The Natural Approach to Endometriosis: Getting to Your Root Causes


At 36, Liz came to me as a patient popping Percocet before breakfast, several ibuprofen before lunch, and another round of narcotics before the kids got home from school. She was tired, constipated, and in chronic pain. A drug addict? No! She’s an otherwise well-adjusted suburban soccer mom who has suffered with well over a decade of debilitating chronic endometriosis pain, who has undergone multiple surgical procedures that have only temporarily eased her discomfort, and who is now dependent on strong and potentially addictive and dangerous medications to get her through the day with a manageable pain level. 

What is Endometriosis?

Endometriosis is when the type of tissue that normally lines the uterus – called the endometrium – is found in other locations of the body where it’s not supposed to be. The most common place is the abdominal cavity where it can land on the peritoneum, the thin layer that covers the inside of the abdomen, the ovaries, and fallopian tubes.

Like the lining of the uterus, the misplaced endometrial tissue is triggered by the same hormonal changes that trigger your period to come, causing this tissue to shed, or bleed, as well. When this shedding occurs, blood, which is trapped in the abdomen, is irritating to the nerves in the abdomen, causing much of the pain associated with endometriosis.

Over time, this shedding leads to chronic inflammation and the formation of scar tissue. Additionally, the endometrial cells cause abnormal immune responses in that tissue, leading to further chronic inflammation and scarring.

Nobody knows exactly why this happens, and there are many theories. The important thing is that we know that it is an inflammatory condition with an abnormal immune response, and it is triggered by cyclic hormonal changes, environmental hormonal exposures, and other factors that cause inflammation.

Who Gets It?

About 1 in 10 women and girls in the US have endometriosis. Severe pain and cramping is estimated to affect 6.5 million in the United States and Canada, who suffer with the condition. And this is likely a conservative number, given how frequently the diagnosis is missed in teenaged girls, according to a recent New York Time articles exploring the horrible pain and miserable experiences of young women who have bounced from one gynecologist to another hoping for an answer or a solution.

Of women undergoing laparoscopy for pelvic pain, here are the numbers of women found to have endometriosis:

  • 2 to 32% of women of reproductive age undergoing laparoscopy to determine the cause of pelvic pain
  • 9 to 50% of women undergoing laparoscopy for infertility versus 6.7 percent of women undergoing laparoscopy with no past infertility
  • 50% of teenagers undergoing laparoscopy for evaluation of chronic pelvic pain or dysmenorrhea

The rates of endometriosis are going up, most likely as a result of chronic exposure to toxin environmental chemicals, so you can use the information in this article now to protect yourself and your daughters later.

What are the Symptoms?

The most common symptoms of endometriosis include killer cramping at the time of the menstrual cycle that sometimes won’t even go away with NSAIDS (motrin, ibuprofen, that kind of stuff), periods from hell (long. heavy), often with chronic and sometimes severe pain between periods, constipation and bloating, painful  sex, urinary problems, low back ache, and chronic fatigue. Some women also report abnormal vaginal bleeding.

Endometriosis is one of the most common causes of infertilityleading to as many as 50% of cases. Some women may have endometriosis without symptoms, only to discover that they have the problem when they experience difficulty becoming pregnant. As many as 30-40% of women with endometriosis will experience fertility problems. 

Endometriosis typically progresses and worsens over time as the chronic inflammation leads to accumulation of scar tissue causing  “adhesions” that cause the organs like the intestines and bladder to become fixed in place leading to frequent or even pain with bowel movements and urination, and painful sex.

The percentage of women with endometriosis reporting various symptoms is:

  • Painful periods (79%)
  • Pelvic pain (69%)
  • Pain with sex (45%)
  • Bowel upset (e.g., constipation, diarrhea) (36%)
  • Bowel pain (29%)
  • Infertility (26%)
  • Ovarian endometrial mass/tumor (20%)
  • Pain with urination (10%)
  • Other urinary problems (6%)

Conventional Treatments for Endometriosis – Not Always So Helpful or Healthy!

Conventional medicine has not yet determined what the optimal treatment is for endometriosis, and mostly aims at symptom relief through medications and surgery.

The chronic use of the commonly recommended pain medications like Ibuprofen and other NSAIDS can provide temporary relief, but have risks including long-term damage to the gut lining. Hormonal therapies, such as oral contraceptives, progestins, and GnRH agonists can relieve symptoms of mild to moderate pain but also have potential short and long-term side effects, and don’t get to the root causes of the problem.

While removal of endometrial tissue via a laparoscopy can relieve symptoms for as a long as 2 years, the symptoms do eventually return in most cases, and the procedure itself increases the likelihood of forming scar tissue. Hysterectomy is sometimes recommended, but this is not an option for women who want to become pregnant, and it’s important to recognize that this is one of the most over performed unnecessary surgeries in the US – including its use for endometriosis. While it is sometimes helpful when all else fails or if symptoms are unbearable, it is major abdominal surgery – and a major cash cow for doctors and hospitals – so get more than one opinion if you’re not sure you want this done!

The Natural Approach to Endometriosis: Getting to Your Root Causes

 

We know that endometriosis is an immune and inflammatory problem that is triggered by cyclic hormonal changes and worsened by chronic environmental toxin exposure. Exposure to a class of chemicals called endocrine disruptors (which mimic hormones), as well as other environmental toxins that increase our inflammation and disrupt the normal functioning of the immune system has been implicated in endometriosis. The natural approach supports an optimal immune response, reduces inflammation and pain, promotes natural detoxification of environmental toxins, and helps to balance hormones.

I recommend a comprehensive approach that incorporates an anti-inflammatory diet as well as a selection of the supplements from each of the categories below.

It takes about 6-12 months to see a reduction in the overall number of endometrial implants in your abdomen (these are seen on laparoscopic evaluation). However, it is not necessary to follow up with laparoscopy if you have been getting these done; if your symptoms improve, that can be your guide that you’re getting better, so it is ideal to keep a record of how you are feeling on a 1-10 scale during the times your pain is typically at its worst.

You should start to get some pain relief within a few hours of taking the pain supplements.

Anti-inflammatory Diet for Healing Endometriosis

The most important first step is to get onto an anti-inflammatory, low-toxin diet, and check your environment, especially food, for common environmental toxin exposures – especially from food and food packaging – that increase your estrogen load (these are called xenoestrogens).

An anti-inflammatory diet includes up to a pound of combined fresh vegetables, especially leafy greens (kale, collards, broccoli, Brussels’s sprouts) and fresh fruits (especially berries) each day.

The three main triggers to remove for an anti-inflammatory diet are dairy products, gluten-containing products, all corn, and most sugar. Red meat is also pro-inflammatory, so if you are suffering from endometriosis, a plant-based diet with no red meat, and small amounts of poultry and fish is preferable. All meat should be organic to avoid chemicals used in meat production that might be adding to your problem.

While they may seem like no big deal because everyone uses them, plastics are major sources of xenoestrogens that can wreak hormonal havoc and cause or worsen endometriosis. Do your best to avoid foods that come in soft plastic wrap, are stored or microwaved in plastic, are contaminated with pesticides and herbicides (i.e., many fruits and vegetables – and even more so if imported from another country where highly toxic chemicals that have been banned in the US are still used) and plastic water bottles.

Caffeine may exacerbate endometriosis in some women, so if you’re drinking coffee each day, try a couple of months without it. On the other hand, green tea is antioxidant and may be especially beneficial if you have endometriosis.

Keeping your blood sugar steady is also important for keeping inflammation in check, and keeps you from binging on inflammatory sugar and baked goods.

Being overweight increases the likelihood of being estrogen dominant; appropriate weight loss can also be very helpful in reducing general inflammation. The anti-inflammatory diet is a great way to lose weight without having to work too hard to try!

Herbs & Supplements for Healing Endometriosis

Here is my 5 Step Plan for the herbs and supplements to add to your anti-inflammatory diet. These should not be taken during pregnancy, but can be taken up until conception – just discontinue when you try to get pregnant, and resume if you have not conceived, and they can be taken while you are breastfeeding.

1. Reduce Inflammation

Natural anti-inflammatories such as curcumin (from turmeric), bromelain (from pineapple), quercetin (from apples, onions, and other plant sources) ginger root, boswellia, and fish oil are all fabulous anti-inflammatories that I use to treat my patients who have endometriosis. I recommend a combination of these, and use products including Inflammatone from Designs for Health, InflammaResponse from Herb Pharm and Turmeric Supreme: Joint by Gaia Herbs, along with 1-2 tsp. daily of Nordic Naturals Ultimate Omega for a high dose of fish oil (talk with your doctor before taking if you are on blood thinners, though the risks are very small according to medical literature).

Not only will inflammation be reduced, but these herbs also relieve pain over time.

2. Prevent and Repair Damage with Antioxidants

Antioxidants help to prevent and reverse local tissue damage from inflammation. Some of our best antioxidants come from foods highest in vitamins E, A, and C, which you can also supplement by taking a daily multivitamin. Resveratrol from red grapes, N-acetylcysteine (NAC), pine bark, green tea, and curcumin are powerful antioxidants. 

NAC is a powerful antioxidant with 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, improved pain reduction or because they had gotten pregnant! Fourteen of the women in the NAC group had decreased ovarian cysts, while 8 had a complete disappearance; 21 had pain reduction and 1 became pregnant. 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.

In yet another study of an antioxidant herb, this time pycnogenol from pine bark, women taking 30 mg twice daily for 48 weeks showed a 33% reduction in pain, including severe pain, and 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.

3. Balance Your Hormones

When estrogen is running wild, it not only increases the size and number of the endometrial tissue, but certain forms of it also contributes to inflammation.

Getting enough dietary or supplemental fiber and having a daily bowel movement are essential for reducing inflammation, overall body toxin load, and eliminating excess estrogen from your system. I recommend taking 1-2 TBS of freshly ground flax seed daily in a smoothie, or mixed into food, and if constipation is a problem, natural treatments are available.

4. Avoid Environmental Triggers and Support Natural Detoxification

Numerous environmental toxins in our food, food packaging, air, water, homes, and workplaces increase our hormone burden, cause inflammation, and also have the capacity to cause our immune cells to malfunction. Avoiding these chemicals whenever we can, such as in our foods, body products and cosmetics, household cleaners, and flame-retardant treated fabrics can reduce body burden.

Given how common these are, though, if you are suffering from endometriosis, avoiding toxins is not enough – your body can need some extra detoxification support.

Some of the supplements I’ve already mentioned, including NAC, curcumin, resveratrol, and quercetin all support natural detoxification, and so you’re already ahead of the game here! One additional supplement that I haven’t mentioned yet is Indole-3-Carbinol, which is excellent for supporting the detoxification and elimination of excess hormones. One product I love is called Xeno-Pro-Tex by Xymogen, which has many of the detox supplements in the blend, though you may want to add in additional NAC to meet the level I mentioned above. Endocrine Disruptor Relief by Vitanica is also an excellent product.

5. Treat Pain

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. Other herbs that are excellent for pain relief include Jamaican dogwood, curcumin, cramp bark, and devil’s claw. I recommend Turmeric Supreme Pain by Gaia Herbs to my patients, along with ginger capsules or extract at the previously mentioned dose.

One study demonstrated that 10 mg of melatonin per day significantly reduces chronic pelvic pain due to endometriosis, pelvic pain during menses and during sex, pain during urination and associated with bowel movements, to the tune of an overall 80% reduction in the need for pain medication in women taking it. At this dose, melatonin supports the body’s natural detoxification processes. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue. I recommend starting at 1-3 mg/day, and build up, and preferably take it in the evening, as it can make you feel tired. It is the natural substance that increases at night in our brains to tell us to get some sleep!

These can be taken with or in place of the herbs mentioned in the above section on inflammation – there will be some crossover, but that’s ok. Acupuncture in one study has been shown to possibly be helpful for endometriosis pain, and I also recommend using alternating hot and cold sitz baths if you can make this happen at home. It stimulates pelvic circulation, getting good blood and lymph flow moving to help wash out inflammation and toxins.

Bonus Tip: Break up Adhesions with Arvigo Massage

In addition to the recommendations above, I suggest working with an Arvigo Massage Therapist or a physical therapist who is skilled in pelvic pain from endometriosis. These therapies are important for helping to break up adhesions. While some of the anti-inflammatory supplements, particularly the enzymes, may help with this to some degree, it really takes the addition of physical manipulation to break down scar tissue.

You can  try these natural approaches at home on your own – or work with an integrative, functional medicine doctor, a licensed naturopath, or a midwife who practices comprehensive women’s health, to create a more customized plan for your needs. The evidence is not clear for the long-term benefits of conventional therapies, surgeries are invasive and only provide symptomatic relief, and natural therapies can be safe and effective in the short and long term.

I hope this article allows you to create an endometriosis healing plan that works for you, relieves pain and adhesions, and gives you back your life and hope! 

Corona LE et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol 2015 Mar212:304.e1.

Altman RD, Marcussen KC.Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001 Nov;44(11):2531-8.

Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res 2012;26:1719-25.

Dunselman GA, et al. ESHRE guideline: management of women with endometriosis. European Society of Human Reproduction and Embryology. Hum Reprod. 2014;29(3):400.

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, 7 pages http://dx.doi.org/10.1155/2013/240702

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.

Sinaii N, et al. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008;89(3):538.

Srivastava K. C, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses. 1992;39(4):342–8

Taylor RA, Leonard MC. Curcumin for inflammatory bowel disease: a review of human studies. Altern Med Rev. 2011 Jun;16(2):152-6.

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Liz

While this article seems very helpful with lots of good replacement suggestions and innovations, it's missing one thing. What about the ladies who have been fed pain pills for years and are having extreme trouble getting off of them? I was told I was an addict and needed to go through opiate treatment. I am currently on subutex and slowly tapering. It's been almost two years since I started and I have not been able to quit this drug yet. I am sick of it and want to be done as soon as possible, but I have two young children to care for, therefore I can't just quit and be sick for months. I need a helpful way to get off of this medicine, but it seems the only way out is to keep struggling and eventually have to experience the extreme withdrawals. I need a better way out, but there doesn't seem to be one, at least that's what I'm told by my doctors. Any help would be much appreciated.

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    aviva

    Hi Liz, Yes, this is a super big problem and tough, too! Working with a pain doc is important -- one with an integrative approach. I've used cannabis with patients (in a medically rx'd way and thru their self-medication) to help reduce the use of narcotics -- there is good evidence for this and it's effective clinically -- but still requires on site help. Withdrawal is miserable -- I've gotten many patients thru it -- but not life threatening with narcotics -- so can be done safely. Wishing you the best on this! Aviva

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Erica

What things would be safest for a nursing mother who has these issues? I am having severe pain anytime my Body tries to ovulate. (I had tests done and had some infection that was given doxy for but after months the pain came right back- I have fibroids and endo too)

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Pamela

Do you feel that long-term use of 10mg I melatonin would be disruptive? 10mg seems like a lot!

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    aviva

    Might make you sleepy...

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Jennifer

As a pelvic pain sufferer (while I'm personally quite sure it's endo, I can't be 100% positive that it is because I've never had the surgery to confirm), I can definitely vouch for Arvigo. I started with an Arvigo therapist in November 2014 and of all the other approaches I have tried (herbs, acupuncture, elimination diet, etc) it has made the most remarkable difference in my pain. You have to be faithful to the self-care routine which involves self-massage, castor oil packs and vaginal steams (I know, I know... "vaginal steam" sounds crazy and I was skeptical too, but you've GOT to try it--especially with the traditional herbs). Trust me, it is SO worth it. If you've heard of Arvigo and are on the fence, just do it--you won't be disappointed. It has basically given me my life back. Best of luck ladies!

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    Luz

    What herbs do you use for the vaginal steam?

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Abbie

Aviva, thank you so much for this article! I have endometriosis and the past few months have gotten onto a better vitamin regiment. Feeling like I need to really tackle it. Thanks for all the tips and nutrition advice. Definitely will get on this! One thing I'd like to add is Chaga mushrooms -- they eat up endometrial tissue!! other medicinal mushrooms are good too (reishi, immune 7, etc). Have you used those before? I take 800 mg Vitex, 2 capsules Evening Primrose, Omega 3's, 3000-5000 IU Vit. D, lots of Tumeric(will increase tho)(aiming for 24,000mg/day- thoughts??), Chlorella, thyroid support, EstroSmart(4/day), and I think something else but can't remember. One question I have- what time of day do you take the melatonin at? I'm thinking right before bed so I'm not even sleepier during the day. Does that work? So interesting to hear about NAC!!! I take it after surgeries and for my PCS sometimes so it's exciting to hear that it can help so much with Endo. Thanks again, you'll never know how much I appreciate you for writing this. :)

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April Johnson

Hi thank you for writing about this topic! I cannot tolerate flax seed do you know another fiber and what could help constipation? Also, to clarify when one starts their period and cramps is it the tumeric surpreme and ginger they take? TIA

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    aviva

    Hi April, Many other excellent therapies including magnesium citrate, 1 lb of fruits, vegetable, and leafy greens steamed, sautéed, or in salads daily, and numerous herbs are helpful for constipation. And yes, that is correct regarding the pain formulations; however, you can also take turmeric and ginger throughout the month for their anti-inflammatory effects. Best, Aviva

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    sophia

    chia seeds are a great alternative! u can buy them in bulk at costco for under $10. one bag will last forever and u can put them in smoothies, juice on salads in soups etc, they're pretty much tasteless. they help with constipation as well.

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    Colleen

    April, I do not tolerate flax seeds either but do well with chia. I have read that flax seeds are estrogenic and when I ate them heavily for one cycle, they made my pain so much worse! If you need a little help keeping your bowels moving, magnesium before bed is great. If you have a problem with corn though, skip the magnesium citrate (corn derived citric acid chelate) and stick with a magnesium glycinate product. Mag oxide is also ok but can be hard on some.

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      Claudia

      Good Belly is a liquid probiotic I buy at Whole Foods. It really helps me keep regular bowel movements. It tastes like juice. Even my father will drink it.

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Colleen

I work with many patients who have endometriosis and suffer from it myself. I'm chiming in because I have read many times that you recommend ground flax. Personally, I have found flax to exacerbate my endometrial pain. I assume this is because of it's estrogenic nature. Have you seen this before? I recommend ground Chia as an alternative. Also, I would also like to endorse The Arvigo Techniques of Maya Abdominal Therapy! I had amazing results with ATMAT. Another therapy that I have found extraordinarily helpful is vaginal steaming. Done 2-3 times the week before your period can greatly reduce the pain. In regards to Melatonin, there was a study that showed 3mg in combination with myoinositol improved egg health for women about to undergo IVF (an added bonus for those trying to conceive). 10mg does sound high. I wonder if you have some experience with your patients taking melatonin for endo yet? I'm curious whether or not it would be wise to start with 3 mg a day and work up if necessary? I know women want to be out of pain yesterday, but just curious to know how you are exploring this treatment option in practice? Thank you and blessings of health to all my sisters.

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    aviva

    Hi Colleen, Thank you for writing. Not sure why the flax is a trigger -- it does not contain estrogen nor act like one really any more than any legumes, beans, or other plants with phytoestrogens -- in fact, this is generally considered protective. But various people don't tolerate various things and we don't always know why. Good that you're trusting your body! Yes, I mentioned Arvigo in my blog -- Rosita is a friend and colleague, and her work is excellent for women. Yes, I have patients who take melatonin and at this dose; starting small is a good idea and I've adjust the blog to reflect this. Melatonin is very important for estrogen detoxification and sometimes even higher doses are used in conjunction with integrative therapies in breast cancer.

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      Colleen

      Thanks Dr. Aviva! Somehow I did not remember writing my comment and just wrote a new one as I was doing some re-reading/researching. You can delete my comment awaiting moderation:) Thank you for the response too. I did not receive it in my email, so I guess I have to check back in the blog comments? Is there a setting that I forgot to click on? I love the conversations that you stimulate with your blog and value your dedication to women's health! Thank you healing sister<3

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    Sanja

    Flax seeds didn't work for me either. I started grinding them in the coffee grinder, as they become more absorbent then, and adding 1Tbsp into my bread mixture, but my estrogen rocketed at that time, this could be because of their fitoestrogen potency. I haven't noticed anything similar when eating beans and such. I'll keep it off for the time. If eaten whole, flaxseed just go out whole, body has no use of them then, right? Will try Chia seeds as Colleen suggested. Do you know anything about using Femara in endo treatment? I started using it, following doctor's advice. It inhibits production of estrogen in the liver. There is some info here http://www.webmd.com/women/endometriosis/news/20040213/breast-cancer-drug-may-ease-endometriosis. Thank you for a very informative text.

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      Nicole

      This is a late comment, but people who are sensitive to flax seed should try soaking the seeds overnight in water with a bit of salt. Flax can be diffiuclt to digest--like beans--because it has phytic acid. Soaking the flax, and rinsing the water off before consuming, helps begin to digest the phytic acid.

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Joann Vollmer LMT, ATMAT

Hi Aviva, I always look forward to reading your articles. Endometriosis is a big topic with a complexity of areas to approach. Thank you for informing your readers about Arvigo Therapy as a treatment plan. As a certified Arvigo Therapist, I would recommend taking a look at a recently published book, Journeys in Healing, that includes many case studies of Arvigo practitioners and their clients explaining how we work together to bring about healing and homeostasis. Sincerely, Joann

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    aviva

    Wonderful! Thank you for sharing this with all of us Joanne! I will definitely recommend this.

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      Joann

      Readers can find an Arvigo Therapist in their location by logging onto www.arvigotherapy.com Many Healing Blessings!

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        jan

        Good article and comments. I have stage 3 Endo and always looking or new info. I think not every one is allergic to dairy as actually seems to like me but I'm now organic , green smoothie / ginger / lemon user , love berries , use turmeric ,flaxseed ( I love it) ,fish oils and trying to source organic chicken and grass fed beef. Beetroot also good for clearing out liver from toxins . I've stopped smoking ,stopped caffeine ,use magnesium ( helps hormones ..lots woman find) ,and drink her all tea etc . The other things you suggest . .what is NAC?..and where do you get it ,and the Indol ..and Xeno ! I'm a nurse but it's all a bit confusing ! Also latest research seems to be suggesting that Fish ( especially farmed salmon ) and fish oils ?! contain more toxins than animal fat so are they safe to take ? Something that saddens me is that the NHS ( I'm in Edinburgh ,UK) don't have a more holistic approach and all these treatments cost money !! Are you aware many Endo sufferers including me are unable to work and afford lots treatments. For example is Arvigo available on NHS or in Scotland !? I got some good advise,and herbal mix from a herbalist in Edinburgh but can rarely afford the mix. Woman with Endo face discrimination already with their illness never mind on a monetary level so please be aware of this ! Healthy eating/ drinking including gut health ( important for Endo) is a good start and including ginger ,turmeric , etc into diet. If there was one supplement to start with( bar turmeric ,ginger ,fish oil) what one would you recommend ..Thanks Jan. X

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          Megan Liebmann

          Hi Jan, This is Megan from Dr. Aviva's team. Thank you so much for writing and please know that Dr. Aviva values your questions. Unfortunately she can't address every question and she can do much better justice to health questions in an appointment… Her NEW! Integrative TeleWellness Consultations may be a great option for you if you’d like to discuss your health and wellness concerns with an expert in Integrative and Functional Medicine for women and children, and you don’t have this option in your community, or if are unable to come to see her in NYC when my practice opens in late autumn (2015). Although she cannot diagnose you, order labs or prescriptions, or treat you without an initial in person appointment, she can provide a thorough discussion of your current health-related questions and concerns, including reviewing your health history and laboratory results, helping you to make sense of how you might bring an Integrative, Functional Wellness approach into your health and wellness goals. Based on your conversation and information you might provide ahead of time, Dr. Aviva can offer a set of Integrative/Functional Medicine suggestions that you can discuss with your local doctors to see whether those would fit into your current health plan. If you would like more information, or to schedule an appointment, please go here: http://avivaromm.wpengine.com/integrative-telewellness-consultations If you would like to join her practice in the autumn, please check back on her website in late autumn for booking information. With warmest wishes, Megan- Dr. Aviva Romm Nutritionist


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Jamie

Aviva, Thank you for educating people about the dangers of plastics. I'm actually married to a man who is allergic to plastics. Styrofoam is the worst and will cause his throat to start shutting off. Other plastics cause rashes and itching and other symptoms in varying degrees. We have eliminated them from our lives as much as possible, but as you know in our plastic-laden world, it is very difficult, and sometimes impossible. Thank you for your passion to educate and care for people as you do. Jamie

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Angela

What about someone who has (for the most part) asymptomatic edometriosis? She had no idea there was a problem until a palpable mass was discovered during a routine physical. Surgery was performed and the Dr. said it was one of the largest edometrial masses he'd seen, and her abdomen was a mess. She has no pain or abnormal menses and is currently on BC pills to control speed of recurrence. She is reluctant to try natural alternatives simply because she has no way of measuring effectiveness without followup surgery. Suggestions or thoughts?

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    aviva

    Absolutely -- try the recommendations in the article -- same things apply. Best wishes! Aviva

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Nicky crick

I would love to hear your opinion on birth control? I am with a reproductive endocrinologist with stage III, excruciating daily pain. I just spent the last six months TTC post-surgery and he is now reccomending birth control or IVF. I am in so much pain I'm just ready to give up and go on it. Could I temporarily take it and begin this diet and herbals as well?

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Nadia

How do you dose the NAC? 600 mg TID for 3 consecutive days/week seems like an odd way to dose?

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    aviva

    I typically just dose it 600 mg 3 times daily to keep it simple; this above dosing is based on the study showing effectiveness for endometriosis.

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Becca Sarich

Aviva, I love this article! Natural treatments are so needed for this condition, and I love that you are sharing it with so many women. So happy to see the Arvigo work mentioned as well! I know you recommend it frequently. I am having great results with my clients with endometriosis through the Arvigo work that I practice, and through all the suggestions on nutrition, botanical therapies and supplements I have learned from you! Thank you for your incredible work!

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Kimberley

I'd love to try the anti-inflammatory diet, but I do have some concerns. Red meat is high in iron and protein - two important nutrients women need. Protein for the muscles and iron to prevent fatigue and for O2 to be carried around the body. If we don't get enough iron we'll end up tired and anaemic. Dairy, we can minimise or substitute with soy products, coconut milk and nuts, but really cannot afford to eliminate it altogether. We need dairy or dairy substitutes for for our teeth and bones, as it has calcium. Yes, leafy greens and other fresh fruit and vegetables contain iron, protein and calcium, but they won't provide us with as much of these as red meat and dairy will.

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    C

    Iron, protein and calcium are found in LOADS of other foods than those you mention. Cow's milk actually contains a substance that make it hard for our bodies to absorb the calcium in milk.

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turmeric and black pepper

Apply in the forehead before going to bed for couple of days if you have severe cold and cough. What's so fascinating about this is that curcumin has the ability to unleash a groundbreaking response with the sole purpose of killing cancer. You will have the ultimate protection with turmeric.

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Lissa

Hi Aviva, Thank you for this great and informative article, I very much appreciate it. I have pretty advanced endometriosis, thankfully without too much pain though it seems to be getting worse. I have a few questions- are plastics that say chicken come in ok? it's hard to fine meat not sold in plastic! And I drink water from a spring and transport some of it in BPA free plastic jugs, would even that be something to avoid? Is there a brand of the pine bark and NAC supplements you recommend? many thanks, Lissa

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Michelle Clark

Thanks for all the information. I am feeling a little overwhelmed and uncertain which to buy as you list different alternatives in each category. Can you clarify which products you would use together and which you would use as an either/or option. For example you list 3 products for inflammation along with fish oil. Would you use all three or pick one? Thanks. Can't wait to start this journey.

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    aviva

    Hi Michelle, My suggestion would be to pick one or two from each category, seeing which ones resonate the best for you. Sometimes, it does take a combination of all 3, but you can start slower since taking a lot of supplements can get expensive.

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Adena BrighT

thanks for the Arvigo shout out! And so glad the above commenter recommends Rositas new book.

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Brandi

Hi, I've read a lot about avoiding chemicals & toxins, but have seen little mention of which chemicals and toxins to avoid. After all water is a chemical and can be toxic taken at high volumes :) Do you have specific or at maybe a top 10 to avoid?

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    Megan Liebmann

    Hi Brandi, This is Megan from Dr. Aviva's team. Great question! Though it is not a top 10 list, the Environmental Working Group's EWG website is one of the #1 resources that Dr. Romm suggests her patients get to know for chemical and toxic exposure risks. They have many consumer guides that are really helpful. http://www.ewg.org/consumer-guides Megan- Dr. Aviva Romm Nutritionist

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Jei

Have you seen good results with DIM for estrogen dominance symptoms and/or endometriosis? What dose and pattern of administration do you suggest? Thanks for the great articles and solutions!

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Zita

Dear Aviva, Thank you for this wonderful article, the practitioners and doctors I follow have not mentioned this topic yet although it is so important for us, who suffers from the disease. I have two questions: 1. Why is corn on the forbidden list? Because of the GMO? Since I live in Hungary, Europe, where all GMO is practically forbidden, should I quit corn altogether as well? 2. The other question is that should I follow all these principles if I am on the pill continuously, so I do not have a period for a year now? I am planning on quitting the pill, but after the surgery I needed some time to adjust my new lifestyle. Thank you very much for the answers. <3

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Maja

Hello, I was wondering about iodine supplementation. There are some sources (ref. to US patent US6019970 A) claming that endometriosis, ovarian cysts, PMS, breast cancer,etc., are iodine deficiency diseases. Could it hurt actually taking daily allowance of liquid iodine supplement, especially if not getting iodine from other sources? As ovaries and adrenals need iodine as well, it would make sense, but I know there is a controversy regarding the iodine supplementation.

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    Megan Liebmann

    Hi Maja, Below is a direct link to a blog Aviva wrote on nutritional supplements for women where Aviva talks about Iodine. http://avivaromm.wpengine.com/nutritional-supplements-for-women I hope this helps! Megan- Dr. Aviva Romm Nutritionist

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Melissa

Thank you, Aviva! I can't tell you how timely this article is! I just spoke to a doctor yesterday about scheduling a laparoscopy. I've been doing many of the things in your article and have experienced a marked decrease in pain, and I'd like to experiment with NAC to see if I can get off pain meds entirely, since they throw my digestion out of whack every month. Is there a brand that you recommend? Thanks again for such a great article!! :)

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Liliane Sommer

Hi Dr. Romm, When you say to avoid all corn, does this mean organic corn, as well? Corn tortillas is our go-to now that we're not eating bread/gluten. It is all such a huge lifestyle change, but do we need to get rid of the organic corn tortillas too? It is so difficult to eat a meal with this diet, and I'm trying to gain weight. Thanks, Liliane

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    Megan Liebmann

    Hi Liliane, Yes, it is best to avoid corn as it can be a trigger. If you have not already, take a peak at Dr. Aviva's blog on How and Why to do and Elimination diet. It's loaded with great information as well as good alternatives for substituting corn (I personally know how hard it is!!) http://avivaromm.wpengine.com/elimination-diet I hope this helps! Megan- Dr. Aviva Romm Nutritionist

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Ihappy

Just wish I lived near that "local cafe" so I could overhear all of your stories! Thank you for this excellent and useful information. Bravo for the cheerleader reminder on plastics, .... in our Dunkin Donuts Styrofoam love affair world, it can sometimes feel lonely to take a stand for staying away from endocrine disrupting packaging and foods. And thank you for the shout out for Arvigo Therapy (also known as Maya Abdominal Massage). I offer this in my practice in NYC as a LMT. Thank you. Pamela

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Dr Christine Maren

Wow! Thank you for addressing the environmental toxins and endocrine disruptors here! I really appreciate the specific recommendations in terms of dose/ brands that you use. I will be referencing this article in the future when I see patients with endometriosis. Thanks for sharing some valuable information!

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Kathryn

Great article! I learned so much and appreciate all that you do!

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Michele

Still reading through the article, but wanted to comment before I forget: The reference to corn caught me. A friend recently informed me (her daughter has a corn allergy) that most, if not all, adhesives, are corn-based. Medical tape. Stickers. Band aids. Personal items that need to stay in place. Another avenue for corn that came up was through milk. When cows eat corn, it shows up in their milk (not AS corn). When we switched to grass-fed milk, the diaper rash went away. It may seem small, but corn as an ingredient is far more pervasive than most people think. I've even run across disposable cups made from it. And with most corn being GMO (and it is a wind-blown pollination process, so it scatters everywhere, not just one controlled area), genetic modification - designed to disrupt life patterns in insects - probably does a whole lot more in the irritation department than most people would think.

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    Megan Liebmann

    Hi Michele, This is Megan from Dr. Aviva's team. Great information and thank you for sharing! Yes, corn does indeed hide in so many things! Megan- Dr. Aviva Romm Nutritionist

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Kara

Great article! I follow most of these already. But do go through stages if following it more or less strictly. One thing though. The studies indicate that the percentage of women suspected of having Endometriosis is 2 to 8 percent in most studies. Only a few found 2 to 10 percent. So it really is incorrect to just say 10 percent. Also endometriosis is the 3d leading cause of infertility in women, many men are infertile too... 20 to 45 percent of the 2 to 10 percent of women with Endometriosis are infertile. But again, love the info. Thank you.

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Samantha

Dr. Aviva, I'm always looking for new things to help women out, gave this article to a woman at church the other day, I hope it helps her. I plan to post a link to your page on both my website and Facebook page. I'm excited to find as many sources as I can to help women take back their health. I'm quite honestly sick of Dr.s that prescribe symptom relief but do nothing for the root of the problem, thank you so very much, from the bottom of my heart for not being one of them, and for sharing your valuable information for free with the public!

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    Megan Liebmann

    Hi Samantha, This is Megan from Dr. Aviva's team. Thank you so much for your feedback and for sharing Aviva's work! It is her mission to make health and wellness available to as many women as possible and to provide as much information as possible that enables people to take back their health. <3 Megan- Dr. Aviva Romm Nutritionist

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Linda

Hi Dr Romm! I met you at CampGLP and loved hearing your talk on Adrenal Fatigue, I was also lucky enough to attend your Q & A session. I have endometriosis, was diagnosed in 1998...I managed it fairly well for 10+ years, then began having chronic back pain and 5 fibroids. I went the route of a hystrorectomy (removing uterus and cervix, but kept my ovaries). I am still experiencing the lower back pain and much of it seems to "radiate" in my abdomen and hip area. I have an amazing PT that specializes in Pelvic Floor manipulation (wish I would have found her before hystrorectomy) We are stuck though (there is nothing wrong with my back, i.e. slipped disk etc) , I have had chronic pain for 5+ years and nothing I do seems to help. My question, is...of the above mentioned, what would be helpful for me at this point, I feel I am dealing with damage from the Endo? I also have many of the symptoms of the adrenal fatigue and am looking at the adaptogens...wondering if the two are connected? Thanks Dr Romm!!

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Nicole

I was wondering about using melatonin while trying to conceive? I take melatonin often as a sleep aid, but do not do so between ovulation and the first day of my cycle. Now that I hear it has beneficial properties for endometriosis, I am wondering whether it is safe to take during my whole cycle as well, even if I am TTC? Thanks.

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Jessica Cox

Hello! Wonderful article. Can one still have endometriosis even if their functional medical lab tests reflected completely normal hormone levels?

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    aviva

    Yes - sure can!

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Irina

Hi, Aviva! Thank you for sharing your knowledge and experience with us for free! I respect you deeply for your dedication to the well-being of women and your alternative, natural way of healing. Right now I am applying your advices from this article. The problem is that here, in Bulgaria, I can`t find the same mixes of supplements (like "Inflamma Response"). I can buy the supplements separately but different producers produce tablets containing different mgs and the recommended daily intake on the labels varies as well. Could you recommend some milligrams for each supplement?

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    aviva

    Usually you can follow the recommendations on specific packages; but yes, happy to include mg in future!

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Sandra

Hello from Portugal, Dr Aviva! First I'd like to congratulate you on your approach to endometriosis, it's refreshing to see a Dr validating a natural treatment. I had surgery scheduled for April 20, they were going to remove the lesions, a segment of intestine (colostomy), a part of the ovary and its endometrioma, and, the left tube. On the 9th of April, I've noticed my urine was way too dark, and since I had spent the last couple of months unable to leave bed, with excruciating pain, and eating all sorts of cocktails including opioids like candies, I figured that my liver was highly intoxicated. So I took the liberty to set myself on a detox diet, based on homemade juices and soups, and guess what, after three days my pain decreased 60%, I was finally able to get out of bed and go to the kitchen to prepare my meals. I went to see my Dr and she recommended that I'd cut off the gluten, meat, sugar, milk and anything with milk, plus processed and packaged food. She also recommended exercise as soon as I could, and a daily dose of vitamin D. And so I did. One week later the pain decreased 80%, and I was able to walk 2 miles. I cancelled the surgery. I've been taking melatonin for about 5 months now, because I had trouble to sleep, but I only take 1mg a day. I've tried to interrupt it a couple of weeks ago, but I've noticed that the lack of sleep was making me worse, so I'm back on it for the past three days, and I've noticed that having a deep regenerating sleep helps a lot. My question is regarding the pill. My Dr says that I should take it forever, and I've been taking it uninterrupted since December, but I'm worried with the long term side effects, plus my AMH is 0,30 at the moment. I want to leave the pill, but I'm worried that the lesions will grow again. I'm 35, got pregnant for the first time a year ago spontaneously on the first cycle but lost it at 10 weeks. We haven't tried again since. What is your opinion regarding the pill, is it too soon to interrupt it? Should I take any supplements while I'm withdrawing from it? Thank you so much and keep up the amazing work!

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bobbi

Thank you for this amazing article! I have struggled with endometriosis for over 22 years! I am turning 40 soon and I have really struggled with my symptoms.Especially here lately with weight gain (20 lbs), foggy brain, and extreme fatigue everyday. I am still trying to figure out if its my gut or still just the side effects of my endometriosis or both due to the 22 plus years of over taking motrin for the pain. Based on your article, I plan to start taking Inflammatone, Inflamma Response, Tumeric Supreme, fish oil, NAC, flax seed, xeno pro tex, and melatonin. I also have blood clots, severe vit D deficiency and sarcoidosis and I am on a daily aspirin and Vit D. With this new regimen, would you suggest that these be taken in the mornings or evenings? My stomach is always upset and I don't want to be nauseous on top of it all. Thank you in advance for any thoughts!

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Layla Forndez

I had endometriosis for 18 years and i never thought i would ever get a cure due to the terrible symptoms i had and this made it impossible for me to get pregnant even after 12 years of marriage and it was a serious issue. I got to know about Dr. Aleta who treated someone and the person shared a story of how she got a cure and let her contact details, i contacted Dr. Aleta and she actually confirmed it and i decided to give a try too and use her herbal medicine that was how my burden ended completely. My son will be 2 this december and i am grateful to God and thankful to her for medicine too. If you have (Endometriosis, PCOS, Fibroid, Ovarian cyst, Ectopic Pregnancy or any infertility issues) just reach her on (aletedwin @ gmail. com) she has professional advise and a cure too.

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Erika

Hi! Thanks for all that info! There are so many suggestions online... What are your thoughts on probiotics, castor oil packs, inositol powder and primrose oil? Would'not those help too? Do you think essential oils can be useful too? How a bout bone broth? Thanks again!

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Jo

Hi Aviva, My question is on Vitalzym. Do you recommend taking it to reduce scar tissue? Can it heal Endo.

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    Aviva

    Never used it for this.

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Nicole Sugihara

Thank you Dr. Romm! This was a great and very helpful article on endo! I just finished listening to your Adrenal Thyroid Revolution book via audible! It was a refreshing combination of information that I have learned over the years and thought it was a clear and concise delivery of information that can be a bit challenging to get all in one place. I had one comment about food intolerances and another about bioidentical hormone replacement therapy. 1st, after many challenges trying to figure out food intolerances for myself, I figured out I have a FODMAP's intolerance (my triggers are mainly garlic and onions). I know you mentioned fructose intolerance, but there are many other long-chain sugars that can also wreck havoc. I didn't know if you left these out of the book because they can be difficult to figure out or if you didn't have familiarity with them? I was curious and hoping to help others out that may have suffered for a long time with is as an issue and finally stumbled upon FODMAP's much later. It explained also why so many of the "healthy foods" caused me such issues for a long time, especially when I went Paleo and felt horrible. My 2nd question was in reference to endo, as I have suffered many years with it and after surgery found a doctor that works with bioidentical hormone replacement therapy, and put me on BIHRT progesterone. I haven't seen you mention this as an option for women with endo and was curious about your thoughts on this as part of a treatment plan. My understanding is that part of why women can get endo is because of low progesterone and can frequently benefit from taking it? Thank you for helping to bridge the gap and shine a light on this challenging and difficult realm of women's health! I appreciate the work you are doing! Cheers!

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    Aviva Romm

    FODMAPS - can be very important to try - publishers only give an author so many pages - so I had to choose the most common pathway that would meet most people's needs. But yes, in my practice I do put patients on a FODMAPS diet to see how they respond. HRT will be discussed in my next book and in upcoming articles - but it is not an approach I usually take with endometriosis. Also within my articles online I try to present options as much as possible that women can apply themselves - HRT requires a prescription and has potential side effects. Low Pg does not cause endometriosis. Though I do use BIHRT in my medical practice when approrpiate.

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Jess

Dr. Romm, Thank you so much for this article. In the past year I was diagnosed with three ovarian emdometrioma. I have been plagued with severe pain and vomiting with every cycle. Since I was 14, I would go to the Dr. every few years hoping for a solution other than the pill. Every time I was told pain is a normal part of a cycle. This last year, I was vomiting so severely from the pain, my throat kept splinting open and I was vomiting blood. I finally found a Dr. who said that isn't the norm. She then found then diagnosed the endo. I found your site about a month ago researching Endo and Chaga mushrooms. I immediately ordered NAC off your recommendation. This is the first month in years (over 7 years) where I did not have splitting pain (akin to a glass covered knife ripping my insides) or vomiting. No vomiting at all. It feels like a miracle. I did not take the NAC without the Chaga so I have no idea how they do on their own. But together it's a dynamic duo. I have another ultrasound in about 6 months and I'll follow up regarding the size of the masses. I've never been this optimistic regarding controlling the pain and stopping the vomiting naturally. You are a G-d send. Thank you! Jess

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    Aviva Romm

    BRILLIANT! I am so happy to hear this! This is wonderful news. I wish you continued ease, improvement, and good health! BTW that combo is great - and indeed both may be helping.

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Amanda

Hi Dr. Romm, I realize this post is on the older side at this point, but I've been wondering about something... what is your take on toilet paper? I'm a women's holistic health coach and RN and have struggled with severe hormonal disruption myself for years, and this is something I think about often. What role does bleached, processed toilet paper play in hormonal disruption? Especially for those of us who go pretty often, we are constantly touching sensitive mucous membranes with chemically processed materials. I have tried to use reusable/washable cotton wipes at home, which obviously creates more housework, but then let go of that because of the nuisance, however I wonder if it's worth the extra work. And then of course there is the fact that we must use paper out in public. Wondering if you've thought about this. It's the most frequent way I've found myself coming into contact with chemicals since I've worked very hard to get them out of my home and personal care products.

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    Aviva Romm

    Great Q - yes - we absorb softeners, fragrances, etc down there, too - and all act as endocrine disruptors. So ideally, unbleached or natural bleach, no scent, etc for TP is best! And BTW we first bought recycled TP in 1985. When my husband came home from the store with the recycled TP my first statement was "Yuck, how do they do THAT?" Until I realized it wasn't the TP that was being recycled....LOL -that's a true story. PS When travelling or working outside the home (in an office, etc), have tissue in your bag... At home with just peeing, you can use a peri-bottle with water as a rinse instead of TP. Sort of a modified bidet. Doesn't work for #2's though.

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seguridad industrial accidentes

Do you have any video of that? I'd love to find out more details.

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    Aviva Romm

    Not yet - but more video is coming soon!

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Mallory

Amazing article! Do you have recommendations regarding duration in taking these supplements? For instance, can Indole-3-Carbinol be taken 24/7/365 or should it be taken intermittently throughout the year? Should Melatonin also be cycled? Would love to know which ones I should take daily and which ones I should cycle. Thanks so much for your work! <3

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    Aviva Romm

    Hi Mallory, They are taken daily, usually for at least 6, or for 12 months or more - after 12 months if there's no improvement at all, I'd say other options should be tried. There's no need to cycle these. :) Aviva

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ChagaHerb.com

Thanks for letting me know about Endometriosis, I was not aware of the term before.

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Sherry Schmidt

I am looking on this site for the questionnaires that are in your book. I have printed them off one time, but now do not see them. I regret my lack of savvy related to online learning.

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sidra

v helpful article

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