Endometriosis: What Is It and What Can Help?

Over 80 percent of younger people who menstruate experience period pain. Twenty percent report that their period pain severely disrupts their lives. One condition gaining more public attention is endometriosis, but what is it and what can help with it?

Endometriosis is a chronic, often very painful condition where tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus. This tissue can appear on the ovaries, fallopian tubes, outer surface of the uterus, and even on non-reproductive organs like the bladder or intestines. Like the uterine lining, this tissue responds to hormonal changes during the menstrual cycle ––– it thickens, breaks down, and bleeds. However, unlike endometrial tissue, it has no way to exit the body, then causing inflammation, scarring, and sometimes cysts. These changes can lead to symptoms including pelvic pain, heavy menstrual bleeding, fatigue, and digestive issues.

Overview of Symptoms and Why They Happen

Pelvic Pain

Pelvic pain in endometriosis stems from a combination of inflammation, nerve involvement, and structural changes in the pelvic cavity.

When endometrial-like tissue grows where it shouldn’t, it triggers an immune response, resulting in inflammation. This inflammation can irritate nearby nerves, leading to cramping and sharp pain, especially around your period or during sex. If inflammatory lesions form near sensitive areas like the uterosacral ligaments (ligaments near the lower back and uterus), the pain might feel deeper or more intense.

Over time, the body tries to heal these inflamed areas by forming scar tissue. In some cases, this leads to adhesions, bands of tissue that cause organs to stick together. Organs that usually move freely, like the uterus or bladder, can become tethered together, resulting in sharp, cramping, or pulling pain, particularly when these organs shift during digestion, urination, or menstrual cramps.

Heavy Flow

People with endometriosis often experience heavier periods due to a combination of hormonal and structural factors. Endometrial-like tissue can disrupt the uterus’s normal contractions and shedding process, leading to longer or more intense bleeding. In some cases, endometriosis occurs alongside adenomyosis –– a condition where similar tissue grows into the uterine muscle –– further intensifying flow and pain. Endometriosis tissue also produces its own estrogen and is more sensitive to it, creating a localized hormonal environment that encourages more tissue growth and inflammation. Even if overall hormone levels appear normal, this estrogen dominance in the pelvic area can worsen bleeding and symptoms. However, some people with regular, or even very light, periods also have endometriosis. Pain and other symptoms can happen independently of flow.

Fatigue

Chronic pain and inflammation from endometriosis can activate an ongoing immune response, leaving the body in a constant state of stress and exhaustion. Hormonal imbalances and iron deficiency from heavy menstrual bleeding can make fatigue even more intense, making even everyday tasks feel exhausting.

Digestive Issues

Bloating, constipation, and diarrhea –– often grouped under the term “endo belly” –– are common for many with endometriosis. When endometrial implants grow on or near the bowel, they can cause irritation and pain during digestion or bowel movements. Even without direct involvement, systemic inflammation can mimic or worsen symptoms of conditions like IBS.

What Can Help Symptoms

Endometriosis is not your fault, and it’s not caused by diet, stress, or lifestyle choices. There is currently no cure, and diet alone won’t “fix” it. But incorporating certain changes may help ease symptoms and support overall well-being.

Diet

Reducing Inflammation

Inflammation plays a key role in endometriosis symptoms, including pain and bloating. By reducing chronic inflammation, you may be able to manage pain and discomfort more effectively.

• Anti-inflammatory foods: Leafy greens (spinach, kale), berries (blueberries, strawberries), nuts (almonds, walnuts), fatty fish (salmon, mackerel), and olive oil contain compounds that help calm inflammation.

• Turmeric and ginger: Both are naturally anti-inflammatory due to compounds like curcumin and gingerol, which help reduce inflammation.

• Omega-3 fatty acids: Found in fish, chia seeds, flaxseeds, and walnuts, omega-3s help reduce inflammation and may lessen endo-related pain.

• Low-glycemic foods: Choosing foods with a low glycemic index, like sweet potatoes, lentils, oats, and quinoa, helps stabilize blood sugar levels, which can reduce inflammation and hormonal fluctuations.

Supporting Hormone Balance

Endometriosis is fueled by estrogen, so managing hormone levels is crucial in alleviating symptoms.

• Fiber-rich foods: High-fiber foods like vegetables, fruits, whole grains, and flaxseeds help regulate estrogen by assisting with its elimination from the body.

• Cruciferous vegetables: Broccoli, cauliflower, Brussels sprouts, and cabbage contain compounds that help balance estrogen metabolism.

• Flaxseeds: Contain lignans that can help modulate estrogen levels in the body, promoting more balanced hormone regulation.

Foods to Consider Avoiding

Some people with endometriosis report more flare-ups after eating highly processed foods (especially those high in added sugars and trans fats), excess red meat, caffeine, alcohol, and in fewer cases, dairy, and gluten. It’s important to listen to your body –– there’s no one-size-fits-all “endo diet,” but tracking how certain foods affect you can help alleviate pain.

Movement

Pelvic Floor Physical Therapy

Pelvic floor therapy helps manage chronic pain and tension. Studies show that up to 70% of people with endometriosis experience significant relief from pelvic pain through targeted physical therapy. It can reduce discomfort, improve pelvic function, and decrease pain from muscle tightness.

Gentle Exercise

While exercise can be difficult during flare-ups, light activity like walking or yoga can improve circulation, reduce inflammation, and boost mood. Research shows that moderate exercise can decrease endometriosis-related pain by 30-40%, especially when combined with stress-relief techniques like yoga or meditation.

Treatment

Currently, there is no cure for endometriosis. Most treatments focus on managing symptoms by preventing or reducing the growth and shedding of endometrial-like tissue.

Hormonal treatments

Hormonal therapies, including birth control pills, IUDs, and GnRH agonists, can suppress the growth of endometrial tissue and reduce pain, though side effects like mood changes or bone loss (in the case of GnRH agonists) can be significant. About 50–60% of people with endometriosis report significant pain relief and symptom improvement with hormonal treatments.

Managing Pain

Over-the-counter pain relievers (like ibuprofen or naproxen) are commonly used to ease mild to moderate pain. For more severe cases, doctors may prescribe stronger medications, but these can carry risks with long-term use, including dependency or gastrointestinal side effects. Pain management should be tailored to each person’s needs, ideally with guidance from a healthcare provider.

Surgery

Laparoscopic surgery is a minimally invasive procedure where a small camera and instruments are inserted through the belly button to locate and remove endometrial implants and scar tissue. Around 70–80% of people experience symptom relief after surgery, but pain can return in some cases, especially if the tissue regrows. Often, laparoscopic surgery is followed with hormonal treatment.

How Do I Know If I Have It?

Unfortunately the only definitive way to diagnose endometriosis is through laparoscopic surgery. Endometriosis can’t always be seen clearly on imaging tests like ultrasounds or MRIs, especially if the lesions are small, hidden, or not causing visible structural changes. Blood tests can’t detect it either. Since symptoms can overlap with other conditions (like IBS or pelvic inflammatory disease), surgery allows doctors to directly see and confirm the diagnosis, and sometimes remove the tissue at the same time.

Thankfully, new non-invasive methods are being explored. Some research-backed tools include:

• Symptom-tracking apps, like Phendo, help identify patterns and flare-ups that suggest endometriosis.

• MRI protocols with contrast that are improving in accuracy, especially for deep infiltrating endometriosis.

• Biomarker research is ongoing, aiming to develop a simple blood or saliva test in the future.

If you suspect you have endometriosis, track your symptoms, advocate for yourself, and speak to a provider familiar with the condition. Early intervention can make a huge difference.

What Causes Endometriosis?

The exact cause is still unknown, but researchers believe it's a mix of genetic, hormonal, immune, and environmental factors.

Retrograde Menstruation

One leading theory is retrograde menstruation, where menstrual blood flows backward through the fallopian tubes into the pelvic cavity. This happens in many people –– possibly up to 90% –– but only some go on to develop endometriosis, suggesting that other biological or immune factors are involved.

Hormonal Sensitivity

Endometriosis is a hormone-sensitive condition, particularly driven by estrogen. Endometriotic tissue can produce its own estrogen and has more estrogen receptors, and is also resistant to progesterone, a hormone that usually keeps estrogen’s effects in check.

Some people naturally have higher estrogen levels, but environmental exposure to endocrine-disrupting chemicals (like BPA, phthalates, or dioxins) may also play a role –– especially if exposure happens early in life and affects how genes are expressed (a field known as epigenetics). This exposure is often higher in low-income communities, communities of color, and people working in agriculture, manufacturing, or beauty industries.

Genetics & Immunity

Endometriosis tends to run in families, suggesting a genetic component. At the same time, people with endometriosis may have a dysfunctional immune system that doesn’t clear out stray endometrial cells or properly resolve inflammation, allowing lesions to grow unchecked.

Metabolic and Historical Links

Emerging research also explores connections to insulin resistance, blood sugar regulation, and inflammatory conditions like diabetes. These factors may influence hormone levels and immune function in ways that contribute to disease risk, though these links are still being studied.

Living with Endometriosis

“I was made to think the pain was all in my head.”

People with endo navigate daily life with intense pelvic pain, fatigue, digestive issues, and more –– often without a diagnosis for years. Scar tissue and adhesions can literally stick organs together. Endometriosis isn’t just “period pain”— it’s a serious, often invisible condition that deserves recognition, research, and real support.