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Health Protocols


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. 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.

Mounting evidence suggests natural interventions such as omega-3 fatty acids from fish oil and N-acetyl cysteine may play a role in the management of endometriosis.


  • Pelvic pain
  • Infertility

Risk Factors

  • A family history of endometriosis is one of the most important risk factors
  • Early menarche and never having been pregnant
  • Exposure to certain pesticides (eg, organochlorine)


  • The gold standard for diagnosing endometriosis is visual inspection via laparoscopy. Laparoscopy also helps classify the severity of endometriosis into four stages: minimal, mild, moderate, and severe.

Conventional Treatment

  • Pain-relieving medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain. However, NSAIDs can lead to gastric ulcers and may inhibit ovulation.
  • Suppressing the activity of the ovaries via the use of oral contraceptives is one of the most commonly used medical treatments.
  • For women who cannot obtain satisfactory relief with NSAIDs and oral contraceptives after six months of therapy, other medications may be tried. These medications include progestins, which are synthetic progesterones.
    • Note: Progestins are meant to function like natural progesterone, but a huge body of data indicates potential for adverse side effects.

Novel and Emerging Therapies

  • Clinical trials using pentoxifylline have shown significant increases in fertility and pain relief as compared to placebo.
  • Clinical trials have found that adding aromatase inhibitors to conventional treatments reduces endometriosis pain and may improve quality of life.
  • Studies have found that acupuncture is effective at relieving chronic pelvic pain in women with endometriosis.

Dietary and Lifestyle Considerations

  • Consuming red meat increases the risk of endometriosis, while increased consumption of long-chain omega-3 fatty acids (prevalent in fatty, cold-water fish) is associated with a decreased risk.
  • Women consuming a diet rich in trans fats are at higher risk of being diagnosed with endometriosis.
  • Eating more fruits and vegetables may play a protective role.
  • Support groups can be invaluable as they can provide a connection to other women suffering from similar symptoms.

Integrative Interventions

  • Omega-3 fatty acids. A large study found that women who ate greater amounts of long-chain omega-3 fatty acids were also less likely to develop endometriosis.
  • Vitamins C and E. In a randomized placebo-controlled trial, 59 women between 19 and 41 years of age were allocated to receive a combination of vitamins E and C or placebo daily for eight weeks. Following the treatment period, 43% of women who received vitamins E and C experienced reduction in chronic pain, 37% experienced reduction in pain associated with menstruation, and 24% experienced reduction in pain during intercourse compared with the placebo group.
  • N-acetyl cysteine (NAC). After the 3-month study period, endometriotic cysts were slightly reduced in size among women who took NAC, while a significant increase in cyst size was observed in the women who received no treatment. The researchers noted their findings for the efficacy of NAC were better than those reported after hormonal treatment of endometriosis.
  • Epigallocatechin gallate (EGCG) from green tea. In preclinical research of endometriosis, EGCG decreased the growth of endometrial implants and reduced the formation of new blood vessels to endometrial tissue.
  • Resveratrol. In preclinical research of endometriosis, resveratrol reduced endometrial implants by 60% and total volume of lesions by 80%.