Endometriosis? Treat the Immune System

endometriosisEndometriosis is not a hormonal condition. It’s affected by estrogen but it’s not caused by estrogen or “estrogen dominance.”

Instead, endometriosis is a whole-body inflammatory and immune disease, and possibly a microbial disease.

What does that mean for treatment?

For one thing, it means that contraceptive pills and injections are basically the wrong tools for the job. They can relieve symptoms for some women (which is good), but there’s actually no clear evidence that the pill works for endometriosis.

Natural hormone-balancing treatments are no better. In my twenty years as a clinician, I have never seen that natural modulation of hormones with herbs like Vitex can do much, if anything, for endometriosis.

The future of endometriosis treatment is immune treatment. Let’s take a look.

Causes of immune dysfunction in endometriosis

Researchers are still debating whether endometriosis is, in fact, an autoimmune disease. Certainly, endometriosis is similar to other autoimmune diseases, but at the end of the day, it probably doesn’t matter whether it’s officially classified as an autoimmune disease or simply an immune disease.

There’s very little doubt that immune dysfunction is at the heart of what is going on. Immune dysfunction is what prevents the immune system from clearing up endometrial lesions; it’s also what promotes the growth and invasion of those lesions.

So, the big question is “what is causing the immune dysfunction?” And it looks to be a combination of the following factors:

The bacterial contamination hypothesis of endometriosis

Women with endometriosis have a high level of gram-negative bacteria in the pelvic microbiome and researchers think that the toxin LPS (lipopolysaccharide) from those bacteria could play a role in the development of the disease.

The most likely source of gram-negative bacteria in the pelvis is translocation from the gut. In other words, the movement of bacteria or bacterial toxins from the gut, which is more likely to happen when there is small intestinal bacterial overgrowth or SIBO causing intestinal permeability.

👉 Tip: The link with SIBO could be why a low FODMAP diet relieves symptoms of endometriosis.

LPS stimulates immune cells to release inflammatory mediators and is a known inducer of inflammation and immune dysfunction.

There are a few more lines of evidence that bacteria could be a driver of endometriosis:

None of this means that bacteria directly cause endometriosis; only that bacterial toxins drive and worsen the disease in combination with other factors.

One possible scenario is this:

  • The presence of endometriosis lesions.
  • PLUS an immune system that is vulnerable to dysfunction either because of genetics or epigenetic changes from toxins (or both).
  • PLUS the natural surge in estrogen that occurs with the menstrual cycle.
  • PLUS the presence of gram-negative bacteria and LPS toxin.

So, in addition to surgical removal of the lesions (which I support), what is the best immune treatment strategy?

Treating the immune dysfunction of endometriosis

Strictly avoid gluten and A1 casein

Step one is to calm the immune system by strictly avoiding immune-disrupting proteins like gluten, A1 casein from cow’s dairy, and possibly eggs. Unfortunately, it’s not sufficient to partially avoid these foods because even a small amount of casein or gluten can generate inflammation for days or even weeks.

According to reproductive immunologist Dr. Jeffrey Braverman, most women with endometriosis have the genotype associated with celiac disease.

Consider an immune-modulating supplement

Step two is to take one or more of the immune-modulating natural medicines that are being investigated for endometriosis. They include:

For more information about endometriosis supplements, see Endometriosis: 5 Natural Treatments That Really Work and Period Repair Manual.

Consider a course of a herbal antimicrobial

The herbal medicine berberine seems to work for endometriosis and I think it’s because it reduces levels of gram-negative bacteria and LPS toxin. It has not yet been studied for endometriosis but it has been studied for adenomyosis, which is a similar disease. In one study, researchers were able to demonstrate that “berberine ameliorates the LPS-induced progression of adenomyosis.”

Berberine is best used under the care of a clinician as it can interact with other medications. For more information, see Period Repair Manual.

Reduce mast cell activation and histamine

Mast cells are important players in the immune system and the immune dysfunction of endometriosis.  Mast cells are also highly sensitive to estrogen.

For more information about estrogen and reducing mast cell activation and histamine, read The Curious Link Between Estrogen and Histamine Intolerance.

Natural hormonal treatment for endometriosis

I do not prescribe hormonal treatment as front-line treatment for endometriosis. But I do consider it as second-line treatment.

Estrogen-reducing supplements such as calcium-d-glucarate can be helpful because estrogen strongly stimulates endometriosis, particularly in the presence of the LPS bacterial toxin. The best plan is to first reduce bacterial toxin and inflammation, and then think about reducing estrogen.

Natural progesterone directly suppresses endometrial lesions and also helps to normalize immune function. Progestin drugs such as Visanne, hormonal IUD, and birth control pills can suppress endometriosis, but so does natural progesterone and with fewer side effects.

This post is in honor of Endometriosis Awareness Month and is dedicated to the 1 in 10 women who suffer this terrible disease.

Have you tried immune treatment for endometriosis? Share your story.

Dr Lara Briden

96 thoughts on “Endometriosis? Treat the Immune System”

  1. Vitex has been my life saver. I am diagnosed with endometriosis, but it’s vitex that finally gave me the relieve that surgeries couldn’t. I have been taking it for years, at least 2x a week along wtih other herbs.

  2. Hi! My name is Jessica and I have benefited a great deal from Lara Biden‘s book “The Repair Manual.”
    I have been avoiding dairy and taking supplements to try to alleviate the pain of my periods. I am considering having a scope done to determine for sure if I have endometriosis or not and also to have her remove any lesions she finds. I am concerned about the potential risks of surgery and how likely it is that I might have scar tissue that occurs. I would rather have only the pain from my period than ongoing pain from scar tissue. Is there any info out there on the likelihood of that or testimonials from other people who have had endo surgery. Also, my doctor uses a combination of excision and cauterizing. I would be interested to know what your thoughts are on that type of surgery? I also am having a hard time determining how skilled I gynecologist is in endometriosis surgery. Do you have a framework for evaluating potential surgeons? Currently I am scheduled for surgery but I’m debating about whether or not I’m going to go through with it. Thank you for any info!

  3. Hi Lara!
    I first heard about you after I began to do some of my own research about endometriosis. I listened to a podcast where you talked about endometriosis and treatments for pain. I decided to cut A1 casein dairy products and noticed quite a big difference. I also started several supplements that you recommended and also noticed a difference in my pain level. I cannot tell you how appreciative I am of your work. My gynecologist and I are discussing the possibility of a laparoscopic surgery to remove some of the endometriosis. I know in your book you discuss only doing excision surgery. I was wondering if you could explain why you recommend excision only surgery? Also, I’m very worried about scar tissue causing me permanent pain. How likely is scar tissue to occur during a laparoscopy where endometriosis is removed? What causes the scar tissue? My gynecologist uses both excision and cauterization when she works with endometriosis. I value your opinion about that. Is it bad to have cauterization? I’m still on the fence about whether or not to go through with the surgery.
    Thank you so much!

  4. That was possibly the most helpful information regarding my “problem” I have ever received. Feeling helpless and without direction just to try and get better.

  5. Hi Laura, is there a connection between a ureaplasma infection of the cervix and endometriosis? I cannot thank you enough for all your great work!!

  6. Hello Doc 🙂
    Hoping you will answer me to get an advice. I will shortly tell my story.
    I am 30 years old.
    I was diagnosticated with endometiosis 1 year ago. Left ovary 4 cm endometrioma. Right ovary 3 cm endometrioma.
    Now, me and my husband want to concieve a baby so I am taking some suplements recomanded from a naturopat like:
    – in the morning: vitex, jarro-dophilus, serrapeptase, Q10 Coenzyme, BroccoMax/Calcium D-Glucarate
    – at noon: serrapeptase, Q10 Coenzyme, BroccoMax/Calcium D-Gkucarate.
    – in the evening: Omega 3, Magnesium, Selenium, D3.
    What do you think?
    Should I consider the surgery to remove those endometriomas ? Or do I have chances to get pregnent without the surgery?
    Thank you

  7. Hello Dr. Briden,

    Thank you very much for this article. It was very informative. But now I am not even sure if I really have endometriosis. I have had surgery and the diagnosis that I have endometriosis. But the surgery was done because there was a cyst that did not disappear on it’s own and which was instead growing. I have always had a very constant period )almost every 28 days) and I never took the pill until the diagnosis. I had very normal period pain, which went away after I took ibuprofen 400 and for the rest of the month I was pain free. Completely. I never was in pain. So how is it possible that I have endometriosis? Do you think, the doctors made a mistake? I do not want to take birth control anymore. The pills are making me crave sugar, I gained a lot of weight, and I suddenly start crying out of nowhere, I have also had severe back pain since I had surgery and began taking the pill… My doctor says I have no other choice though.


  8. Hi Lara,

    Thank you so much for sharing this information. I have been struggling with endometriosis and a smattering of hormonal symptoms for the past couple years. I had excision surgery by an expert surgeon a year ago (he found some endo, but not much), but I still struggle with hormonal imbalance, presumably after being on the pill for years and then trying multiple other hormonal therapies since then. I have the Kyleena IUD but am considering adding/switching to natural progesterone for a more systemic therapy. That said, I’m wondering how much natural progesterone I’d need to take (and how often) for it to be effective.

    Thank you again!

  9. I’m not sure if you would know, but my nursing son is HIGHLY reactive to dairy in my diet. I am 100% dairy free for him, but reading your article, I wondering about A2 dairy. Do you know of any information or resources to point me to? I’m going to do a Google search as well. Thank you

  10. Hi Lara,

    I’m at a bit of a loss as what to do and am wondering if you can help with some advice in relation to Adenomyosis?

    I have been reading your book as I decided to go off the pill in February as I was very moody, had a low libido and was honestly just sick of being on it!

    Once going off I got my period every two weeks and once my period went for ten days.

    My doctor thought it might be my body readjusting itself to life off the pill but I went to see a gynaecologist and get an internal ultrasound.

    That was when I got the diagnosis of Adenomyosis. The gynaecologist suggested I go back on the pill to manage the pain/period and also to stop endometriosis occurring.

    I wasn’t sure whether I wanted to do this because I wanted to manage things naturally. I have now had my period for 14 days and the pain is awful!

    I didn’t really want to go back on the pill but I don’t want Adenomyosis to develop into endometriosis.

    I’m 31, no kids, no miscarriages and no issues with my period since going off the pill.

    Any advice you can give would be really beneficial.

  11. Hi Lara, is it safe to consume Maca powder while taking Visanne and Levelen for treatment of endometriosis? I’ve been taking Visanne and Levelen for 3 and 9 years respectively now with great success and nil symptoms. A friend recommended Maca powder and I wouldn’t want to mess with things or it to react with the efficacy of Visanne and Levelen. Can you advise if it is safe to consume Maca powder?

  12. Are estrogen reducing supplements safe for someone who cannot take pharmaceutical hormones? I had a pulmonary embolism caused by the nuva ring in 2007 and haven’t been able to take anything like that ever since. I am so nervous about taking anything relating to hormones ever since then. I have SEVERE endometriosis and had a partial hysterectomy about 7 years ago. About 3 years ago I had surgery for a 7cm endometrioma in my c-section scar. I know I need surgery again because I recently had the worst flare since before the hysterectomy. I am doing my best to avoid surgery for as long as possible and am looking for an alternative in the mean time. The right side of my lower abdomen literally sticks out a few inches further than the left, so I know it probably won’t be long, unfortunately. This is a terrible, wicked disease.

  13. Dear Lara,
    How much turmeric/curcumin do you recommend? and for how long?
    Also do you have type of capsule to recommend? should there be other “things” in these tablets?
    I was looking at Curcudyn. As I haven’t found a naturopath (living in Belgium) who knows enough about a natural approach to treating endometriosis yet…
    Thank you

  14. Just realized that the term “endotoxin” gets a new double meaning in this context, not standing only for LPS but also “toxic for endo (metriosis)”. I just discovered another related paper speaking of the “Endobiota”, another great term (but maybe a bit too early according to the current state of research ;)). https://www.nature.com/articles/s41598-019-39700-6

    Do you know a good paper/review about the microbiome related to histamine intolerance/mast cell activation? I am a scientist and currently doing my PhD in clinical microbiology/biofilms and am so interested in this topic as I have endo myself. Thinking about setting up a research project in this field….

    Thanks so much for all your work and information, it is so helpful and gives hope for future treatment of endometriosis.

    Many greetings,
    Lara (I am in Nicole’s apprenticeship and was asking about the microbiome/endo also 🙂 )

    • Thanks so much for commenting. Off the top of my head, I can’t think of a review paper about microbiome and mast cell activation but I suspect they exist. Are you on Twitter? I’d like to keep in touch. I recently spoke with a Sydney microbiologist who is doing a research project into endometriosis and the pelvic microbiome.

  15. Hello! There’s lots of good information here and I find the LPS theory really interesting. There’s definitely a lot of moving parts and it’s hard to say what causes the disease in each case.

    One thing I do have to say though is that progesterone does not suppress all endometrial lesions. In particular, endometriomas are shown to not be reactive to progesterone at all, hence why the condition can continue to get worse even with hormonal treatment.

    • thanks for commenting.

      And, yes, endometriosis lesions can definitely have “progesterone resistance” but I’ve never seen that natural progesterone (oral micronized progesterone) can make them worse. Estrogen-based birth control can though.

  16. Hi Dr. Briden,

    I recently discovered your work and am so grateful. After considering the symptoms I’ve had since I was 10 (my first period – I am now 40, with symptoms over the past year+ that are controlling my life), a pelvis MRI, and family history, my ob/gyn thinks that I have endometriosis. She gave me the usual options of surgery, hormones, or some combination of the two, and I want to explore some other things before I go down that road.

    I’ve also been diagnosed with fibromyalgia, IBS, and anxiety, and after reading several of your posts and work from other practitioners I’m thinking they are all related. I’ve started reading your book, and while I already don’t consume gluten or dairy for the most part, I’m going to eliminate it completely (along with eggs as much as possible) as well as focusing on a low-histamine diet. I’ve stopped my probiotic (had a lot of lactobaccili and bifidobaceterium) and will start with the daily 30mg zinc picolinate as soon as it arrives.

    My question is regarding the herbal microbial for SIBO. Does it make sense to go ahead and try an herbal remedy for it on my own, or should I be working more closely with a doctor before trying it? My preference is to work with a medical professional on this, but my ob/gyn is not open to this and I haven’t had much luck with my general physician either. I was thinking of trying the Microb-Clear product from Amy Myers, as well as her Primal Earth probiotic.

    I’ve also decided to go ahead and schedule the laparoscopy to get a clear diagnosis and remove any visible endometrial tissue. Should I put off some of the steps above until after the surgery, or go ahead with everything with the surgery potentially in the middle of it all? It hasn’t been scheduled yet.

    – I’ve been seed cycling for about 10 months, and it seemed to address my ovulation pain for about 8 months but not so much recently. No reduction in period pain, length or volume.
    – I’ve had a few visits with an acupuncturist, who was very alarmed about my large clots during my period, and has me taking some TCM herbals along with weekly visits (I’ve had 4 visits, with only 2 focused on reproductive health – and none in the past month due to health and scheduling conflicts) – and I noticed that my clots have disappeared along with the pre-flow dark spotting (I thought this was a good sign).

    I guess my questions there are regarding whether it makes sense to continue with seed cycling, and whether I should continue with the acupuncture and herbals that she recommended or whether to stop all of it while I’m dealing with the laparoscopy, zinc, diet changes, and potential SIBO treatment.

    Thanks so much for all you do,

  17. I’ve been diagnosed with both PCOS (based on symptoms and insulin resistance) and endometriosis (based on laparoscopy), and to some extent, the conditions seem at odds with each other. However, I’ve had the PCOS symptoms since puberty whereas the endometriosis didn’t flare up till my mid 20s. Trying to cope with the symptoms of both and consider treatments is really stressful, and I worry about the long-term effects of both on my health.

  18. Yes. I had one ovary removed 4 years ago bc of an endometrioma. Got the other one removed when I had my hysterectomy. I feel soooooo much better. I use a natural progesterone every day. I don’t have hot flashes and haven’t had any trouble sleeping. My testosterone is super low and my labido could use some help. Lol. What are your thoughts on Bio T testosterone pellets?

    • Progesterone also has bone-building benefits so that’s a consideration. (ie. progesterone can help bones. Even if it turns out you can’t tolerate estrogen.)

      I’m wary of testosterone supplements because they can cause weight gain.

  19. Love this Lara – thank you! What kind of therapeutic dosage do you recommend of Berberine? I use a herbal Throne product for urinary support with 300mg per serve.

  20. I’m 43. Had a full hysterectomy in October. Dr found endometriosis all over. It was covering my ovaries. I had adenomyosis too. My endocrinologist wants me on estrogen therapy for bone health. I don’t feel good when i have estrogen. What do you suggest to your younger patients for HRT after hysterectomy?

    • so, your ovaries were removed as well? I do think that estrogen is very important for bone health. But, there is a chance that it can flare existing endometriosis lesions.

  21. Hi! I am curious as to why you do not see vitex as an appropriate supporting herb for endo. There are some studies showing that this herb can stimulate production of melatonin, which I see you recommend as an immune-modulating supplement. Since Vitex can act on the brains opiod receptors for pain, reduce uterine bleeding and inflammation, and reduce occurence of fibroids, in addition to being a potential anti-viral, could it not provide some relief to sufferers of this condition? Is it due to the hormone modulating effects that you do not recommend vitex for use with endometriosis? Thanks for the article and your help!

  22. …and antiphospholipid syndrome confirmed. What about heparin/apixaban/low dose acetylsalicylic acid and endometriosis? What painkiller do you recommend? NSAIDs have no effect.
    Thank you.

    • I’m 30 and I had a laparoscopy 5 years ago – pelviperitoneal endometriosis, deep infiltrating endometriosis, ovary teratoma. I have severe pain for 15 years, but had worsen since the surgery -2 weeks/month now . I also have digestive and urethral endometriosis, horror sacral pain and suspected for lupus and other autoimmune diseases.
      I don’t know what to do!
      What about Plaquenil and endometriosis? I now have normal estrogen levels , but high inflamation and antibodies.

  23. oops, I meant to post my comment here as a reply and not as a new comment.

    So, my understanding of your hierarchy of meds (if natural only treatments aren’t enough) is:
    1) Prometrium
    2) Visanne
    8) Conventional bcp (fake estrogen + progestin)
    9) Orilissa
    10) Lupron – would you say a GnRh Agonist is worse than a GnRh Antagonist? If so, why?

    Is this correct? If not, do you think you can list the most common drugs from best to worst? I’ve tried several different drugs and would prefer to try the ones with the least side effects first. Thank you so much for your reply. 🙂

    • I would also put the hormonal IUD in there, so maybe:
      1) Prometrium, 2) Mirena or Skyla IUD, 3) Visanne..
      Then, yes, the pill and the GnRh agonists and antagonists nearer the bottom of the list. I don’t have a lot of experience with agonists and antagonists, but yes, my understanding is that Orilissa is gentler than Lupron.

  24. So, my understanding of your hierarchy of meds (if natural only treatments aren’t enough) is:
    1) Prometrium
    2) Visanne
    8) Conventional bcp (fake estrogen + progestin)
    9) Orilissa
    10) Lupron – would you say a GnRh Agonist is worse than a GnRh Antagonist? If so, why?

    Is this correct? If not, do you think you can list the most common drugs from best to worst? I’ve tried several different drugs and would prefer to try the ones with the least side effects first. Thank you so much for your reply. 🙂

  25. Dr Briden, What do you think of Orilissa (new GnRh Antagonist approved by FDA last year) for severe endometriosis? How does Orilissa compare to Visanne in terms of efficacy and side effects?

    • GnRh antagonists and progestins like dienogest (Visanne) and entirely different sorts of drugs.

      Elagolix (Orilissa) completely shuts down hormones and induces a strong temporary menopausal state. It, therefore, produces menopausal symptoms such as hot flashes, night sweats, insomnia, anxiety, and pretty serious loss of bone density. Not a nice drug, and one that I would consider a drug of last resort.

      Dienogest is a progestin drug and so causes typical progestin side effects like anxiety. See my blog post The Crucial Difference Between Progestins and Progesterone. And see Hannah’s patient story in Chapter 9 of Period Repair Manual. She ended up using Prometrium (natural progesterone) rather than Visanne.

  26. What are your thoughts on Lysteda? I am 47 and started in January with irregular, flooding periods. Went on a short course of Progesterone to stop the bleeding. Now the doctor has ordered Lysteda to take as needed for heavy bleeding. I am concerned about the side effects.

  27. Thank you Lara!!
    I found your blog about a year after having surgery to remove as much endometriosis, adenomyosis and adhesions and insert a mirena in 2016. I also had confirmed PCOS with elevated insulin levels despite being fit and having a heathy weight. Prior to that I had tried naturopathy, acupuncture, the OCP and diets recommended by various professionals. I myself am a midwife, so I felt I had fairly good knowledge about women’s health.

    The surgery helped with some bladder pain (due to adhesions) and the mirena dealt with the menorrhagia. However I still had loads of pain.

    Then I found your blog. All I can say is thank you, thank you, thank you!! I began a gluten & dairy free diet & decided to stop working shift work to reduce stress & therefore inflammation in my body. I took tumeric, zinc & magnesium for the first 6 months as well.

    I can honesty say that making these changes has meant that now I have PAIN FREE PERIODS!!! I had been praying for this for 15 years!! Sometimes I have a small twinge of pain if I haven’t been strict on avoiding all gluten/dairy, but I never need any analgesia, which is a huge change from the past when I needed constant pain killers.

    So, thank you for sharing your knowledge on your blog. I hope that my story will encourage others also to give a gluten/dairy free diet a go in the quest for a happier body!

    Thanks again!

    • Nice! You said you had elevated insulin levels…diet works for this. And what about Celiac Disease? You are lucky indeed! What kind of endometriosis do you have? What stage?

  28. Dear Lara Briden,
    I’m 28 years old (from Berlin, Germany) and only recently stumbled upon your Instagram profile. After having read some of your articles on Endometriosis, I ordered your book “Period Repair Manual” and devoured it within a few days. My period or rather my hormones have been a constant source of sorrow for me during the last years, since I was diagnosed with Endometriosis in 2017. I’ve been suffering from serious period pains that got worse every month for about half a year. During this time I went to my doctor 4-5 times and repeatedly told her about my symptoms and that I felt they were NOT normal, but it took three more months until she finally referred me to an Endometriosis specialist since I insisted on having it tested. I had stopped taking the pill about two years before, since I suffered from depressions and did not want to take hormones anymore. Nevertheless she tried to persuade me to start taking it again instead of considering my worry, that I might suffer from Endometriosis (my mother’s cousin suffered from it, too, so I got suspicious).

    The specialist I went to afterwards confirmed my assumption and recommened an operation, which I did. After the operation in April 2017 I was diagnosed with a light Endometriosis with stage 1A that was removed during the operation. After this I took Visanne dienogest for three months and then stopped taking it. The following year my period was very regular (every 25-28 days) and I did not suffer from period pains anymore. Nevertheless my doctor recommend me to take hormones again, especially since I had not planned to have children during the following three years, for otherwise having children would be hard or impossible. Still I did not take the pill again. In the second half of 2018 the period pains started to come back and I had to take pain killer again to get through the day. I was upset upon the prediction of not being able to have children after three years, so I went to another doctor again, to have a second opinion. She tested my hormones to make a fertility check and then told me that my AMH was unusually low for my age (under 2,0 already) and that I should consider to freeze eggs since she cannot guarantee my fertility for a longer period than 1-2 years. In the end she recommend me the Visanne again as a treatment for my Endometriosis and also as a measure to “calm down” my period to slow down the whole process, although she also told me that the pill cannot prevent the decline of egg cells. I’m very desperate since I definitely want to have children, just not right now. I feel uncomfortable with taking the Visanne and also with freezing eggs, since it implies taking highly dosed hormones as well. Nevertheless I started taking the Visanne again two months ago, since it seemed to be the only possible relief for my monthly pains. I started believing that taking hormones might be the only option I have (although I feel depressed again), until I discovered your book that gave me new hope.

    Now I want to try out changing my diet according to your recommendations and taking natural supplements instead of Visanne. But I have a few questions: How do I make sure to get supplements of good quality and should I start taking all at once (e.g. curuma, zinc, magnesium and vitamin B6)? Does the diet only work if I do it 100% strict and will it be ruined if I happen to consume one milk product in a month? I’m afraid that having my normal period again will somehow weaken my fertility since I was told that the pill somehow “pauses” the whole process. Everything you write corresponds 100% to the intuition I had during all those years, but unfortunately for all the doctors I have met here in Germany, the pill seems to be the one and only solution for everything. Thank you for your work!!!

  29. Hello Lara, in regards to PCOS which kind of cinnamon are we supposed to supplement? Is it Cassia or Ceylon? I’m so confused! Thank you!

  30. Hi Lara,

    Thanks for all your tips! Unfortunately I have stage 3 DIE endometriosis (30 years old). I had one surgery, I’ve tried many plant extracts for 15 years, alternative therapies and mild sports that only alleviated my pain for max 2 months. What about endometriosis and lupus , myasthenia and other autoimmune diseases? It seems I might also have one of those…or endometriosis took the lead?! I read some articles on pubmed about 2 cases of endometriosis in MEN – interesting! So it’s about stem cell differentiation and proliferation? Do you recommend Plaquenil, cortisone?

  31. Hello Lara,
    I’ve been struggling with Insomnia related to my cycle for the past two years and am dumbfounded on what to do, I have tried most things at this point and to no avail!

    A few months back I was able to see a doctor and she told me that I was just stressed and prescribed melatonin and exercising. Even though I had already been exercising and tried taking melatonin prior to seeing her.

    I experience this sleeplessness during the week before my period, as well as during my period, and even around the time I’m supposed to be ovulating..that’s a lot of no-sleeping. After doing hours of research on it I’m frustrated to say the least. I really do feel like I’m doing and have tried everything I can.

    I know you are against going on the pill, but I’m really starting to think that it might be my only option after trying for so long. Would you mind sharing your thoughts on this? Thank you so much in advance.


  32. Dear Lara,

    Do you think cycling Evening Primrose Oil would work the same or similar to Dr. Prior’s Progesterone approach to slow down the rapid fire of GnRH and LH? Would love to hear your thoughts on this! Thank you!


    • No, I can’t think that it would. And just to clarify, her protocol is for PCOS, not endometriosis. (I only mention it because we’re commenting under the endometriosis post)

  33. Hi Lara, thank you for all your advice and your wonderful book. Your advice means so much to those of us pursuing a natural cure for this disease. I wanted to share what has worked for me – taking vitex has reduced my pain by 80% and also relieved my PMDD symptoms. I am oestrogen dominant (have had bloods done) with both low progesterone and high oestrogen.
    Can I ask a question re gluten & dairy – I have had food sensitivity tests done and do not have a high reaction to these foods. Do I still need to strictly avoid them?

  34. This all makes so much sense. I have severe endometriosis and now that I know it’s auto-immune related I’m wondering if it is somehow linked to my skin issues. I developed syringomas on my face (on the skin beneath my eyes) right around the time I started menstruating at age 13. They have never gone away and the dermatologist said there’s nothing they can do since they are swollen glands. In my 30s, I developed a few more on my face. Do you think my syringomas are related to my endometriosis in some way? Do you know of any treatments to get rid of them? I’ve been able to manage my endo symptoms by implementing the treatments you suggested in your book (thank you for that!), but I’ve not been able to decrease my syringomas.

  35. This is excellent! I don’t have endometriosis but I kept getting recurrent infections that I’m pretty sure were caused by leaky gut and your statement about translocation from the gut stood out for me.

    It took me awhile to figure it out and I was on one heck of a journey to investigate what was going on. I consulted with a naturopath first — but ultimately I took organic oregano oil by mouth (via gelatin capsules) for 10 days which I’m pretty sure killed off the nasty stuff in my gut. Then I had to clear out my womb — I used castor oil packs over the abdomen and after using these 2-3 times per week I was totally healed.

    I also think I cleared a lot of stuff out my kidneys and liver too, and my entire cycle changed, my breasts were less dense, and I didn’t have nearly as many issues with PMS and breast tenderness. I am thinking of going for new blood tests to see if my hormones are in balance again, along with my cholesterol and thyroid function. I feel like new person, and I’m definitely glad to be healed.

    Thank you for this post 🙂 xo

    • Hi cespringer, thank you for your comment. I am very happy for you being able to regain your health. Could you please share the brand of oregano oil and dosage?. For how many weeks did you use castor oil packs?
      Thank you very much!

  36. Hi Lara, very interesting article. I recently was diagnosed with endometriosis and Dermatographia. First I didn’t think any relation between the two but after reading your article, it make sense that they are related. Doesn’t your book talks about histamine intolerance and treatments?

  37. Wow! This is a whole new world to me. I have been receiving two types of treatment so far. My natural fertility advisor has had me taking Vitex, maca, inositol and neprinol (serrapeptase type ingredients) and my kinesiologist has had me on all kinds of amino acids, and a few specific strains of probiotic. I was worried that i’d wasted a whole lot of money, but maybe the two have worked symbiotically as my symptoms have improved quite a bit!

  38. Thanks so much for this article! I have suspected endo and IBS. Every day I have mild cramps and then for the first day or two of my period severe cramping and vomiting. My friend had told me that that would indicate it’s got to the point where I need a laparoscopy. But I’m trying to reduce the pain and inflammation with diet first. I’ve recently cut out gluten and dairy and I’m reducing sugar too. Is there anything else I should be cutting out from my diet? I’m still in the trial and error phase and I find I react a lot of all different foods (even potato) when I never used to. Any advice would be great.

  39. Hi Lara, I have severe endometriosis and stopped the pill 3 yrs ago. I haven’t had my period in about 7 yrs or so (except for the odd once off tinge of pink on the toilet paper every now and then – maybe once or twice a year). I don’t have any symptoms of endometriosis. And I have been taking my temperature for over a month now and I haven’t ovulated so I am assuming I don’t ovulate regularly (I am still taking my temperature to find out). I have no clue what’s wrong with me and neither do the doctors. They say that I don’t have PCOS so I feel like I’m a lost cause and can’t get help anywhere. Is there anything I can do or anyone you know of that could help me, I live in Melbourne. Thankyou XX Anj

  40. Dear Ms. Briden,
    Thank you for this website. I have the good fortunate of not suffering from endometriosis – and have had a life of straightforward female health – no PMS, easily birthed two children, and the worst I’ve suffered is hot flashes over the last ten years in post-menopause, which I am realizing are probably histamine intolerance. However, I most look forward to reading your book because:

    1. I have a 63-year old sister who has been, after a hysterectomy fifteen years ago, controlling severe dispersed endometrial pain with hormonal blockers – fumara and levonogestrol. The poor quality of foreign-made pharmaceuticals combined with no temperature controls during transport plus their cost is a huge nightmare. I am trying to encourage her to look at her condition more holistically. Where would you start?!

    2. My 29-year old daughter has also suffered from PMS, now controlled by birth control pills – and as I fear that she might have/end up with endometriosis, I will be sharing your book with her.


    • Translocation means moving through the intestinal wall into the pelvis. In other words, intestinal permeability or leaky gut.

  41. I have endo and yet my inflammation markers have always been pretty low (good). How is then Inflammation seen and proved on endo patients?

    • As far as I’m aware, there is not yet a clinical test to detect the kind of inflammatory cytokines and abnormal immune function that researchers have documented with endometriosis. For example, one of the markers is “anti-endometrial antibodies” and that is not a test that clinicians can order.

      Most of my endo patients have relatively low levels of basic inflammatory markers like CRP and ESR but they test positive for ANA (anti-nuclear antibodies) and often thyroid antibodies.

  42. Amazing and very informative article. I myself was suffering from endo for almost 20 years and this article now really makes sense to all the symptoms I was having. You are the best

  43. Hi,
    I am currently taking 100mg Prometrium/10 days during my luteal phase to help with flooding and heavy clotting. So far, it has been unsuccessful. I’ve been having heavy periods since delivering my stillborn daughter via c-section 6 months ago. My doctor did an ultrasound since and determined that I have extra blood flow going to my uterus since the c-section.
    I also have stage 3 endometriosis, hypothyroidism and two thrombophilias (PAI1 and Factor V Leiden).
    I’ve been suffering with severe bouts of hives/angiodema as well for 9 years. I’ve told multiple doctors that I feel it’s related to estrogen (when I came off of birth control it calmed down for a couple of years), but no one has ever taken me seriously. This is always worse mid cycle and on both ends of my period. I’ve cut all added sugar and A1 dairy. Do you have any suggestions on what else I could do to lighten my periods?

  44. Hi Lara, thank you for this informative article. Can I combine NAC with turmeric and Berberine? Thank you very much!

    • yes, but ideally speak with a clinician before using berberine. As I describe in my book, I don’t usually prescribe it for longer than eight weeks.

      • Thank yo very much for your answer. My clinician prescribed berberine as one of the products to treat the yeast based on my last stool analysis. She wants me to take it for three months in the following way: first month: every other day, second month – twice a week, third month – once a week. Do you think this schedule will be effective for endo or is it better to take it for 8 weeks every day? Your clinical experience with endo is important for me, as my doctor specializes in allergy. If your advice is different from what she recommended I will discuss it with her. Thank you very much!

  45. Hi Lara,

    Thank you for your articles about endometriosis. I have an endometrial cyst on my left ovary, it got smaller after taking Visanne for 18 months. In November’18 I stopped Visanne and I started taking NAC, vit C and Omega 3.

    I take NAC 3 consecutive days per week, 3 times a day x 600 mg. My periods are really ok now with less pain. I have two questions: for how long can I continue to take NAC safely and there is any chance for my cyst to disappear with the NAC treatment (in Dec’18 it had 3 cm).

    Thank you,

    • NAC is safe for long-term use, and it should also be safe to take every day. Is there a reason you’re taking it only 3 days per week?

      • Thank you for your reply.

        I have read this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662115/

        NAC (Angenerico S.p.A., Ancona, Italy) was administered to patients for 3 months according to the following schedule: 600 mg three times a day, three consecutive days a week (Nactivia procedure, PMVENIRE, Stockholm, Sweden).

        If I take NAC daily how much is recommended: 600 mg is enough or more?

        And what about the endo cyst that I still have? Do you know any other effective treatment to reduce the size of it?

        Thank you in advance for your help and support,

  46. Thankyou for this very informative article Lara. With avoiding eggs, do you recommend permanent avoidance? Or reintroducing after a period of time.

    Also, are you able to provide some insight into how to treat persistent Candida non-albicans? Possibly in a separate article? There is so little information and GP’s are unfamiliar. Thankyou again.

    • I usually start with cow’s dairy and gluten. And only consider eggs if there has been no improvement. Or if there are obvious egg sensitivity signs like childhood eczema. IF removing eggs reduces pain, then yes, it would probably have to be permanent. Or at least until there have been at least six months with no pain.

      I don’t have experience treating non-albicans candida but for standard recurrent yeast infections, I often prescribe saccharomyces boulardii or vaginal probiotics (Lactobacillus reuteri GR-1 and Lactobacillus rhamnosus RC-14). It’s also worth noting that contraceptive drugs can promote yeast overgrowth.

  47. Thanks for your very timely post on this topic! I have just spent the day re-listening to your podcasts on endo after a frightfully scary period in which I bled heavy with clots for 20 hrs. I could easily be one of the ones you mentioned who lost upwards of a cup of blood. I couldn’t leave my bed except of course to use the bathroom. Today I just had a severe headache, and felt very weak, but I am reviewing your book and getting back to strict diet and supplement protocol. All this and I just turned 50; I was hoping I was DONE….. Anyway, regarding this article, a while back I tried to take Oregon Grape Leaf instead of the Berberine as it’s cheaper, and still has berberine in it. I believe it did help. Any thoughts on OGL?

    • Flooding periods at 50 years old is more than an endometriosis problem. It’s also the unopposed estrogen situation of perimenopause and it usually requires progesterone. Do you have the new pink version of my book? Please refer to Heavy Periods section in Chapter 10 (the perimenopause chapter). There, I refer to Professor Prior’s guidelines for doctors for using micronized progesterone capsules for the heavy periods of perimenopause. Please also read How to Treat Heavy Periods with Diet and Natural Progesterone.

      • Thanks for your comment, Dr. Briden. I guess I have the grey version of your book. 🙁 The side effects I read for micr. progesterone made it seem I wouldn’t be a good candidate: stroke, clotting, migraines, et. al. and my doctor didn’t seem inclined to provide me a script with anyway. I found that if I adhere to diet and your supplement recommendations, it’s much better. I was eating everything and drank a lot of alcohol over the entire holiday season, just ending in February, with all the celebrations in my family. Perhaps if I get back my discipline it will improve, I am hoping. I should have taken it as a clue that I was estrogen heavy when my breasts which were very sore – and never are or had been – WERE. I am going to try everything natural to not let this happen again. It was horrible. Thanks again for all your work in women’s health.

        • For the record, natural or micronized does NOT have the side effects of stroke, clotting, migraines, even though they’re listed on the label. In fact, natural progesterone can be an excellent treatment for migraines!

          The problem is that they’re listing the side effects of progestins, when in fact, progesterone and progestins have different (sometimes opposite) effects. See my post The Crucial Difference Between Progesterone and Progestins.

          • Dr. Briden,
            Finally my doctor has written me a prescription for Prometrium. But today I realized it is for 200mg, daily – is this too much? She asked me if I wanted to start at a lower dose and I didn’t know what to reply, and said what would the benefits be. She then stated since I had endo, the higher dose might be better. Do you think I should go back and ask for the lower 100mg dosage (as I have noted you recommended 50-100mg dosage)? Thank you for your reply…

  48. Thank you for the article. In my 30’s, I was diagnosed with IBS and at 36, I had a laparoscopic supracervical hysterectomy and was told I also had adenomyosis. Following the procedure, I had three other procedure to freeze my cervix and stop the spotting. I still have issues with spotting 9 years later but I has been better since going on a plant-based, hygienic diet. Now, my 13 yo daughter is having issues with heavy periods coming as often as every other week. Auto-immune disorders run in our family. Could could bacterial contamination be an issue for her? She was recently diagnosed with depression, borderline metabolism disorder, Vitamin D deficiency and is taking Zinc, B6 and PSP 50, and Vitamin D daily. We just started with Anna’s Wild Yam cream as well. Her copper was high and we were told she is at risk for diabetes. I know that nutrition is one way we will be able to restore our bodies, and though I have been gluten free and on a low FODMAP diet at times, I wonder if this would help her. She will be seeing my gynecologist soon and I fear we will be told to use the birth control pill to control the bleeding, however, I would like to get to the root of the problem. Is this connection explored anywhere else? Thank you!

  49. My ob/gyn put me on the hormonal iud for 5 yrs but when I got the second one I had terrible breast soreness and had to have it removed. A thermography showed engorged breasts and thick veins leading toward my nipples. I was worried about developing breast cancer so I had the iud removed and put myself on a low estrogen diet and took vitex berry supplemts every day apart from my period days. After 6 months my periods were healthy and bright red and I had no pms symptoms. The only problem I still had was zero sex drive which I’ve increased with Vitamin C and Zinc supplements. Now if I have any pms breakthrough I take a vitex on those days only.

    • Oh I forgot to mention I had chronic Mittelschmerz and it was one side one month, one side the other. I made a painkiller out of Clary Sage Oil and a carrier oil and rolled it on the painful area to get rid of pain. After 6 months this pain went away. Clary Sage is an incredible pain killer.

  50. Would you recommend this same protocol for adenomyosis? Also, why do you say it might be necessary to eliminate chicken’s eggs? I haven’t ever heard of that. I am already GF and cow’s milk free, but I love my eggs and depend on them for my protein at breakfast. I would hate to give them up.

    • Based on what I’ve learned from your book, I also take magnesium glycinate, zinc, iron bisglycinate, and turmeric, and it’s helped so much.

    • yes, the same protocol can help adenomyosis, but I find that adenomyosis almost always also requires micronized progesterone capsules.

      As for eggs, egg protein can be an immune disruptor in some women. Of all my patients with endometriosis, I estimate about 1 in 3 benefit from avoiding eggs. One clue of a possible egg sensitivity is severe childhood eczema. If you didn’t have that or any indication that eggs are a problem, then you probably don’t need to worry about eggs.

  51. Hi Lara, I have endometriosis and have read your Period Repair Manual which is an amazing resource! I’ve been following you ever since and I greatly appreciate all of your guidance and support. I’ve really learned to do my own research and be my own advocate in terms of treating this disease. I’ve been working with a local Naturopath who just started me on low dose Naltrexone, particularly to calm inflammation, among other benefits. Do you have any thoughts on this for treatment for endo? Thanks again!

    • thanks so much for your comment. I just had someone else ask me about LDN for endometriosis. It makes sense to me that it could work but I have not prescribed it. Can you report back with your experience?

  52. I have been diagnosed with sibo and have severe bloating and swelling but only at ovulation. Not much period pain, however have lots of bowel problems.

  53. As someone who was recently diagnosed with endo and adeno via wide excision surgery with a specialist, this article really resonates with me. I’ve had endo symptoms since onset of menarche, but was able to control them with birth control for many years. The period where my symptoms spiraled out of control was preceded by a perfect storm of hormonal and immune system upsets.

    Now that I am recovered from surgery, I am treating SIBO (confirmed via lactulose breath test) with Xifaxan. I know that the relapse rate is high, but I am still shocked at how much better I feel – both digestively and in my lingering pelvic pain thought to be a function of pelvic floor dysfunction (as a result of being undiagnosed and in pain for 25 years).

    Anyways, I have always found my immune symptoms (food intolerances, rashes, etc) that started at the same time as my endo symptoms fascinating, even though most doctors dismiss the link and have no insight to offer. Prior to surgery, I found a lot of relief with your immune system treatments, so thank you!

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