Endometriosis: Causes and treatment options

What is endometriosis? 

Endometriosis is a condition in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. 

In most cases, these endometriosis lesions are found in the area of your ovaries, fallopian tubes and the tissue lining your pelvis. In rare cases, endometrial tissue has been found next to the lungs and even in the brain. 

The endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with the changing hormones of the menstrual cycle however this tissue has no way to leave your body so it stays stuck in your pelvic cavity. This trapped blood then forms into cysts of dried blood, often called “chocolate cysts” because of it’s appearance. 

When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

How do I know if I have endometriosis?

Firstly, if you have many of the symptoms in the above list, I suggest you make an appointment with a Dr who specialises in endometriosis. It’s important that you see a doctor who is familiar with endometriosis and all of the presenting symptoms. 

In Israel today, there are several centers that specialise in endometriosis. You should contact your local Health Fund and ask for a referral to an endometriosis specialist. 

An early diagnosis is in your favour! In addition, finding a conventional doctor and holistic support may result in better management of your symptoms.

How will a doctor determine if I have endometriosis? 

Your doctor will listen to your symptoms, perform an internal ultrasound (the probe is inserted into your body via your vagina similar to ultrasounds in early pregnancy) and palpate your abdomen. Not all endometriosis lesions can be felt externally or seen on ultrasound.

Diagnosis via laparoscopy:

In the past, it was felt that the only real way to determine if you have endometriosis is via a surgery called laparoscopy. During the procedure the surgeon makes several small incisions in your abdomen and inserts a tiny probe with a camera and light which enables the surgeon to see what is going on inside your abdomen on a screen connected to the probe. If they find tissue that appears to be endometriosis, they will take a small sample to test it.

Many women decide they don’t want to undergo a laparoscopy and will commence treatment based on their doctor’s diagnosis without a laparoscopy. Diagnosis without laparoscopy is becoming more and more common. 

What causes endometriosis?

Unfortunately, there is no known cause for endometriosis. Several possible theories exist including:

Retrograde menstruation: during menstruation, some of the endometrium lining (menstrual blood containing endometrial cells) escapes from the uterus via the fallopian tubes and enters the pelvic cavity. These cells then stick to surfaces of the organs in the pelvis eg bowels, ovaries, fallopian tubes, liver, even the lungs. Each time the uterine lining thickens in response to changing hormones in your menstrual cycle, these cells also grow and bleed.

Immune system disorders: Another theory states that all women have some endometrial tissue outside of their uterus but mostly their immune system keeps it under check. However, in women with endometriosis their immune systems do not manage to control it.

Many women who have endometriosis also are more likely to suffer from other conditions like auto immune disease, rheumatism, fibromyalgia, etc.

Transformation of peritoneal cells. Some experts suggest that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells. 

Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.

Surgical scar implantation. Endometrial cells may attach to a surgical
incision following a surgery, such as a hysterectomy or C-section causing
endometriosis lesions.

Endometrial cell transport. Your body is constantly transporting blood and fluids around your body via the circulatory system and lymphatic system. One theory suggests  endometrial cells may be transported to other parts of the body via the blood or lymph.

Conventional medical approach to managing endometriosis

Pain killers

Usually the first conventional medical approach if pain exists is to use pain killers to stop the pain. You can ask your doctor for recommendations and see what works best for you. Numbing the pain is a temporary solution as it doesn’t treat the underlying cause of the pain. However, sometimes it’s necessary while exploring longer term solutions.

Depressing the menstrual cycle

Many women with endometriosis are advised to take the birth control pill (and other hormonal options that depress the menstrual cycle) as a way of controlling the hormones that cause the endometriosis to grow and react

Again, this is not a real solution to the issue but for many women this is an option that allows them to manage the symptoms of endometriosis.


The only real way to determine if you have endometriosis is via a surgery called laparoscopy. During the procedure the surgeon makes several small incisions in your abdomen and inserts a tiny probe with a camera and light which enables the surgeon to see what is going on inside your abdomen on a screen connected to the probe. If they find tissue that appears to be endometriosis, they will take a small sample to test it.

If your doctor finds endometriosis during the laparoscopy, he/she may be able to remove some of the tissue growths during the procedure. They are usually cut or burnt out with laser. 

Some women find surgery very helpful in reducing pain and for others the effects are temporary or non-existent. Some doctors are now recommending women find alternatives to reduce the pain BEFORE surgery. 

A holistic approach to managing endometriosis

My work with women suffering from endometriosis has shown me how different the various symptoms and level of pain and suffering can be among women. However, regardless of the severity of symptoms or the length of time a woman has been suffering from endometriosis related pain, positive improvements can be made with the Sobada therapy, also known as Maya Abdominal Massage or womb massage. 

These ancient Maya healing techniques help eliminate the main cause of reproductive and digestive health issues – congestion in the pelvis and abdomen. 

While many approaches only treat the symptoms, we seek to apply these techniques to remove the cause of the disease and support the body’s natural healing capability.

During this treatment, which consists of massage techniques on the abdomen and back, we are gently encouraging improved blood flow to the organs in the pelvis – ovaries, uterus, intestines, etc and gently removing any restrictions that may be impeding that flow. In addition to blood flow, we are encouraging good flow of lymph, nerve energy and general energy (called Chi in Chinese Medicine and chu-el in the Maya tradition) to the whole of the pelvis. 

In addition to performing the massage techniques on you, I teach you to complete a short massage technique on your own at home which complements the treatments with me.

Like any holistic approach, my intention is to help return the body to a state of balance and that sometimes necessitates a multi-faceted approach. We look together at lifestyle issues which may be impacting your condition, nutrition and movement that can support you in becoming pain free and having healthier cycles.

As a result you’ll feel calmer and you’ll be able to anticipate your monthly period without fear. 

I incorporate hand and foot reflexology to help you truly relax and return to a state of balance. Foot reflexology is very effective in improving your cycles and improving your hormone levels. 

Emotional support for your hormonal health:

The stress, fear and anxiety of life plus coping with endometriosis can have a huge impact on your emotional health. 

I help my clients reduce their stress, anxiety and fears and concerns around endometriosis using Bach Flowers, visualisation and EFT (Emotional Freedom Technique) Tapping. 

I believe that when you feel calm, you’re sleeping well and you generally feel good your cycles are more likely to be regular and pain free and you can cope better with the challenges of endometriosis. 

I’m a holistic therapist and I am here to help you!


I love helping women to overcome their fertility challenges and other issues related to your cycles, pregnancy, periods and/or anxiety. 

I treat women with abdominal and womb massage techniques known as Sobada (formally the Arvigo Techniques of Maya Abdominal Massage) and reflexology.

I’m also an Advanced EFT Tapping practitioner and I work with women in particular issues around anxiety, depression, stress levels. 

I teach Fertility Awareness to help women better know their bodies and improve their chances of conceiving or prevent pregnancy naturally.     

I live in Modi’in, Israel and that’s where I spend my days helping women during their fertile years, pregnancy, menopause and other hormonal conditions. Bodywork sessions (massage and reflexology take place in my clinic in Modi’in but EFT Tapping sessions and Fertility Awareness education can take place online or in person).

Learn more about working with me here.


I came to Annette about half a year ago in the middle of a terrible endometriosis attack with extreme pains that lasted for several days. Even at the end of the first treatment I felt a reduction in pain. For several years I have tried various types of alternative treatments and never experienced anything that helped like the treatment from Annette. 

Since then I have been going to Annette once every week or so. After many years of taking the contraceptive pill continuously because of endometriosis I stopped the pill in order to get pregnant. I was terrified the pains would get worse once I stopped the pill. I was pleasantly surprised that I didn’t have any painful endometriosis attacks  when I stopped the pill. I had also made changes to my diet with the help of a dietician who specialises in endometriosis. The month after I stopped the pill I got pregnant naturally.

Annette is sensitive, professional, pleasant and very exact in her treatment. I am so happy I came to see her. I warmly recommend her to anyone with endometriosis, it was really life-changing for me. 

Rinat, Modi’in

I came for treatment after being diagnosed with adenomyosis. I was suffering from pain all the time and I was so discouraged. The treatment allowed me to express myself, my difficult feeling and at the same time feel much better physically. 

Annette, thank you so much for the support, for listening and your kind words. I really enjoy coming to you. Thank you for helping me not to feel discouraged and to feel more positive. 


My dear Annette, the treatment with you was great. Physically - relaxing and releasing and also emotionally I feel like I have a place to unload everything that is weighing me down and then feel so much lighter and more optimistic. When I come to you, I also feel like I am doing something to improve the endometriosis which worries me a lot. I am hoping with your continued help it will continue to improve. 

Neta, Modi'in

I always look forward to coming for treatment with Annette. I have seen a big reduction in endometriosis related pain and side effects. I feel like the abdominal massage and reflexology has helped me recharge my body to feel like new again. Annette is amazing and has magic hands. Thank you so much. 



I came to you a year ago in pain and sad without any tools to effectively deal with my medical situation (suspcied endometriosis). It has been a journey. From treatment to treatment I feel stronger and learned to treat myself. Thank you so much for everyone, love, Noam.

Hi Annette, I wanted to share with you that I have been thinking a lot about the year that has passed since Pesach until today. Last Seder night I was experiencing extreme pain all over my body and before the last day of chag I came to you for a treatment for the first time and left with a really really good feeling.

I am so happy with everything I received from you in the past year - physical treatment that touched especially where it was needed, emotional guidance that also touched exactly where it was needed and in general I feel like you are a life teacher and a source of inspiration. 

I am so happy that I met you, almost by chance (or actually not by chance at all). Thank you so much. Happy Passover.

Update from two months later: pregnant naturally without returning to IVF. 

Adina, Modi'in

The treatment for me was a safe space. One one per week that I know is just for me. Connecting to my body and thoughts, to my breath and my heart beat were a gift to myself. 

Especially in a person like Annette it complemented the experience not just in her impressive experience and her dedication but also her pleasant manner and lack of judgement. She always succeeded in sending me home with a great feeling and new ideas. 

The physical sensation and also emotional and mental at the end of each treatment was perfect. The scent of the oils sent me back many generations to the period of time when people were more connected to nature and to themselves and helped create an indescribable calm. 

I don’t understand how the treatment works but it just works. As someone with endometriosis, from the first treatment I felt an improvement and relief from symptoms and with time it just kept improving until I no longer worried about pain each time I expected my period.

Even with the attempts at getting pregnant, which was not easy and included fertility treatments like IVF, Annette’s treatment helped balance my body, to be calm and optimistic and even to enjoy the process. Annette was also like a life coach about different life challenges and always advising me well. Thank you for everything!! 

Rotem, Beit Shemesh

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