Endometriosis is not a hormonal condition. It’s affected by estrogen but it’s not caused by estrogen or “estrogen dominance.”
Instead, endometriosis is a whole-body inflammatory and immune disease, and possibly a microbial disease.
What does that mean for treatment?
For one thing, it means that contraceptive pills and injections are basically the wrong tools for the job. They can relieve symptoms for some women (which is good), but there’s actually no clear evidence that the pill works for endometriosis.
Natural hormone-balancing treatments are no better. In my twenty years as a clinician, I have never seen that natural modulation of hormones with herbs like Vitex can do much, if anything, for endometriosis.
The future of endometriosis treatment is immune treatment. Let’s take a look.
Causes of immune dysfunction in endometriosis
Researchers are still debating whether endometriosis is, in fact, an autoimmune disease. Certainly, endometriosis is similar to other autoimmune diseases, but at the end of the day, it probably doesn’t matter whether it’s officially classified as an autoimmune disease or simply an immune disease.
There’s very little doubt that immune dysfunction is at the heart of what is going on. Immune dysfunction is what prevents the immune system from clearing up endometrial lesions; it’s also what promotes the growth and invasion of those lesions.
So, the big question is “what is causing the immune dysfunction?” And it looks to be a combination of the following factors:
- Epigenetics (heritable changes to genes from exposure to toxins like dioxins).
- The presence of bacterial toxins in the pelvis.
The bacterial contamination hypothesis of endometriosis
Women with endometriosis have a high level of gram-negative bacteria in the pelvic microbiome and researchers think that the toxin LPS (lipopolysaccharide) from those bacteria could play a role in the development of the disease.
The most likely source of gram-negative bacteria in the pelvis is translocation from the gut. In other words, the movement of bacteria or bacterial toxins from the gut, which is more likely to happen when there is small intestinal bacterial overgrowth or SIBO causing intestinal permeability.
👉 Tip: The link with SIBO could be why a low FODMAP diet relieves symptoms of endometriosis.
LPS stimulates immune cells to release inflammatory mediators and is a known inducer of inflammation and immune dysfunction.
There are a few more lines of evidence that bacteria could be a driver of endometriosis:
- Women with a history of a gynecological infection are twice as likely to develop endometriosis.
- Antibiotics can relieve the symptoms of endometriosis.
- Antibiotics were shown in a recent animal study to reduce the size of endometriosis lesions.
None of this means that bacteria directly cause endometriosis; only that bacterial toxins drive and worsen the disease in combination with other factors.
One possible scenario is this:
- The presence of endometriosis lesions.
- PLUS an immune system that is vulnerable to dysfunction either because of genetics or epigenetic changes from toxins (or both).
- PLUS the natural surge in estrogen that occurs with the menstrual cycle.
- PLUS the presence of gram-negative bacteria and LPS toxin.
So, in addition to surgical removal of the lesions (which I support), what is the best immune treatment strategy?
Treating the immune dysfunction of endometriosis
Strictly avoid gluten and A1 casein
Step one is to calm the immune system by strictly avoiding immune-disrupting proteins like gluten, A1 casein from cow’s dairy, and possibly eggs. Unfortunately, it’s not sufficient to partially avoid these foods because even a small amount of casein or gluten can generate inflammation for days or even weeks.
According to reproductive immunologist Dr. Jeffrey Braverman, most women with endometriosis have the genotype associated with celiac disease.
Consider an immune-modulating supplement
Step two is to take one or more of the immune-modulating natural medicines that are being investigated for endometriosis. They include:
For more information about endometriosis supplements, see Endometriosis: 5 Natural Treatments That Really Work and Period Repair Manual.
Consider a course of a herbal antimicrobial
The herbal medicine berberine seems to work for endometriosis and I think it’s because it reduces levels of gram-negative bacteria and LPS toxin. It has not yet been studied for endometriosis but it has been studied for adenomyosis, which is a similar disease. In one study, researchers were able to demonstrate that “berberine ameliorates the LPS-induced progression of adenomyosis.”
Berberine is best used under the care of a clinician as it can interact with other medications. For more information, see Period Repair Manual.
Reduce mast cell activation and histamine
Mast cells are important players in the immune system and the immune dysfunction of endometriosis. Mast cells are also highly sensitive to estrogen.
For more information about estrogen and reducing mast cell activation and histamine, read The Curious Link Between Estrogen and Histamine Intolerance.
Natural hormonal treatment for endometriosis
I do not prescribe hormonal treatment as front-line treatment for endometriosis. But I do consider it as second-line treatment.
Estrogen-reducing supplements such as calcium-d-glucarate can be helpful because estrogen strongly stimulates endometriosis, particularly in the presence of the LPS bacterial toxin. The best plan is to first reduce bacterial toxin and inflammation, and then think about reducing estrogen.
Natural progesterone directly suppresses endometrial lesions and also helps to normalize immune function. Progestin drugs such as Visanne, hormonal IUD, and birth control pills can suppress endometriosis, but so does natural progesterone and with fewer side effects.
This post is in honor of Endometriosis Awareness Month and is dedicated to the 1 in 10 women who suffer this terrible disease.
Have you tried immune treatment for endometriosis? Share your story.