CBD for endometriosis

Magnesium is a low-risk adjunct for endo-related pain, though most evidence comes from primary dysmenorrhoea rather than endo specifically. The strongest endo-specific evidence is the Pirnia 2020 RCT (n=163), where IV magnesium plus opioids reduced pain more than opioids alone. A 2024 review singled out endo pelvic pain as one of the few chronic pain conditions where IV magnesium evidence is genuinely good. Oral magnesium has decent but low-quality evidence for menstrual pain (2016 Cochrane review), and the 2026 Dutch consensus recommends co-prescribing magnesium hydroxide with all endo pain medications to prevent constipation.

Exercise likely helps endo symptoms but the story is more nuanced than often presented. Two recent meta-analyses (2023, 2025) show moderate pain reduction and quality-of-life improvements. However, the most rigorous RCT to date (Gabrielsen 2025, n=81) found supervised exercise plus pelvic floor training improved "current" pelvic pain but NOT "worst" pain — so exercise may help baseline symptom management rather than flare pain. For menstrual pain specifically, the 2019 Cochrane review found exercise reduced pain by about 25mm on a 100mm scale. Resistance and multi-component training have the best evidence; Pilates is particularly well-supported for dysmenorrhoea.

Omega-3 has a split evidence picture. For primary dysmenorrhoea, multiple meta-analyses show moderate-to-large pain reduction with supplementation. For endometriosis specifically, a 2025 meta-analysis of 5 RCTs found no significant pain benefit — despite a clear reduction in inflammatory markers. The SAGE RCT (2020) in adolescents with endo actually found fish oil did slightly worse than placebo. Observational data suggests higher dietary omega-3 may lower endo risk. Low-risk and good for general health, but don't expect dramatic pain reduction. Typical effective doses in dysmenorrhoea trials: 300-1800mg EPA+DHA daily, with lower doses counterintuitively more effective.

Acupuncture has surprisingly decent evidence for endo-related pain. Multiple meta-analyses of RCTs show significant pain reduction versus controls, with electroacupuncture and auricular acupuncture showing the strongest effects. A 2024 Bayesian network meta-analysis ranked acupuncture among the top three non-pharmacological interventions for menstrual pain. The main caveats: most trials are small and Chinese, placebo-controlled effects are smaller than no-treatment-controlled effects, and benefits often fade after treatment stops. Reasonable option if accessible — low risk, moderate evidence.