Endometriosis! Now What? Part 2 | Dr. Tamara Darragh

If you didn’t catch Part 1 of this Endometriosis Blog Series, check it out! Part 1 covers all the symptoms, causes, and diagnostic details. We’ll dive into some of the therapeutic options here, and finally, Part 3 will discuss more nuances related to Endometriosis Associated Infertility. Just as a disclaimer, it’s ALWAYS important to work with a qualified, personal healthcare provider. They will guide you along a path that fits your unique situation. Check the links below if you haven’t found that person yet!

Endometriosis therapeutic options Blog Post written by Dr. Tamara Darragh a naturopathic doctor specializing in Integrative Fertility

Endometriosis: Conventional Therapeutic Options

Medications

Medications have been used to alter hormone levels and ovulation, reduce pain, and modulate the immune system. While there is evidence that these medications all offer relief of symptoms, there are many adverse effects from long term use and most can’t be used while you’re trying to become pregnant. It’s imperative to understand the risks, benefits, and alternatives.

Commonly Used Medications for Endometriosis

Angiogenesis inhibitors
Aromatase inhibitors
Cox-2 inhibitors
Danazol
Estrogen receptor beta-agonists
Gonadotropin-releasing Hormone (GnRH) agonist
Immune modulators
Oral progestin-only pills & combined oral contraceptives
Progesterone receptor modulators

A discussion regarding each of these is beyond the scope of the post. However, information is readily available on each of these medication types if you’re interested.

Surgery

Surgery can be very effective but is also not without risk. 20-40% of women have a recurrence within five years. There are currently three surgical options most commonly used. Surgery (except for hysterectomy) is often very effective at improving fertility in the short term.

ablation: cautery or laser removal of the tissue starting with the surface layer
excision: cutting out the tissue
hysterectomy: removal of the uterus (and often the ovaries too)

** See the resources section below for help finding a skilled surgeon in your area!**

Endometriosis: Naturopathic, Functional & Integrative Therapeutic Options

Root Causes

It is crucial to address the root causes, which are essentially different for every woman. With that said, there are some basic tenets of Endometriosis that unequivocally need to be addressed. These may include:

reducing inflammation and oxidative stress
decreasing estrogen exposure (endogenous & exogenous)
improving estrogen metabolism & detoxification
modulating immunity
supporting optimal nutritional status & removing food triggers
stabilizing blood sugar
providing acute pain relief
optimizing gut health
modulating the reproductive microbiome

It is important to find a qualified Naturopathic, Functional, or Integrative healthcare provider that can dig deep into your history and biochemistry, to provide a unique plan. This can be in conjunction with your conventional provider.

Functional Laboratory Testing

Some additional testing that I have found to be useful when taking a deeper dive into helping clients with Endometriosis include:

Assessment of sex hormones and estrogen metabolites
8-OHdG
Nutritional status
Functional stool test (inflammation, digestion, absorption, microbial environment, pathogens)
Epigenetics
Food sensitivity and allergy
Blood sugar handling

Comprehensive Plan

A comprehensive plan may include recommendations involving:

nutrition
lifestyle changes
reduction of environmental exposures
nutritional & herbal supplements
physiotherapy
mind/body awareness
acupuncture

Nutrition Basics

Mediterranean style, plant-rich, anti-inflammatory diet
- 8-10 servings of non-starchy vegetables: This provides tons of nutrients, antioxidants, prebiotics, and fiber.
  - Cruciferous vegetables (broccoli, cauliflower, kale, Brussels sprouts, cabbage, etc.) and other veggies such as garlic and onions contain plant compounds which are incredibly supportive of estrogen metabolism.
- Gluten-free: A gluten-free diet was shown to reduce pain in a 12-month study of women with Endometriosis.²¹
- Dairy-free: I would pass on dairy due to the possibility of extra hormone exposure, especially estrogen.
- Omega-3 Fatty Acids: These healthy fats can be found in cold-water fish, eggs from pastured chickens, grass-fed beef, and supplemental fish oil. If you’re interested in more information about omega-3 fatty acids and their influence on fertility, check out my blog on this topic.
- Eliminate trans fats, alcohol, and caffeine

Lifestyle Support

Movement: Get your sweat on in whatever way is fun for you! Exercise has been shown to lower your risk of endometriosis.²⁰ Sweating also helps with detoxification of estrogen.
Sleep: 7-9 hours per day. Seriously, you’ve gotta get your rest. Sleep quality has been correlated to greater pain in women with endometriosis.¹⁹ Make this a priority, ladies!
Joy & Community: Laughter and companionship may decrease inflammation and bolster your immune system.

Reduce Environmental Exposure to Endocrine Disrupting Chemicals

Dioxins: Check out this link from the EPA: Common Sources of Exposure to Dioxin¹⁴
PCBs: Check out this link from the EPA: Learn About Polychlorinated Biphenyls (PCBs)¹³
Phthalates: Check out this link from the FDA: Phthalates¹⁴

Nutritional & Botanical Supplement Basics

Curcumin²²: Curcumin, a plant chemical found in turmeric root, has been shown to reduce inflammation, pain, and oxidative stress.
- How it’s used: 500 mg 2-4 times per day
- Turmeric root can also be added to the diet but is difficult to absorb in high enough quantities to be used alone therapeutically.
Melatonin^{1, 2}: Shown to boost detoxification, reduce pain, improve sleep, and provide antioxidant activity.
- How it’s used: 1-10 mg per day, usually taken before bed. A smaller 1 mg dose is usually a good starting point, increasing to 10 mg, if tolerated, over a 4-5 week period.
NAC (N-Acetyl Cysteine)^3: Improves estrogen’s detoxification through the upregulation of glutathione, decreases pain, and can help with the regression of endometrial lesions and ovarian cysts.
- How it’s used: 600 mg 3 times per day
Ginger^4-7: Decreases inflammation and pain.
- How it’s used: 500 mg 2-4 times per day
- Ginger root can also be added to the diet, but it is difficult to get enough to be used alone therapeutically. Check out my Ginger Juice Recipe!

This list of nutritional and botanical supplements have literature supporting their use and are generally well tolerated. However, they are not the only beneficial options. Please remember that supplements should only be part of a holistic plan. Check with your personal healthcare provider before starting any new supplements. Your provider may also be able to personalize an appropriate dosage.

Physiotherapy Considerations

Pelvic Floor PT²³: Endometriosis can contribute to spasming muscles in the pelvic floor, which, you guessed it, can make the pain worse! Nobody wants that. Some physical therapists specialize in pelvic floor therapy and endometriosis. This type of therapy can also be a game-changer if you’ve had pelvic surgery.
Abdominal Massage: There are multiple proprietary forms of abdominal work directed toward the reproductive organs, pelvis, and abdomen. These hands-on techniques may help increase circulation, break up adhesions, and reduce muscular tension. Talk with your providers to find someone in your area!
Low-Level Laser Therapy²⁴: Cold laser therapy has gained traction for tissue healing over the past two decades. It is postulated to regulate inflammation, reduce oxidative stress, improve circulation, and decrease pain.

Mind-Body Awareness

“Psychological and mind-body interventions have shown promise in alleviating pain, anxiety, depression, stress, and fatigue in women with Endometriosis.”²⁵

Yoga¹⁵
- Check out Yoga With Adriene, a free YouTube channel with 100’s of free yoga videos.
Meditation, deep breathing, mindfulness^{16, 17, 25}
- Headspace is an app dedicated to meditation and mindfulness. They offer a free trial.
- HealthJourneys offers audio guided meditation and imagery specifically to Help With Fertility and for Women with Pelvic Pain, Interstitial Cystitis, or Vulvodynia.
Psychotherapy, Cognitive Behavioral Therapy^{16,17, 25}
- Psychology Today is a highly searchable website for mental health providers
Acupuncture^{18, 25}

There are SO many effective integrative strategies for endometriosis. As I already mentioned, it is important to find a qualified Naturopathic, Functional, or Integrative healthcare provider that can dive into your uniqueness.

Endometriosis! Now What? Parts 1 & 3

Check out Part 1 and Part 3 of this Endometriosis Blog Series to learn about symptoms, causes, diagnostic details, and endometriosis-associated infertility!

Additional Resources

Naturopathic, Integrative & Functional Medicine Providers

If you’re looking for help with endometriosis and interested in working with me I’m available via virtual consult. Schedule a FREE 15-Minute Discovery Call today! Alternatively, if you would like to find a practitioner in your area, see the resources below.

Endometriosis Resources

Nancy’s Nook Endometriosis Education (Facebook Group): This group is serious about educating individuals and practitioners about Endo. They have a helpful list of surgeons across the US that specialize in excision surgery.
Endometriosis.org
American College of Obstetricians and Gynecologists: Frequently Asked Questions About Endometriosis
Endometriosis Association

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In addition, If you’re looking for individualized, Integrative Fertility Support or help with Preconception Health Optimization, Dr. Tamara Darragh is available via virtual consult. Schedule a FREE 15-Minute Discovery Call today!

References

Disclaimer: This website and post include general information about nutrition, health, and fertility. This content is not medical advice. It is not a replacement for medical advice, diagnosis, or treatment of any health condition or illness. With that said, if the reader or any other person has a medical condition, concern, or illness, they should consult with their personal doctor or another appropriately licensed healthcare provider. The reader should also never disregard professional medical advice or delay in seeking advice because of something discussed in this information. It is imperative to consult your doctor or another appropriately licensed healthcare provider before implementing any changes to your diet, fitness routine, lifestyle, medications, or nutritional supplements.

Information provided in this document and the use of any products or services related to this document by you does not create a doctor-patient relationship between you and Tamara Darragh, ND, DC. Statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.