What is endometriosis?

Endometriosis is defined as the presence of normal tissue in an abnormal place. The endometrium (lining) of the uterus spreads to the pelvis through the tubes and settles most commonly in the pelvis. Like the lining of the uterus, the endometrium grows under the influence of the major female hormone estrogen.

The most common sites in the pelvis are on and below the ovaries, and deep in the pelvis behind the uterus, called the Pouch of Douglas. Here the endometriosis grows on the ligaments behind the uterus and on the vagina and rectum. It also may grow on the bladder, appendix, abdominal wall and even sometimes in the upper abdomen.

It is a disorder in which the endometrial cells (cells found within the endometrial lining and confined inside the uterine cavity) find their way outside the uterus to other parts of the body such as the abdomen or the pelvic cavity. They can also be scattered throughout the body. Endometriosis usually results in severe pain during or prior to menstruation. The cause is unknown although it is often referred to as an estrogen driven disease and familial.

What causes endometriosis?

Although the exact cause is still unknown, there are a number of factors which influence the development of the disease. The most likely explanation is that women menstruate backwards through the tubes into the pelvis and the cells of the uterine lining then implant and grow. Although 70% of women do menstruate through the tubes, only 10% develop the disease so this is only a partial explanation of why it develops.The majority of women have a natural defence, killing the cells of the menstrual fluid before they implant. Women who develop endometriosis have reduced ability to kill these cells or a reduced ability to stop their growth after they implant in the pelvis. These defence systems involve the immune system.

Sometimes the disease will develop in the absence of the uterus and this must result from normal cells lining the pelvis changing to the same cells that line the uterus and thus forming endometriosis.

What are the symptoms of endometriosis?

• Changes in bowel, bladder, sexual or menstrual function of a cyclical nature


• Changes in menstrual pain: increasing severity or duration of pain, pain not responding to drugs such as Ponstan or Naprogesic, pain which interferes with normal daily activities or employment


• Bowel symptoms of pain, constipation or diarrhea at time of the period. Sometimes blood or mucous may be passed from the rectum


• Frequency and pain when passing urine, pain when the bladder is full in the morning. Sometimes blood may be passed in the urine


• Menstrual changes including heavy bleeding, prolonged or shortened periods or periods which stop and start.


• Spotting before the period


• PMS syndrome including heavy bleeding, prolonged or shortened periods or periods which stop and start


• Tiredness, depression


• Pelvic pain


• Low back pain


• Infertility


• Ovulation pain


• General body & muscle stiffness


• Fatigue & exhaustion due to pain stress


• Mood alterations & atypical behavior / attitude swings


• Pain with sex, felt deep in the pelvis which is worse before and during the period and may alter with change of position. A similar pain may be felt during pelvic examination when the doctor places pressure behind the uterus

Factors increasing the risk of endometriosis

• Early onset of menstrual periods


• Heavy periods


• Painful periods


• Prolonged periods


• Hormone imbalance


• Allergy (eg: foods, eczema, hay fever)


• Obesity


• Family history of endometriosis eg: mother or sister


• Prolonged stress


• Insidious, unknown origins

Environmental toxins are also a possible cause of the disease as dioxin has been shown to cause disease in a factory where it was used excessively and also has been shown to cause endometriosis in monkeys.

Endometriosis is very difficult to treat and can be very debilitating. It’s one of the most painful inflictions a woman can experience. The symptoms of cramping and abdominal pain result from the islets of endometrial tissue which migrate out of the uterus and scatter throughout the pelvic area and attach themselves to the ovaries, the intestinal walls, the bladder wall and even membranes in the abdomen, and between the uterine muscle wall (ademyoses).

When a woman’s body responds to her monthly surges of estrogen, these tiny islets become swollen with menstrual blood at the same time the uterine lining sheds bringing on a period. These endometrial islets also shed blood, but because it has nowhere to go, it creates local tissue inflammation in the pelvic and abdominal regions, resulting in significant scar tissue. This internal bleeding and chronic inflammation creates congestion, the internal bleeding needs to be re absorbed back into the body, again putting a lot of stress and workload on the body. Many women suffering endometriosis have experienced adhesions of organs as a result of many years of internal bleeding.

It is not life threatening and it is not related to cancer (although cells proliferate as such but are not malignant). This disease is very debilitating and often leads to other complications such as compromising a woman?s auto-immunity, and left untreated long term often leads to chronic fatigue and fibromyalgia, and other difficult to treat conditions that compound.

Diagnosis is difficult and often delayed. It will not show up in x-rays and often it is very hard to detect because these little islets can be scattered throughout the body, often hidden. Exploratory surgery will reveal the evidence of endometriosis.

Factors reducing the risk of endometriosis

• Aerobic exercise of 5 hours per week which in two studies has shown a 50% reduction in the risk of recurrence.


• Childbearing reduces the risk of recurrence by about 50%.


• Smoking also reduces the risk of endometriosis, we won’t know why it helps, although it is obviously not a reason to continue smoking.


• Eat whole foods free of chemicals - organic where possible


• Avoid foods high in chemical estrogen, i.e. chicken


• Eat regularly, don’t skip meals or use stimulants to keep your going


• Avoid caffeine - disorients the endocrine system


• Keep very high roughage in your diet to speed up the elimination process, shortening the life span of excess toxins in the bowel which can be re absorbed back into the body mimicking xenoestrogens.


• Find a good masseur who will assist in lymphatic drainage and cell oxygenation which helps reduce the pelvic inflammation and pelvic congestion, and stress.


• Use of anti-oxidants and anti-inflammatory nutritional supplements (vitamin C, selenium, MSM and vitamin E have proved beneficial for our women in facilitating healing and boosting the immune system).


• Address fatigue and exhaustion


• Learn to handle stress


• Learn to drink at least 8 glasses of pure water a day


• Positive attitude


• Rest and recreation


• Most importantly (in our opinion) use progesterone therapy

From observation, other factors that reduce or help control the progression of endometriosis is early diagnosis, this includes looking for the disease in young menstruating girls. Too often they are placed on the contraceptive pill to band-aid ‘period problems’ without thorough investigation. Granted, this disease is difficult to diagnose, but managing symptoms rather than looking for the underlying cause is the approach we would NOT recommend.

Why is progesterone effective in treating endometriosis?

It is thought that endometriosis is an estrogen driven disease. We know that when a woman falls pregnant, often endometriosis will disappear, only to return again after pregnancy. There is some very strong correlation between the two. This suggests that the sex hormones are involved and that high progesterone levels produced in pregnancy play an important part in controlling this disease. That’s
why progesterone is recommended from days 5 to 28 or whenever your normal menstrual cycle ends.

This mimics a pseudo-pregnancy state, and facilitates healing. Higher than normal doses are required which appear to be well tolerated. In fact, levels around about 54-60mg are usually required for pain management. Most women will find that they can reduce their dosage of progesterone after 7-12 months, however, attempts to go below say 4% progesterone often allows symptoms to creep back in. We don?t believe progesterone cures endometriosis but we certainly know that it plays a major role in controlling its distressing symptoms.

We have had great success with the usage of progesterone and the treatment, or maintenance of endometriosis, particularly for pain control. Usually we see a great swing around within 7 months.

Young girls contact our website presenting symptoms that look suspiciously like endometriosis. Treated early with progesterone, their symptoms disappear. Many of these young girls actually get well enough to no longer require progesterone therapy.

Chronic Endometriosis

Women who have been long term sufferers of endometriosis and undergone years of various treatments often leading to chronic fatigue syndrome (CFS) and other complex health issues, we’ve found that the progesterone does not respond in the same way as those with an early diagnosis of endometriosis. Progesterone therapy and recovery is slow. Hormone imbalance is not the only issue at play here.

Women who have had any form of surgery - a caesarean, appendicectomy, tubal ligation - and present with symptoms of lower pelvic backache, particularly before period, muscle stiffness, estrogen dominant symptoms, period irregularity or period problems, we suspect that perhaps endometriosis may be involved, despite unconfirmed diagnosis.

Often women intuitively know there is a hormonal link to their problems even though their doctor fails to find anything wrong with them. They present with randomised, non-specific symptoms that may persist for many years.

A delayed diagnosis after numerous years of medication and synthetic hormone cocktails often leads to liver dysfunction, adrenal exhaustion, and chronic pain/fatigue. Progesterone therapy is valuable and contributes towards overall improvement, however, it requires a consistent, persistent effort in conjunction with nutritional and often psychological support.

It is a very long haul back for women who have suffered say ten to twenty years of endometriosis undiagnosed, with perhaps a lot of medical mismanagement as a result of an incorrect diagnosis. Some women also have had a lifetime of synthetic HRT which really does compromise their body in the long run.

We’ve witnessed some very odd cases involving women with chronic endometriosis. One woman in her 40s complained about lactating for years outside pregnancy and without any underlying sinister causes such as a tumor on the pituitary. This in itself is a huge indication of hormonal imbalance and perhaps progesterone deficiency in her own unique way. To this day, doctors have not be able to determine why this is occurring. But this woman, a trained nurse, has great faith that progesterone is one of the missing links in treatment, and her long-term healing.

We have to encourage these women to go step by step. It is simple by the inch but hard by the yard. We say it takes endurance, patience and commitment and often we recommend that they seek out a very top herbalist and/or naturopath who will also embrace progesterone therapy.

Can you be suffering from endometriosis and fibroids at the same time?

Often women will come here with diagnosis of fibroids coupled with other symptoms such as pain which leads us to believe there is endometriosis lurking the background. The very fact that such a woman responds so well to the progesterone in reducing pain is a positive indication for us. We suggest that they use their progesterone according to alleviation of pain and bleeding concerns. Usually after about 7 months women are able to start reducing back to a physiological dose, but again, we tell women that it is an individual thing according to their symptom management. Every woman?s pain threshold is different and her need for progesterone will vary, averaging between 54-64mg for 4-7 months is quite common. With the confidence and knowledge their disease is under control, women can start relaxing and incorporate normal activities back into their life such as exercise. This, in turn, will promote further healing and sense of wellbeing.

Will progesterone cure endometriosis?

We are sure by the reports that it doesn?t get rid of the disease because we found that women who had stopped for a few months felt great for a while and then suddenly the disease will re-flare itself. Most women stay on progesterone for maintenance, and adjust their dose when necessary, increasing when indicated such as in times of stress.

Will a hysterectomy cure endometriosis?

Not necessarily. The aim of a hysterectomy is to remove the uterus to stop periods, thereby reducing blood loss thus and slowing down progression of the disease and further migration of endometrial tissue. However, if the endometrial islets that escaped to other regions of the body and have not been removed by surgery, can continue to grow under the influence of estrogen. Please refer to our section on ‘Hysterectomy’.

Women have had hysterectomies as a result of severe endometriosis and one particular lady who comes to mind was sent home on estrogen patches to help prevent her from going through the discomforts of hot flushes once she had had her hysterectomy and ovaries removed. Sadly, 12 months later that woman ended up back in hospital with kidney problems and, on investigation, they found that the endometriosis had actually almost encased her kidneys and severed her ureters. She had to have kidney tubes put in to allow the urine to pass through. This is just so sad because any woman who has had endometriosis will probably know that estrogen is not a good thing for her body and would try and steer clear of it at all costs. Progesterone works wonders for controlling post-hysterectomised symptoms without the danger of endometriosis reemerging under the influence of estrogen replacement therapy.

We have also found that women who’ve had very severe endometriosis long term require an average of around about roughly 4?6% which is between say 40-60mg of progesterone, varying of course, but again it depends on how the body uses it. And this is where charting is very important. Because these women work at high stress levels and have a background of pulling on the corticosteroid pathway, they tend to use every bit of the 4-6% without ever running the risk of overdosing.

We never ever ridicule a woman for her choice of treatment. A woman will choose a treatment which is right for her at the time, regardless. If she finds us, then this is where she is meant to be. But we do encourage women to do their research and to look at options and to do it diligently and ask for guidance.