by georgia hartmann
Women’s Health Expert
Endometriosis is an inflammatory condition characterized by endometrial tissue that grows in places other than inside the uterus. It is a condition that affects an estimated 176 million women worldwide (though it is suspected that this data could underestimate the real number of affected women, considering the only way to properly diagnose endometriosis is via surgery). [1,2]
One of the main symptoms of endometriosis is chronic pain. I’m talking painful pelvic, painful periods, painful defecation, painful urination, and painful intercourse. As endometriosis can affect multiple peripheral nerves, period pain that radiates down the legs can also occur. Due to the inflammation, up to 50% of women experiencing endometriosis also experience difficulty conceiving. [1-4]
It is to note that although the purpose of this article is to help you understand how to manage endometriosis-associated pain, up to half of the women affected by endometriosis are asymptomatic (meaning they do not experience any symptoms – and I have definitely seen this in my own clinical practice).
Nonetheless, if you have (or suspect) endometriosis, here are my 4 steps to managing pain:
1. Cut out pro-inflammatory foods
A high intake of trans fats (found in fried and processed foods including cakes, biscuits, donuts, pizza, fast food, the like) is linked with higher levels of inflammatory markers. Interestingly, a study out of Harvard University showed that women in the highest quantile for the consumption of trans fats were 48% more likely to develop endometriosis as compared to those whose trans fat consumption was in the lowest quantile.[5,6]
Similarly, foods containing gluten (including whole wheat bread, pasta, baked goods, snacks, and condiments) are known to promote inflammation. A small study showed that simply following a gluten-free diet for 12 months reduced painful symptoms in 75% of women with endometriosis.
While you may be feeling lost for what to eat or drink, start by focusing on including more fruits and vegetables of all colours. A recent study published in Human Reproduction showed that women who simply consumed one or more serves of citrus fruits (think lemon, lime, orange, grapefruit, mandarin, the like) per day had a 22% lower endometriosis risk.
2. Support oestrogen metabolism
Aside from reducing inflammation, it is important that we also support oestrogen metabolism to ensure we are ridding the body of excess levels. Supporting oestrogen metabolism is a two-step process.
First, your liver needs to inactive oestrogen by attaching a little molecule called ‘conjugation’. Aside from requiring an adequate supply of nutrients and protein, your liver also needs to be relatively free from the toxic effects of drugs, smoking, alcohol and endocrine-disrupting chemicals. Fun fact: just one standard alcoholic drink can increase oestrogen levels by 18%.[9,10]
The second step of oestrogen metabolism is the elimination of conjugated oestrogen through the bowel. This requires you to have a healthy gut microbiome (which basically means healthy intestinal bacteria). When healthy bacteria are present in your gut, they assist with the removal of conjugated oestrogen via your stool. However, when unhealthy bacteria are present, an enzyme called beta-glucuronidase is created which de-conjugates oestrogen allowing it to be reabsorbed into your body and resulting in excess oestrogen.
3. Move & Meditate
Moving your body and calming your mind is not a new concept when it comes to chronic pain management. An interesting study titled ‘Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic’ reported the benefit of regular exercise and meditation practices in managing endometriosis-associated pain. Considering the pandemic brought about a postponement of surgeries and limitations to visiting healthcare providers for the diagnosis and management of endometriosis, the authors concluded that “this is a time to seek alternative solutions.” 
4. Seek additional support
As pain is often at the heart of endometriosis, its management has great significance on one’s happiness and quality of life. This is where naturopathic medicine can play a profound role. There are many herbal medicines and nutritional compounds that can act as natural painkillers for the pelvis and abdomen, just as there are those that support the immune system, those that reduce inflammation, and those that support a healthy stress response. If you are looking for additional support, refrain from self-prescribing as we first need to understand your whole body, analyse or undergo any relevant testing, and have an in-depth discussion about the symptoms you may (or may not) be experiencing. 
 Parveen P., et al. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports, 2017. 6(1). PMID: 29276652.
 García-Ibañez, P., et al. Brassica Bioactives Could Ameliorate the Chronic Inflammatory Condition of Endometriosis. International Journal of Molecular Sciences, 2020. 21(24). PMID: 33321760.
 Missmer, S.A., et al. A Pilot Study of the Prevalence of Leg Pain Among Women with Endometriosis. Journal of Bodywork and Movement Therapies, 2011. 15(3). PMID: 21665106.
 Mishra, V.V., et al. Prevalence; Characteristics and Management of Endometriosis Amongst Infertile Women: A One Year Retrospective Study. Journal of Clinical & Diagnostic Research, 2015. 9(6). PMID: 26266170.
 Helbig, M., et al. Does Nutrition Affect Endometriosis? Thieme Geburtshilfe und Frauenheilkunde, 2021. 814(2). PMID: 33574623.
 Missmer, S.A., et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction, 2010. 25(6). PMID: 20332166.
 Marziali, M., et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Surgery, 2012. 67(6). PMID: 23334113.
 Harris, H.R., et al. Fruit and vegetable consumption and risk of endometriosis. Human Reproduction, 2018. 33(4). PMID: 29401293
 Parazzini, F., et al. A metaanalysis on alcohol consumption and risk of endometriosis. American Journal of Obstetrics & Gynaecology, 2013. 209(2). PMID: 23707678.
 Frydenberg, H., et al. Alcohol consumption, endogenous estrogen and mammographic density among premenopausal women. Breast Cancer Research, 2015. 17(1). PMID: 26246001.
 Kwa, M., et al. The Intestinal Microbiome and Estrogen Receptor–Positive Female Breast Cancer. Journal of the National Cancer Institute, 2016. 108(8). PMID: 27107051.
 Leonardi, M., et al. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Human Reproduction Open, 2020. PMID: 32509977.
 Ilhan, M., et al. Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current Drug Delivery, 2019. 16(5). PMID: 30588884.
women’s health expert
by georgia hartman
Women’s Health Expert