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Endometriosis describes a condition in which tissue that normally resides in the inner lining of the uterus, the endometrium, emerges elsewhere in the body, usually in the pelvic area. The growth of this misplaced (ectopic) endometrial tissue can cause significant pelvic pain, pain during menstruation or sexual intercourse, fertility problems, and in some cases gastrointestinal or urinary problems and abnormal vaginal bleeding (Connolly 2009; Schenken 2013; Giudice 2010; Cox 2003). Endometriosis is estrogen-dependent and often progressive, resulting in worsening pain and other symptoms over time (Simoens 2007; Bulun 2009; Schenken 2013; Laufer 2003). Endometriosis should not be confused with endometrial cancer (Connolly 2009).

In the United States, chronic pelvic pain accounts for 10% of all outpatient gynecologic appointments and 66% of women with pain or tenderness on a pelvic examination have endometriosis (Giudice 2010). In 2002, endometriosis cost an estimated $22 billion in the United States due to treatment costs and lost productivity; this number increased to over $69 billion in 2009 (Simoens 2007; Burney 2012). It has been estimated that about 5–10% of women of reproductive age in the United States are affected by endometriosis (Bulun 2009).

There are many treatment options for endometriosis; however, there is no consensus that one type of therapy is superior to another (Kennedy 2005; Schenken 2012). Consequently, therapeutic regimens are determined on a case-by-case basis, dependent on a number of factors, including the extent of disease, woman’s desire for pregnancy, and cost. Conventional treatment options include pain relievers, hormones, and other pharmaceuticals. In some cases, surgery may be necessary to reduce pain and restore fertility. Unfortunately, these treatments are not always effective and can have significant side effects, including weight gain, irregular bleeding, and changes in the uterine tissue (Schenken 2012; Connolly 2009).

A fundamental problem with conventional medicine’s approach to many women’s health concerns is the reliance upon synthetic hormones. Copious evidence shows that natural bioidentical hormones may offer a safer alternative. Since unopposed or excessive estrogenic activity drives endometriosis, many women with this condition are treated with synthetic progestins, which mimic the action of progesterone but are structurally different than progesterone produced naturally in a woman’s body (Schweppe 2001). This exposes them unnecessarily to increased risk of several diseases, including breast cancer and heart disease (Zhou 2013; Chlebowski 2013; Liang 2010; Baker 1994; Vehkavaara 2001; Adams 1997; Morey 1997; Houser 2000). Topical application of a natural progesterone cream may combat endometriosis while sparing women from the ravages of synthetic hormones.

In addition to natural bioidentical hormones, several other promising interventions exist that may ease the suffering women with endometriosis experience.

An overlooked drug called pentoxifylline has been shown in both experimental and human studies to improve several endometriosis-related outcomes, including pain intensity and pregnancy rates. Moreover, laboratory studies have shown that this unique drug can counteract some of the specific mechanisms that contribute to endometriosis (Balasch 1997; Creus 2008; El Darouti 2011; Gonzalez-Espinoza 2012; Kamencic 2008; Vlahos 2010).

Mounting evidence suggests that natural interventions such as omega-3 fatty acids from fish oil and N-acetyl cysteine may play a role in the management of endometriosis. Incorporating natural compounds that may modulate the underlying pathophysiology of endometriosis alongside conventional therapies represents an encouraging option for women afflicted by this condition, especially given the relative safety of these natural approaches (Porpora 2013; Hansen 2013; Netsu 2008; Herington 2013; Missmer 2010; Ngo 2009).

This protocol will discuss the pathophysiology of endometriosis and how it can cause pain, infertility, and other complications. It will also outline the conventional treatments for endometriosis and their associated risks, as well as some emerging therapies. Several natural interventions and lifestyle considerations that may provide relief to women afflicted by endometriosis will also be discussed.