Endometriosis

Hormone CareFertility Care
Written By Jennifer Tang

Overview

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. It can affect menstrual health, pelvic pain, digestion, sexual health, fertility, energy, and overall quality of life.¹˒² Symptoms vary widely, and the amount of pain someone experiences does not always reflect the extent of the condition.¹˒²

At Tangible Health, we take an individualized, whole-person approach to endometriosis care. We focus on supporting pain and symptom management, nutrition, digestive health, sleep, stress, fertility goals, and overall well-being alongside appropriate medical and gynecological care.

What Is Endometriosis?

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterine cavity.¹˒² It most commonly occurs within the pelvis and may involve the ovaries, fallopian tubes, pelvic lining, bowel, bladder, or surrounding tissues. In some cases, endometriosis can occur outside the pelvis, including within the abdomen or chest.¹ These areas of endometrial-like tissue can contribute to inflammation, scar tissue, adhesions, and pain. Depending on where endometriosis is located, it can affect fertility, bowel or bladder function, sexual health, mental health, and everyday activities.¹˒²

There is currently no known cure for endometriosis, but medical treatments, surgery when appropriate, fertility care, pain-management strategies, and supportive therapies can help manage symptoms and improve quality of life.¹˒³

Common Symptoms of Endometriosis

Endometriosis can present differently from person to person. Common signs and symptoms may include:¹˒²

  • Painful periods that interfere with everyday activities

  • Chronic or recurring pelvic pain

  • Pain during or after sexual intercourse

  • Heavy menstrual bleeding

  • Pain with bowel movements, especially around menstruation

  • Pain with urination, especially around menstruation

  • Abdominal bloating or nausea

  • Constipation, diarrhea, or other digestive symptoms

  • Fatigue or low energy

  • Difficulty becoming pregnant

  • Anxiety, depression, or emotional distress related to chronic symptoms

Some people have significant symptoms while others have few or none. Symptom severity does not necessarily correspond with how extensive the endometriosis is.¹˒²

Causes & Contributing Factors

The exact cause of endometriosis is not fully understood. Current research suggests that hormonal, genetic, immune, inflammatory, cellular, and environmental factors may all play a role rather than there being one single cause.¹˒²

Hormonal Influences
Endometriosis is influenced by reproductive hormones, particularly estrogen. Hormonal activity can influence endometriosis lesions and symptoms, which is one reason hormonal therapies are commonly used as part of medical management.³

Genetics & Family History
Endometriosis can occur more frequently within families, suggesting that genetics influence a person’s likelihood of developing the condition. However, there is no single identified gene or inherited cause that explains all cases.¹˒²

Immune & Inflammatory Factors
Endometriosis is associated with inflammation, and research continues to explore how immune function and inflammatory signalling may contribute to the development and persistence of the disease.¹˒²

Other Proposed Mechanisms
Retrograde menstruation, where menstrual fluid travels backward through the fallopian tubes into the pelvis, is one proposed mechanism. However, this theory alone does not explain why endometriosis develops in some people and not others. Other cellular and developmental mechanisms are also being studied.²

Our Approach to Endometriosis

At Tangible Health, we focus on supporting the whole person alongside conventional medical care. Naturopathic medicine does not cure or remove endometriosis lesions, but it can be part of an integrative care plan focused on symptom burden, nutrition, digestive health, pain, stress, energy, and quality of life.

Your Symptoms & Pain
We look at your menstrual cycle, pelvic pain, pain during sex, digestive or urinary symptoms, fatigue, and how symptoms change throughout your cycle. With persistent pain, we may also consider factors that can influence the pain experience, including sleep, stress, movement, pelvic floor health, and nervous system sensitization.⁴

Your Digestive & Overall Health
Bloating, constipation, diarrhea, nausea, and abdominal discomfort are commonly reported by people with endometriosis.¹ We may explore nutrition, bowel habits, nutrient intake, sleep, energy, stress, and other areas of health that may be affecting how you feel.

Your Goals
Your priorities may include reducing pain, improving digestive symptoms, supporting energy and quality of life, trying to conceive, managing symptoms while waiting for specialist care, or navigating treatment alongside a gynecologist or endometriosis specialist. Your care plan is developed around the outcomes that matter most to you.

Treatments That May Be Included

Your individualized endometriosis care plan may include:

Endometriosis often benefits from collaborative care. Depending on your needs, this may include working alongside a gynecologist, endometriosis specialist, pelvic floor physiotherapist, fertility specialist, pain specialist, or other healthcare provider. Canadian guidance recognizes the value of multidisciplinary approaches for persistent pelvic pain and endometriosis management.³˒⁴˒⁵

What to Expect

Initial Assessment
We start with a comprehensive review of your menstrual history, pelvic pain, digestive or urinary symptoms, fertility goals, medical history, nutrition, sleep, stress, medications and supplements, previous treatments, testing or imaging, and overall well-being.

Targeted Testing
We review any previous diagnosis, imaging, specialist assessments, medical treatments, or surgery and consider whether additional medical investigation may be appropriate. Endometriosis may be assessed through symptoms, clinical evaluation, and imaging such as ultrasound or MRI; surgery is not required for every person before a diagnosis or treatment can be considered.¹˒²˒⁶ Routine hormone panels, gut testing, inflammatory markers, or functional medicine testing do not diagnose endometriosis.

Personalized Plan
You’ll receive a personalized care plan designed around your specific endometriosis presentation, symptoms, health history, medical care, reproductive goals, and priorities. Recommendations may focus on pain and digestive symptoms, nutrition, sleep, stress, energy, and other areas that are relevant to how endometriosis is affecting you.

Ongoing Support
Endometriosis management is an ongoing process, and your symptoms and priorities may change over time. Follow-up allows us to monitor your progress, adjust your plan, review new investigations or treatments, and adapt care as your health or reproductive goals change.

When to Seek Support for Endometriosis

You don’t need to wait for symptoms to become severe before seeking help. Consider speaking with a healthcare provider if you are:

  • Experiencing periods painful enough to interfere with work, school, sleep, or everyday activities

  • Living with persistent or recurring pelvic pain

  • Experiencing pain during or after sex

  • Having pain with bowel movements or urination, particularly around your period

  • Experiencing digestive symptoms that consistently worsen around menstruation

  • Managing heavy menstrual bleeding

  • Trying to conceive without success

  • Finding that your symptoms are becoming more frequent or severe

Delays in recognizing and diagnosing endometriosis are common. Current Canadian guidance supports earlier clinical assessment and appropriate imaging, rather than requiring every patient to undergo surgery before receiving care.²

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Frequently Asked Questions

  • No. Endometriosis is a chronic inflammatory condition that can cause painful periods, but it can also affect pelvic pain, digestion, sexual health, fertility, energy, mental health, and everyday functioning.¹˒²

  • Common signs include painful periods, pelvic pain, pain during sex, digestive symptoms that worsen around menstruation, fatigue, and difficulty becoming pregnant.¹˒²

  • Endometriosis may be assessed based on your symptoms, medical history, clinical examination, and imaging such as ultrasound or MRI. There is currently no routine blood test that can confirm endometriosis on its own.¹˒²

  • Yes. Current guidance recognizes clinical and imaging-based diagnosis, meaning surgery is not required for every person before treatment can begin. Surgery may still be appropriate in some situations.²˒⁶

  • It can. Bloating, nausea, constipation, diarrhea, abdominal discomfort, and pain with bowel movements are commonly reported, particularly when symptoms change around menstruation.¹˒²

  • Yes. Endometriosis can make becoming pregnant more difficult for some people, although many people with endometriosis are able to conceive. Fertility assessment and treatment depend on your individual circumstances and goals.¹˒³

  • There is currently no known cure for endometriosis. Symptoms may change over time, and treatment can help manage pain and other symptoms, support fertility when needed, and improve quality of life.¹˒³

  • Naturopathic care can be used alongside conventional treatment to support nutrition, digestive symptoms, sleep, stress, pain-management strategies, appropriate supplementation, and overall well-being. It does not replace medical assessment or treatments directed at endometriosis itself.

 

Related Care

Endometriosis is closely connected to broader areas of health. You may also benefit from:

Jennifer Tang
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