Endometriosis and Fibroids: A Functional Medicine Approach to Women’s Health
Endometriosis is associated with chronic pelvic pain, fibrosis, adhesions, infertility, and reduced quality of life. It may be missed or diagnosed late, particularly in women with mild, unclear, or no symptoms.
Uterine fibroids may be associated with heavy menstrual bleeding, pelvic pain or pressure, abdominal fullness, frequent urination, constipation, and iron deficiency. Their effects vary depending on their size, number, and location.
Functional medicine views endometriosis and uterine fibroids as multifactorial conditions. Rather than applying the same protocol to every woman, the functional medicine approach evaluates the interaction between hormones, inflammation, gut health, nutritional status, metabolic health, lifestyle, and environmental exposures.
What Factors Does Functional Medicine Assess?
Although there is no single clearly established cause that explains every case of endometriosis or fibroids, functional medicine explores several potentially contributing factors.
1. Hormone Balance and Estrogen Metabolism
Endometriosis and uterine fibroids are sensitive to hormonal signals. Therefore, functional assessment may look beyond a single estrogen measurement and consider:
The relative balance between estrogen and progesterone.
Estrogen metabolism pathways.
The role of the liver and gut in processing and eliminating hormone metabolites.
Menstrual cycle regularity, length, and bleeding patterns.
The effects of stress and disrupted sleep on hormonal regulation.
The relationship between insulin, metabolic health, and hormone balance.
Comprehensive hormone testing, such as DUTCH Complete or DUTCH Plus, may be used to assess estrogens and their metabolites, progesterone metabolites, androgens, cortisol, and DHEA-S.
DUTCH Cycle Mapping Plus may be considered when cycle-long hormonal patterns, irregular cycles, or fertility-related questions need to be evaluated.
Not every woman requires advanced hormone testing. Testing should be selected according to her symptoms, medical history, and the specific clinical questions that need to be answered.
2. Inflammation and Immune Dysregulation
Endometriosis is associated with complex inflammatory and immune processes, as well as oxidative stress. Research has also identified associations between endometriosis and other inflammatory conditions, including:
Irritable bowel syndrome.
Inflammatory bowel disease.
Fibromyalgia.
Chronic fatigue syndrome.
Autoimmune conditions such as rheumatoid arthritis.
Increased mast-cell activity in some individuals.
These associations do not prove that one condition causes another. However, they highlight the importance of evaluating immune function, gut health, and systemic inflammation rather than viewing the reproductive system in isolation.
Functional assessment may include inflammatory markers such as high-sensitivity C-reactive protein, or hs-CRP, with ESR when clinically relevant.
3. Gut Health and the Microbiome
The gut microbiome is connected to immune regulation, systemic inflammation, and estrogen metabolism. The term estrobolome describes the collection of bacterial genes in the gut that can influence how estrogen is metabolized and recirculated.
Gut dysbiosis, impaired digestion, chronic constipation, and irregular bowel movements may affect the elimination of hormone metabolites. Bloating, constipation, diarrhea, nausea, and painful bowel movements are also frequently reported by women with endometriosis.
A Rupa Health review of the functional medicine approach to endometriosis discusses differences observed between the gut microbiomes of women with and without endometriosis. However, the direction of the relationship remains unclear: dysbiosis may contribute to the condition, the condition may alter the microbiome, or both processes may occur together.
When significant gastrointestinal symptoms are present, functional assessment may include comprehensive stool testing to evaluate digestion, the microbiome, intestinal inflammation, and factors affecting bowel regularity and estrogen metabolism.
4. Iron and Micronutrient Status
Heavy or prolonged menstrual bleeding may increase the risk of iron deficiency, even before anemia becomes apparent.
A functional assessment may include:
Complete blood count.
Ferritin.
Serum iron and transferrin saturation.
Total iron-binding capacity.
Vitamin D.
Vitamin B12 and folate.
Broader micronutrient assessment when multiple nutritional deficiencies are suspected.
The goal is not to prescribe a standard collection of supplements. It is to identify actual deficiencies and provide targeted nutritional support based on the results.
5. Blood Sugar and Insulin Regulation
Metabolic health can influence inflammatory and hormonal signaling. Functional assessment may therefore include:
Fasting blood glucose.
Fasting insulin.
HbA1c.
Weight and waist circumference.
Physical activity.
Intake of added sugars and refined carbohydrates.
The Rupa Health functional medicine protocol for uterine fibroids includes insulin regulation and metabolic health among the factors that may be evaluated when developing an individualized plan to support hormone balance.
6. Environmental Exposures and Endocrine-Disrupting Chemicals
Functional medicine also evaluates exposure to substances that may interfere with hormonal signaling. These substances are commonly described as endocrine-disrupting chemicals.
Potential sources include certain:
Plastic containers and food packaging.
Personal-care products and fragrances.
Pesticides.
Household cleaning products.
Persistent organic pollutants.
Contaminated food or water sources.
Assessment begins with a detailed occupational, dietary, and environmental exposure history. Selected environmental toxin or heavy-metal testing may be considered when there is a relevant history of exposure rather than being used routinely for every woman.
Which Functional Medicine Tests May Be Considered?
Testing is selected according to the individual’s symptoms and health history. It may include:
Complete blood count with ferritin and a full iron panel.
Vitamin D, vitamin B12, and folate.
hs-CRP and ESR when indicated.
Comprehensive metabolic and liver panels.
Fasting glucose, fasting insulin, and HbA1c.
Thyroid assessment when clinically relevant.
Hormones and hormone metabolites when indicated.
Comprehensive stool testing when significant digestive symptoms or dysbiosis are suspected.
Environmental exposure testing based on a clear exposure history.
The value of a test is not determined by the number of biomarkers it contains. A test should address a specific clinical question and have the potential to change the individualized plan.
A Functional Nutrition Approach to Endometriosis and Fibroids
The functional medicine nutrition approach generally emphasizes an anti-inflammatory, plant-forward eating pattern similar to a Mediterranean-style diet.
The plan may include:
A diverse range of vegetables and fruits.
Cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, and kale.
Adequate protein.
Fish and other omega-3-rich foods.
Extra-virgin olive oil.
Nuts and seeds according to tolerance.
Adequate fiber to support regular bowel movements.
Prebiotic and probiotic foods according to gastrointestinal tolerance.
Herbs and spices such as ginger, garlic, rosemary, and turmeric.
Whole grains or gluten-free whole grains, depending on individual tolerance.
Foods and exposures commonly reduced in these protocols include:
Ultra-processed foods.
Fried foods.
Trans fats.
Added sugar.
Refined carbohydrates.
Processed meat and excessive red meat.
Alcohol.
Excessive caffeine.
A supervised, time-limited trial excluding gluten or dairy may be considered when symptoms suggest an intolerance. This does not mean that every woman needs to eliminate these foods permanently.
What Does the Research Say About Diet?
A systematic review examining the effect of diet on endometriosis-related pain found that several dietary interventions were associated with improvements in pain perception. The approaches studied included polyunsaturated fatty acids, a gluten-free diet, and a low-nickel diet.
However, the number of studies was limited, and not all interventions were evaluated in controlled trials.
A more recent 2024 systematic review and meta-analysis of randomized controlled trials found that dietary interventions and nutrient compounds may have the potential to reduce endometriosis-related pain, particularly dysmenorrhea.
However, the studies had substantial heterogeneity and moderate or high risks of bias. The results therefore cannot be translated into one standardized endometriosis diet for all women.
Supplements From a Functional Medicine Perspective
Supplements should be selected according to laboratory findings, symptoms, medications, bleeding patterns, liver and gut health, and pregnancy intentions. They should not be used as a fixed protocol for every woman.
Options discussed in functional medicine resources and scientific studies include:
Omega-3 fatty acids.
Curcumin.
Vitamin D when deficiency is present.
Vitamins C and E.
Magnesium when indicated.
N-acetyl cysteine, or NAC.
Alpha-lipoic acid.
Glutathione.
Green tea extract containing EGCG.
Vitex for selected menstrual-cycle patterns.
A review of dietary supplements for endometriosis found that the strength of evidence varies considerably between supplements. Some findings come from human studies, while others are based mainly on laboratory or animal research.
The review also noted that studies are frequently limited by small sample sizes and experimental designs. There is currently no consistent agreement on standardized doses or treatment durations.
Vitamins C and E for Endometriosis-Related Pain
A 2024 systematic review and meta-analysis included five randomized controlled trials. Combined vitamin C and vitamin E supplementation was associated with a higher proportion of participants reporting reductions in chronic pelvic pain, dysmenorrhea, and pain during intercourse compared with placebo.
However, the included trials were small, follow-up was short, and several studies had some risk-of-bias concerns. The findings are promising but require confirmation in larger and longer randomized trials.
Vitamin D and Uterine Fibroids
A 2024 systematic review and meta-analysis found that women with fibroids had lower serum vitamin D concentrations and higher odds of vitamin D deficiency.
The randomized trials included in the review also reported a modest difference in fibroid-size changes among women with vitamin D insufficiency who received supplementation.
However, heterogeneity between studies was high, and the doses and treatment durations varied. Vitamin D supplementation should therefore be individualized according to blood levels and follow-up rather than based on a universal dose.
Green Tea Extract and Uterine Fibroids
A preliminary randomized clinical study of green tea extract reported improvements in total fibroid volume, symptom severity, quality of life, and anemia related to blood loss over four months.
However, it was a preliminary study and is not sufficient by itself to establish a universal protocol. Concentrated green tea extracts may not be suitable for everyone, and the dose, product quality, and liver health require consideration.
Supporting the Liver and Regular Elimination
In functional medicine, supporting detoxification does not mean relying on juice cleanses or taking a large collection of detoxification supplements.
The goal is to support the body’s normal pathways for processing and eliminating hormones and external compounds.
Foundational strategies include:
Adequate protein and micronutrient intake.
A diverse intake of vegetables.
Gradually increasing fiber according to tolerance.
Maintaining regular bowel movements.
Adequate hydration.
Reducing alcohol and ultra-processed foods.
Addressing constipation and gastrointestinal dysfunction.
Supplements such as NAC, alpha-lipoic acid, glutathione, or milk thistle may be considered when there is an individualized indication rather than being prescribed automatically to every woman.
Movement, Sleep, and Stress Regulation
A functional medicine plan may also include lifestyle factors that influence inflammation, hormonal regulation, and pain perception.
Options include:
Regular physical activity according to individual ability.
Yoga and gentle movement.
Breathing exercises.
Progressive muscle relaxation.
Meditation and mindfulness practices.
Mindfulness-based psychological interventions.
Cognitive behavioral therapy.
Consistent sleep routines and sleep-quality support.
Acupuncture provided by a qualified practitioner.
Massage as a supportive relaxation strategy when appropriate.
These approaches are selected according to symptoms, physical capacity, personal preferences, and response rather than being applied as one standard program.
How Is a Functional Medicine Plan Monitored?
A functional plan requires clear outcome measures. These may include:
Pain severity, location, and relationship to the menstrual cycle.
Bleeding duration and intensity.
Menstrual cycle length and regularity.
Bloating, constipation, or diarrhea.
Energy levels.
Sleep quality.
Bladder symptoms.
Ability to complete daily activities.
Overall quality of life.
Iron, vitamin, hormone, or inflammatory markers when relevant.
Some nutritional, hormonal, and inflammatory markers may be reassessed after approximately three to six months, depending on the intervention.
The timing of repeat imaging for fibroid monitoring should be individualized according to fibroid size, symptoms, previous findings, and the clinical situation.
Frequently Asked Questions
Can functional testing identify the single root cause?
Endometriosis and fibroids are multifactorial conditions. Functional testing may identify modifiable imbalances and contributing factors, but it does not necessarily reveal one single cause.
Would You Benefit From a Personalized Functional Medicine Plan?
If you have endometriosis or uterine fibroids accompanied by painful periods, heavy bleeding, bloating, digestive symptoms, fatigue, or iron deficiency, a functional medicine consultation can help evaluate the factors relevant to your individual health.
The assessment may be used to develop a personalized nutrition, lifestyle, testing, and supplement plan based on your symptoms and health history.
Dr. Samar Shadly
Consultant Pulmonologist and IFM Certified Functional Medicine Practitioner
Founder of Radical Wellness
Explore the available consultation options and book your appointment
This article is intended for health education and does not represent an individualized diagnosis or treatment plan. Testing and supplements should be selected according to personal assessment.
Related Topics
Endometriosis and gut health: What is the microbiome connection?
The estrobolome and its role in estrogen metabolism.
An anti-inflammatory diet for endometriosis.
Endometriosis and bloating: Could the gut be involved?
Vitamin D and uterine fibroids: What does the research show?
Iron deficiency and heavy periods: Which tests should be considered?
Endocrine-disrupting chemicals and women’s hormonal health.
Insulin resistance and hormone balance in women.
Supplements for endometriosis: Evidence, limitations, and individualized use.
Functional testing for endometriosis and uterine fibroids.