Hyperbaric Oxygen Therapy for Endometriosis

Hyperbaric oxygen therapy may have a complementary role

Hyperbaric oxygen therapy for endometriosis is being investigated as a complementary treatment that may help symptoms and healing in select patients. It functions best alongside established care, not as a substitute for excision surgery or medical management. Its biological rationale and early observations are promising, but large randomized human trials remain limited.

What HBOT does and why oxygen may matter

Oxygen delivery in a pressurized chamber

Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a chamber pressurized above normal atmospheric pressure. This allows more oxygen to dissolve into the bloodstream and reach tissues, significantly increasing tissue oxygen levels.

HBOT has long-standing applications in wound healing, radiation injury, decompression sickness, and chronic infections. Its proposed role in endometriosis centers on changing the low-oxygen environment that helps lesions survive and grow, rather than acting on hormones or pain pathways alone.

Low-oxygen conditions around lesions

Endometriosis lesions frequently exist in low-oxygen conditions, called hypoxia. This environment drives inflammation, new blood vessel formation, scarring, and pain signaling. Hypoxia-inducible factors (HIFs), proteins that help cells respond to low oxygen, are increased within endometriotic tissue and support lesion survival and progression.

A 2016 laboratory study examining endometrial tissue and an ovarian endometriotic cell line found increased HIF-1α and miR-210, a molecule involved in regulating cell activity, in ectopic lesions. In cells grown under low-oxygen conditions, miR-210 helped preserve cell survival and promoted autophagy, a process through which cells recycle their components.

These findings help explain how endometriotic cells adapt to low oxygen. The 2016 laboratory study did not test HBOT, however, so it supports the biological rationale rather than demonstrating a treatment benefit. By raising tissue oxygen levels, HBOT may counteract these hypoxia-driven pathways.

Potential effects on lesions and symptoms

Inflammation, blood vessels, and lesion activity

HBOT may reduce inflammation both around lesions and throughout the body. It may also reduce HIF signaling and inhibit angiogenesis, the formation of new blood vessels that support lesions.

In animal models, exposure to hyperbaric oxygen has been shown to decrease the size and activity of endometriotic implants and lower levels of inflammatory cytokines, the chemical messengers involved in inflammation. These are animal findings, not established outcomes for people receiving HBOT for endometriosis.

Cellular repair and immune responses

Other potential effects include improved mitochondrial function, cellular repair, and immune regulation. Mitochondria supply energy for cells, so improving their function may help address tissue dysfunction and support healing.

Together, these proposed effects make tissue oxygen levels a distinct treatment target. Whether they translate into lasting symptom relief in people still needs clarification.

What the evidence shows so far

Early clinical observations and limited studies suggest that HBOT may alleviate pelvic pain and improve endometriosis symptoms. Some reports also describe reduced blood vessel supply within lesions and lower inflammatory markers following treatment.

Large-scale randomized controlled trials in humans remain limited, and HBOT is not regarded as a standalone therapy. Further clinical work is needed to establish treatment protocols, identify who is most likely to benefit, and clarify long-term outcomes.

Where HBOT may fit in a treatment plan

Situations in which it may be considered

HBOT may be considered for select patients within an integrative treatment plan, particularly when persistent inflammation, impaired healing, or complex pain syndromes are present. Its role is complementary: it does not replace excision surgery or medical management.

Discuss with your own doctor what specific benefit HBOT is intended to provide and how it would fit alongside other treatment. If you’d like a specialist’s second opinion on a proposed treatment plan, our team can review your options.

Sessions and treatment setting

Protocols vary, but treatment typically involves multiple sessions over several weeks. HBOT should be administered in an accredited medical facility under physician supervision.

Before committing to a course of treatment, useful questions for your doctor include:

• What symptom or healing problem would HBOT target in my case?
• How would it fit alongside my current medical treatment or a recommendation for excision surgery?
• What session schedule and treatment duration are you recommending, and why?
• How would we assess whether it is helping?

Safety and screening before HBOT

Careful screening is needed before starting HBOT. Potential risks include ear or sinus barotrauma, meaning injury caused by pressure changes, and temporary vision changes.

Oxygen toxicity is a concern with prolonged exposure. Claustrophobia can also make the chamber difficult to tolerate and should be part of the pretreatment discussion.

Ask the clinician supervising HBOT:

• Could my medical history or existing ear, sinus, or vision problems affect treatment?
• How does the proposed protocol limit the risk of oxygen toxicity?
• How would difficulty tolerating the chamber be handled?
• What screening will be completed before my first session?