1 July 2022


Endometriosis affects up to 176 million women worldwide. Too often Endometriosis is pigeonholed as a “hormonal problem”, because of oestrogen dominance. Endometriosis is not a hormonal condition. It’s affected by oestrogen but is not caused by oestrogen or a dominance of oestrogen.

So what IS going on? Endometriosis is a whole body underlying inflammatory immune system condition requiring a multi system approach. It is affected by oestrogen, which is a proliferative hormone (keep this in mind).

  • During a menstrual cycle the lining of the uterus is shed. Some of the cells and debris backwashes through the fallopian tubes, termed retrograde menstruation (universal in all women) 
  • This tissue debris, infiltrated with white blood cells enters the peritoneal cavity
  • First line responding Immune cells like mast cells in the pelvis RESPOND to the presence of this dead tissue, releasing histamines and call in other immune troops like chemokines, macrophages & create a huge inflammatory reaction in the pelvic region
  • This Inflammatory storm triggers the production of more oestrogen (via the aromatase enzyme) locally in the pelvis. Remember, oestrogen is proliferative & healing: and here develops the growth of new blood vessels, via the production of vascular endothelial growth factor (VEGF) driving further growth of established endometriosis lesions but is not caused by oestrogen or “oestrogen dominance.” (see image)
  • A dysregulated immune response that includes an; overexpression of mast cells = histamine, high levels of cytokines from dysfunctional macrophages, an aberrant adaptive immune system.

Rather the mechanisms are multifactorial, all require exploring. A starting strategy would be to reduce mast cell activation & histamine because mast cells are key players in the immune dysfunction of endometriosis. See my blog post tips ♀HistHERmine: The Link with Women's Hormones and �� Histamine 

Women with endometriosis have a high level of gram-negative bacteria in the pelvic microbiome & researchers think that the toxin LPS (lipopolysaccharide) from those bacteria could play a role in the development of the condition.

Imbalances in gut & reproductive tract microbiota composition, known as dysbiosis, disrupt normal immune function, leading to the elevation of proinflammatory chemicals (cytokines), compromised immunosurveillance - all of which may contribute to the pathogenesis of endometriosis.

Over time, this immune dysregulation can progress into a chronic state of inflammation, creating an environment conducive to increased adhesion and angiogenesis (the development of new blood vessels), which may drive the vicious cycle of endometriosis onset & progression. 

Recent studies have demonstrated endometriotic microbiotas have been consistently associated with diminished Lactobacillus dominance: Lactobacillus jensenii, Lactobacillus reuteri, and Lactobacillus iners, as well as the elevated abundance of bacterial vaginosis-related bacteria and other opportunistic pathogens: Clostridium butyricum, Clostridium disporicum, Alloscardovia omnicolens, and Veillonella montpellierensis. 

So much so that a study reported that women with a history of gynaecological infection are twice as likely to develop endometriosis! 

I highly recommend working with a practitioner that uses Invivo Healthcare to assess the vaginal microbotia through their Vaginal Ecologix test so species and strain-specfic probiotics can be prescribed accordingly. 

And of course working on the microbiome as a whole is vitally important here - it’s all about plants, fibre and phytonutrients. 

Endometriosis - working on the microbiome

Our daily food intake should include:

2 cups dark leafy greens - Choose from: beet greens, dandelion greens, kale, lettuce (endive, greens, radicchio, romaine, spring, mustard greens, spinach, chard).

2 cups cruciferous vegetables - Choose from: rocket, bok choi, broccoli, broccoli sprouts, brussels sprouts, cabbage, cauliflower, kale, kohlrabi, mustard greens, radishes, swede, turnips, watercress.

3 cups colourful vegetables - Choose from: artichokes, asparagus, bean sprouts, peppers (red, orange, yellow, green), cucumbers, aubergine, green beans, green peas, leeks, okra, onions, parsley, radicchio, radishes, sea vegetables (kelp, spirulina, wakame), squash, sweet potato, tomato (including sun-dried tomatoes), watercress, courgette.

In health,