Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health but also emotional and mental well-being.

This template, developed in partnership with OvationLab, aims to provide healthcare providers with practical suggestions for supplements and lifestyle strategies, helping them design personalized, whole person care plans for patients looking to support the physical and emotional aspects of an endometriosis diagnosis.

Effective management requires a multi-disciplinary approach, including surgical and medical management alongside adjunctive dietary, nutritional, and lifestyle interventions. (Mazur-Bialy 2024)

Evidence-based supplements featured in this guide have been studied for their anti-inflammatory, analgesic, immunomodulatory, and hormone-regulating effects. 

Lifestyle modifications address common contributors to disease burden, support systemic balance, and improve patients’ physical and emotional resilience.

Imaging

Transvaginal ultrasound (TV-USG) is the first-line imaging modality for endometriosis due to its accessibility, cost-effectiveness, and high sensitivity for detecting endometriomas and deep infiltrating endometriosis (DIE), especially when performed by experienced operators. TV-USG is also valuable for ongoing monitoring and preoperative mapping, with dynamic maneuvers (e.g., sliding sign) enhancing the detection of adhesions and deep lesions. (Daniilidis 2022)(Young 2024)

Magnetic resonance imaging (MRI) is reserved for cases with suspected DIE or when TV-USG is inconclusive. MRI offers a comprehensive pelvic assessment, with high sensitivity (91–94%) and specificity (75–98%) for deep lesions. (Bourgioti 2017)(Avery 2024) It is beneficial for mapping complex or extrapelvic disease and surgical planning. MRI is less operator-dependent than ultrasound and provides superior soft tissue contrast. (Kido 2022) 

Specialized imaging is indicated for specific clinical scenarios. (Nisenblat 2016) Transrectal ultrasound (TRUS) is used to evaluate rectosigmoid and ileocecal involvement. (Rossini 2012) Multidetector CT (MDCT) is occasionally used to assess urological lesions or bowel involvement. (Biscaldi 2011)(Biscaldi 2014) Scintigraphy may be considered for functional renal assessment in cases of suspected ureteral endometriosis. (Langebrekke 2011)

Histological Analysis of Tissue Biopsies

Despite advances in imaging, endometriosis remains challenging to detect noninvasively. Laparoscopy with histologic confirmation remains the gold standard for definitive diagnosis. (Bafort 2020) Endometriosis is defined by its histology: extrauterine lesions consisting of endometrial glands, endometrial stroma, and/or hemosiderin-laden macrophages. (Agarwal 2019)

Ingredients

Alpha-Lipoic Acid (ALA)

Dosing: 600 mg once daily for at least 3–6 months (Di Tucci 2018)(Lete 2018)(Di Tucci 2021) 

Supporting evidence:

• In-vitro studies demonstrate that ALA reduces the expression of estrogen receptor-β, the secretion of pro-inflammatory cytokines, and cellular adhesion and invasion of endometriotic cells. (Di Nicuolo 2021)
• Animal models show that ALA administration reduces endometrial implant volume, serum and peritoneal TNF-α, and histopathologic inflammation scores. (Pınar 2017) 
• In a multicenter clinical trial, a combination antioxidant supplement containing ALA, N-acetylcysteine, and bromelain led to significant reductions in endometriosis-associated pelvic pain and decreased the use of rescue analgesics over six months. (Lete 2018)

Antioxidants

Dosing: Variable based on ingredient and formulation; use for a minimum of two months (Santanam 2013)(Amini 2021)

Supporting evidence:

• A systematic review and meta-analysis including 13 RCTs concluded that supplementation with antioxidant vitamins helped reduce the severity of dysmenorrhea, improved dyspareunia and pelvic pain, and enhanced quality of life in patients with endometriosis (n=589). (Zheng 2023) 

N-acetylcysteine (NAC)

• Human studies support the use of NAC as an adjunctive therapy for treating pain and improving fertility outcomes in patients with endometriosis. Positive clinical outcomes associated with supplementation include reductions in pain, endometrioma size, and cancer antigen 125 (CA125) levels, inhibiting endometriotic lesions, and suppressing pro-inflammatory molecules and oxidative stress. (Clower 2022)(Dymanowska-Dyjak 2024) 
• In one study, 75% of women achieved a successful pregnancy within six months of supplementing with 1,800 mg of NAC. (Anastasi 2023)

Resveratrol

• Resveratrol is a naturally occurring polyphenol found in plant-based foods. Animal and human studies suggest it exerts antiproliferative, proapoptotic, antiangiogenic, and anti-inflammatory effects on endometrial cells. In human trials, doses ranging from 30–800 mg daily have shown synergistic benefits when combined with oral contraceptive pills. (Dymanowska-Dyjak 2024)

Vitamin C

• Vitamin C exhibits anti-inflammatory and antiangiogenic effects. (Mikirova 2008)(Ellulu 2015)  
• Animal models suggest that vitamin C may prevent the growth of endometrial implants and endometriosis-associated cancers. (Hoorsan 2022) 
• Human studies have observed a reduction in pain (dysmenorrhea, dyspareunia, pelvic pain) and oxidative stress markers (malondialdehyde (MDA), reactive oxygen species (ROS)) in women with endometriosis after supplementing vitamins C and E. (Amini 2021)(Bayu 2024)

Vitamin E

• Vitamin E inhibits lipid peroxidation and oxidative stress. (Niki 2015) In-vivo studies have reported lower vitamin E levels and higher lipid peroxidase in patients with endometriosis. (Yalçın Bahat 2022) Supplementation may help improve endometriosis-associated chronic pelvic pain. (Santanam 2013) 

Zinc

• Women with endometriosis have lower serum zinc levels, suggesting that suboptimal or deficient zinc status may increase disease risk. (Messalli 2014)(Lai 2017)
• Zinc has immunomodulatory properties that may help manage inflammation associated with endometriosis. (Kim 2021) However, its effects appear to be dose-dependent. One study found that women consuming more than 14 mg of zinc per day had a significantly higher risk of endometriosis than those consuming 8 mg or less, suggesting a possible link between high zinc intake and increased disease risk. Although the findings are observational and not necessarily causal, they highlight the need to delineate the safety concerns of excessive zinc intake. (Huang 2024)

Curcumin

Dosing: 500 mg twice daily for a minimum of eight weeks (Sharifipour 2024)(Sargazi-taghazi 2025)

Supporting evidence:

• Curcumin is one of the primary polyphenolic compounds in turmeric. It has antioxidant, anti-inflammatory, antineoplastic, and analgesic properties. (Kamal 2021)
• In-vitro studies and animal models suggest that curcumin may help reduce endometriotic lesion size by targeting several key pathways. It suppresses inflammation and oxidative stress in endometrial cells, inhibits their ability to invade and adhere by downregulating matrix metalloproteinases and NF‑κB signaling, promotes apoptosis of ectopic tissue, inhibits the formation of new blood vessels (angiogenesis), and reduces estrogen production. (Zhang 2013)(Vallée 2020)
• Supplementation with curcumin and other anti-inflammatory nutrients reduced symptoms of endometriosis, prostaglandin E2 (PGE2), and CA125 after three months. (Signorile 2018)
• When used as an adjunct to dienogest (a progestin medication), nanocurcumin significantly improved pain outcomes (dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia) and enhanced quality of life and sexual function compared to dienogest monotherapy in women with stage 2–3 pelvic endometriosis and moderate-to-severe pain (n=86). (Sargazi-taghazi 2025)

Epigallocatechin-3-gallate (EGCG)

Dosing: 150 mg daily for four months (Porcaro 2020) 

Supporting evidence:

• No human clinical trials to date have specifically evaluated the effects of EGCG (a compound found in green tea) on endometriosis. However, preclinical studies consistently demonstrate that EGCG exerts multiple biologically relevant effects that support its biological plausibility as a therapeutic agent in the context of endometriosis. (Yalçın Bahat 2022)
• EGCG suppresses the growth and vascularization of endometriotic lesions in animal models by suppressing estradiol-mediated activation of endometrial cells and inhibiting vascular endothelial growth factor (VEGF) expression and angiogenesis. (Laschke 2008)(Wang 2013) 
• EGCG reduces the number and volume of endometriotic lesions in animal models, with effects comparable to other polyphenols like resveratrol, by increasing cellular apoptosis. (Xu 2009)(Ricci 2013)   
• In related gynecologic conditions, human trials have shown that EGCG supplementation can be beneficial in helping treat uterine fibroids, with reported outcomes including a 35–38% reduction in total fibroid volume, improved quality of life, and decreased symptom severity. (Porcaro 2020)

Magnesium

Dosing: 300–500 mg, total per day, for a minimum of four weeks (Morel 2021) 

Supporting evidence:

• Magnesium administration in animal models reduces uterine VEGF levels and markers of oxidative stress (superoxide dismutase (SOD), glutathione peroxidase (GPx), MDA), suggesting a potential mechanism for limiting angiogenesis, tissue proliferation, and inflammation relevant to endometriosis pathophysiology. (Hoşgörler 2020) 
• Magnesium acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, modulating central pain pathways. A systematic review including 33 studies found that intravenous magnesium can reduce endometriosis-associated pelvic pain. (Onyeaka 2024)
• Human studies specifically examining the relationship between magnesium and endometriosis are currently lacking. However, observational data in women with hormone-related conditions demonstrate that magnesium supplementation is associated with normalization of serum magnesium, reduction in symptom severity, and improvement in quality of life. (Orlova 2021)

Omega-3 Polyunsaturated Fatty Acids (PUFAs)

Dosing: 1,000 mg fish oil once daily for six months (Nodler 2020)

Supporting evidence:

• Omega-3 PUFAs may suppress endometriotic lesion activity and reduce the risk of endometriosis. This likely occurs through their anti-inflammatory and immunomodulatory effects, including the downregulation of pro-inflammatory cytokines (e.g., TNF-alpha, IL-6, IL-1). (Liu 2025)
• Animal studies suggest omega-3s can prevent the development of postsurgical endometriosis adhesions and decrease endometriotic lesion size. (Herington 2013)(Yalçın Bahat 2022)
• A randomized control trial (RCT) in young women (aged 12–25 years) with endometriosis and pelvic pain (n=69) found that daily fish oil supplementation for six months was well tolerated and led to a modest reduction in pain scores (visual analog scale (VAS) score from 5.9 to 5.2). However, the effect was not statistically significant compared to the placebo. (Nodler 2020)

Palmitoylethanolamide (PEA)

Dosing: Ultramicronized-PEA (um-PEA) 600 mg twice daily for ten days, followed by co-micronized PEA/polydatin (m-PEA/PLD) 400 mg twice daily for 80 days (Stochino-Loi 2019)

Supporting evidence:

• PEA is a naturally occurring endocannabinoid-like molecule that has analgesic, immunomodulatory, and anti-inflammatory effects through its interactions with nuclear receptor peroxisome proliferator-activated alpha (PPAR-α) and cannabinoid receptors 1 and 2 (CB1 and CB2). (Clayton 2021)
• In an animal model, m-PEA/PLD exerts multimodal benefits relevant to endometriosis pathophysiology, including targeting pain, immune cell infiltration, and inflammatory signaling pathways. (Di Paola 2016)
• The American College of Obstetricians and Gynecologists (ACOG) notes that preliminary data show promise for using PEA-transpolydatin in the context of gynecological pain relief. (ACOG 2024)
• An open-label pilot study with 30 women with endometriosis indicated that PEA, in its ultramicronized form and combined with polydatin, holds significant potential in helping mitigate endometriosis symptoms by reducing chronic pelvic pain, deep dyspareunia, dysmenorrhea, and dyschezia. Additionally, supplementation improved quality of life and psychological well-being. (Stochino-Loi 2019)
• Compared to nonsteroidal anti-inflammatory drug celecoxib, PEA-transpolydatin is less effective for acute pain relief but offers a favorable safety profile and may be considered in patients unable to tolerate conventional analgesic therapies or as an adjunct. (Cobellis 2011)

Probiotics

Dosing: 1–10 billion colony-forming units (CFU) daily, prioritizing probiotic blends utilizing Lactobacillus species, for 8–12 weeks (López-Moreno 2020)(Norfuad 2023)

Supporting evidence:

• Endometriosis is associated with reduced Lactobacillus dominance and increased abundance of pathogenic bacteria in the gut and reproductive tract. (Jiang 2021) Probiotics can dampen local and systemic inflammation by restoring microbial balance, enhancing mucosal barrier function, and modulating the immune system. (Guo 2024)(Virk 2024)
• The gut microbiota, via the estrobolome, influences systemic estrogen levels. Probiotics may reduce β-glucuronidase levels, limiting enterohepatic recirculation of estrogen and potentially attenuating estrogen-driven endometriotic proliferation. (Salliss 2021)(Baușic 2025)
• Research is in early stages, but currently available data indicate that regulating bacterial flora via Lactobacillus-containing probiotics could be a therapeutic avenue for helping suppress endometriosis progression, improve gynecological pain, and manage psychological disorders associated with endometriosis. (Itoh 2011)(Khodaverdi 2019)(Liu 2019)
• Conventional management of endometriosis includes hormonal suppression therapy and surgical intervention. Women who underwent conservative pelvic surgery for advanced endometriosis (stage 3–4) (n=222) and were given dietary therapy (including Lactobacillus and Bifidobacterium probiotics) postoperatively had reductions in pelvic pain comparable to those given hormonal suppression mono-therapy. (Sesti 2007)

Propolis

Dosing: 500 mg twice daily for nine months (Ali 2003) 

Supporting evidence:

• Propolis is a bee product that contains polyphenols and flavonoids with antioxidant, anti-inflammatory, and immunomodulatory properties. (Zullkiflee 2022) 
• Emerging research in rat models shows promise for its role in endometriosis management via proapoptotic effects and suppression of endometriotic tissue growth. (Situmorang 2023)
• According to a small RCT, propolis may support fertility in women with mild or minimal endometriosis-associated infertility. In the study, 40 women with endometriosis-related infertility for at least two years were given either bee propolis or a placebo. 60% of the women who took propolis for nine months became pregnant, compared to only 20% in the control group. (Ali 2003)

Quercetin

Dosing: 500 mg twice per day for at least 2–8 weeks (Duranti 2018)(Ostadmohammadi 2019)

Supporting evidence:

• In preclinical models, quercetin antagonized nuclear receptor 4A1 (NR4A1), a transcription factor involved in the progression of endometriosis. This interaction led to the inhibition of growth-promoting pathways, fibrotic signaling, and epithelial/stromal cell proliferation. (Zhang 2023)
• Data from a case-control study suggest that higher TNF-α levels are associated with an increased risk for endometriosis in women younger than 40 years. (Mu 2017) Quercetin is a polyphenol with antioxidant and anti-inflammatory effects. (Aggarwal 2025) It has reduced serum TNF-α and estradiol levels and increased antioxidant enzyme activity in animal models. Combination with metformin showed additive effects, further reducing lesion size and improving markers of inflammation and oxidative stress. (Jamali 2021)
• In a small clinical study, supplementation with quercetin and other bioactive ingredients led to significant reductions in endometriosis-related symptoms and decreased serum PGE2 and CA125 levels. (Signorile 2018) 

Vitamin D

Dosing: 50,000 IU every two weeks for 12 weeks (Mehdizadehkashi 2021)

Supporting evidence:

• Vitamin D reduces the inflammatory milieu that supports endometriotic lesion survival and proliferation by downregulating the synthesis of pro-inflammatory cytokines and prostaglandins and inhibiting nuclear factor kappa B (NF-κB) activation. (Miyashita 2016)
• Vitamin D also reduces the proliferation and invasion of endometriotic cells by downregulating matrix metalloproteinases and modulating the Wnt/β-catenin pathway implicated in endometriosis pathogenesis. (Miyashita 2016)(Pazhohan 2018)
• Large epidemiological studies have demonstrated an inverse relationship between serum 25-hydroxyvitamin D levels and the risk of endometriosis, suggesting that vitamin D deficiency may be a modifiable risk factor. (Harris 2013)(Xie 2024)  
• An RCT demonstrated that vitamin D supplementation significantly reduced pelvic pain, the total/high-density lipoprotein (HDL) cholesterol ratio, and high-sensitivity CRP (hs-CRP) and increased total antioxidant capacity (TAC) in women with endometriosis (n=60, aged 18–40 years) compared to placebo. (Mehdizadehkashi 2021)

Lifestyle recommendations

Nutrition

Description: Adherence to a healthy dietary pattern—characterized by high intake of fruits, vegetables, fish, and PUFAs, and low intake of red meat, processed foods, and saturated and trans fats—is associated with a reduced risk of endometriosis and improvement in pain symptoms. (Harris 2018)(Arab 2022) 

Recommendations:

• Anti-inflammatory diet: The anti-inflammatory diet is linked to lower odds of developing endometriosis and reductions in painful symptoms, including dyspareunia and non-menstrual pelvic pain. (Barnard 2023) Examples include the Mediterranean and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets, which are rich in plant-based ingredients (including fruits and vegetables, whole grains, legumes, nuts, seeds, and olive oil) and seafood. (Cirillo 2023)(Noormohammadi 2025)
• Omega-3 fatty acids: Eat fatty fish 2–3 times weekly. (Missmer 2010) 
• Estrogen elimination: Consume a high-fiber diet (25–35 grams per day). (Huang 2025) 
• Therapeutic/specialized diets for gastrointestinal symptoms: Consider low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) or gluten-free diets. (Sverrisdóttir 2022)(Varney 2025) 
• Pro-inflammatory foods: Discourage processed foods, trans fats, sugar, refined carbohydrates, and excessive red meat. (Arab 2022)

Movement/Exercise

Description: Regular exercise has been associated with reduced endometriosis-related pain, including pelvic pain and dysmenorrhea. Physical activity may also help improve mood, reduce stress, and enhance overall quality of life, which are essential factors to address while managing chronic pain conditions. (Xie 2025) 

Recommendations: 

• Regular physical activity: Recommend regular exercise at least three times per week, tailored to patient capability based on baseline fitness, comorbidities, and symptom burden. (Ensari 2022)
• Aerobic training: Moderate-intensity aerobic exercise, such as brisk walking, cycling, and swimming, can reduce oxidative stress and systemic inflammation. Preclinical and clinical studies have demonstrated that aerobic exercise is associated with reduced endometriotic lesion size and improved quality of life. (Montenegro 2019)(Artacho-Cordón 2023)
• Prehabilitation before surgery: Initiated 4–6 weeks prior to scheduled surgery, prehabilitation and lumbopelvic stabilization exercises improve core strength, pelvic stability, and functional capacity, which may enhance postoperative recovery and reduce pain. Programs should include stretching, resistance, and stabilization exercises, ideally supervised by a physiotherapist. (Salinas-Asensio 2022)(Artacho-Cordón 2023)
• Menstrual cycle syncing: Adapting exercise to the menstrual cycle may help optimize energy levels, reduce pain and fatigue, and support hormonal balance throughout the different phases of the cycle. (McNulty 2020)

Sleep

Description: Sleep disturbances are highly prevalent in women with endometriosis, affecting over 70% of patients, and are closely linked to chronic pelvic pain. Pain disrupts sleep architecture, while poor sleep worsens pain perception, fatigue, and psychological symptoms like anxiety and depression, creating a self-perpetuating cycle. (Sumbodo 2024)(Zhang 2024)(Baldi 2025)

Recommendations:

• Screen for and manage psychological comorbidities (e.g., anxiety, depression) that are strongly associated with sleep disturbances and will require integrative management if present. 
• Provide structured sleep hygiene counseling, including:
  • Maintain a consistent sleep and wake schedule, even on weekends.
  • Create a sleep-conducive environment: A dark, quiet, and cool bedroom; comfortable bedding; minimal noise and light exposure.
  • Limit screen time and exposure to blue light in the hour before sleep.
  • Avoid caffeine, nicotine, and large meals within several hours of bedtime.
  • Reserve the bed for sleep and intimacy only. (Chow 2022)(Baldi 2025)

Stress/Relationships

Description: Chronic stress can exacerbate inflammation and hormonal imbalances, while unresolved relational or sexual difficulties—often stemming from pain, stress, or emotional strain—may contribute to isolation, anxiety, and depression. 

Recommendations:

• Routinely assess for depression, anxiety, and stress in all patients with endometriosis using validated tools.
• Offer cognitive behavioral therapy (CBT) to patients with significant psychological distress, depression, or anxiety. CBT has demonstrated efficacy in improving emotional health and quality of life, both postoperatively and in chronic management, in patients with endometriosis. 
• Recommend mindfulness-based interventions (MBIs) as adjuncts to standard care, which can improve quality of life, reduce psychological stress, and positively impact pain perception and self-regulation.
• Encourage relaxation techniques, such as progressive muscle relaxation, guided imagery, and yoga, which are associated with reduced pain, stress, and improved quality of life. Regular yoga sessions can be standalone interventions or incorporated into physical therapy or exercise routines. (Evans 2019)(Wu 2022)(Hansen 2023)(Desai 2024)(Mazur-Bialy 2024)

Environment

Description: Endocrine-disrupting chemicals (EDCs) found in plastics, pesticides, industrial pollutants, and personal care products can mimic or interfere with hormonal signaling and promote inflammation, estrogen dominance, and abnormal endometrial tissue growth. Studies have linked higher levels of phthalates and bisphenol A with an increased risk of endometriosis.

Recommendations:

• Replace plastic food containers with glass or stainless steel.
• Minimize handling of thermal paper receipts.
• Choose fragrance-free personal care and household products.
• Filter drinking water.
• Select organic produce when possible, especially items on the Environmental Working Group’s “Dirty Dozen” list. (Dutta 2023)(Interdonato 2023)(Chandrakanth 2024)(Chitakwa 2024)(Fuzak 2024)

Resources

• Supporting Endometriosis – Handout