Endometriosis is commonly considered to be an estrogen-dependent condition that occurs during one’s reproductive life.  Due to its correlation with hormone activity within the body, treatment and management for endometriosis typically comes in the shape of birth control pills, IUDs, and other hormonally suppressive medication that can help regulate estrogen levels and support symptoms.

Absolutely, hormones have an undeniable name in the game. There is no negating the connection and affects of hormones and how they go hand-in-hand with endo. Any woman with endometriosis can feel the fluctuating affects of her hormones and how they impact flare ups throughout her menstrual cycle, manifesting themselves in the form of:

• Pain during ovulation
• Pain during periods
• Pain with bowel movements
• Pain and changes with intercourse

However, recent advances in research have made exponential growth within the world of endometriosis, dramatically shifting our understanding of both the condition and its underlying factors. Within the past 5 years, new evidence suggests that hormones are not the only key contributors. Cases of endometriosis have been seen in women going through menopause, men, and even children and infants, indicating that there is much more at work than just estrogen levels. This suggests that focusing solely on hormones offers an incomplete understanding and management of endometriosis, as hormones and estrogen levels alone do not provide a comprehensive picture of what’s going on.

So, if we can’t pin the whole thing on only estrogen and hormones, then who else is a major player when it comes to endometriosis? We know that hormones are a huge part of the what when it comes to endometriosis. But in order to get into the root of the why, we need to look at endo’s emerging underlying partner in crime: inflammation.

Inflammation and Our Immune System

To answer the foundational why—why does someone develop endometriosis, why does it get worse, why does inflammation play such a crucial role in it all—we need to consider our immune system.  Our immune system is our body’s natural surveillance system. A healthy, functioning immune system can scan our body and identify any areas in need of some TLC, be it an infection in our nose or a splinter in our toe. In the case where endometrial cells are growing outside of the uterus, the immune system should be able to assess the pelvic cavity and flag these growth areas, also known as endometrial lesions. These lesions are areas where there’s an overgrowth of tissue where tissue doesn’t typically grow. In endometriosis, these uterine growth environments are commonly found on the bowel, bladder, and other abdominal areas. The immune system of someone without endometriosis is able to go in, identify these lesions and clean them up. The immune system of a person with endometriosis, however, is unable to do so. This is because endometrial lesions release inflammatory signals out into the surrounding area, which not only causes local inflammation but also triggers the immune system to send out an inflammatory reaction to the lesion as well, leading to a double dose of inflammation in that area. This excessive inflammation prevents the immune system from accessing the area to effectively clean it out, resulting in scar tissue and damage to surrounding tissues and organs.

Inflammation and Our Hormones

Another impact we see is a breaking in the body’s cardinal rule: a body should never choose to dedicate blood flow and resources to cells that aren’t where they are supposed to be. With endometriosis, this is exactly what happens. With the immune system unable to clean up the endometrial lesions, these growth environments are free to grow and develop. As they do, our bodies grow and develop around them, sending blood flow, nerve growth, and other resources that feed and support them. It’s been seen that along with this list of resources, the body also changes the hormones locally within the lesioned area. This causes a significant impact on endometriosis and the severity of its symptoms as now, not only is the affected area subject to the hormones routinely released during ovulation, but these clusters of cells are now producing their own hormonal environment. This increase of hormones can combat with those the body is already systematically releasing. This leads to an imbalanced cycle: the bigger the lesioned area grows, the more inflammation ensues, increasing the blood flow required by the area, which increases the release of additional hormones. This results in an increasing excess of hormones throughout the body, which can lead to an increase in the severity of symptoms. When considering this cycle, it can be seen that endometriosis is an inflammatory condition that is affected by hormones, not necessarily caused by them.

Inflammation and Our Microbiome

Recent research has also discovered significant changes regarding endometriosis and its relation to our gut health. New studies have found different types of bugs that live in our gastrointestinal tract, or our microbiome. These bugs have been seen to increase inflammation in the abdomen and within the peritoneal cavity, or the space that houses our abdomen and pelvic wall. This cavity is filled with peritoneal fluid, which acts as lubricant for our vital organs and allows nutrients, antibodies, and other resources to pass through the area. It’s been seen that women with endometriosis have a different type of peritoneal fluid that contains higher levels of oxidation, a damaging reaction that causes inflammation (Duffin, 2021). It’s also been seen that endometriosis can change and disrupt the patterns in which the immune system communicates within this cavity. These new microbiome bugs, differentiating fluid and changing communicative patterns between the peritoneal cavity and the immune system have all indicated significant inflammation within the body.

“Endometriosis is an inflammatory condition that is affected by hormones.” – Dr. Sarah Wilson, ND

With all these connections to inflammation, endometriosis needs to be treated by looking through an inflammatory lens to effectively get to the root of the condition. Significant advances in research have shown that inflammation is a vital contributor to endometriosis and pelvic health. Focusing on hormone levels alone is not sufficient to thoroughly support and manage endometriosis. Current hormonal-suppressive therapies can categorically reduce symptoms and provide relief specifically to period pain. However, they do not necessarily make the lesions smaller, they do not improve fertility outcomes, and they do not improve the more systemic symptoms of endometriosis such as body aches and pains, fatigue, brain fog, mood changes and digestive issues. In order to holistically support and manage endometriosis, we need to look deeper into its interdependent relationship with inflammation.

References

Duffin, J. (2021, August). Understanding Inflammation and Endometriosis. Retrieved from Endometriosis.net: https://endometriosis.net/living/inflammation-pain