Endometriosis Is an Autoimmune Disease

endometriosis is autoimmuneA change is coming for endometriosis treatment. Until now, the clinical approach has been surgery followed by hormonal suppression with hormonal birth control or other drugs. Going forward, the approach will shift to anti-inflammatory and immune-modulating treatments. That’s because there is growing evidence that endometriosis is not primarily a hormonal condition. It is autoimmune.

[For a 2022 update, see Endometriosis is a disease of immune dysfunction.]

The autoimmune connection is explored in detail in the 2012 paper: Is there an association between autoimmunity and endometriosis? After an extensive literature review, the authors conclude that endometriosis fulfils most of the classification criteria for autoimmune disease including blood markers of inflammatory cytokines and tissue-specific autoantibodies. They make the point that endometriosis frequently occurs with other autoimmune conditions such as autoimmune thyroid disease and inflammatory bowel disease.

Pharmaceutical immune treatment for endometriosis may still be a few years away. Fortunately, natural immune modulation is already at hand. I have used it with my endometriosis patients for many years.

What is endometriosis?

Endometriosis is a painful gynecological condition in which tissue that is similar to endometrial tissue grows outside of the uterus. The most common site is the ovaries (resulting in a type of ovarian cyst called endometrioma or chocolate cyst). Lesions also occur on the Fallopian tubes, pelvic ligaments, and on the outside of the uterus, bowel and bladder. Active lesions are hormone-sensitive, so they swell and then bleed with each menstrual cycle. This causes pain, scar tissue, and heavy clotted periods. It can cause infertility.

Why does it happen?

We don’t yet know the origin of the endometrial-like tissue. In some cases, it may be from retrograde menstrual flow but in some cases, it may be laid down before birth.

Regardless of how the original origin of the tissue, what matters is how the immune system responds. In a normal situation, the immune system stays calm and does not react to the endometrial tissue. In the case of endometriosis, the immune system makes inflammatory cytokines and autoantibodies that inflame the lesions and promote their growth.

Possible reasons for this aberrant immune response include exposure to environmental toxins such as dioxins and bacterial endotoxins (lipopolysaccharides) such as those from intestinal bacteria.

I look forward to future research about the endometriosis-autoimmune connection.

Natural treatment of endometriosis

The following treatments help by normalizing immune function, thereby reducing inflammation.

  • Avoid A1 dairy. Holstein cow’s milk contains a powerfully inflammatory protein called A1 casein that causes immune problems in some people. My clinical experience is that most women with endometriosis improve when they stop having normal dairy products. Goat and sheep dairy (A2 casein) are usually okay. Please see What dairy does to periods.
  • Avoid gluten. Like A1 casein, gluten is immune-disruptive for some people. And endometriosis has been found to improve after twelve months on a gluten-free diet. Avoiding gluten can also improve intestinal permeability (see next point).
  • Repair intestinal permeability. Intestinal permeability or leaky gut drives autoimmune conditions such as thyroid and inflammatory bowel disease, so it makes sense that it drives endometriosis. Treatments for intestinal permeability include a gluten-free diet and supplementation with zinc and the herbal medicine berberine.
  • Turmeric is a powerful anti-inflammatory and immune-modulating herbal medicine. A 2012 animal study demonstrated that turmeric can promote regression of endometriosis lesions. The authors went on to propose turmeric (curcumin) as a novel anti-endometriotic medicine.
  • Selenium and zinc are important immune-modulating nutrients and may be deficient in women with endometriosis.

Conventional treatment of endometriosis

  • Surgical excision of the lesions is helpful, especially for women who are trying for pregnancy. Other treatments can then be used to prevent a recurrence.
  • Micronized progesterone inhibits the growth of endometriosis lesions and has fewer side effects than the progestins of birth control.
  • Hormonal birth control suppresses hormones and prevents the hormonal stimulation of endometriosis lesions.

71 thoughts on “Endometriosis Is an Autoimmune Disease”

  1. I have been struggling with endometriosis for a while, without knowing that ANYTHING was wrong. I assumed that everyone had god-awful cramps like I did, and even cramps in between periods and so forth.

    It wasn’t until I recently went to a gynecologist for a pap and some blood work did she tell me the symptoms that I described sounded like endo. After an examination and some more questions, she confirmed that it was, indeed, endo.

    She prescribed the pill Diane-35 to ease up the pain. I am to take them constantly for 3 months and 3 weeks, so that I only have periods a year and wouldn’t have to deal with the pain as much.

    Now, I have spotting ALL THE TIME (It’s beginning to look like mini periods), I still have the little cramps (like they were in between my period), and I think I have hormonal imbalance.

    I get really fatigued all of a sudden, to the point where I can’t stand up long enough to take a shower. I feel like I can’t catch my breath, or that I’m not getting enough oxygen in my lungs. My legs feel like I’ve been walking for miles, but I haven been anywhere.

    I’m due to go back to my gynecologist in four days (the earliest appointment I could get), and it can’t come fast enough.

  2. I had stage 4 endometriosis and a dermoid cyst removed in 2011 at age 31. I then became so sick from cysts on my one remaining ovary, I could hardly function. I then had a total hysterectomy and more endo with many adhesions in 2012. I had done research online that suggested waiting to start HRT to starve off my endo. I waited 2 years, suffering through hot flashes, insomnia, and anxiety until I started getting heart PVC’s and my joints and muscles were hurting. My Dr. said I needed to start HRT right away, and took magnesium for my heart. My heart improved after about a year. I still have occasional PVC’s and muscle pain, but it is much better. I have been on Minivelle .075 patch for 4 years. Should I be taking Progesterone too?

  3. I have suffered from adenomyosis with severe cramps during and after my period. It was very painful and heavy bleeding and severe lower back pain my pain was unbearable to a point of being not able to move and a stabbing like pain on the left of my ovaries. Pain goes away when a clot comes out. But it took a while for the clot to come out. After several meetings with my gynaecologist which she suggested “laparoscopies” but I refused I know what laparoscopies is and how heart aching it can be then she stated that Allopathic treatment will help in pain management but it will not cure the disease. I started treatment with a drug named “endoheal 2 mg”. This gave me pain relief but reduced my periods almost to no periods with numerous side effects – spotting and fluctuation in my dates. I was not mentally satisfied to bear the side effects so I came across ”Ayurvedic doctor” who started my treatment with herbs. Though I continued above drug ‘endoheal 2 mg'” parallel for nine months for easy pain management. From then I continued taking the treatment. It reduced the size of my lesion but did not reduce it further after few months. And there was no relief in pain during menstruation but my Dr. Advised me to continue it during 3 months without any gap. I had noticed a quick ageing of my skin in the last 2 years. I am a smoker but for some reason I feel my quick ageing has to do with something else because I have been smoking for a long time and it’s only recently that I noticed a fast decline of my skin elasticity. After then pain radiates very badly in my left leg, lower left back and left side of my vagina. The pain normally start anytime during 3, 5,6 days, but at time I had to take a painkiller for this also as it irritates whole day. Then pain disappears after fews day. My digestion was slow but Dr. Ronnie’s supplements has improved it impossible situations is becoming possible miracles gradually.

    I was lucky to read in the internet about a lady who was cured from Adenomyosis through Herbal Medication. I contacted Ronnie through an email address I got from a testimony shared on the internet. Without further delay I made an order, I switched over to it. I had great breakthrough, that in the first month, I was already testifying of the effective of the Herbal medication. After 3months course of taken the medicine, all symptoms were gone. It has been 1 year and four months since I became free from adenomyosis. Anyone who is not in my position would not understand what I went through, the heart break, the pain and how frustrated I was for 6 odd years. Believe me, it was hell. I am so happy; I never believed I will be this happy again in life. My story is quite lengthy, it might help you too. You may contact Dr. Ronnie to know more via his email on. [email protected]

  4. Can endometriosis be seen on an ultrasound? I’ve had some functional cysts seen on ultrasound which sometimes make me feel sick but i’m told they’re nothing to worry about as long as they keep bursting.
    I also have a lot of clotting but very light irregular periods with little to no pain, sometimes they’re mostly clots with very little fluid at all, I’m not even sure these are periods since they can sometimes occur just a week or two after my last period.
    I have several autoimmune conditions, hashimoto’s, colitis and lichen planus, I am gluten free, have tried a year dairy free (on the AIP diet).
    I must have a hormonal imbalance of some kind, I’m just so confused as to which hormone might need a boost, possibly estrogen? My hair is falling, i have some darker hair on my torso than i usually do and breast, hips and bum have diminished, also depressed around menstruation.
    I’m on 62mg of spironolactone at the moment for cystic acne which i have tried to come off whilst on AIP but the scarring from the acne is just not worth it. I’m 36.
    I take zinc daily and have taken high dose P5P in the past but had some breakthrough cystic acne whilst on these supplements so have since ceased them. not sure if the P5P was to blame, could have been something else in the supplement. All so confusing.

  5. Hi Lara, I was just wondering what berberine supplement you use in Australia and the dose for endometriosis? I was having trouble submitting my comment on your other endometriosis article so hopefully this one works.
    Thank you!

    • Hi Steph, sorry, I had to rescue your comment from the spam folder for some reason. I use Mediherb Phellodendron tablets. I also like the Thorne Berberine-500 capsules for anyone overseas.

  6. I’m so glad I found your site! I will definitely have to encorporate these dietary recommendations! I am 34 and have had three surgeries for endometriosis in the last three years. The first was for a ping pong ball sized endometrioma in my abdominal wall that required a permanent mesh since so much of my fascia had to be removed. A year later I was back in the OR with stage 4 endometriosis throughout my entire abdominal cavity. I had my uterus and right ovary removed during that procedure, along with two hours of clean up of endometriosis everywhere else. After this surgery I had some blood work done that came back with a low positive ANA result. I actually had a doctor tell me it was likely due to the endometriosis. The ANA went negative about 6 months post op. I also did 6 months of Lupron to try to “starve” any remaining endometriosis. Now this year, I had another surgery to remove endometriosis from my ureters. My doctor has now prescribed Prometrium 200mg/day to try to suppress my remaining ovary. The concern I have is that the prescription came back as the generic version Progesterone made by Virtus Pharmaceutical. When I looked it up online, it shows all the warnings for “progestins” and cancers from the FDA, and even uses the term. Is it possible that the generic version is synthetic, even though it says “Progesterone Cap, sub for Prometrium” on the bottle? I don’t want to have more surgeries, but I don’t want to increase my risk of cancer either!
    One more question, what is your take on melatonin for endometriosis?

    • Prometrium is natural progesterone. But, yes, the labeling mistakenly lists all the standard progestin warnings.
      Yes, I have heard some promising things about melatonin for endometriosis. I haven’t yet prescribed it for that purpose.

  7. Hi Lara

    Some good points here related to diet and treating endometriosis 😊 Please though be careful of stating that endometriosis is an autoimmune disease. This is not true at present. Such information is misleading and can cause confusion for women with the condition. What endometriosis is has yet to be confirmed. More research is needed. Yours in gratitude. Kate Davidson acupuncturist.healer.mujercreativa

    • Yes, taken on board, thanks Kate. We know that endometriosis is a disease of immune dysfunction with has similarities to autoimmune disease. I’ve amended the wording in my more recent posts and also my soon-to-be-released book.

  8. Good article. Do you have any experience with Wobenzym N and endo? The studies are positive when it comes to endo and fertility, but I don’t know anyone else who uses or recommends it.

  9. Thanks for this article, it’s really helpful. I have Grade IV endo and do feel that the most logical conclusion is that it is autoimmune. The pain did improve for me with a gluten-free diet… am interested in tumeric supplements. Do you find they are effective? I saw a study where tumeric was only found to show an effect when taken in pure form i.e. In cooking. The supplement didn’t show any effect. Am desperate to find any way to improve my condition/lessen my ovarian cancer risk, without needing more surgery.

    • I find turmeric supplements to be very helpful for most endometriosis patients. Choose a good brand like Thorne Meriva and take with food. And also, please consider strictly avoiding cow dairy.

  10. Hi Dr. Briden,

    Do you have any advice as to choosing supplement brands? I see you’ve mentioned Thorne brand curcumin- any specific reason you choose them over other brands? It’s so hard to find unbiased supplement information. Thanks for all that you do!

    • For North American brands, I like Thorne, Metagenics, and Douglas Labs because I am convinced of their quality. I’m sure there are other good brands out there as well. But unfortunately, there are also a lot of not-so-good brands.
      I mainly prescribe Australian brands of supplements.

  11. Thank you for the vast amount of information you shared. I am longing for the day when the medical community acknowledges Endo for what is truly is.

    Too many of our sisters are being turned away, being told they are “faking” it, being sent in circles just to get a proper diagnosis, and or being treated like they are “drug seekers”.

    Now to my question. I am 31 years old and I have been diagnosed with Stage 4 Endo when I was 21.

    Since then I’ve had my right ovary and tube removed, my appendix removed, and my gallbladder removed, and more surgeries all because of Endo spreading to those areas.

    Yesterday, I was diagnosed with Shingles. Yes, Shingles at 31 years old. My symptoms includes: Rash on my left leg, severe migraines, rash on my tongue, burning throat, muscle spasms in my lower back(sciatic nerve), mental fogginess/cloudiness, body aches, stuffy nose, sinus pressure, and tiredness. I am also on my “monthly”.

    My question: Do you think I got Shingles because my immune system was already weakened because of Endo? Everything that I’ve read said Shingles occur in people 60 and older. So, I’m not understanding how or why it activated?

    If you can, can you help me make sense of things?

    • Shingles can occur at any age when immunity is suppressed, often due to stress. Often post-surgery. Did it occur within a month or so of your last surgery?

      • It occurred after I received an epidural injection for the sciatic nerve. That rash has since cleared up but I still have the pain and spasms.

  12. Hello, thank you for the info! I have endometriosis and as a result I lost a kidney due to an endometriomia cutting through my ureter. I also lost an ovary and Fallopian tube. I was told I would not be able to have children. Devastated, I read everything I could get a hold of and tried everything I could to get pregnant. Despite the grim report I was able to have three healthy babies naturally after I did a few things that were very successful, and may be able to help others who read this post. The main thing that helped me conceive was switching to an organic diet. Not only does that have the ability to regulate your hormones, an organic diet ensures that you are not consuming GMO foods and ingredients as sadly they are lurking in almost all of our food. Studies have shown that eating a GMO diet causes leaky gut in animals so I thought it was interesting that you mentioned that in your post.
    Thank you!

    • Melanie, thank you for your post! It gives me hope! You mentioned an organic diet was one of the main things you did to help you conceive… do you mind sharing other techniques? Supplements? Etc? Any advice would be great!

  13. Could you recommend any newer books on endometriosis being an autoimmune disease? Also, are the items you list above along with Berberine all I need to get to start to naturally heal the pain I have? Do you have an opinion on MSM for cysts, dissolving them, which I also have? Finally, please write more on endo (I’ve read what you have written so far and have learned a lot) with the dosages you recommend. I am at my wits end in pain and just want it to end.

  14. A friend shared with me that the essential oil ‘Clary Sage’ – one drop with a carrier oil rubbed all over the lower abdomen – uterus area of the skin will help balance hormones. I tried it & within a month I saw results! The month before I had the worst clotting & bleeding ever. I was ready to get an ablation but once I started using the oil things have calmed down enough to feel somewhat normal again. I had been anemic for at least a couple of years from my heavy cycles. I also take blackstrap molasses for help with the anemia to get more iron in naturally & cheated iron capsules 18 mg daily. I am so thankful for my friend sharing the info on Clary Sage. Safe & Natural. I am also working on being dairy & gluten free, sometimes hard to do. But I am very limited to those foods now. So this was encouraging to know dairy & gluten can cause some of the havoc on my system. I refuse birthcontrol because I don’t want to distrupt my system with synthetic hormones. So i am on the right track & getting some of my energy back with two young children keeping me busy!

  15. Hi Lara,

    I am almost 31 (tomorrow!) and my husband and I are TTC. I also have endometriosis. We have tried two cycles of letrozole and IUI without success. I recently started vitex 400mg daily and have noticed increased breast tenderness in my LP, decreased menstruation and decreased pain. I have some questions: should I stop vitex with letrozole for this coming cycle? Should I ask for progesterone support after I ovulate? If I go back on vitex after this cycle when do you recommend weaning if pregnancy occurs?

    thank you!

    • Vitex should not be combined with fertility drugs like letrozole. As I explain in the post, the best treatment for endometriosis (and for enhancing endometriosis-related infertility) is immune-modulating diet changes such as a dairy-free diet.

    • An autoimmune disease is a disease in which the body produces antibodies that attack its own tissues, leading to inflammation of that tissue.

      • Except Endo isn’t actually the bodies own tissue. It’s a foreign cells/tissue.
        The autoimmune theory would seem plausible if endo was actually endometrium tissue outside of the uterus. But, it’s NOT!!
        Endometriosis is *only* similar to endometrium tissue. Under the microscope, endo tissue looks different than endometrium tissue. They can be distinguished between. Endo has a few similar characteristics of endometrium tissue but endo also has different characteristics that endometrium tissue does not have. Endometriosis and endometrium are NOT the same thing!!
        Therefore, Endometriosis tissue is a foreign cells/tissue inside of the body!! The immune system might be involved with endometriosis but it’s not an autoimmune involvement.
        With autoimmune disease, the body attacks itself. It attacks things that are supposed to be in the body. Endometriosis is a foreign cell/tissue that is not supposed to be there. When something isn’t supposed to be in the body and is a foreign cell/tissue, the immune system attacks it to try and get rid of it. That is a normal functioning immune response.
        Endometriosis is not an autoimmune disease because the immune system is responding approprietly to what is a foreign thing(endo) inside of the body.

        Yes, there are current research studies backing up everything that I’ve stated. The top doctors who treat endometriosis and the top researchers of endometriosis all agree that endometriosis is NOT an autoimmune disease!!

        • Thanks for your comment.

          Yes, I agree with that current research that endometriosis lesions are only similar to endometrium and not identical. And I’m familiar with that argument that it’s a normal immune response to “foreign tissue.” Except that there is a growing amount of evidence that abnormal immune function lies at the heart of the disease.
          That idea is explored in this recent paper: Involvement of immune cells in the pathogenesis of endometriosis.

          And also by reproductive immunologist Jeffrey Braverman in his presentation Outsmarting Endo where he says: “Over this 20 year time period what I have learned is that almost all of these patients that have come to our practice had some undiagnosed autoimmune disease. There is no question in my mind that endometriosis is one of them.”

          You can read more about the immune factors in my presentation Endometriosis, Immune Dysfunction, and the Microbiome. The references are in the slides.

  16. Hi Lara I came across your website trying to find answers for my daughter who is 21 yrs old. She had irregular and very painful periods. I took her to obGYN who concluded that she has endometriosis. She did not do any biopsy she just concluded from her symtoms. She tried to put her on birthcontrol pills which I did not because I think she is estrogen dominant. Her thyroid with the tests that you recommend came back normal. A naturopath recommended for her to use profeme 10 from lawley pharm which she has been taking for about 3 months now about 50 mg every day. She has responded well to it but she has started losing her hair I am really worried. I don’t know what to do. Should she stop using the creme completely or take other supplements. Is it the cream causing the hair loss she is so young.Please help.

    • So she takes 1/2 gram of Profeme= 50mg progesterone? That’s a bit higher dose than I would usually use with young woman, but it’s probably okay since it’s working so well for her. I doubt the progesterone cream is the cause of your daughter’s hair loss. Did she take any other medication or having other health events about 3 months ago? Are her periods very heavy? You might want to check her iron.

  17. I really enjoyed this article, sent to me by a friend, and I am printing it out to give to a lady who is having surgery for endometriosis. The article was really well written and very informative. Thank you very much.

  18. i was diagnised with endo on April 7th this year after lap surgery. i am 29 years old, i am not worried about my fertility as myself and my husband do not want a family. i suffer massively form psychological side effects as well as PMS. I have had and am still experiencing pain in my left ribs, on my side, and know endo can spread here but no Drs seem bothered or even willing to explore why i get this pain!

    i have your book, read it in one day, its amazing and have begun taking

    Vit E
    Omega fatty acid

    do you think i could have endo in my chest? am i going about the supplements right?

    • Hi Lucy, Supplements look ok, but you probably shouldn’t take iron unless you know that you need it, because iron can be inflammatory. Best to ask you doctor for a blood test for “iron studies”. Also, don’t forget that diet is far more important than supplements. The single most important thing for endometriosis is to avoid normal dairy products. I can’t say that’s true for every woman, but it is for the vast, vast majority.

      As for your chest pain, it’s common to have some diaphragm pain after laparoscopic surgery (caused by the pressure of the gas they pump into the abdomen). Beyond that, I might think first about the possibility of intestinal bloating. Under the left ribs is the “splenic flexure” where the large bowel takes a sharp turn downward. It’s really common for digestive gas or wind to become trapped there, and it can be quite painful. Would make sense that you have new digestive problems if they gave you any antibiotics or painkillers with the surgery. Also, if you do have digestive problems (problems with intestinal bacteria), it might be very important to correct that because intestinal bacteria regular immune function and therefore have a strong effect on an inflammatory condition like endometriosis.

      As to whether there could be endometriosis in your chest cavity, it’s possible of course, but you may also have scar tissue or adhesions on the bowel near the lower part of your diaphragm. Did the surgeon say where she found the endometriosis lesions?

      • Hi Lara thanks so much for your reply. I’ve been eating a clean, paleo style diet for nearly 5 years, no gluten, wheat, dairy etc so I have that covered, I also don’t drink.
        I’ve not seen the surgeon so as of yet don’t know anything only that I had a large cyst they drained my my right ovary and endo but as I say I don’t know where.
        The pain in my chest I was having for about a year and a half when I had my endo pains, very painful and radiating which is why I was worried it could be endo. But no one has even looked into it.

  19. I shared your article on a FB site for Endometriosis sufferers and it got a huge response. I would like to share with you some of the thoughts of the physician who is specialized in endometriosis (he is the moderator for the page).

    “The correct conclusion from the article above is this: Since less than 2% of women with endometriosis also have a putative autoimmune disease, there appears to be no strong link between endometriosis and autoimmune diseases. If someone’s agenda, however, is to promote the unsupported idea that there is a strong link between endometriosis and autoimmune diseases, then a non-relationship will be touted as a relationship. Another point about scientific publications and truth is repetition and consistency of results. Authors have been trying to define endometriosis as an autoimmune disease for over three decades, but nothing clinically useful or believable has resulted. The article quoted above is over a decade old and remains unconfirmed by other studies. Unsubstantiated conclusions were made which were not supported by the evidence because there was a preconceived notion that endometriosis is an autoimmune disease. This has led many patients to a treatment dead end which is not a help.”

    “There is no question that endometriosis is an inflammatory disease, just like many other diseases, infections, and injuries. Inflammation is the generic way the body responds to these processes. If steps are successfully taken to reduce inflammation, patients can certainly feel better, but this is not evidence of an autoimmune disease. A sprained ankle results in the four signs of inflammation: calor (warmth), dolor (pain), edema (swelling), rubror (reddish discoloration). Treatment of a sprained ankle with elevation of the ankle and ibuprofen can make if feel better, but that doesn’t make a sprained ankle an autoimmune disease. The issue can get somewhat confused because there is also no question that the immune system plays a role in inflammation and healing, although this is considered a normal response to injury rather than an autoimmune disease because once the injury is healed, the immune system calms down again. Endometriosis never ‘heals’ unless it’s removed by excision, so the inflammation remains ongoing, as does the body’s response to it”

    I have suffered form endometriosis for many years, I was found to have severe stage 4 after excision surgery 3 years ago. I was not cured of my pain, in fact it got worse post op. I suffer from infertility, anxiety and digestive issues all (I feel) to be related to ENDO. I am an intelligent person who does a lot of reading and research and I get exhausted by all of the conflicting information out there about endo. I just do my best and try to stay as informed as possible but it is very difficult with so many opinions floating around and not enough evidence. I feel that physical therapy, diet and stress relief has helped my ENDO more than anything. I appreciate you trying to educate others about endo but sadly I don;t think this is very accurate and only adds to the confusion. Perhaps a less definitive title would be helpful next time…

    • Hi Lois, Thank you for sharing the comments of your site’s physician-moderator. I welcome his thoughts about the research paper, and I invite him to comment here directly because I’m sure my readers would benefit.

      I would like to respond to a couple of his points. First of all, to which paper is he referring when he says it is over a decade old? The Eisenberg review paper that I quote in the post is from 2012. I’ve read the full paper and it references recent research including a 2011 paper from the journal Fertility and Sterility.

      It’s true that the autoimmune idea has been around for a while (since this 1987 paper), but it has by no means been discounted. Quite the opposite. The Eisenberg paper concludes with this statement: “The potential use of immunomodulators should be further investigated.”

      Finally, he says that “Endometriosis never ‘heals’ unless it’s removed by excision”. I wholeheartedly agree that surgery is often necessary. In fact, I state that in my post (so his comment makes me wonder if he actually read the post). I am not saying that immune-modulating treatment will replace excision surgery, but rather than it can be used in conjunction with surgery, and that in my clinical experience immune-modulating treatment is far more effective than hormonal suppression.

      • Hi Lara!!!
        I first want to thank you for this very informative article. I have basically suffered a miserable existence for this past decade secondary to sheer exhaustion, unexplained infertility, “mild” endometriosis (and the surgeon told me I shouldn’t have as much pain as I do with it as I had” and unexplained skin pain and eruptions (i think I’m celiac although the level of exhaustion I have is so severe I don’t even have it in me to run the gammot of tests required that could potentially come back negative because testing is so inconclusive… What was that science based argument against???). I am an RN so I tend to look at things scientifically and autoimmune, leaky gut, malabsorbtion, malnutrition seem so evident that I can’t believe it’s taken me this long to realize. I am at the beginning of of my journey and hope to have some strong guidance through a locally well trusted midwife (who now has her own holistic practice) because there’s so much disputing thoughts that I’m not sure what I should believe (red meat for B12 or no red meat cause hormones?). I have had excision x1 as well as uterine polyp removal x3, each time with more and more polyps identified. While it’s frustrating to say the least that surgery might be the only option to physically dispose of the abnormal tissue, the inflammation always seemed like it was worst symptom (systemic here). I am looking forward to this journey of self care and preventing further damage such as full blown adrenal, thyroid or pancreatic dysfunction (diabetes).
        All this said, have you ever heard of enzymatic therapy, namingly serrapeptase? Say I am able to successfully treat the inflammation, health my gut and actually live my life. Is it really possible this enzyme could come through and sweep out all of the tissue?? I have also read studies where turmeric in conjunction with black pepper reduced the amount of intestinal polyps, so hoping it’s a systemic action rather than local (within the intestines). Just curious of your feedback. Thanks again!!!


        • Hi Elaine,
          I don’t have any experience with serrapeptase so I cannot comment on that. I have seen turmeric do very good things for endometriosis, and I cite a study in the post where they explain why turmeric is a “potent anti-endometriotic compound”. It definitely has a systemic action, but it needs to be an absorbable form like liposomal or Meriva.

          I also get good results with immune-modulating treatments berberine, zinc and selenium, which I discuss in the endometriosis section of my book. Finally, I think dairy-free diet is key for most endometriosis sufferers. I don’t usually restrict meat, as long as it is grass fed and raised without antibiotics

  20. I too agree that diet is critical in managing endometriosis. I have been diagnosed with stage 4 endo five years ago…..with changes to my diet, I’ve been pain free since 2012 and i have never taken medications. I avoid gluten, meat and its by product, processed food, wheat, sugar, dairy and its by product , spices, along with other lifestyle changes. I also take tumeric daily.

  21. Hi Laura, for those women that are trying to conceive, would you recommend the natural progesterone only after ovulation, or throughout the whole cycle is safe?

    • Generally, natural progesterone should be taken after ovulation. If used before, it can act like birth control and suppress ovulation.

  22. Hello, i am really interested in reading this book! I have been put on the waiting list for the surgery of endo, this will be the 3rd time. Anything that could help to prevent it from coming back, i will try! They have put me on primolut ontop of my pill and when its really heavy, i have to take tranexamic acid to stop the bleeding. If theres anything that can help me recover and to stop this coming back? Kim

    • Hi Kim, so far you are only using hormonal treatment (and anti-bleeding treatment). You’re not yet doing anything for the inflammatory/autoimmune aspect of endometriosis. So, if you try immune-modulating treatment, then you are about to embark on a whole new aspect of treatment. It could make a big, big difference. I have patients who have ended up not needing surgery.

  23. I found your blog from the FB endometriosis group. That is interesting to find out that it was an “auto-immune” disease. I have experienced a series of auto-immune diseases and now wondering if someone could be
    a predisposition or susceptibility to auto-immune diseases? I personally agree wholeheartedly that nutrition plays a major part in the treatment of inflammatory conditions. I have witness the impact that diet has on persons who are subject to auto-immune conditions and am an eyewitness to the healing that occurred even when coupled with medication. I know of a condition treated with oral methotrexate in which the patient was not responding to oral medication and it was not until the patient changed their diet and went on no gluten, no dairy, no tomatoes, etc that medication started to work within their system.

    Congrats on your blog. I have not found many blogs of this type talking freely about endometriosis so I am glad you took the time to clearly articulate about this most relevant subject.

  24. Hi there,

    I found this post very accurate base don what I’ve experienced. Medicine had done little to help m manage my symptoms of endometriosis. Excision surgery did help, but long term, the thing that has helped the most if diet changes. I avoid gluten, dairy, soy, red meat, caffeine, and processed foods as much as possible. I also have IC which i control 100% through diet by avoiding foods high in acidity, vitamin c, potassium, or anything spicy. I have lived pain free for two and a half years and I have been able to get back into racing triathlons which i never thought would be possible after years of horrid pain from endo and IC. I’ve recently introduce turmeric into my diet and its wonderful! Thanks again for your post!

  25. Hi Lara.
    I found your post very interested. I have tried many options in diet and take the pill continuously. In combination it has worked well though not perfect, as I get older it seems that my estrogent dominance has changed. If I eat phytoestrogens, I avoid soy, LSA, nuts and seeds in general as my endo becomes painful and I get other PMS symptoms.
    My question is that I have read that turmeric has phytoestrogens, is this accurate? And do you know to what level? As you suggested it to treat a condition based on estrogent dominant.
    Kind regards Eva

    • Phytoestrogens can be beneficial for endometriosis because they generally have an anti-estrogen effect. They’re so weakly estrogenic that they protect and buffer estrogen receptors, and also promote the healthy detoxification of estrogen.

      So, turmeric’s phytoestrogen component is a bonus, but the main reason I recommend it is for its anti-inflammatory effect.

  26. I believe that endometriosis is autoimmune and is aggravated by diet choices, but what diet choices I could never pinpoint. I was diagnosed with endo in 1999 (at age 29 following one natural childbirth in 1995), had surgical laparoscopy followed by drugs that stopped my period entirely and sent me into early menopause for months. I was told that having another child would help my endo, with uterine lining being shed during childbirth- and no periods while pregnant. My husband and I had two more children, and I do believe they saved my life. However, after each pregnancy endo symptoms (unfortunately) returned. I have suffered.

    Over the last three years I have been diagnosed with autoimmune hepatitis and more recently now adenomyosis (thickening of the muscle lining of the uterus from endometrial tissue embedment.) From the adenomyosis my uterus is the size of a 6-9month pregnant woman’s (via pelvic ultrasound and in person), and I literally have contractions (I believe from my body wanting to, but unable to expel the uterus.) I also suffer from fibroids, bad cramping and Menorrhagia. My very recent uterine/cervical biopsy was negative.

    When I reflect on the suffering I have endured over the years, coupled with the fact that I am now not wanting additional children, my immediate desire is to have a hysterectomy. My GYN believes that inserting Mirena IUD could help my symptoms- BUT…and here is the glitch- I have (as I stated) autoimmune hepatitis of unknown origin. Even the Mirena site contraindicates Mirena with liver disease presence. Do you have any recommendations with this set of circumstances? I value your opinion and wish you practiced in the States.

    My GYN has not performed any hormonal blood testing, and I plan to seek that out STAT. In todays day, women must seek out important testing through homeopathic doctors, as traditional medicine is still lacking in many areas. Even in prominent research oriented medical centers, the obvious is sometimes overlooked.

    Thank you for the valuable information you provide, Please let me know if there is a safe direction you can steer me in.

    • Hi Clark6292, in reference to the Mirena. I have endo, have had 3 laparoscopies. After the first 2 I had 2 children (it took until my late 30’s) and then one surgery post children at which time a Mirena was inserted. The pill has never worked well for me so I guess it was desperation that made me agree to inserting a device without more research (plus the idea of no periods was attractive). I was fine with the side effects you are warned about (the bleeding etc) but I also started developing strange things which initially I didn’t connect. I run and post run I would get pain down my groin and leg. This would only last 24 hours but then would happen again. After seeing a physio and osteopath, concluded it was referral pain from my pelvic region. Just like when you are pregnant and all your ligaments are loose that is what was happening. I was also getting continually ‘achy’ legs which is a symptom I get monthly. Have always referred to this as aching bones and just need to pound them but this was now happening continually. I couldn’t find any evidence of this associated with the Mirena but for my sake decided to use the elimination method. It was removed and these symptoms went away. I’m not saying this will happen to others with the Mirena, just often wondered if it is because of the endo my body reacts so bad to the hormones or if things do happen to you like this, don’t dismiss it because like initially happened with me the Dr hadn’t heard of it so said no it wasn’t related.
      Anyway, good luck!

    • Thank you for sharing your story. With two autoimmune diseases (endometriosis/adenomyosis and hepatitis), you could really benefit from an immune-modulating treatment such as I describe in the article (eg. dairy-free, gluten-free diet). Such an approach will help both conditions.

      With regard to Mirena, I think it is worthy of consideration. The severity of adenomyosis that you describe is not an easy situation, and is not likely to dramatically improve with any kind of natural treatment. Yes, Mirena is a synthetic progestin, and that’s why it has to list all the standard precautions for synthetic hormones (including the liver precaution). But Mirena is a much lower dose than the Pill (about one tenth the dose), so your doctor may believe that the low dose is not going to a be problem for your liver (you could just ask her about it).

      Because Mirena is low dose (and because it permits ovulation), I think it is better than other synthetic hormones, and is sometimes helpful. Put it this way: If your choice is hysterectomy or mirena, I would lean towards Mirena. But of course that’s a choice for you and your doctor.

  27. Hello Lara,

    I’m so grateful to have found your blog! Thank you for the time and effort you’ve put into it. The information is wonderful. I was diagnosed with endometriosis at 17 through laparoscopy and have explored many treatments. Now at 28 years old,I stopped the Pill approx. 5 mos ago (after nearly 10 years) as my husband and I decided to try to have a baby. I’m excited to follow your above recommendations for endometriosis. However, anything different I should do if I’m trying to conceive? I also was intrigued by your PMS solution post. Again though, anything to be wary of due to endometriosis?


    PS – Does your book have a section on endometriosis as well?

    • Hi Morgan, thanks for your comment. Yes, the diet changes and supplements (for endometriosis and for PMS) are safe when you are trying for pregnancy (but you should stop turmeric tablets once you are pregnant).
      Yes, Period Repair Manual does have a section on endometriosis. 🙂

  28. Most recent studies show it isn’t retrograde menstruation, since it doesn’t really “spread,” but will grow back in the same places time and again if it isn’t excised properly. Instead, they are finding that the Endo markers are laid down before birth and flare up with hormones. Great advice though. I noticed a huge difference going dairy free and I try to eat as anti-inflammatory as possible.

    You can follow several patients and doctors on a few different Facebook pages. I’ve learned a ton regarding research, best practices and road blocks to service. Here are just some of the pages: Nancy’s Nook Endometriosis discussion and education, EndoMetropolis, Endometriosis Research Center’s Diet & Nutrition Sub-Group, Endometriosis Research Center Fitness Group

  29. I find the auto-immune/inflammation connections just a fascinating area of research. Coming up more and more.


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