By Merritt Jones, DAIM, LAc, FABORM, MS
March is Endometriosis Awareness Month. Every year it brings into focus something I witness in my clinic week after week: people who have been living with significant, life-altering pain for years, sometimes decades, without ever receiving a clear explanation for it. People who have been told they are fine, that their pain is normal, that they simply need to manage better. People who have quietly built a case for their own suffering because no one around them seemed to take it seriously.
This month exists because that experience is far too common. And it is personal to me. I lived it too, before I ever had the language or the diagnosis to understand what was happening in my own body.
So in this month of awareness, I want to offer something more than a definition of endometriosis. I want to talk about what it actually feels like to navigate this disease, what the research tells us, and what options exist beyond the narrow path most patients are handed at diagnosis.
Endometriosis Symptoms: The Basics, Without the Minimizing
Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, on the ovaries, fallopian tubes, bladder, bowel, and in some cases far beyond the pelvis. It is not “bad periods.” It is not stress. It is not something you can push through with ibuprofen and a heating pad, though many people spend years trying.
Prevalence estimates range from 6 to 10% of people with menstrual cycles, though some estimates run considerably higher when accounting for underdiagnosis and populations, including transgender, nonbinary, and gender-fluid people, frequently excluded from research.[1,2] What the data consistently show is that a significant proportion of cases remain undiagnosed, and that diagnostic delay is not an outlier. It is the norm.
The average diagnostic delay across international studies is approximately 6.8 years.[3] Some research puts it closer to 10 years and at least 7 provider visits before a correct diagnosis is made.[4] A national survey of 758 patients with endometriosis found that nearly 76% reported being misdiagnosed with another condition before receiving a correct diagnosis, most commonly by their gynecologist or general practitioner.[2] That number is not a failure of patients. It is a failure of how medicine has long approached pain in people with uteruses.
If you have spent years being told your pain is normal: it is not your fault. And you are not alone.
What It Actually Feels Like
Endometriosis is not just a physical disease. It is a disease that asks you to constantly justify your own suffering: to a doctor who is skeptical, to a workplace that doesn’t understand, to a partner who can’t fully see it, and sometimes to yourself after years of being told nothing is wrong.
I can speak to this from both sides of the treatment room. One of my early core memories relating to what I now know was endometriosis was on my first day at a new job. I was maybe 20 years old, and I was riding my bike to work in downtown San Francisco when it hit out of nowhere. Pain so severe it felt like what I imagine labor to be. Nausea. Cold sweats. Vomiting. Simply debilitating. I jumped off my bike and lay down on the sidewalk, amidst the crowded streets, curled in the fetal position, wondering if something was seriously wrong with me – again.
This had become my normal. After years of being told that period pain is simply something we have to endure, that the trick is to “get ahead of it with ibuprofen,” I had no framework for understanding what was happening in my body. Looking back now, I know I should have called for help. I should have gone to the ER. I absolutely should have been worked up for endometriosis. But I was young, and I trusted what the doctors told me.
My story is not unusual. For many people, the journey to diagnosis begins in adolescence. Severe cramps dismissed as growing pains. Heavy periods chalked up to hormones. A trip to the ER sent home with ibuprofen and a suggestion to try birth control. The message, delivered repeatedly and in different ways, is that this is normal. That you are being dramatic. That you need to manage better.
That gaslighting accumulates. It teaches people to minimize their own symptoms, to preemptively apologize for bringing them up, to search for evidence that they are not crazy before walking into the next appointment. By the time many patients receive an endometriosis diagnosis, they have spent years building a case for their own pain. That is an exhausting and demoralizing way to be a patient.
The disease itself is exhausting in ways that are hard to communicate. Endometriosis causes fatigue that is not fixed by sleep. It causes pain that doesn’t reliably correspond to cycle phase or disease stage, which means even people with mild disease can experience severe symptoms, and vice versa. It disrupts work, relationships, sex, and the simple ability to make plans without calculating whether you’ll be functional that day. The grief that comes with all of this is real and largely unacknowledged in conventional medical settings: the birthday dinners missed, the workouts abandoned, the fertility fears that settle in quietly and then louder.
And then there is the isolation. Endometriosis is a disease that is mostly invisible. You can look completely fine and be in significant pain. You can have a diagnosis and still have people around you, including providers, question whether it’s really that bad. That invisibility is its own particular kind of loneliness.
Endometriosis and Fertility: What You Actually Need to Know
For many people, a fertility struggle is what finally leads to an endometriosis diagnosis. That is a painful irony: years of symptoms dismissed, and then a diagnosis that arrives only once conception becomes difficult.
Endometriosis is found in approximately 25 to 50% of people experiencing infertility, and it can affect fertility through several interconnected mechanisms. Chronic inflammation alters the pelvic environment in ways that affect egg quality, sperm function, and fertilization. Adhesions can distort pelvic anatomy and compromise tubal function. Endometriomas on the ovaries are associated with diminished ovarian reserve, even in people who are otherwise young and healthy. And the inflammatory milieu created by endometriosis can impair implantation, even in cycles where fertilization occurs.[5]
Understanding these mechanisms matters because it changes how we approach care. A patient with endometriosis and unexplained infertility is not the same as a patient with unexplained infertility alone, and the treatment plan should reflect that.
It also matters to say clearly: an endometriosis diagnosis does not equal an infertility diagnosis. Many people with endometriosis conceive without intervention, and many others conceive with targeted support. What makes the difference, consistently, is having a team that understands the disease fully and approaches it from multiple directions at once. Addressing inflammation, supporting hormonal balance, optimizing the uterine environment, and coordinating with reproductive medicine when needed are not separate tracks. They are part of the same goal.
This is exactly why integrative, collaborative care matters so much for this population.
What Integrative Care for Endometriosis Actually Looks Like
I eventually got answers, and they changed everything, including the direction of my entire career. I became a Doctor of Acupuncture and Integrative Medicine and a board-certified reproductive acupuncturist because I know what it costs to go without proper support. That experience is baked into the care model we offer at Natural Harmony Reproductive Health in San Diego.
Most people with endometriosis are offered a narrow set of options: hormonal suppression, pain medication, or surgery. All of these have a place. But they are not the whole picture, and for many patients they are not enough on their own. Here is what a more complete approach can include.
Surgical care: why excision matters
Excision surgery has become one of the gold standards for treating endometriosis, and for good reason. Unlike approaches that only address the surface of lesions, excision removes endometriosis tissue at the root, including deeply infiltrating lesions that involve the bowel, bladder, or other pelvic structures. Peer-reviewed evidence supports its effectiveness: a prospective cohort study of 176 patients found that laparoscopic excision significantly reduced pain across all domains and improved quality of life for up to five years post-surgery.[10] A separate review similarly identified laparoscopic excision as the current gold standard approach for endometriosis management across all disease stages, noting improved outcomes when adjacent involved structures are also addressed.[11]
Surgery is not a cure, but for patients with moderate to severe disease, deeply infiltrating lesions, endometriomas, or significant fertility concerns, a skilled excision surgeon is one of the most important people to have on your team. The operative word is skilled: excision is a technically demanding procedure, and outcomes are closely tied to surgical experience and specialization.
But here is what I want to emphasize, because it often gets lost in the surgery-forward conversation around endometriosis: surgery works best when it is part of a larger plan. The patients I see who fare best are not the ones who found the right surgeon and stopped there. They are the ones who built a village. An excision specialist who understands the disease deeply. A reproductive endocrinologist when fertility is part of the picture. An acupuncturist and integrative medicine provider to address inflammation, nervous system regulation, and the body’s capacity to recover and thrive. Pelvic floor physical therapy. Mental health support. Providers who communicate with each other and treat the patient as the expert on their own experience.
That multidisciplinary model is not aspirational. It is the standard of care endometriosis patients deserve, and it is what we work toward at Natural Harmony Reproductive Health. The other options described above — acupuncture, herbal medicine, dietary support, nervous system care — are not consolation prizes for patients who can’t access surgery. They are part of the same comprehensive approach, before surgery, after surgery, and for patients for whom surgery is not the right next step.
Acupuncture
Acupuncture is not a cure for endometriosis, and I want to be clear about that. But there is a meaningful and growing body of research supporting its role in pain management and quality of life for people living with this disease.
A 2024 systematic review and meta-analysis published in Archives of Gynecology and Obstetrics, analyzing 14 randomized controlled trials and 793 patients, found that acupuncture produced significant reductions in endometriosis-associated pain severity compared to controls, with improvements in clinical response rates and reductions in serum CA-125 levels.[6] A multicenter randomized placebo-controlled trial published in Fertility and Sterility found that acupuncture significantly reduced dysmenorrhea and shortened pain duration, with measurable improvements across validated quality-of-life measures.[7] A 2024 network meta-analysis of 42 RCTs and 3,635 participants found that combination acupuncture therapies outperformed Western medical management alone for pain reduction, CA-125 levels, and overall clinical response rate.[8]
The mechanisms are well-studied. Acupuncture modulates prostaglandins, endorphins, and substance P, all of which are dysregulated in endometriosis, and exerts anti-inflammatory effects through neuroimmune pathways.[6] In clinical practice, we often use acupuncture in combination with Chinese herbal medicine, which has its own evidence base for endometriosis-related pain and inflammation and can be tailored to each patient’s presentation.
Anti-inflammatory diet and lifestyle support
Endometriosis is fundamentally an inflammatory disease, and what you eat can meaningfully affect your inflammatory load. A diet rich in vegetables, omega-3 fatty acids, and fiber while minimizing processed foods, refined sugar and alcohol is consistently supported in the endometriosis literature as a complement to other treatments. This is not about restriction or perfection. It is about giving your body less to fight.
We also look at sleep, movement, and general lifestyle factors that either amplify or dampen systemic inflammation. These conversations are often absent from conventional endo care, and they matter.
Nervous system regulation
Chronic pain changes the nervous system. In endometriosis, prolonged inflammation and unmanaged pain can contribute to central sensitization, a state in which the nervous system becomes hypersensitive and pain signals are amplified beyond what the tissue damage alone would produce. This is not psychological. It is a well-documented neurophysiological process, and it is one reason why some patients continue to experience significant pain even after surgical intervention.[9]
Nervous system support through acupuncture, breathwork, somatic practices, and targeted lifestyle interventions is an underutilized but important piece of comprehensive endo care. Helping the body feel safe is not soft medicine. It is science.
Join Us: Endometriosis Panel on March 28th in San Diego
On Saturday, March 28th, Dr. Chandra Spring-Robinson, excision surgeon and Director of Minimally Invasive Gynecologic Surgery at United Medical Doctors, is hosting a panel on endometriosis that I genuinely wish had existed when I was looking for answers.
Joining her will be Dr. Anne Davis, reproductive endocrinologist, myself, and other leading voices in endometriosis care. Together, we’ll be discussing diagnosis, surgical options including excision, fertility implications, and the role of integrative medicine in a comprehensive treatment plan.
If you have endometriosis, or have spent years suspecting you might, this is the room to be in.
Register for this FREE event here.
There Is More Support Available Than You Think
Please don’t wait another year, another dismissive appointment, or another cycle to advocate for yourself. The path to answers in endometriosis is rarely fast and almost never straight. But there is far more support available than most patients are ever told about, and finding providers who believe you is the starting point for everything.
If you’d like to explore whether acupuncture and integrative care have a place in your endometriosis or fertility journey, we would love to meet you.
Book a consultation at Natural Harmony Reproductive Health – We’d love to connect.
Written by Dr. Merritt Jones, LAc, DAIM, FABORM Clinic Director & Founder | Natural Harmony Reproductive Health
Dr. Merritt holds a Doctorate in Acupuncture and Integrative Medicine and is board-certified in reproductive acupuncture (FABORM). Her practice draws on the full spectrum of Traditional Chinese Medicine — acupuncture, herbal medicine, and functional nutrition — alongside evidence-based Western medicine to support her patients through every stage of the reproductive health journey.
Medically reviewed by the author. Last reviewed: March 2026.
References
- World Health Organization. Endometriosis. Updated March 2023. https://www.who.int/news-room/fact-sheets/detail/endometriosis
- Bontempo AC, Mikesell L. Patient perceptions of misdiagnosis of endometriosis: results from an online national survey. Diagnosis (Berl). 2020;7(2):97–106. doi:10.1515/dx-2019-0020
- Forde J, et al. Understanding diagnostic delay for endometriosis: A scoping review using the social-ecological framework. Health Care for Women International. 2024;46(3):335–351. doi:10.1080/07399332.2024.2413056
- Forde J, et al. Understanding diagnostic delay for endometriosis: a scoping review. medRxiv preprint. 2024. doi:10.1101/2024.01.08.24300988
- Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441–447. doi:10.1007/s10815-010-9436-1; see also Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839–852. doi:10.1016/S0140-6736(21)00454-X
- Chen C, Li X, Lu S, Yang J, Liu Y. Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024;310(4):2101–2114. doi:10.1007/s00404-024-07675-z
- Li PS, Peng XM, Niu XX, et al. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril. 2023;119(5):815–823. doi:10.1016/j.fertnstert.2023.01.034
- Li H, Wang X, Wang Y, et al. Acupuncture and related therapies for endometriosis: a network meta-analysis of randomized controlled trials. J Pain Res. 2024;17:3197–3216. doi:10.2147/JPR.S488343
- Zheng P, Zhang W, Leng J, Lang J. Research on central sensitization of endometriosis-associated pain: a systematic review of the literature. J Pain Res. 2019;12:1447–1456. doi:10.2147/JPR.S197667. PMID: 31190954.
- Healey M, et al. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. J Minim Invasive Gynecol. 2014. PMID: 12923150
- Wright J. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol. 2004;16(4):299–303. PMID: 15232483
- Zheng P, Zhang W, Leng J, Lang J. Research on central sensitization of endometriosis-associated pain: a systematic review of the literature. J Pain Res. 2019;12:1447–1456. doi:10.2147/JPR.S197667