Finding Endometriosis Pain Relief: Your 4-Step Guide

How Diet, Probiotics, and Other Natural Therapies Can Improve Endometriosis Pain

• 4-Step Treatment Guide|
• Meal Plans|
• Probiotics|
• Nutritional Supplements|
• Complementary & Alternative Treatments|
• Endometriosis Defined|
• The Gut-Endometriosis Connection|
• The Bottom Line|

Women with endometriosis often experience difficult-to-treat chronic pelvic pain, painful menstrual periods, cramping, and bloating, which can significantly disrupt day-to-day family and work life. 

Traditional treatments for endometriosis-related pain, like medications (ibuprofen and hormone therapy) and surgery (hysterectomy), vary in their effectiveness and can come with their own side effects [1].

If you’ve tried the traditional approach but haven’t found measurable endometriosis pain relief, there are a variety of natural treatments including several diets, vitamin and mineral supplements, probiotics, herbs, fish oil, movement, and acupuncture that have shown to help reduce endometriosis symptoms.

In this article, we’ll lay out a four-step natural treatment plan. We’ll also dive into the gut-endometriosis connection and teach you how healing your gut can be a powerful way to improve your endometriosis symptoms. 

4-Step Guide for Endometriosis Pain Relief

In the clinic at the Ruscio Institute for Functional Medicine, we’ve found nutrition-related changes to be the foundation for improving a variety of concerning symptoms. This is also true in the treatment of endometriosis. 

In step 1, we’ve outlined the meal-plan options that have shown to improve endometriosis pain. 

Step 1: Meal Plans for Endometriosis Pain Relief

When it comes to endometriosis, there is no one specific meal plan to recommend, but observational studies have shown symptom improvement with several different meal plans [2]:

• A gluten-free diet for 12 months improved endometriosis pain in 75% of participants and quality of life in 100% of participants.
• Twelve women with endometriosis who implemented individualized dietary changes (not specified) reported a decrease in their symptoms and improvements in quality of life.
• A low-nickel diet for three months significantly improved gastrointestinal and endometriosis symptoms.
• A Mediterranean diet (high in olive oil, fish, and plant-based foods) for five months led to significant improvement in general pain.

Since endometriosis and poor gut health often go hand-in-hand, you may be wondering about a low-FODMAP diet. In one 2017 observational study, 160 women with IBS (59 of which also had endometriosis) were placed on a low-FODMAP diet for four weeks. The women with IBS plus endometriosis were three times more likely to have significant improvement in bowel symptoms when compared to the women with just IBS [3].

If you’re new to making diet-related changes, you may want to consider starting with the Mediterranean or Paleo diet, since these are well-rounded and pretty easy to implement. If you don’t experience your desired results, a low-FODMAP diet would be a great next option.

Step 2: Probiotics for Endometriosis Pain Relief

If you’ve changed your diet and still struggle with symptoms, adding probiotics may be helpful. Probiotics are a therapy staple in the clinic and two randomized controlled trials have found them to be beneficial for endometriosis pain relief:

• Endometriosis patients who took a Lactobacillus probiotic for 12 weeks experienced significantly less menstrual pain when compared to the placebo group [4].
• Women with moderate and severe endometriosis who took a Lactobacillus probiotic for eight weeks had significantly less menstrual and overall pain when compared to the placebo group (pain during sexual intercourse and chronic pelvic pain scores weren’t significantly different between the groups though) [5].

If you’ve addressed your diet and added probiotics but still experience troubling symptoms, consider moving on to step 3.

Step 3: Nutritional Supplements for Endometriosis Pain Relief

We’ve established that probiotics are likely helpful, but what about other nutritional supplements?

• A randomized controlled trial found vitamin D for three months did not result in significant improvement in endometriosis symptoms [2].
• A randomized controlled trial found taking a combination of a multivitamin/mineral, a Lactobacillus/Bifidobacterium probiotic, and fish oil (along with an elimination-type diet) for six months was more effective than placebo for endometriosis symptoms [2].
• A 2021 randomized controlled trial found 1,000 milligrams of vitamin C plus 800 international units (IU) of vitamin E for eight weeks resulted in significant reductions in pelvic pain, as well as pain during menstruation and sexual intercourse when compared to a placebo [6].
• Resveratrol (a polyphenol found in many plants and red wine) in addition to an oral contraceptive (birth control pill) was found to significantly improve pain scores (period pain and pelvic pain) after two months, but another study only found benefits early on and not at the end of the study [7, 8].

When it comes to nutritional supplements, it’s important to choose high-quality versions and to seek medical advice.

Hopefully, steps 1 through 3 have led to significant symptom improvement. If not, step 4 offers several different endometriosis pain-management options.

Step 4: Complementary and Alternative Therapies for Endometriosis Pain Relief

Acupuncture (the insertion of thin needles through the skin at specific body areas) has the strongest evidence in favor of its use for endometriosis pain relief [9], but there are several other complementary and alternative endometriosis treatments to consider:

• One study found manual physical therapy to address adhesions (scar tissue) and soft-tissue mobility in the abdomen and pelvic floor led to significant improvements in sexual function, pain during sexual intercourse, and period pain [10].
• Hatha yoga is associated with improvements in pain, quality of life, and well-being [9, 11].
• Electrotherapy, including electro-acupuncture and self-applied transcutaneous electrical nerve stimulation (TENS), may significantly improve chronic pelvic pain, painful sexual intercourse, and quality of life [9].
• A 2012 systematic review of randomized controlled trials found women given Chinese herbal medicine experienced greater improvements in menstrual pain than those given a pharmaceutical [12].
• Medicinal herbs such as French maritime pine bark extract (pycnogenol) have been found to reduce endometriosis chronic pain scores, possibly related to anti-inflammatory and antioxidant properties [13].
• Endometriosis may contribute to pelvic floor dysfunction pain. Pelvic floor physiotherapy has been found to improve pelvic floor muscle function, pain during sexual intercourse, and chronic pelvic pain [14, 15].

Of course, exercise and physical activity provide a myriad of positive health effects, but no specific research has confirmed to what extent they can help with endometriosis pain relief [9, 11].

What Is Endometriosis?

Endometriosis is an estrogen-dependent, chronic inflammatory disease where tissue similar to the lining of the uterus implants outside the uterus [16]. It affects 10-15% of women of reproductive age and is thought to be caused by the backward movement of the menstrual flow [17]. But there’s no single theory that explains all types of endometriosis [18, 19].

Endometriosis is often asymptomatic (without symptoms), but some symptoms include [17, 18, 20]:

• Painful sexual intercourse
• Painful menstrual cycles
• Bleeding between periods
• Painful urination
• Painful bowel movements
• High pain sensitivity and severe pain
• Chronic lower-abdominal and low-back pain
• Uterine masses
• Infertility (found in 90% of patients) [21]
• Bloating (found in 96% of patients) [22]

Traditional treatments for endometriosis include [1]:

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
• Progestins (synthetic progesterone)
• Combined hormonal contraceptives
• Gonadotropin-releasing hormone (GnRH) antagonists
• Aromatase inhibitors
• Danazol (pharmaceutical for endometriosis pain and infertility)
• Surgery (such as operative laparoscopy or hysterectomy) to remove ectopic tissue

The Gut-Endometriosis Connection

Endometriosis patients have been observed to have lower bacterial diversity than their healthy counterparts [23] and there seems to be a strong connection between the gut and endometriosis:

• One 2019 review suggested a relationship between the microbiota of the gut and the female reproductive tract, as well as associations between certain patterns of gut bacteria and endometriosis [24].
• Two studies have found women with endometriosis have a two- to three-fold increased risk of having IBS [25, 26]. The authors in one of the studies observed “the research on inflammation in endometriosis almost completely mirrors that observed in IBS [26].”

Both endometriosis and IBS are characterized by [27]:

• Chronic low-grade inflammation
• Activation of mast cells (immune cells involved in allergic responses)
• Stimulation of pain receptors
• Dysbiosis
• Leaky gut

Estrogen is required for endometriotic tissue to grow and persist. However, gut dysbiosis can disturb estrogen levels, and contribute to the pain and inflammation associated with endometriosis [16]. In addition, dysbiosis can disrupt normal immune function, leading to an inflammatory response, which may create an environment conducive to endometriosis development [28].

Target Gut Health to Find Endometriosis Pain Relief

Many of the endometriosis pain-relief strategies outlined above aim to improve gut health. If you’ve tried various pain medications and over-the-counter drugs and/or home remedies, but still aren’t feeling well, consider implementing our four-step plan. 

If you continue to struggle with endometriosis-related pain, my book Healthy Gut, Healthy You has an even more detailed gut-healing action plan. For a more personalized option, contact us at the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.