What is Endometriosis? Do You Have It?

by Christiane Northrup, M.D.

Fertility & Birth Control Inflammation Pain Pelvic Health Women's Health

Endometriosis is a mysterious and increasingly common condition in which the tissue that forms the lining of the uterus grows in other areas of the pelvis, and sometimes even outside the pelvis entirely.

Endometriosis and Pregnancy

Endometriosis is sometimes associated with infertility and pelvic pain, though not always. Approximately 40–50 percent of women who undergo laparoscopy to determine the cause of their problems with infertility are found to have endometriosis.1

Endometriosis does not cause infertility, but is felt to be a contributing factor. Whatever is causing the endometriosis symptoms may also be responsible for the infertility, but one does not cause the other. Bancroft2

As fibroids and endometriosis are often present in the same individual, much of the information concerning fibroids pertains to endometriosis, as well.

Like fibroids, endometriosis is related to diet and blocked pelvic energy. It is an illness of competition that comes about when a woman’s emotional needs are competing with her functioning in the outside world. Myss3 

One Jungian analyst referred to endometriosis as “a blood sacrifice to the Goddess.” It is our bodies’ effort to recall us to our feminine nature, our need for self-nurturance, and our connection with other women.

A society that did not require a mental–emotional split between business and personal environments would serve to protect against this disease, but this could be a long time coming. In the meantime, each woman can work toward healing herself, starting by understanding and listening to her body and its messages.

Endometriosis Symptoms

While endometriosis symptoms vary a great deal from woman to woman, the classic symptoms of endometriosis are pelvic pain, abnormal menses, and infertility.

A woman with advanced endometriosis may experience no symptoms and be unaware she has it, whereas another with minimal endometriosis may experience debilitating pelvic pain and cramps almost continuously. Most women with endometriosis fall somewhere in-between these extremes.

Endometriosis most commonly occurs between the uterus and the rectum, where its presence can cause painful intercourse, rectal pressure, and pain with bowel movements, especially before a period.

Endometriosis of the pelvic cavity can be diagnosed definitively only via laparoscopy, though I often suspect it in women whose symptoms are consistent with endometriosis, such as a history of pelvic pain and intermenstrual spotting.

In a few rare cases, it can be seen during a pelvic exam if endometrial lesions are present on the cervix, vagina, or vulva. Unfortunately, studies show that the average woman with endometriosis goes to about five doctors before the diagnosis is made because many other medical conditions, such as irritable bowel syndrome, mimic endometriosis.

Why Is Endometriosis Painful?

The pain associated with endometriosis clearly results from an increased production of inflammatory chemicals such as cytokines and prostaglandins that are produced by the endometriosis lesions.

Endometriosis lesions are also stimulated in part by the hormones of the menstrual cycle, and the pain is worse at ovulation and during the premenstrual and menstrual times of the cycle.

Since endometrial lesions are the same as the tissue inside the uterus, it is understandable that when a woman bleeds with her menstrual cycle, her endometriosis implants bleed microscopically inside her body, too.

Some experts feel that the endometrial lesions also secrete some kind of chemical that results in bleeding from surrounding capillaries in the peritoneum (the Saran Wrap–like lining of the pelvic cavity, where endometriosis is found). Over time, this recurrent monthly bleeding into the pelvic cavity is believed to cause painful cysts and adhesions that tend to flare up under the right circumstances.

What Causes Endometriosis?

The theory that makes the most sense to me is that endometriosis is a congenital condition that is present at birth. According to this theory, endometriosis arises from embryonic female genital tissue that never made it to the inside of the uterus during development. This helps explain why endometriosis can run in families and why some girls have severe pelvic pain from endometriosis as soon as they start their periods. Yet in this theory all females have the capacity to develop endometriosis if embryonic cells in their pelvis get stimulated by the right set of circumstances.

The uterus is related energetically to a woman’s innermost sense of self and her inner world. It is symbolic of her dreams and the selves to which she would like to give birth. Its state of health reflects her inner emotional reality and her belief in herself at the deepest level. The health of the uterus is at risk if a woman doesn’t believe in herself or is excessively self-critical.

When a woman feels that her innermost emotional needs are in direct conflict with what the world is demanding of her, endometriosis is one of the ways in which her body tries to draw her attention to the problem.

It is our bodies trying not to let us forget our feminine nature, our need for self nurturance, and our connection with other women.

Ask yourself to honestly define your emotional needs; what you can envision in your job or your life that would nourish you fully; whether you are caught up in competition of any sort in your life; and whether you believe you have the power or will to make the changes necessary in your life. Trust in the process and know you will learn something, whatever option you choose.

Endometriosis Treatment

The most common treatment for endometriosis is hormonal therapy, in the form of oral contraceptives, synthetic progestins, danazol (Danocrine), or the GnRH agonists (gonadotropin–releasing hormones), such as Lupron or Synarel. Danazol and GnRH agonists can be helpful in shrinking endometriosis prior to surgical removal.

These drugs act on the pituitary gland to make a woman temporarily menopausal, thereby allowing the endometriosis to regress by stopping its cyclic hormonal stimulation.

The problem with these approaches is that they don’t cure the disease; they simply shut down its hormonal stimulation for a while. Moreover, the side effects of these treatments are ill-tolerated by many women, they cannot be used indefinitely, and they can be prohibitively expensive.

Nonetheless, some women badly need these hormonal treatments as a respite from pain, even though the pain often recurs once the drug is discontinued.

Many women with severe endometriosis, having tried hormones and pain medication for years, end up having complete hysterectomies, including removal of their ovaries. Though this can be the best choice in some cases, there are alternatives to this aggressive surgical approach.

More and more gynecologists are being trained in conservative pelviscopic surgery that removes only the endometriosis and preserves the pelvic organs. If you intend to undergo surgery for endometrial pain, be sure to find someone who is skilled in this form of treatment.

Spiritual and Holistic Options for Endometriosis

A whole foods, eicosanoid–balancing diet high in fiber that avoids trans fats can provide dramatic relief from symptoms of endometriosis. Many women have had remarkable pain relief from simply stopping consumption of dairy foods, eggs and red meats. Also avoid caffeine. Be sure to eat one to two servings daily of cruciferous vegetables, such as kale, collard greens, mustard greens, broccoli, cabbage, and turnips (or take a supplement containing Indole-3-Carbinol, the active ingredient in these vegetables). Additionally, a diet rich in phytohormones, such as those found in soy foods, helps endometriosis by blocking estrogen receptors from excess stimulation. Supplementing the diet with a good source of essential fatty acids and a multivitamin–mineral supplement rich in B complex, zinc, selenium, vitamin E, and magnesium can also help.

Regular application of castor oil packs to the lower abdomen, a course of acupuncture and Chinese herbs, regular total body massage, and the use of bioidentical progesterone are other options that help bring about marked improvement in symptoms.

Also consider finding a physical therapist trained in the Wurn Technique, a noninvasive, nonsurgical type of deep tissue massage that can be very helpful in treating endometriosis and pelvic pain.

Women with endometriosis do best with a comprehensive treatment program that fully supports their immune systems while they remain open to finding out what they need to change about their lives. Anything that improves immune system functioning and increases the flow of energy in the body is apt to help.

Learn More — Additional Resources


  1. Petersen, N., & Hasselbring, B. (May–June 1987). Endometriosis reconsidered. Medical Self Care.
  2. Supporting evidence can be found in Bancroft, K., Vaughan Williams, C. A., & Elstein, M. (1989). Minimal/mild endometriosis and infertility: A review.Br. J. Obstet. Gynaecol., 96 (4), 454–460; and Mahmood, T. A. & Templeton, A. A. (1989). Minimal/mild endometriosis and infertility. Br. J. Obstet. Gynaecol., 96 (10), 1248–1249. The role of minimal or mild endometriosis in the etiology of infertility remains unclear, but an increased prostanoid content and macrophage activity in peritoneal fluid may exert an effect by a variety of mechanisms, including altered tubal motility, sperm function, and early embryo wastage. Ovarian function may be altered in a variety of ways, including many subtle abnormalities detectable only by detailed investigation. Autoimmune phenomena may also be contributory; Bancroft, K., Vaughan Williams, C.A., & Elstein, M. (1992). Pituitary–ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility. Clin. Endocrin. (Oxf.), 36 (2), 177–181.
  3. Lunar data adapted from Caroline Myss.
Last Updated: October 8, 2006

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Claire Grondin
    5 years ago

    Is it necessary to have a biopsy if my doctor told me that I have a thick uterus.

  2. luminita
    6 years ago

    I am a homepathic doctor and I have treated succesfully many women with endometriosis.Also , I put much emphasis on the emotional life of the woman , and the quality of her relationships , with close people, husband, mother , brother , etc, and I always inquire about relationship difficulties in her life.I always find one kind of abuse , more or less subtle , or overt.It is very important to acknowledge the feelings that you have in your relationships.Dr.Northrup wrote-Dodging energy vampires- which brings into light a very important subject-The emotional abuse.You can study also about codependency with Ross Rosenberg, Lisa .A Romano, Melania Tonia Evans,Dana Gelsomino, Inner Integration, etc.

  3. K
    6 years ago

    I developed a softball sized endometrioma in the months following a time in my life when I felt my emotional needs, my inner self, being squashed and trampled by expectations upon me. Are there any other articles or resources that will help me to reclaim my emotional boundaries and my innate feminist? I’m bookmarking this article! Thank you so much for helping me make this connection!

    1. K
      6 years ago

      Oops…I meant ‘innate femininity’!

  4. J
    6 years ago

    Hi Dr. Northrup,

    I recently started doing castor oil packs on my lower abdominal area. It has caused me to have bleeding in the middle of my cycle. Have you heard of this happening from castor oil packs?



  5. simonne
    7 years ago

    Dear Christine
    I have been experiencing hip pain every month before and during menstruation… could this be endometriosis?
    Kind regards

  6. Ami
    8 years ago

    Your information about endometriosis is oupdated. Endometrial cells are not uterine cells, though they are similar. Also, scientific studies have shown endometrial cells present during fetal autopsties, way before the “blood sacrifice” or physical-emotional disconnect you speak of.

    But, thank you for acknowledging that surgery should be done by a skilled professional. To expand on that, it is called excision surgery and can only be performed by approximately 100 doctors in the United States. Chooseven wisely to prevent the need for hormonal therapies or multiple surgeries.

  7. Diana
    8 years ago

    Hi ,please can you tell me if Amata can help with endometriosis?many thanks

    1. Christiane Northrup
      8 years ago

      Hi Diana, Because of its properties as an adaptogen ( blocking the effect of excess estrogen in this effort who need it or acting estrogenic in those whose levels are too low), it makes sense that Pueraria mirifica could help endo. I have not used it in this regard clinically but colleagues have. It’s worth a try! Thanks for asking.

  8. K
    8 years ago

    I was under the impression that the phytoestrogens in soy added to the problem of excess estrogen. Can you explain how it can actually help, and why I should eat it as you recommend? Also, have you read Women Code, and what are your thoughts on it? Thank you for your help.

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