When Mandy Moore walked into Capitol Hill in September 2024, she wasn’t there to promote a movie or album, but to speak up for the 190 million women living with endometriosis—a condition she herself was once misdiagnosed with. After years of fertility struggles and a near-surgery experience, Moore joined Lupita Nyong’o to call out the chronic underfunding of women’s health research, which leaves conditions like endometriosis misunderstood and undertreated for years. While conventional care often focuses on suppressing symptoms with surgery or synthetic hormone shutdown, physician-developed protocols like Inner Balance’s Oestra™ instead use bioidentical vaginal hormone therapy to restore hormonal balance, reduce inflammation, and support uterine health without shutting down your body’s natural rhythms.
Key Takeaways
- Celebrity advocacy matters: Mandy Moore’s Capitol Hill testimony highlights how even women with resources face lengthy diagnostic delays and medical dismissal
- Systemic underfunding: Women represent half the population, yet conditions like endometriosis have historically received a disproportionately small share of NIH research funding for conditions like endometriosis
- Hormonal connection: Endometriosis tissue responds to estrogen and progesterone fluctuations, making hormone therapy a key component of comprehensive care
- Beyond surgery: While recent years bring new oral medications like linzagolix, bioidentical vaginal hormone delivery offers superior tissue targeting without medical menopause side effects
- Root cause approach: Inner Balance addresses hormonal imbalance rather than simply suppressing ovulation or removing tissue
Oestra®
A prescription vaginal hormone cream formulated to treat hormonal imbalance and relieve your specific symptoms.
6-month money back •
Free shipping • Cancel anytime
Mandy Moore’s Journey with Endometriosis: A Personal Account
Mandy Moore’s endometriosis story doesn’t follow the typical narrative. Unlike many women who endure years of dismissed pain before diagnosis, Moore’s journey took an unexpected turn that revealed how close she came to unnecessary intervention.
After struggling to conceive “for a while,” Moore consulted a fertility specialist who suspected endometriosis. “I was fully prepared to go have surgery and fix my uterus and hopefully get rid of the endometriosis, if it was there,” she told Romper in 2021. The diagnosis seemed certain—until it wasn’t.
Just before her scheduled laparoscopy, Moore discovered she was pregnant. “Because of the issue with my uterus, I was very hesitant to believe it and put any stock in it,” she admitted. A second medical opinion later revealed she’d been initially misdiagnosed, a reality that fundamentally changed her understanding of how limited research leaves women navigating fertility challenges without clear answers.
This experience of medical uncertainty became Moore’s catalyst for advocacy. “Since becoming a mother, it’s so much easier for me to advocate on behalf of myself and my children and the future generations,” she explained during her Capitol Hill testimony.
Moore’s near-surgery moment illustrates a critical reality: when medical science lacks comprehensive data on women’s conditions, even specialists make judgment calls that can profoundly impact fertility, health outcomes, and quality of life.
Understanding Endometriosis: What Women Need to Know
Endometriosis affects approximately 1 in 10 women globally—roughly 190 million people worldwide. Yet despite its prevalence, most women know remarkably little about the condition until they’re diagnosed themselves.
The condition occurs when tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and peritoneum. This misplaced tissue responds to your monthly hormonal fluctuations just like your uterine lining does—thickening, breaking down, and bleeding with each cycle. But unlike menstrual blood, this tissue has nowhere to go, causing inflammation, scarring, and the formation of adhesions that can bind organs together.
What drives endometriosis development remains partially mysterious, but hormonal influence plays a central role. The tissue responds to estrogen and progesterone, which is why symptoms often worsen during certain phases of your cycle and why hormonal therapy forms a cornerstone of treatment.
The condition doesn’t correlate neatly with visible disease extent—some women with extensive endometriosis experience minimal pain, while others with small lesions suffer debilitating symptoms. This variability makes diagnosis challenging and contributes to the average diagnostic delay of 4-12 years between symptom onset and proper identification.
Risk factors include never having given birth, early menstruation onset, short menstrual cycles, heavy periods lasting more than seven days, higher estrogen levels, and family history. But having risk factors doesn’t guarantee you’ll develop endometriosis, and their absence doesn’t protect you.
Recognizing the Signs: Common Symptoms of Endometriosis
The hallmark symptom of endometriosis is pain—but not just any discomfort. We’re talking about pain that disrupts your life, forces you to miss work, and leaves you curled up unable to function.
Common symptoms include:
- Severe menstrual cramps that worsen over time and don’t respond adequately to over-the-counter pain medication
- Chronic pelvic pain that persists outside your period, often intensifying during ovulation
- Pain during intercourse (dyspareunia), particularly with deep penetration
- Heavy or irregular bleeding, including prolonged periods or bleeding between cycles
- Painful bowel movements or urination, especially during menstruation
- Digestive issues including bloating, nausea, constipation, or diarrhea that worsen with periods
- Fatigue that goes beyond normal tiredness, often described as complete exhaustion
- Infertility, affecting an estimated 30-50% of women with endometriosis
Here’s what makes diagnosis so challenging: up to 40% of women with confirmed endometriosis experience minimal or no symptoms. Others suffer debilitatingly but get told their pain is “normal” or “all in their head.”
The dismissal of women’s pain represents a systemic problem in healthcare. Studies show women experience longer wait times for pain medication and receive less aggressive treatment for the same conditions as men. This gender bias contributes directly to the lengthy diagnostic odyssey many endometriosis patients endure.
Early symptom recognition matters tremendously. The longer endometriosis progresses untreated, the more extensive the scarring, adhesions, and potential fertility impact become.
Beyond Pain Relief: Addressing the Root Causes of Endometriosis
While pain medication and surgical removal of lesions address immediate symptoms, they don’t tackle the underlying hormonal dysregulation that allows endometriosis tissue to thrive. The root cause involves complex interactions between hormone imbalance, immune dysfunction, and inflammatory pathways.
Endometriosis tissue can be influenced by estrogen levels. When progesterone levels are insufficient to balance estrogen’s growth-promoting effects, the condition worsens. This hormonal imbalance—often called estrogen dominance—creates an environment where endometrial-like tissue continues expanding outside the uterus.
Inflammation serves as another key driver. Women with endometriosis show elevated inflammatory markers and immune system dysfunction that fails to clear misplaced tissue. This chronic inflammation contributes to pain, scarring, and disease progression.
A comprehensive root-cause approach addresses multiple factors simultaneously:
Anti-inflammatory nutrition: emphasizes omega-3 fatty acids, colorful vegetables, and antioxidant-rich foods while reducing processed foods and inflammatory oils. Research shows this dietary pattern can significantly reduce pain and inflammatory markers.
Stress management: becomes crucial because chronic stress elevates cortisol, which competes with progesterone for receptor binding and worsens hormonal imbalance. Practices like yoga, meditation, and adequate sleep support better hormone regulation.
Gut health optimization: matters more than many realize. Your gut microbiome helps metabolize and eliminate excess estrogen. When gut function falters, estrogen recirculation increases, feeding endometriosis growth.
Hormone restoration: using bioidentical progesterone and estradiol in proper ratios can help regulate the menstrual cycle, reduce inflammation, and support uterine health. Unlike synthetic hormones that suppress your body’s natural production, bioidentical therapy works with your physiology to restore balance.
This is where Inner Balance’s approach differs from conventional care. Rather than shutting down ovarian function entirely or simply removing visible tissue, physician-developed protocols focus on restoring hormonal equilibrium.
Hormonal Support: A Key Component in Endometriosis Management
Hormone therapy for endometriosis has traditionally meant suppression. Conventional treatments use synthetic hormones to shut down ovulation, creating medical menopause to starve endometriosis tissue of estrogen.
While this approach can provide relief, it comes with significant trade-offs: hot flashes, night sweats, bone density loss, mood changes, and the complete halt of reproductive function.
A more nuanced understanding recognizes that the goal isn’t hormone elimination—it’s hormone balance. Endometriosis thrives in environments where estrogen dominates without adequate progesterone to regulate growth and inflammation.
Progesterone serves multiple protective functions:
- Counteracts unopposed estrogen’s proliferative effects on endometrial tissue
- Reduces inflammation throughout the reproductive system
- Regulates menstrual cycles and prevents heavy bleeding
- Supports immune function and helps clear aberrant tissue
- Calms the nervous system, reducing anxiety and sleep disturbances
Research shows vaginal progesterone delivery creates particularly effective endometrial tissue targeting through the “first uterine pass effect.” When progesterone is applied vaginally, it reaches reproductive organs at higher concentrations than oral delivery achieves.
Estradiol plays an equally important role when used strategically. Rather than eliminating estrogen entirely, maintaining steady physiologic levels prevents dramatic fluctuations that can trigger endometriosis flares. The key lies in ratio—ensuring progesterone levels remain appropriately higher than estradiol.
How Bioidentical Estradiol and Progesterone Can Help
Bioidentical hormones match your body’s natural hormone structure exactly, unlike synthetic versions. This molecular identity means they bind to receptors properly and metabolize through normal pathways, reducing side effects and improving outcomes.
Vaginal delivery of bioidentical hormones offers distinct advantages for endometriosis management. The rich vascular network of vaginal tissue allows direct absorption into the bloodstream, bypassing first-pass liver metabolism.
Studies comparing vaginal versus oral estradiol show vaginal delivery supports efficient absorption, avoids first-pass liver metabolism, and can help maintain more stable local hormone levels.
For progesterone specifically, pharmacokinetic research confirms progesterone administration supports effective absorption with less reliance on liver metabolism than oral forms.
Inner Balance’s Oestra™ combines bioidentical estradiol and progesterone in a vaginal cream formulation designed to restore optimal hormone levels. For women with endometriosis, this approach can help reduce inflammation and flare-ups, promote uterine health and prevent heavy bleeding, ease pain while supporting overall wellbeing, and improve sleep, mood, and energy.
The treatment works with your body rather than against it, supporting natural regulatory mechanisms instead of shutting them down entirely.
Mandy Moore and Advocacy: Changing the Narrative for Women’s Health
When Mandy Moore testified on Capitol Hill alongside Lupita Nyong’o in September 2024, they weren’t just sharing personal stories—they were spotlighting a systemic failure in medical research funding that has left women’s health conditions chronically understudied and undertreated.
The statistics they presented are staggering: women make up 51% of the population but have historically received less than 10% of NIH research funding. Conditions like endometriosis, which affect 1 in 10 women globally, receive a fraction of research investment devoted to diseases with similar or lower prevalence rates.
To put this in perspective: diabetes receives significantly more research funding than endometriosis. Breast cancer receives substantially more investment. Crohn’s disease, despite being rarer, receives more funding per patient affected.
“For us to just allow women to be in pain, for it to be normalized and accepted, is unacceptable,” Nyong’o declared during the testimony. Her words captured what millions of women experience—having debilitating symptoms dismissed as “bad periods.”
Moore’s advocacy centers on legislation like the U-FIGHT Act and the IMPROVE Act, which would allocate over $53 million annually for NIH maternal health research programs. These bills represent concrete steps toward closing the research gap.
The impact of celebrity advocacy extends beyond policy. When public figures share health struggles, it reduces stigma, validates other women’s experiences, drives media coverage that educates the public, encourages women to seek proper diagnosis, and pressures healthcare systems to take women’s symptoms seriously.
Moore joins a growing chorus of celebrities speaking out about endometriosis: Lena Dunham, Padma Lakshmi, Amy Schumer, Halsey, Chrissy Teigen, and Julianne Hough have all publicly shared their battles with the condition.
Moore’s testimony emphasized how even with resources, connections, and access to top specialists, she still faced confusion navigating fertility challenges and came close to potentially unnecessary surgery. If someone with her platform struggles to get clear answers, what chance do women without those advantages have?
The answer lies in systemic change—more research funding, better diagnostic tools, improved provider education, and treatment options that address root causes. Celebrity advocacy accelerates this change by making women’s health impossible to ignore.
Inner Balance: Closing the Women’s Health Gap
The gap Mandy Moore highlighted on Capitol Hill extends beyond research funding. It manifests in physician training that inadequately covers hormonal conditions, in treatment protocols that prioritize symptom suppression over restoration, and in systems that normalize suffering.
Inner Balance was founded to close this gap. Created by Dr. Sarah Daccarett, a board-certified physician specializing in women’s hormonal health, the company provides evidence-based, comprehensive care.
The mission is straightforward: treat the root cause of hormonal imbalance at every stage of life. That means understanding the hormonal dysregulation underlying conditions like endometriosis, PCOS, perimenopause, and postpartum challenges—then restoring balance through physician-developed protocols.
Our Mission: Care That Believes Women
“Care that believes women” challenges how medicine has traditionally approached female patients. For too long, women’s symptoms have been dismissed as psychological, exaggerated, or simply “normal.”
The average woman with endometriosis spends years seeking diagnosis, seeing multiple providers who minimize her pain. Women presenting to emergency rooms with cardiac symptoms wait longer for treatment than men. Hormonal symptoms affecting millions get trivialized.
Inner Balance starts from a different premise: your symptoms are real, they have a biological basis, and they deserve comprehensive evaluation and treatment.
This approach means taking detailed health histories, evaluating symptoms rather than relying solely on labs, creating personalized treatment plans, providing ongoing support from healthcare teams, and adjusting treatment based on how you feel.
Inner Balance’s Approach: Physician-Formulated Care for Hormonal Balance
What sets Inner Balance apart is the science-backed methodology behind treatment protocols. Every formulation is physician-developed, every prescription reviewed by board-certified providers, and every ingredient sourced from FDA-approved pharmacy suppliers.
Oestra™ is compounded as a custom prescription in an FDA-inspected pharmacy. Each batch undergoes third-party testing for potency, purity, sterility, pH, and quality.
The formulation reflects a deep understanding of hormone physiology. Rather than using synthetic progestins or conjugated equine estrogens, Oestra contains plant-based bioidentical estradiol and micronized progesterone that are molecularly identical to what your ovaries naturally produce.
The vaginal delivery method offers multiple advantages. The vaginal mucosa’s rich vascularity allows direct absorption into pelvic blood vessels, bypassing the digestive system. This means no first-pass liver metabolism, higher bioavailability requiring lower doses, fewer side effects, and preferential delivery to reproductive organs.
The Science Behind Oestra™
For women with endometriosis, Oestra’s dual-hormone approach addresses multiple aspects of the condition simultaneously.
Progesterone’s anti-inflammatory effects help calm immune overactivation and inflammatory cascades that drive endometriosis pain. Studies show progesterone reduces prostaglandin production, modulates cytokine release, supports tissue repair, and prevents excessive tissue growth.
When delivered vaginally, progesterone achieves particularly high concentrations in uterine and pelvic tissues through the first uterine pass effect.
Estradiol’s role proves equally important. Rather than eliminating estrogen entirely, maintaining steady levels prevents dramatic fluctuations that can trigger flares.
Women using Oestra report significant improvements:
- Vaginal Dryness: 97% relief
- Mental Health: 78.7% report better mood
- Sleep Quality: 80.2% sleep better
- Brain Fog: 67% experience clearer thinking
- Energy Levels: 63% notice increased vitality
These improvements reflect comprehensive hormonal restoration that addresses why endometriosis symptoms develop and persist.
The treatment integrates seamlessly into daily life. Applied once daily, the cream absorbs quickly. Most women apply at bedtime, and the sustained-release formulation maintains therapeutic levels throughout the day.
Every new patient consults with a board-certified physician who reviews health history and symptoms before prescribing. The care team remains available for ongoing questions and dose adjustments.
Inner Balance’s money-back guarantee reflects confidence in the approach. The treatment isn’t right for everyone—women with a history of estrogen-sensitive breast cancers need specialized evaluation. But for the vast majority of women struggling with endometriosis symptoms, heavy bleeding, or pelvic pain, Oestra offers a science-backed path to relief.
The path forward for endometriosis care isn’t just more research funding—though Mandy Moore’s advocacy for that remains crucial. It’s also better treatment options that recognize hormonal imbalance as the root cause and address it comprehensively.
You don’t have to wait years for diagnosis or accept that severe pain is “normal.” You don’t have to choose between complete ovarian suppression and surgical intervention. And you don’t have to navigate this alone.
Inner Balance provides physician-developed, evidence-based care that closes the gap between what women’s health should look like and what it too often is. Because you deserve care that believes you—and treatment that works.
Oestra®
A prescription vaginal hormone cream formulated to treat hormonal imbalance and relieve your specific symptoms.
6-month money back •
Free shipping • Cancel anytime
Frequently Asked Questions
Can bioidentical hormone therapy help with endometriosis if I’m still trying to conceive?
Unlike treatments that shut down ovulation entirely, vaginal bioidentical hormone therapy can support hormonal balance while preserving fertility potential. The key lies in using progesterone to regulate the cycle and reduce inflammation without suppressing ovarian function completely. Many women use this approach to manage symptoms while actively trying to conceive. Work closely with both your fertility specialist and hormone therapy provider to coordinate care.
How does Oestra™ differ from new oral endometriosis medications like linzagolix?
Linzagolix and similar medications work by blocking hormone production entirely, creating medical menopause that requires add-back therapy to prevent bone loss and severe symptoms. Oestra takes the opposite approach—restoring bioidentical hormones in balanced ratios rather than eliminating them. This means you avoid hot flashes, night sweats, and long-term health risks while still addressing hormonal dysregulation. The vaginal delivery also provides superior tissue targeting compared to oral medications.
What if I’ve already had surgery for endometriosis—can hormone therapy still help?
Absolutely. Surgery removes visible lesions but doesn’t address the hormonal environment that allowed endometriosis to develop, which is why recurrence rates can reach 20-40% within five years. Using bioidentical hormone therapy after surgical intervention can help prevent recurrence by maintaining hormonal balance, support tissue healing, manage remaining symptoms, and provide long-term protective benefits for bone, cardiovascular, and cognitive health.
How long does it take to notice improvements in endometriosis symptoms with vaginal hormone therapy?
Most women begin noticing changes within 2-4 weeks, though comprehensive symptom resolution typically takes 2-3 months as hormone levels stabilize. Data shows around 90% of women report feeling better after 30 days, with specific improvements varying by symptom type. Heavy bleeding often regulates within 1-2 cycles, pelvic pain reduction becomes noticeable within weeks, and energy and mood improvements emerge within the first month.
Is vaginal hormone therapy safe long-term, and will I need to use it indefinitely?
Research shows vaginal hormone therapy provides health benefits without increasing cancer risk when properly formulated. Many women continue use for years, particularly as they transition through perimenopause and menopause. Whether you need indefinite treatment depends on your individual situation—some use it during peak reproductive years, then transition to different approaches; others find ongoing use provides quality of life benefits they choose to maintain. The approach emphasizes flexibility, allowing you to adjust based on evolving needs.
