Let’s ask what is Endometriosis?

According to Dr. Kristin Patzkowsky 1 – a minimally invasive surgeon from the department of Gynecology on Johns Hopkins Medicine- Endometriosis is the presence of endometrial glands and stroma outside of the uterus. Or where we found the endometrial tissue outside the womb rather than inside.

Endometriosis. Endometriosis occurs when bits of the tissue that lines the uterus (endometrium) grow on other pelvic organs, such as the ovaries or fallopian tubes

On research by Endometriosis Foundation of America 2, it found that: Endometriosis may not just affect women with 25 and 35 years, which are arguably their most productive years. But also it might affect women under the age of 20. Endometriosis can cause painful periods, exhaustion, bloating, back pain, and can result in fertility complications.

What are the signs of Endometriosis?

The symptoms of endometriosis vary and not linked with the severity of the disease. They can get worse over time but tend to decrease during pregnancy and stop with menopause. Or you may have no symptoms at all. The treatment depends on the symptoms’ severity, the age of the woman, and her desire to have children. The most common symptoms are:

  • Pain with periods.
  • Pain outside of periods.
  • Feeling pain with intercourse.
  • Pain with bowel movements.
  • Discomfort with urination.
  • Low back pain.
  • Pelvic pain.

We can also diagnose Endometriosis when evaluating other gynecological problems or an assessment of infertility.

How to test for Endometriosis?

Pelvic Exam:

First of all, your doctor diagnoses Endometriosis by a Pelvic Exam. During this exam, your doctor manually examines the areas of your internal reproductive organs for anomalies, such as cysts, abnormal flows, or scars behind your uterus. Often, it is not possible to feel small areas of Endometriosis unless it causes the formation of a cyst.

Pelvic exam
A pelvic test is a doctor’s visual and physical examination of a woman’s reproductive organs. During the exam, the doctor inspects the vagina, cervix, fallopian tubes, vulva, ovaries, and uterus.

Endometrial biopsy:

An endometrial biopsy is removing a sample of endometrial tissue for testing. It may be done to screen for cancer or precancerous cells or to investigate fertility problems. Furthermore, it can be done in your doctor’s office in 10 to 15 minutes without the use of a sedative.

Similarly to the previous test, you will lie on an examination table. Your doctor or nurse will extend the walls of the vagina by inserting an instrument called a speculum to expose the cervix. An anesthetic spray can also be applied.

The doctor will use a tenaculum to keep the uterus stable for biopsy. Using a catheter, the doctor will insert it through the cervical opening into the uterus. And it will then gently rotate and move the tip of the catheter to collect small pieces of endometrial tissue, which he send it to the lab for review.

Endometrial biopsy
An endometrial biopsy is a procedure performed to obtain a small tissue sample from the lining of the uterus, called the endometrium.

Risks during Biopsy:

Even if the biopsy of the Endometriosis is secure, there is a risk of bleeding and contamination. The wall of your womb could also get notched by equipment used at some stage of the biopsy; however, it is infrequent. And don’t forget to tell your doctor that you may be pregnant. The biopsy could cause you to abort.

Laparoscopic surgery:

In some cases, you will need to do a laparoscopy, which is a surgical procedure allowing a doctor to visualize the inside of your abdomen. Usually, under general anesthesia, your doctor makes a small incision near your navel and inserts a slender visualization instrument (laparoscope) to detect signs of irregularities in your pelvic organs.

Laparoscopic is a specialized technique for performing surgery.

Laparoscopy can provide information on the location, extent, and size of endometrial implants. Your doctor may take a tissue sample (biopsy) for further testing. Often, with accurate surgical planning, your doctor can properly treat Endometriosis during laparoscopy.

My fertility: Can be affected?

The Journal of the Florida Medical Association 3 published research admitting that women with Endometriosis multiply by eight their chances of being infertile. But researchers don’t fully understand all how Endometriosis may impact your ability to become pregnant.

In some cases, there is scarring inside the abdomen, which probably affects the ability of an egg to make it from the ovary into the uterine cavity. They also think that endometrial implants seem like it produces factors that can impact the ability of implantation.

Endometriosis Treatment Options.

There are many treatment options that range from medical to surgical. Most of these options are hormonally based, a combination of birth control medicines or progesterone.

hormonal contraceptive

And also, medicines that can put you into a temporary menopausal state are additional options that you can use. Research confirms that taking a hormonal contraceptive can stop the abundant menstrual bleeding that usually coexists with Endometriosis. So, Your doctor may advise you to take a hormonal contraceptive on an ongoing basis for three to six months or more to prevent you from having your period.

For the surgical treatment options, it depends on the stage of the disease, and also someone’s symptoms and childbearing wishes. Both minimally invasive surgery and open surgery are different routes of achieving the same outcome for the treatment.

minimally invasive surgery

But minimally invasive surgery allows your doctors to use procedures that limit the number of cuts and the size of the incisions that they need to make. It usually tends to be safer and reduce blood loss than open surgery. You will return to daily life more quickly, spend less time in the hospital, and feel more relaxed during your recovery.

What foods to eat if you have Endometriosis?

Certain foods may increase or decrease the risk of Endometriosis, and some women find that making dietary changes can help reduce symptoms. Here are the best diet strategies to overcome and manage Endometriosis.

“Good” Fat and “Bad” Fat: 

Firstly, you need to focus on Fats. As Endometriosis is an inflammatory disorder, it’s essential to focus on consuming foods that can reduce inflammation. I’m sure you’ve heard about “good” fats and “bad” fats. Well, bad fats promote inflammation, but good fats reduce it. So you need to check your Endometriosis diet for good fats.

For example, a fat found in processed foods such as fried food, pastries, cakes, biscuits, and refined oils is “bad” fat. They are produced through high levels of processing and induce an inflammatory response in your body. Check our article about some processed foods that are healthy.

Palmitic Acid: is another fat linked to increased rates of Endometriosis. This fat is found mostly in red meat and again heightens the inflammatory response in your body. So, a practical strategy would be to replace some of your red meat intake with vegetable sources of protein such as lentils, chickpeas, or tofu. 


Omega-3 Fats:  are anti-inflammatory fat, which can decrease Endometriosis inflammation. One observational study made by STACEY MISSMER 4, ScD From Brigham and Women’s Hospital found: that women who ate high levels of omega-3 rich foods have reduced by 22% the chance to have Endometriosis, compared to women who consumed the lowest amounts.


So adding fish, as well as, Soybeans, Nuts and Seeds on your diet, increase the portion of your anti-inflammatory fat. Here is a table providing the quantity of Omega-3 on some foods, according to Food Data Central 5. (last update 2019)

Mackerel 5,72g/100g Herring  2,791g/100g
Salmon 2,397g/100g Oysters 0,443g/100g
Sardines 1,82g/100g    
Walnuts 6,126 g/100g Almonds 3,802g/100g
Soybeans 3.127 g/100g Pistachios 5g /100g


The second strategy is to boost your intake of Antioxidants. Women with Endometriosis have an increased number of highly reactive substances in their bodies, known as free radicals. Because of these little monsters “oxidative stress” is produced, which means they enhance inflammation. Antioxidants can reduce the number of free radicals by binding with them to create a more stable form. Antioxidants reduce the amount of oxidative stress and therefore reduce inflammation in those with Endometriosis.

Antioxidants may play a role in preventing heart disease, cancer, and other diseases. See which foods are abundant in antioxidants.

In 2012, published research that studied the effects of antioxidants 5 finds that the use of vitamin E and C supplements on diets in cases of Endometriosis decreased by 43% period pain and back pain compared to 0% in the group without supplementation. Not only this, but three different inflammatory markers were found to be significantly lower in those taking the antioxidant supplement compared to those without supplementation.

Getting your antioxidants from food will ensure that you’re getting all of the other vital nutrients that you need from these healthy foods too. For example, Vitamin C is found in oranges, strawberries, spinach, broccoli, mangoes, and kiwifruit, while Vitamin E is in avocados, nuts, seeds, and grain.


The third strategy is FiberFiber can help excrete estrogen out of the body through a process known as “barrier protection” in which Fiber surrounds substances and takes them on a journey outside the body before they can be absorbed.

Excess estrogen in the body can worsen the effects of Endometriosis by promoting inflammation. Along with this, too much estrogen increase Endometriosis cell growth and numbers, meaning more giant cells and more of them. 

So, diets in Endometriosis with at least 25 grams of fiber per day from foods like:

source of fiber

Fruits: bananas, apples, oranges, mangoes, raspberries, strawberries.

Vegetables: beets, carrots, collard greens, broccoli, artichokes. The rule is: the darker the food color, the higher the fiber content.

Glycemic Index foods :

The fourth one is to focus on choosing low Glycemic Index foods. High GI foods enhance the insulin response, which may lead to an increase in the numbers of Endometriosis cells. So, put down the white bread and potatoes and choose low GI foods like sweet potato, pasta, oats, and barley. 


Finally, strategy number five is to reduce your intake of Pesticides. A diet rich in fruit and vegetables is a good idea, as they are rich in antioxidants and high in Fiber. However, exposure to pesticides and dioxins found on fruit and vegetables was positively associated with increasing by 30% to 70% the risk of Endometriosis 7 and its symptoms.


This association is probably due to certain pesticides interfering with hormonal pathways and contributing to oxidative stress. So, if you’ve got Endometriosis, or have a high risk of developing it, you may wish to consider trying organic freshest products on your diet and using a wide range of foods every day. Which would remove the risk of pesticides worsening your symptoms, and you still get all the benefits of eating fruit and vegetables.


Advice for women who suspect that they may have Endometriosis: The first step would be going to your primary gynecologist to discuss your symptoms. An additional testing exam would be done. The first line of treatment is just medical therapy with something like birth control pills. If pain or symptoms persist, at that point, it should consult someone who specializes in the treatment of Endometriosis.