Endometriosis: Anti-Inflammatories and Antioxidants

Inflammation is a hallmark of endometriosis, and as discussed, free radical damage may be part of the etiology of this disorder. It has been suggested that growth factors and inflammatory mediators produced by activated peritoneal leukocytes participate in the pathogenesis of endometriosis by facilitating endometrial cells growth at ectopic sites. Elevated levels of inflammatory cells and mediators such as peritoneal macrophages, prostaglandins, proteolytic enzymes, complement fragments, IL-1, and tumor necrosis factor (TNF) have been identified in the peritoneal fluid of patients with endometriosis. Numerous herbs that have been used traditionally for inflammatory types of conditions demonstrate significant anti-inflammatory and antioxidant effects and should be considered for use in formulations for treatment and symptomatic relief, along with herbs whose use for inflammation is only recently being discovered. These are discussed in the following.

Dong Quai

Dong quai has antispasmodic, analgesic, and tonic effects, and has demonstrated significant antioxidant and free radical scavenging actions, partially through inhibition of anion radical formation. Limited animal and in vitro studies have reported on the specific immunomodulatory effects of dong quai, including a stimulation of phagocytic activity and interleukin-2 (IL-2) production, and an anti-inflammatory effect. There is evidence to suggest that the polysaccharide fraction of dong quai may contribute to these effects. Immu-nostimulatory and anti-inflammatory effects have also been documented for isolated ferulic acid. Dong quai has been traditionally used in Chinese medicine for the treatment of “blood stasis,” which encompasses a diagnosis of endometriosis.


Echinacea is widely used by herbalists for its immunosti-mulatory and anti-inflammatory effects, to support and promote the body’s natural immune responses.S,S’ Antioxidant effects appear to include free radical scavenging mechanisms and transition metal chelating, whereas immunostimulating effects include enhanced phagocytosis, and the stimulation of cytokine and immunoglobulin production.


Feverfew has been used for the treatment of menstrual complaints since at least the time of the ancient Greeks. In fact, its botanical name may reflect such use — parthenos means “virgin” in Greek. It is mentioned by the Eclectic physicians for use in the treatment of menstrual irregularity. Feverfew also has been used for the treatment of other inflammatory conditions, including headache, fever, psoriasis, and arthritis. Although studies have not been done on the use of this herb in the treatment of endometriosis, and indeed, it is not widely discussed for such use even in the herbal literature, its pharmacology and actions as an antinociceptive and anti-inflammatory suggest that consideration of such use is warranted. Feverfew has exhibited inhibition of prostaglandin synthetase, which inhibits the conversion of arachidonic acid to inflammatory prostaglandins, inhibits mast cell degranulation and subsequent histamine and serotonin release, and has shown inhibition of other inflammatory cytokines such as TNF-a, IL-1, NFkB, and IFN-y, as well as inhibiting peritoneal cyclooxygenase in animal models.


Herbalists use ginger root as an anti-inflammatory and antispasmodic herb for the treatment of numerous painful inflammatory conditions from arthritis to dysmenorrhea. No studies have been identified for its use for painful gynecologic complaints. One trial of 120 women reported ginger to be an effective antiemetic for the treatment of postoperative nausea, with specific trials demonstrating its efficacy in reducing postlaparoscopic gynecologic procedures. However, two other trials demonstrated either no effect compared to placebo, or negative effect (increased nausea) with increased doses of ginger. Ginger remains popular among Western and traditional Chinese medicine herbalists as an antispasmodic treatment for dysmenorrhea. It is taken in tincture form in combination with other herbs, in infusions, and also used externally as a poultice and in baths for pelvic discomfort.

Gotu Kola

Numerous studies support the traditional uses of the popular Ayurvedic herb gotu kola to promote wound healing, and as an anti-inflammatory and antimicrobial herb. Additionally, it has been demonstrated to have antiproliferative and antioxidant effects, and to prevent the formation of keloid scar tissue. Its use as a neurogenerative and neurotrophoretorative adaptogen makes it particularly useful in the treatment of stress disorders, and may play some role in its mediation of other effects. Given the association of these actions with the clinical and etiologic picture of endometriosis, this herb deserves consideration as part of a protocol for this condition both when botanical treatment is the primary modality, or to heal from surgical intervention and reduce adhesion and scar formation. Gotu kola is typically used in combination with other herbs as part of a comprehensive formula.

Green Tea

Green tea is rich in polyphenolic compounds, with catechins as its major component. Studies have shown that catechins possess diverse pharmacologic properties that include antioxidative, anti-inflammatory, anticarcinogenic, and antibacterial effects. Tea catechins are well absorbed in the gastrointestinal tract; thus drinking unfractionated green tea is the most simple and beneficial way to consume this herb.

Licorice, Calendula, and St. John’s Wort

Licorice root (Glycyrrhiza glabra) and calendula blossoms (Calendula officinalis) are used by herbalists as anti-inflammatory herbs, and may frequently be included in formulae for treating endometriosis. The aim of one recent study was to investigate whether standardized hy-droalcoholic plant extracts such as calendula, St. John’s wort, plantain (Plantago lanceolata), and licorice can suppress the activities of 5-lipoxygenase (5-LO) and cyclooxygenase-2 (COX-2), key enzymes in the formation of proinflammatory eicosanoids from arachidonic acid (AA). The researchers concluded that licorice extract might be a potential drug possessing anti-inflammatory activity devoid of the most troublesome (gastric) side effects seen for drugs used as COX-2 and 5-LO inhibitors. They purport that St. John’s wort, plantain, and licorice extracts can be added to an already impressive list of botanicals with anti-inflammatory activity.

Peony and Rehmannia

Two herbs commonly used in traditional Chinese medicine formulae, peony and rehmannia, have demonstrated significant anti-inflammatory and antispasmodic activity. Both are specifically recommended by Mills and Bone for endometriosis, whereas Low Dog discusses the use of peony in the traditional Japanese medicine Shakuyaku-kanzo-to (which also contains the anti-inflammatory Glycyrrhiza uralensis). Studies using the latter formula have demonstrated prostaglandin production inhibition in the uterine myometrium via phospholipase A2 inhibition, whereas other studies have demonstrated arachadonic acid inhibition, PAF inhibition, reduction in free radical formation, and smooth muscle relaxation. Note that nearly all of the studies use these herbs in traditional formulae rather than in isolation, and that studies are conducted in animal models, and have focused on arthritis, ulcers, and other chronic inflammatory conditions. Licorice, a potent anti-inflammatory, is frequently included in traditional Chinese medicine formulae that also contain peony and rehmannia, as is dong quai when these herbs are used for gynecologic conditions. It must be remembered that in traditional Chinese medicine, herbs are not prescribed on the basis of a disease entity or a pharmacologic expectation of efficacy, but rather on an individual diagnostic approach using traditional parameters and categories.

Sour Cherries and Raspberry Fruit

Although not part of a traditional botanical approach to gynecologic problems, interesting new data suggests that sour cherry anthocyanins may have a beneficial role in the treatment of inflammatory pain. The antihyperalgesic effect may be related to the anti-inflammatory and antioxidant properties of anthocyanins and was found comparable to the commercial antioxidants and superior to vitamin E, at a test concentration of 125 μg / mL. Anthocyanins from raspberries (Rubus idaeus) and sweet cherries (Prunus avium) demonstrated cyclooxygenase-I and cyclooxygenase-II inhibitory activities comparable to those of ibuprofen and naproxen at 10 μM concentrations. The value of these findings in endometriosis is not known, but perhaps this is a worthy reminder that a diet rich in deep-colored berries and other fruits and vegetables may hold a key to improving health and preventing disease.