Endometriosis fatigue

CBD has plenty of mechanistic interest and positive survey data, but the first proper RCT (DREAMLAND 2026, n=102, triple-blind) was negative — oral CBD did not beat placebo for post-surgical endo pain, and CBD had more adverse events. Survey data consistently shows 80%+ of users report pain relief, and animal models suggest CBD reduces endometriotic lesions and inflammation. ACOG concluded in 2024 that there is insufficient evidence to recommend cannabis products for gynaecological pain. The honest summary: plausible mechanism, popular in the community, but the first rigorous RCT disappointed.

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.

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.