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 treatment is not much better. In my twenty years as a clinician, I have never seen that hormone-modulating herbs such as 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 as a disease of immune dysfunction.
Immune dysfunction is at the heart of what is going on with endometriosis. For example, 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 the bacterial toxin LPS (lipopolysaccharide) in the pelvis.
- Possible nickel allergy.
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 (SIBO) causing intestinal permeability.
👉 Tip: The link with IBS, SIBO, and nickel allergy 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 can drive or 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 an irritant such as nickel allergy or the LPS toxin.
So, in addition to surgical removal of the endometriosis lesions (which I support), what are the best ways to treat the underlying immune dysfunction that drives endometriosis?
Treating the immune dysfunction of endometriosis
- Calm the immune system by strictly avoiding immune-disrupting proteins like gluten, A1 casein from cow’s dairy, and possibly eggs. “Strictly avoiding” means having none of those foods at all during a test period of eight weeks. Unfortunately, it usually will not work to partially avoid immune-disrupting 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 a low-nickel diet.
- Consider supplementing with one or more of the following immune-modulating natural medicines: zinc, N-acetyl cysteine (NAC), turmeric or curcumin, resveratrol, melatonin, vitamin A.
- Try a course of an antimicrobial herbal medicine such as berberine, which reduces levels of gram-negative bacteria and LPS toxin. Berberine 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 not safe during pregnancy and can interact with other medications. Check with your clinician.
- Reduce mast cell activation and histamine because mast cells are important players in 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.
- Look at hormone treatment for endometriosis such as natural progesterone or oral micronized progesterone, which suppresses endometriosis lesions but also helps to normalize immune function. Progesterone can work as well as progestin drugs such as Visanne and the hormonal IUD, but with fewer side effects. See Hannah’s patient story in Chapter 9 of Period Repair Manual.
Have you tried immune treatment for endometriosis? Share your story.