Endometriosis: Between Pain, Stigma, and Self-Care

Severe period pain, fatigue, digestive problems, or pain during sexual intercourse are still often dismissed as “normal.” For years, many affected people hear statements such as “That’s just part of having a period” or “You simply have to put up with it.” But pain that regularly interferes with school, work, relationships, or everyday life deserves attention. These symptoms may be caused by endometriosis, a chronic condition that for a long time was poorly understood and socially stigmatized.

A Condition with a Long History

Descriptions of symptoms that, from today’s perspective, resemble endometriosis can already be found in historical medical texts. However, making a definitive retrospective diagnosis is difficult. Pelvic pain, menstrual disorders, or difficulties conceiving were long not regarded as a distinct medical condition.

Instead, for centuries, women’s symptoms were often attributed to supposed “female sensitivity” or psychological causes. The historical term hysteria even derives from the Greek word hystéra, meaning uterus. A wide range of physical and psychological symptoms were therefore broadly attributed either to the psyche or to the female reproductive system.

It was not until the 19th and early 20th centuries that tissue resembling the uterine lining was studied more closely. In the 1920s, physician John Sampson played a decisive role in shaping the modern understanding of endometriosis.

The terminology has changed, but some ways of thinking inherited from historically male-dominated times have not disappeared completely. Even today, affected people may find that severe pain is normalized, psychologized, or not taken seriously enough. Shame surrounding menstruation, sexuality, and digestive symptoms can also contribute to symptoms going unmentioned for a long time.

What Is Endometriosis?

In endometriosis, tissue similar to the lining of the uterus is found outside the uterus. Lesions can occur on the ovaries, peritoneum, fallopian tubes, bowel, bladder, or structures within the pelvis, among other locations.

This tissue can respond to hormonal changes during the menstrual cycle. As a result, local inflammatory reactions, bleeding, cysts, adhesions, and scar tissue may develop.

The extent of visible lesions does not automatically indicate the severity of symptoms. Even small lesions can therefore cause severe pain.

Possible typical symptoms include:

• severe or increasingly painful periods,
• chronic lower abdominal or pelvic pain,
• pain during or after sexual intercourse,
• pain during bowel movements or urination,
• cycle-related digestive problems,
• heavy or irregular bleeding,
• fatigue,
• back or leg pain,
• difficulty conceiving.

Not all symptoms have to occur at the same time. Because of its wide range of manifestations, endometriosis is also known as the “chameleon of gynecology.”

How Common Is Endometriosis?

Exact figures are difficult to determine because endometriosis can remain unnoticed and undiagnosed for years. Estimates suggest that around two million women in Germany are affected. Internationally, it is often estimated that approximately one in ten women or people of reproductive age have endometriosis.

Several years may pass before a diagnosis is made. Reasons include the normalization of severe period pain, the wide variety of symptoms, and the possibility of confusing them with bowel, bladder, or back problems.

Greater awareness of endometriosis therefore does not necessarily mean that the condition has suddenly become more common. Rather, increased awareness can help symptoms to be recognized more effectively and evaluated earlier.

Commonly Used Micronutrients

The following micronutrients may be mentioned as supplements to a normal diet:

• Iron: Heavy or prolonged bleeding can be associated with increased iron loss. Fatigue, reduced physical capacity, paleness, or concentration problems may be possible signs of inadequate iron status. Iron levels should be checked by a physician before supplementation. Iron contributes to the normal formation of red blood cells and hemoglobin and to the reduction of tiredness and fatigue.
• Vitamin D: Vitamin D is frequently studied in connection with endometriosis. Independently of this, vitamin D contributes to the normal function of the immune system and normal muscle function. Higher doses should be based on individual needs and, where appropriate, laboratory testing.
• Magnesium: During menstruation, magnesium intake may receive greater attention. Magnesium is often used in the context of muscle tension, fatigue, or increased requirements. It contributes to normal muscle function, normal functioning of the nervous system, and the reduction of tiredness and fatigue.
• Omega-3 fatty acids and plant compounds: Omega-3 fatty acids are studied in connection with endometriosis, particularly because of their involvement in the formation of inflammation-regulating signaling molecules. Initial studies suggest that EPA and DHA may influence certain inflammatory parameters.

Various plant compounds are also a focus of research. These include curcumin from turmeric, resveratrol, quercetin, and EGCG from green tea. Research is primarily investigating possible associations with inflammatory processes, oxidative stress, cell growth, and the formation of new blood vessels.

Which micronutrients may be appropriate depends, among other things, on diet, laboratory values, the severity of bleeding, symptoms, medications being taken, possible plans to conceive, and individual tolerance.

Everyday Tips

A cycle and symptom diary can help identify connections between bleeding, pain, digestion, sleep, physical activity, and energy levels, as well as help prepare for medical consultations. Heat, a warm bath, or gentle breathing exercises are often perceived as soothing, while physical activity should be adapted to how you feel on a particular day—from walking and gentle yoga to strength training on days with fewer symptoms. A balanced, plant-focused diet with vegetables, whole grains, suitable sources of protein, high-quality fats, and sufficient fluids provides a good foundation; blanket restrictions on gluten, dairy products, or other food groups are not advisable without an individual reason. Regular breaks, sufficient sleep, flexible working arrangements, and support with everyday activities can also provide relief. In cases of persistent digestive problems, severe pain, or psychological distress, specialized nutritional counseling, pelvic floor physiotherapy, psychosocial support, and participation in support groups may be helpful.

Nutrition and Gut Health

There is currently no specific “endometriosis diet” that is equally suitable for everyone affected. Nevertheless, a varied diet consisting of foods that are as minimally processed as possible can provide a good foundation. A plant-focused food selection with plenty of vegetables, green leafy vegetables, berries, legumes, whole grains, nuts, and high-quality plant oils is often recommended. Foods high in added sugar and highly processed foods, as well as large amounts of red or processed meat, can instead be consciously reduced. What matters is not a strict list of forbidden foods, but a balanced diet that can be maintained over the long term and is individually well tolerated.

Gut health is also increasingly becoming a focus of research. Gut bacteria are involved, among other things, in immune processes and estrogen metabolism. However, the specific role of the gut microbiome in the development and progression of endometriosis has not yet been conclusively established. A fiber-rich diet can support normal bowel function and the diversity of gut bacteria. Suitable foods include vegetables, legumes, whole grains, nuts, seeds, and berries. Fermented foods such as plain yogurt, kefir, sauerkraut, or kimchi can complement the diet if they are individually well tolerated.

Water and unsweetened herbal teas are particularly suitable beverages. Ginger tea or “golden milk” with turmeric can be incorporated into everyday life as soothing alternatives to heavily sweetened drinks. Yarrow and lady’s mantle tea are also traditionally used for women’s health complaints. Coffee does not generally need to be avoided. In cases of restlessness, sleep problems, a sensitive stomach, or the personal impression that coffee worsens symptoms, the amount can be reduced individually or temporarily replaced with caffeine-free beverages.

When Is Medical Evaluation Important?

A gynecological evaluation is particularly advisable if period pain regularly prevents normal everyday activities, if pain occurs during sexual intercourse, bowel movements, or urination, if bleeding is very heavy, if painkillers are frequently required, or if attempts to conceive remain unsuccessful.

Sudden severe pain, circulatory problems, fainting, fever, or unusually heavy bleeding should be medically assessed promptly.

Take Care of Yourself: Pain Deserves Attention

The history of endometriosis shows how long women’s symptoms were misinterpreted, stigmatized, or psychologized. Even today, the condition is not always easy to recognize. Severe period pain, however, is not something that simply has to be endured in silence.

Endometriosis is a complex chronic condition with highly individual courses. Good care combines medical diagnostics and treatment with individually appropriate measures for nutrition, physical activity, pain management, and everyday life.

Symptoms are real—even when they are not visible from the outside.