A Definitive Functional Medicine Guide To Endometriosis Causes + Symptoms


Endometriosis is a condition that affects countless women across the world but doesn’t always get the recognition it deserves in conventional medicine. For many women it is a struggle to just get through daily life due to the debilitating nature of this condition. Instead of support, their symptoms have been dismissed, or they have been recommended treatment options with their own long list of side effects. But functional medicine offers a different approach. By learning more about the different endometriosis causes, we can begin to address the underlying factors contributing to this condition and start healing. 


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What is endometriosis?

Endometriosis is a complex and often debilitating medical condition that occurs when tissue resembling the lining of the uterus grows outside of the uterus where it doesn’t belong. Known as endometrial implants or lesions, this tissue can be found on various pelvic organs, including your ovaries, fallopian tubes, and even the lining of your pelvic cavity. 

Endometriosis is estimated (1) to affect between 10-15% of women of reproductive age. Unfortunately, it’s difficult for researchers to accurately conclude how many women actually suffer from endometriosis due to the fact that many women tend to power through their symptoms or worse - have their symptoms dismissed by doctors.

Endometriosis causes + risk factors

Although the exact cause of endometriosis is unknown, several factors have been associated with its development, including:

1. Genetics

According to the Endometriosis Research Center, (2) women with close relatives who have endometriosis are 7 times more likely to develop endometriosis than those who don’t have a family history of this condition.

2. Hormonal imbalances

Estrogen dominance is strongly linked to the development of endometriosis, as estrogen promotes the growth of endometrial tissue. Additionally, retrograde menstruation, where menstrual blood flows back into the pelvis instead of exiting the body, may lead to the implantation of endometrial cells in abnormal locations. 

Other risk factors include early onset menstruation, short menstrual cycles, and never giving birth. Although researchers are continuing to connect the dots between these risk factors and the mechanisms by which they contribute to endometriosis, they believe it has to do with the fact that they all have to do with underlying hormone imbalances.

3. Environmental toxins

Exposure to toxins - specifically endocrine-disrupting chemicals commonly found in women’s makeup, personal care products, and pesticides - have also been shown (3) to play a direct role in the development of endometriosis

4. Abdominal surgery

Certain abdominal surgeries like C-sections can result in displaced endometrial tissue, leading to the development of endometriosis.

5. Age

Endometriosis can develop at any time after the onset of menstruation. But due to the fact that women don’t typically seek help for other symptoms of endometriosis like painful menstrual cramps and heavy periods, most women don’t get diagnosed until their 20s or 30s when they are struggling with infertility - another common symptom of endometriosis.

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Signs and symptoms of endometriosis

Since everyone’s biochemistry is unique, symptoms can vary between individuals. But with that said, these are the most common signs and symptoms of endometriosis.

  • Pelvic pain: Persistent and often severe pelvic pain that intensifies during menstruation is a hallmark symptom of endometriosis.
  • Dysmenorrhea: Painful menstrual cramps that can impact your ability to participate in normal daily activities.
  • Painful intercourse: Discomfort or pain during sexual activity.
  • Heavy periods: Excessive menstrual bleeding that can also be accompanied by clotting.
  • Chronic Fatigue: Constant exhaustion that doesn’t let up regardless of where you are at in your cycle.
  • Digestive distress: Problems like diarrhea, constipation, gas, and bloating that increase during menstruation.
  • Infertility: Close to 30-50% (4) of women with endometriosis have difficulty getting pregnant.
  • Lower back pain: Chronic pain in the lower back or legs not caused by any specific activity.

How is endometriosis diagnosed?

Diagnosing endometriosis usually involves a multi-step approach. First, your doctor will go through a comprehensive health history review to determine how many of the common endometriosis symptoms you are experiencing and to what severity. Then if your doctor determines that endometriosis is likely a factor in your health case, they will suggest a minimally invasive surgical producer known as laparoscopy in order to get a definitive diagnosis.

During laparoscopy, a small camera is inserted into your abdomen to determine if you have any endometrial lesions. This gold standard diagnostic tool not only confirms the presence of endometriosis but also assesses the extent and location of abnormal growths in order for your doctor to put together the best plan of action moving forward for healing. 

Conventional treatments for endometriosis

Unlike functional medicine which aims to identify and heal the reason behind the abnormal tissue growth in endometriosis, conventional medicine looks more at managing the symptoms of this condition. Depending on the severity of a person’s endometriosis, there are a few different treatment options that conventional medicine typically relies on:

1. Pain management

Over-the-counter or prescription pain relievers, such as NSAIDs like ibuprofen and opioids, are often used to alleviate the chronic pelvic pain and painful menstruation associated with endometriosis.

2. Hormonal therapies

Hormone-based treatments, such as birth control pills, hormonal IUDs, or hormonal therapy, aim to regulate the menstrual cycle and reduce endometrial tissue growth. Although these options can help in these areas, they usually have their own list of side-effects including weight gain, anxiety, depression, and further hormone problems if you ever decide to stop using these treatments.

3. Surgery

In severe cases or when fertility is a concern, laparoscopic surgery known as excision might be recommended to remove endometrial growths. Some doctors may even recommend a hysterectomy in severe cases as a last resort, especially if multiple excisions have already been done.

A functional medicine approach to endometriosis

In functional medicine, we like to go with the treatment plan that results in the least amount of side effects while still offering results. Sometimes conventional treatments fit that description - especially for people needing more immediate relief for extreme cases of endometriosis - but for the most part, functional medicine focuses on addressing the underlying factors so that these more invasive procedures and medications are no longer necessary.

1. Get your hormones tested

Since certain hormone imbalances like estrogen dominance can contribute to endometriosis, getting your hormone levels checked can give you and your doctor a clear picture of what is going on beneath the surface.

To learn more about how to get your hormones tested, check out my article here.

2. Try acupuncture

Studies have found (5) that acupuncture can significantly improve symptoms of endometriosis-related pain including dysmenorrhea. 

3. Manage your stress levels

Chronic stress is linked to a multitude of health problems, endometriosis included, with research showing that higher stress levels were associated with higher (6) chronic endometriosis pain. Breathwork, yoga, and mindfulness practices like meditation are all tools to start implementing in your self-care routine if you are looking to manage your stress levels. In fact, one study even found that Brief Mindfulness-Based Intervention (bMBI) improved (7) pain levels and overall mental health as well as, if not more, than conventional medical care.

4. Natural supplements

Deficiencies in certain nutrients like Vitamin D, Vitamin E, and zinc are all linked to a greater risk of developing endometriosis, making supplementation an important part of an effective endometriosis treatment plan. Studies have also shown (8) that regular supplementation with curcumin, omega-3s, and NAC were all able to decrease the size and recurrence of endometriosis lesions. 

Seeking help from a functional medicine practitioner

Although endometriosis can feel overwhelming, it is important to know that there is hope for healing. From stress management to natural supplements, there are many things you can do to support healing naturally. If you believe endometriosis is a factor in your health case, schedule a telehealth consultation today to learn more about how we can help you with functional medicine.

By running the appropriate lab work to uncover underlying hormone imbalances, nutrient deficiencies, toxin exposure, and more to develop a tailored health plan, created just for you and your body's needs.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

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  1. Smolarz, Beata et al. “Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature).” International journal of molecular sciences vol. 22,19 10554. 29 Sep. 2021, doi:10.3390/ijms221910554
  2. Endometriosis Research Center "Do You Have Endo?" Accessed November 2023. https://www.endocenter.org/do-you-have-endo/
  3. Zaraq Khan, Ye Zheng, Tiffanny L Jones, Abigail A Delaney, Luiz F Correa, Chandra C Shenoy, Khashayarsha Khazaie, Gaurang S Daftary, Epigenetic Therapy: Novel Translational Implications for Arrest of Environmental Dioxin-Induced Disease in Females, Endocrinology, Volume 159, Issue 1, January 2018, Pages 477–489, https://doi.org/10.1210/en.2017-00860
  4. Evans, M Blake, and Alan H Decherney. “Fertility and Endometriosis.” Clinical obstetrics and gynecology vol. 60,3 (2017): 497-502. doi:10.1097/GRF.0000000000000295
  5. Li, Pei Shuang et al. “Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial.” Fertility and sterility vol. 119,5 (2023): 815-823. doi:10.1016/j.fertnstert.2023.01.034
  6. Casalechi, Maíra et al. “Endometriosis and related pelvic pain: association with stress, anxiety and depressive symptoms.” Minerva obstetrics and gynecology vol. 73,3 (2021): 283-289. doi:10.23736/S2724-606X.21.04704-3
  7. Moreira, Marcelo de França et al. “A single-blind, randomized, pilot study of a brief mindfulness-based intervention for the endometriosis-related pain management.” European journal of pain (London, England) vol. 26,5 (2022): 1147-1162. doi:10.1002/ejp.1939
  8. Yalçın Bahat, Pınar et al. “Dietary supplements for treatment of endometriosis: A review.” Acta bio-medica : Atenei Parmensis vol. 93,1 e2022159. 14 Mar. 2022, doi:10.23750/abm.v93i1.11237

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Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.

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