Endometriosis

What is Endometriosis?

Endometriosis is a chronic, estrogen-dependent inflammatory disease in which tissue like the lining of the uterus (lesions) is found outside the uterus. It affects up to about 10% of women during the reproductive years.^[1] The lesions are most often on the ovaries and pelvic surfaces, and can occasionally be found in the bowel, bladder or outside the pelvis.^[2]

Common symptoms

Pelvic pain is the main symptom, reported by about 90% of people with endometriosis, including painful periods, pain between periods and pain during sex.^[1] About 26% report infertility.^[1] Fatigue, pain in more than one body area and other symptoms can also occur.^[3]

Some women also have painful bowel movements or urination and bloating or other digestive symptoms, especially around periods. The amount of pain does not always match how much endometriosis is present.

Causes and risk factors

The cause is not fully understood. Researchers have studied genetic, hormonal and immune factors, and the older theory of backward flow of menstrual blood is still discussed.^[3] Known risk factors include starting periods at a younger age, shorter menstrual cycles, lower body mass index, never having given birth, and certain structural abnormalities of the uterus or vagina.^[1] A family history also raises risk.

How it is diagnosed and treated conventionally

Diagnosis is often delayed, averaging 5 to 12 years after symptoms begin.^[1] A doctor can suspect endometriosis from symptoms, an exam and imaging such as transvaginal ultrasound or MRI, but a normal exam or scan does not rule it out, and definite diagnosis requires seeing the lesions during surgery.^[1]

Hormonal medicines, such as combined birth control pills and progestins, are first-line treatment for women who do not want to become pregnant right away. Between 11% and 19% of people get no pain relief from them, and 25% to 34% have pain return within a year of stopping.^[1] Laparoscopic surgery to remove lesions is considered when hormonal treatment is not effective or not suitable. Second-line hormonal drugs include GnRH agonists and antagonists, and third-line drugs include aromatase inhibitors.^[1]

Why Endometriosis calls for a whole-person approach

Endometriosis is not only a pelvic problem. It is a chronic inflammatory disease that can affect energy, mood, sleep and pain sensitivity, and symptoms often persist or return despite treatment.^[3] A review in BMJ recommends a personalized, multimodal, interdisciplinary approach.^[3]

Care that also looks at pain, stress, sleep and movement is a reasonable addition to treatment aimed at the lesions.

Chronic inflammation

Endometriosis is described as an estrogen-dependent inflammatory disease.^[1] Because inflammation is part of the condition, researchers have studied plant compounds with anti-inflammatory activity, although most of that work is in laboratory and animal models.^[4]

Pain that becomes more sensitive over time

Long-lasting pain can become more sensitive through changes in how the nervous system processes pain signals. A systematic review lists pain sensitization among the factors linked to depression and anxiety in endometriosis.^[5] A review of the condition also describes it as neuro-inflammatory.^[6]

Stress, mood and sleep

Depression and anxiety symptoms are more common in women with endometriosis than in healthy women, and they are related to chronic pain.^[5] The same review links poor sleep quality, fatigue and sexual function problems with these symptoms.^[5]

Movement and body awareness

Gentle exercise and yoga have been suggested for symptom control. A systematic review could not determine whether exercise helps endometriosis symptoms because only three small studies met its criteria.^[7]

Acupuncture for Endometriosis

What the research shows

Acupuncture may reduce endometriosis-related pain, but the research has important weaknesses. The best study is a randomized, sham-controlled trial in four Chinese hospitals with 106 women. Real acupuncture lowered painful-period scores more than sham acupuncture right after 12 weeks of treatment, shortened pain duration and improved quality-of-life scores. The difference was gone 12 weeks after treatment stopped. Pain between periods and pain with sex did not differ between groups, and there were no serious adverse events.^[8]

Meta-analyses point the same way but include small or unblinded trials. A 2024 review of 14 studies with 793 patients found less pain with acupuncture than with control treatments, and cautioned that the original studies had design and quality flaws.^[9] A 2025 review of 9 trials with 535 women found acupuncture alone reduced pain more than non-acupuncture treatments, with considerable variation between studies.^[10] A network meta-analysis of 23 trials with 1,545 patients found that acupuncture-related therapies added to drug treatment were effective for symptoms, and called for higher-quality trials.^[11] An earlier Cochrane review found only one adequate trial of 67 participants and judged the evidence limited.^[12]

How acupuncture may work

How acupuncture affects endometriosis pain is not settled. One review proposes that it acts on prostaglandins, endorphins, dynorphins and substance P, which are chemicals involved in pain signaling.^[9] These are proposed explanations and are not proven in people with endometriosis.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the abdomen, lower back, legs and sometimes the ear, usually left in place for about 20 to 40 minutes. The sham-controlled trial used 30-minute sessions three times a week for 12 weeks, timed around the menstrual cycle.^[8] We reassess after a short course of visits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant or could be pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Endometriosis

The Ayurvedic view

Ayurveda has no single classical name for endometriosis. Traditional writers describe painful periods and pelvic pain as a disturbance of Vata, the principle said to govern movement, often with Pitta or Kapha involvement, and describe the lesions as an accumulation of ama (undigested residue). These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally combines:

• Diet and daily routine, such as warm, regular meals and steady sleep hours
• Gentle yoga and breathing practices; a small randomized study of yoga in endometriosis is described below
• Warm oil massage and local heat for the abdomen and lower back
• Herbs such as turmeric, ginger and shatavari, which have been studied in other settings
• Panchakarma, a set of cleansing procedures, only where traditionally appropriate and medically sensible

Panchakarma is not appropriate during pregnancy, acute illness, frailty, or heavy or unexplained bleeding, and it should wait until your doctor has assessed new symptoms. Transdermal medication therapy, in which an herbal preparation is applied to the skin, may be discussed, but no evidence for it in endometriosis was found.

What the research shows

The evidence for Ayurveda in endometriosis is very thin. No clinical trials of an Ayurvedic treatment for endometriosis were found in PubMed. Laboratory and animal studies of curcumin, quercetin and resveratrol suggest effects on inflammation, oxidative stress and cell growth, but the authors say clinical studies are needed to know whether they help women with endometriosis.^[14]

For related daily-routine practices, a randomized trial of 40 women compared 8 weeks of twice-weekly hatha yoga with no yoga. Daily pain was lower in the yoga group and several quality-of-life measures differed between the groups, but the trial was small and the groups were unequal in size.^[15]

Herbal medicine for Endometriosis

Herbs and formulas that have been studied

Chinese herbal medicine is the most studied herbal approach. Trials have used oral formulas, formulas given as an enema, and formulas combined with conventional drugs or with acupuncture.^{[16, 17]} Chinese formulas are individualized to the person's traditional pattern, and a practitioner chooses and adjusts them. Western and Ayurvedic herbs and plant compounds, including curcumin, have mostly been studied in laboratory or animal models.^[4]

What the research shows

The evidence is limited and comes mostly from lower-quality trials. A 2023 meta-analysis of 34 trials with 3,389 participants found that Chinese herbal medicine reduced painful periods compared with no treatment at 3 months, and that adding it to conventional therapy reduced dysmenorrhea, pain with sex and pelvic pain. The benefit did not last 9 months after treatment ended.^[17]

An older Cochrane review included only two trials with 158 women. It found Chinese herbs comparable to the drug gestrinone after surgery and possibly better than danazol, but called for more rigorous research.^[16] A 2025 review of 16 trials found that acupuncture combined with Chinese herbs improved pain more than herbs alone, and described its conclusions as preliminary.^[18]

For plant-based therapies in general, a review noted that there are almost no randomized controlled trials.^[4]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reviews describe interactions such as extra bleeding when danshen, ginkgo or garlic are combined with warfarin or aspirin, and bleeding between periods and unplanned pregnancies when St. John's wort was taken with birth control pills, along with lower blood levels of several other drugs.^[19] Some plant compounds have estrogen-like activity, which is a particular concern in a hormone-driven disease, so any herb should be reviewed by your gynecologist.^[4]

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant, trying to conceive or breastfeeding, have liver or kidney disease, or take hormonal medicines.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes endometriosis pain as blood stasis, with cold or qi stagnation, meaning blocked flow in the pelvis. Researchers study things that loosely parallel this picture, such as local inflammation, prostaglandin signaling, and how the nervous system amplifies pain.^[9]

Ayurveda's aggravated Vata describes cramping, shifting pain that responds to warmth. No study has shown that a dosha or pattern corresponds to a specific biological process in endometriosis.

How this care fits with your medical care

Complementary care for endometriosis is used alongside your gynecologist, not in place of one. Keep your physician and any prescribed hormonal treatment, and do not stop or change prescribed medicines or skip planned surgery without talking to your prescriber. We do not diagnose endometriosis, so new or worsening pelvic pain needs medical evaluation.

If you are trying to conceive, tell both your gynecologist and us, because some herbs and treatments are not suitable then. Please bring your diagnosis, any imaging or surgical reports, a full list of medicines and supplements, and details of any planned procedures.

When to seek urgent medical care

Some symptoms suggest a complication or a different serious problem, and sudden severe pelvic pain should not be assumed to be endometriosis.

• Sudden, severe pelvic or abdominal pain, especially with fever, vomiting or fainting
• Heavy bleeding that soaks a pad or tampon every hour for several hours
• Possible pregnancy with pelvic pain or vaginal bleeding
• Blood in the stool or urine, or being unable to pass stool or urine
• Chest pain or shortness of breath around the time of your period
• Fever with pelvic pain or unusual vaginal discharge

If any of these occur, call 911 or go to the nearest emergency department.