Endometriosis. If you've been suffering with it silently, as so many women are, you know how much it can impact your life. In this article (and podcast) I share some of the science-backed herbs and supplements I use in my medical practice for helping my patients address the symptoms and associated underlying causes of endometriosis, including inflammation and immune dysregulation in endometrium-like tissue.
While studies on natural therapies and endometriosis are still in their infancy (as is the study of endometriosis in general!), these therapies provide you with options your physician is unlikely to be aware of, and which may provide relief and even endometriosis reversal that might allow you to reduce your need for medications and surgery.
Beyond Conventional Medicine: The Power of Endometriosis Self-Care
While medications can be effective in relieving pain and preventing the growth of endometrial implants, and the right surgery, done well, can be highly effective, these therapies also all have side-effects and risks, including addiction to pain medications, the risks of surgery, and high rates of recurrence with improperly done surgery. Further, none of these approaches get to the root causes, which I discuss in The Natural Approach to Endometriosis: Getting to Your Root Causes and dive deeply into in my book Hormone Intelligence.
I support all of the choices a woman makes to live her life free from pain and suffering, I also want you to have access to alternatives so that you avoid the unintended consequences of medical therapies whenever possible, and that you can at least try should you want to, before taking a more aggressive medical approach.
My goal is to introduce you to options that you might not have heard of, that your medical provider likely doesn’t know and therefore can’t inform you of, and that give you additional non-pharmaceutical and non-surgical tools to choose from – whether as alternatives or adjuncts to your medical therapies. Ideally this will allow you to avoid or rely less on conventional therapies, should that be your preference.
There's also something else I want to share: when women feel more empowered about their endometriosis, they actually experience improvements in their quality of life, symptoms, and their ability to get what they need from their healthcare team. Knowledge of your full range of options — and making the choices that are best for you — is empowerment!
Top Herbs and Supplements for Endometriosis
The following herbs and supplements have been shown, in small to moderate sized studies (because of the limited extent to which studies have been conducted) to variously improve quality of life with endometriosis, reduce chronic pain, pain during sex, urinary and bowel pain, and have led to regression or resolution of endometrial lesions and endometriosis-related ovarian cysts. They have been associated with improved fertility, reduced need for surgery, and improved sleep. A number of extracts and active ingredients from herbs, foods, and supplements have also been found to be ‘anti-endometriotic,’ meaning they can cause regression of endometriosis lesions.
At least one of the following herbs may come as a surprise, some you may not have heard of at all, and some may be familiar to you. In my practice, I use these as a core protocol, adding on additional support for pain or other symptoms as needed. I always use herbs and supplements in the context of dietary and lifestyle shifts, as discussed in the article I link to above, and in my book, Hormone Intelligence.
Here's the surprise! We usually think of melatonin as a sleep supplement, and indeed, it is the natural substance that increases at night in our brains to tell us to get some sleep! However, melatonin appears to have quadruple actions with antioxidant, anti-inflammatory, immunoregulatory, and pain-relieving benefits in the treatment of endometriosis. It’s also a powerful natural detoxifier, especially of excess or harmful forms of estrogen, and perhaps also explains its powerful role in endometriosis care.
In one study of 40 women with chronic pelvic pain, who were between 18 and 45 years old, 10 mg of melatonin per day was able to significantly:
- Reduce chronic pelvic pain due to endometriosis
- Reduce pelvic pain during menses and during sex
- Reduce pain during urination and associated with bowel movements, and
- Led to an overall 80% reduction in the need for pain medication in women taking the melatonin, including reduction in NSAIDS and narcotic use.
- Women in the melatonin group also reported substantially improved sleep and a greater sense of wellness on morning waking. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue.
How to use it: Start with 1-3 mg/day, preferably taken in the evening as it can make you feel sleepy (a plus if sleep doesn't come easily!). Over a month build up to 10 mg, which can be taken at bedtime, or if it doesn't make you too sleepy, you can divide it between an evening and bedtime dose. If trying to conceive, drop the dose down to a maximum of 3 mg/day for 8 weeks prior to conception; higher doses may temporarily inhibit ovulation.
Short for N-acetyl-cysteine, NAC is a powerful supplement that increases glutathione, one of the most important detoxifiers naturally produced in our bodies. However, many of us aren't producing quite enough to keep up with the demands put on our bodies by chronic exposure to environmental toxins and even overproduction of our own natural hormones – including estrogen. NAC has some impressive data behind it specifically for endometriosis. In a 2013 study of 92 women in Italy, 47 took NAC and 42 took a placebo. Of those who took 600 mg of NAC three times a day, three consecutive days each week for three months:
- 24 patients cancelled their scheduled laparoscopy due to a decrease or disappearance of endometriosis symptoms, improved pain reduction or because they had gotten pregnant!
- Fourteen of the women in the NAC group had decreased ovarian cysts
- 8 had a complete disappearance of their symptoms – and lesions
- 21 had pain reduction
In the other group, only 1 patient cancelled surgery. A total of 8 women got pregnant in the NAC group, while 6 did in the placebo-only group.
How to use it: NAC is typically taken at a dose of 600 mg three times daily (not just 3x/week as in the study). However, per the study, continue for at least 3 months (the timeframe for seeing substantial reduction of cysts in the above study), and if you experience improvement, this very safe supplement can be taken on an ongoing basis if needed.
Pycnogenol (Maritime Pine Bark)
In a study of women with endometriosis taking Pycnogenol, an extract of pine bark (yes, as in the trees), 30 mg twice daily for 48 weeks, led to:
- A 33% reduction in pain, including severe pain
- While the pain reduction was not as strong as hormonal treatment, it actually persisted without relapse, unlike the medication group
- Further, 5 women in the pycnogenol group became pregnant
How to use it: Pycnogenol, 30 mg, twice daily for 1 year, continue as needed.
B-vitamins as a whole are essential for the breakdown of excess estrogen, but B6 specifically is needed for glutathione production and has been shown to improve hormone related symptoms.
How to use it: 50 to 100 mg/day.
Omega-3 fatty acid supplementation is also associated with a marked reduction in pain. In one study, women with endometriosis were able to decrease their use of pain medication after just three months of supplementing this nutrient.
How to use it: 2 to 3 g of a combined EPA/DHA product daily.
Curcumin has been shown to have anti-endometriotic effects, likely due to a combination of its anti-inflammatory and antioxidant properties, its ability to increase glutathione, and its ability to regulate the immune system, addressing some of the core immune dysfunctions contributing to endometriosis.
How to use it: 500 mg twice a day; avoid if you have gallstones.
Additional Pain-Relief & Anti-Inflammatory Support
Depending on the severity of your pain, it can be helpful to add natural pain-relieving and anti-inflammatory herbs and supplement for extra support.
Ginger root powder (or the equivalent in extract form) at a dose of 500 mg 2-4 times/day has been shown to reduce pain equal to the effects of ibuprofen. I highly recommend taking it with the above supplements daily, and in the few days prior to and during your menses, at the higher dose for best pain relief.
Women across the world use cannabis in various forms to treat endometriosis and period pain — and have been doing so for centuries.. The data emerging on the potential role of CBD and THC products not just to reduce endometriosis pain symptoms, but for cannabinoids to actually have a therapeutic role in resetting the immunologic dysfunction that's happening in endometriosis-like tissue, is impressive and promising. I talk more about using cannabis for gynecologic pain in this article here. It may take a bit of gentle personal experimentation to determine whether Cannabis or CBD is right for you, which product (there are many), and at what dose. I consider it a far safer alternative to a narcotic (opioid), which 25% of women with endometriosis are given a prescription for to manage pain.
The Long Game: What to Expect with Herbs and Supplements for Endometriosis Self-Care
Endometriosis is a tough condition to treat and natural therapy doesn't lead to overnight results. It can take 3 to 6 months to see symptom improvement, and longer (up to 12 months) to see changes on laparascopic evaluation. Unless endo tissue is getting in the way of getting pregnancy, it's not necessary to follow up with laparoscopy. If your symptoms improve, that can be your guide.
I recommend staying on your herb and supplement ‘protocol' on a daily basis for at least 6 months before you decide whether it's working for you – and continue if you feel it is until no longer needed.
I highly recommend keeping an endometriosis symptom journal as you start to use natural therapies, even if just keeping track of dates and a 1-10 pain scale (1 = no pain, 10 = horrible pain) weekly or a couple of times each week can be helpful. Sometimes when we're so used to feeling awful, we don't even recognize when we're starting to get improvement – keeping a journal while you're using a natural approach can give you those insights more clearly, and if at any time you're not getting the benefits you hope for, you can always add in or shift to conventional therapies. Truly integrative doesn't polarize one option as better than the other – it's a continuum that you get to choose from.
Including natural therapies in your endometriosis treatment plan also doesn't preclude using conventional therapies. They can often be combined with standard endometriosis treatments – you'll want to work with an integrative practitioner skilled in doing so. And you can always escalate your conventional therapies if needed. But getting even some natural relief may help you avoid sometimes unnecessarily aggressive measures – including hysterectomy.
And if you can go all natural, why not try?
Want more hormone support? Be sure to get my FREE 7-day Hormone Intelligence Quick Start Guide & 7-day Meal Plan when you order my book!
Reclaim your power. Feel at home in your body. And be the force of nature you really are!
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Kohama T, Herai K, Inoue M. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. J Reprod Med 2007; 52(8):703-708.
Porpora M, Brunelli R, Costa G, et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-Based Complementary and Alternative Medicine. 2013; April. Article ID 240702,
Russo, Ethan. Cannabis Treatments in Obstetrics and Gynecology: A Historical Review. J Cannabis Therapeut. 2002, 2: 5-35. 10.1300/J175v02n03_02.
Schwertner A, Conceicao dos Santos C, Costa G, et al. Efficacy of melatonin in the treatment of placebo endometriosis: A phase II, randomized, double-blind, placebo controlled trial. PAIN 2013;154(6):874-881.