a specific for the pain associated with endometriosis and can help regulate the ratio of
progesterone and estrogen in the body. It is highly indicated in inflammatory conditions of the
uterus and ovaries.

Shatavari (Asparagus racemosus): adaptogen, emmenagogue, tonic. Shatavari is considered the

“hormonal harmonizer” by herbalist Aviva Romm and the “Queen of Adaptogens” in the
Ayurvedic system. It is a rejuvenating tonic that can help with physical and emotional symptoms
of PMS and endometriosis. It can mildly lower estrogen and also improve immunity as well as
fertility.

Milk Thistle (Silybum marianum): hepatoprotective, hepatic, anti-inflammatory. Milk Thistle

contains constituents which not only protect the liver from damage but are also able to promote
healthy liver function and aid in the metabolism of hormones. Healthy liver function is vital in
any approach to dealing with reproductive system issues as the liver is responsible for indirect
hormonal regulation by metabolizing and clearing the body of excess hormones; i.e. estrogen. It
is also indicated for pelvic congestion.

Other important herbs in the treatment and management of endometriosis include:

Turmeric (Curcuma longa): anti-inflammatory, hepatic

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Ginger (Zingiber officinale): warming, carminative, anti-inflammatory, promotes circulation
Cinnamon (Cinnamomum zeylanicum): emmenagogue, carminative, warming, pelvic
decongestant
Ocotillo (Fouquieria splendins): pelvic lymphatic
Western Pasqueflower (Anemone pulsatilla): nervine, antispasmodic, specifically indicated for
pain associated with the reproductive system including endometriosis and dysmenorrhea
Red Clover (Trifolium pratense): alterative, nutritive, phytoestrogen
Burdock (Arctium lappa): hepatoprotetive, alterative, immune stimulator, enhances detoxification
pathways in the liver
Silk Tassel (Garrya spp.): anodyne, antispasmodic, uterine stimulant, smooth muscle relaxant,
specific to pelvic region
Corydalis (Corydalis yanhusuo): anodyne, antispasmodic, emmenagogue, combines well with
Silk Tassel and Dong Quai for menstrual pain
Motherwort (Leonurus cardiaca): nervine, antispasmodic, sedative, uterine stimulant,
emmenagogue
Skullcap (Scutellaria lateriflora): antispasmodic, nervine relaxant

Flower Essences
Flower essences can work on the psychological aspects of endometriosis to aid the person
in healing the subtle layers of the emotional symptoms. They can be used safely and long term
with no side effects. A few flower essences that can work well in dealing with issues concerning
the female reproductive system, specifically endometriosis and other conditions of painful
menstruation include:

Yarrow: Yarrow helps to clarify boundaries and is especially useful for those prone to
environmental illness. Yarrow can help astringe boundaries surrounding a person and aid in
strengthening them to allow for healing to take place.
Mugwort: Mugwort can aid in bodily flows and helps to move things. It can be especially useful
for menstruation as well as childbirth. Mugwort can help connect ones menstrual cycle to the
lunar cycle and can be useful for highly emotional individuals.
Rose: Rose helps promote self love, self care, self confidence, empowerment, and an open heart.
Red Camellia: Red Camellia can be used for hormonal imbalance and helps facilitate the
resolution of underlying emotional issues that could be the perpetuating the imbalance.

Sample Formulas
Days 1-14 of cycle:
Vitex
Dong Quai
Black Cohosh
Licorice + White Peony (combined)
Wild Yam

Days 15-28 (+/-) of cycle:

Vitex
Shatavari
Ocotillo

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Cinnamon
Yarrow

Acute Pain Formula:

Start with herbs such as:
Black Cohosh
Wild Yam
Cramp Bark

If something stronger is necessary one can used herbs such as:

Silk Tassel
Corydalis
Dong Quai
These herbs should be used with caution, under the supervision of an herbalist.

Formulas depend upon the person and their individual constitution. These are sample formulas
given to show how herbs can be formulated based on ones menstrual cycle. For specific
formulations and dosages one should always work with an herbalist.

Diet
Diet plays a vital role in the development of estrogen related diseases. The modification
of diet has shown promising effects on endometriosis and includes supplementation of various
vitamins and minerals. In one review, it was found that the intake of vitamin B complex and
magnesium, along with omega 3, exerted and anti-inflammatory action in patients with
endometriosis. Magnesium aids the liver in detoxification and is crucial for the removal of toxic
substances and heavy metals from the body. As magnesium deficiency is both a sign and
symptom of endometriosis it is important to include supplementation in the treatment plan. Both
vitamin B and magnesium are related to anti-inflammatory prostaglandin production and
myometrial (the middle layer of the uterine wall and part of the endometrium) relaxation. A plant
based diet including B vitamins, vitamin D, omega 3 and 6, and magnesium can reduce
inflammation and excess body weight therefore reducing excess estrogen production [20]. The
relationship between excess levels of estrogen in the body and obesity was observed in a
randomized controlled study evaluating weight loss, exercise, and sex hormones in
postmenopausal women [21].

An ideal diet for patients with endometriosis would incorporate anti-inflammatory foods
including high quality fats, fiber from vegetables and whole grains, bioflavonoid rich foods such
as berries, seaweeds rich in iron, and fermented soy products such as tempeh and miso. The ideal
diet would be very low in saturated fats, oxidized oils like vegetable and canola, processed foods,
white flour and sugar, and animal protein as these are all highly inflammatory and can worsen
symptoms. Caffeine and alcohol intake should be little to none. Given the relationship between
dioxin and endometriosis it is recommended to incorporate a chlorophyll supplement into the
diet as it has been tested and proved to inhibit dioxin absorption in the body. Alfalfa is one of the
highest plant sources of chlorophyll and can be taken daily as a tea.

Lifestyle

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 Lifestyle changes can help immensely in the treatment of endometriosis. As stated
previously, dioxins have been found in tampons and pads. Switching to organic tampons and
pads, menstrual cups, sponges, reusable pads, and/or menstrual underwear, provides safe
alternatives to harmful products and also reduces the burden these products place on the
environment. Exercise is an important part of managing endometriosis and should be done on a
regular basis. Taking hot baths, using heating pads, and practicing good self care are all
important components of managing the disease and can help with the physical and psychological
effects one many experience.

Conclusion
Endometriosis is an enigmatic condition affecting a growing number of people today.
This number increases alongside the rising amounts of toxins in our environment. Although the
etiology of the disease is not fully understood or accepted, it can be proposed that it is a
combination of many complex factors adding up to the development of the disease. The medical
approach fails at addressing any potential causes of the disease and therefore is only able to
relieve symptoms through hormonal or surgical procedures, some with long lasting and
potentially detrimental side effects. A comprehensive holistic approach is less invasive as well as
safer and has shown not only a reduction of symptoms but also a reduction of the persistence and
recurrence of the disease. While the allopathic approach aims at treating the disease from a
singular cause, the holistic approach aims to treat the individual and can therefore provide more
hope in the treatment of endometriosis.

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