Endometriosis

Endometriosis is the presence of endometrial-like tissue outside the uterus, causing pain, heavy periods, pain during sex, bowel and bladder symptoms, and infertility. It affects roughly one in ten women and takes an average of several years to diagnose, and the diagnostic delay is itself a recognised harm.

There is no herbal treatment for endometriosis. This page exists because the internet is full of them, and because every month spent on a herbal trial is a month of pain and of possible progression.

The treatments with evidence. Combined hormonal contraception (continuous, to suppress menstruation); progestins including the levonorgestrel intrauterine system; GnRH agonists and antagonists with add-back therapy; NSAIDs for pain; and surgery — laparoscopic excision or ablation by a surgeon experienced in endometriosis, which is both diagnostic and therapeutic. Fertility treatment where relevant. This is a specialist area and the referral is the intervention.

What helps alongside. Heat, NSAIDs taken early and regularly, pelvic floor physiotherapy (which is under-used and helpful when there is pelvic floor dysfunction), and pain-management approaches for the chronic pain component. Some women find symptom relief from dietary change; the evidence is weak and it should not delay treatment.

The symptoms that should trigger a referral rather than a supplement. Period pain that does not respond to an NSAID taken properly; pain that starts later in life or worsens over time; pain during sex; pain on opening the bowels during a period; heavy bleeding; and infertility. A doctor who dismisses severe period pain is giving the wrong answer, and it is worth asking directly about endometriosis.

One thing to be careful of. The herbal preparations sold for "hormonal balance" and heavy periods include some with genuine toxicity — and anything that affects clotting or hormones needs checking against the treatments above.