Endometriosis and Holistic Health with Aviva Romm, MD

We’re inspired by a lot of people – but when we try to describe the level of respect and admiration we have for Aviva Romm, words fail us. Aviva started her career as a midwife, herbalist, ecologist, mother, and writer – and later became a Yale-trained MD with a focus on integrative health. Women around the world turn to her books for reliable information and sage advice on a range of topics from hormone health to pregnancy to raising healthy children.

To say we were thrilled to interview her for our Endometriosis Month series is an understatement. This conversation is rich in resources for all things hormone balance, inflammation, and healing through supplements and food. We hope you’ll find this knowledge as potent and essential as we did!



Foria: You have a very integrative and individualized lens and approach. Are there any common threads that point to the root causes of endometriosis?

Aviva: While conventional medicine tells us we have no idea what causes endometriosis, there are many threads very clearly woven through the science on nutrition and diet, as well as on environmental exposure, that give us a strong understanding of the underlying – or root – causes of endo.

For many women, these threads start before we were even born – in our moms’ wombs. For example, even high levels of common environmental contaminants like BPA and phthalates, which we all have in our bloodstreams, can alter our immune function during our own critical development, or at any time in our lives – and this can set the changes that lead to endometriosis in motion.

We also know that high levels of environmental estrogens can aggravate this situation. And on top of it, women who eat lower levels of fruits and veggies (which protect healthy immune response and keep our hormone levels healthier), or higher amounts of red meat, are more likely to experience endo.

Foria: What are your go-to food and lifestyle tips for someone dealing with this condition and other pelvic inflammatory conditions?

Aviva: Endo is fundamentally an inflammatory condition that is triggered by our hormonal cycles. So a diet that is anti-inflammatory and low in food-borne environmental toxins, that also supports healthy hormone levels, is essential.

The best approach for achieving this is a plant-based Mediterreanan diet that includes fish rich in essential fatty acids but is low in red meat. Lots of leafy greens and berries are very important. I recommend 8 cups combined fresh vegetables daily—especially leafy greens like kale, collards, broccoli, brussels sprouts.

Getting enough fiber and having a daily bowel movement are essential for reducing inflammation, overall body toxin load, and eliminating excess estrogen from your system. For this, I recommend having 1-2 tablespoons of freshly ground flax seed daily in a smoothie, or mixed into food.

Foria: What are your favorite remedies to use for endometriosis? How have you seen hemp to be supportive?

Aviva: Five supplements and herbs that I use in my medical practice that have been scientifically shown to not only help relieve the pain associated with endometriosis, but actually reduce lesions and cysts, include: ⁠

Melatonin: We usually think of melatonin as a sleep supplement, and indeed, it is the natural substance that increases at night in our brains to tell us to get some sleep! However, melatonin is also a powerful natural detoxifier, especially of excess or harmful forms of estrogen, and perhaps this explains its powerful role in endometriosis care. ⁠

NAC: Short for N-acetyl-cysteine, NAC is a powerful supplement that increases glutathione, one of the most important detoxifiers naturally produced in our bodies. However, many of us aren’t producing quite enough to keep up with the demands put on our bodies by chronic exposure to environmental toxins and even overproduction of our own natural hormones – including estrogen. NAC has some impressive data behind it, specifically for endometriosis.

Pine Bark: In yet another study of natural substances for healing endometriosis, this time pycnogenol,an extract of pine bark (yes, as in the trees – this one being a specific species of Maritime Pine), women taking 30 mg twice daily for 48 weeks showed a 33% reduction in pain, including severe pain, with lasting benefits.

Ginger: Ginger root powder (or the equivalent in extract form) at a dose of 500 mg 2-4 times/day has been shown to reduce pain equal to the effects of ibuprofen. ⁠

Cannabis or CBD for pain, and CBD for sleep and anxiety, too.

Foria: Are there other modalities or tools you find to be supportive? ie abdominal massage, pelvic floor therapy, acupuncture, etc?

Aviva: Arvigo abdominal massage and pelvic floor physical therapy can help when there are adhesions causing pain, bowel or urinary problems, or when a woman is trying to conceive; acupuncture has been found, in small studies, to be helpful for pain, and I’m a big fan of yoga for pain and relaxation.

Foria: What would you tell a patient who has just been diagnosed with endometriosis and is overwhelmed?

Aviva: It’s normal to be completely overwhelmed – but at the same time, for many women, the diagnosis is a relief after years of pain and not having an answer for why. So honoring the overwhelm is first. Then starting to gain an understanding of what it is and what it isn’t can be calming.

So for example, you might read on the internet that it can affect your fertility – but the reality is that most women with endo do get pregnant and many with no problem at all. Which also comes to knowing your info sources and avoiding the fear mongers!

Connecting with other women/people with endo is critical both for a sense of community and not being alone, but also for real tools from real folks navigating medical care and life with endo. 

I always help my patients understand the condition so they can feel really empowered, so I walk them through what it is, what triggers it, and how she can live with it while trying to heal it.

Understanding that it’s absolutely not her fault is something I always make sure I really communicate. And connecting with other women who share similar concerns can help her find grounding and get real skills for coping.

Foria: Adenomyosis is a very similar condition to Endometriosis; so similar in its expression yet challenging to diagnose and less talked about. How similar would you say are the potential root causes and approaches for healing? Basically, could what we’re sharing here also support those with adenomyosis?

Aviva: From an integrative or root cause perspective, I think of endo and adenomyosis - and treat them clinically - as twin sisters living in different towns right next to each other. They are more similar than different, but each have their own nuances. But the protocols are the same. Medically, the main difference in treatment is the type of surgery – with adenomyosis, because the abnormal tissue is imbedded in the uterine muscle, it’s tricksier.

Foria: What inspires you most about your work?

Aviva: Women’s stories – their power, their honesty, their fierceness, their vulnerability, and their right to have care providers who see, hear, and believe them.

Foria: You have some incredible resources including your books, podcast Natural MD Radio with corresponding blog posts, and I know you have a new book coming out! Any particular resources or tools our community should absolutely check out?

Yes, please – come hang out with me on Instagram and my website for an ever-growing library of free articles and podcasts on all things women’s health and natural medicine, and stay tuned for my next book Hormone Intelligence, coming out December 2020!

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