Endometriosis: Not Just A Hormone Condition

Coming off of birth control with acne-prone skin

For many women with endometriosis, they’re told that their diagnosis is a hormonal one. Many believe endometriosis is the consequence of too much estrogen and not enough progesterone. Although hormones are certainly involved, it’s unlikely that they are the only cause (or main cause) of endometriosis. Unfortunately, this misunderstanding of endometriosis has consequences, as most women seeking help are not being treated holistically, leading to the progression of this condition. So if hormones aren’t the main culprit, what is the cause of endometriosis, and how can we best treat it?

looking at the immune system

As it stands, we don’t really understand why endometriosis occurs. A lot of possible theories have been put forward, but one thing that keeps popping up consistently is the immune system. Simply put, it seems that endometriosis is an immune dysfunction issue.

During our periods most of us experience something called ‘retrograde menstruation’. This is when endometrial cells don’t exit the body and instead deposit into areas other than the uterus. These displaced endometrial cells cause inflammation, which normally results in immune cells flooding the area to remove them. In endometriosis, although immune cells do reach the displaced endometrial tissue, it seems that the immune system is unable to recognize or remove them. As a result, immune cells tend to remain in higher concentrations near the displaced endometrial cells, which leads to even more inflammation. The end result is that endometrial cells are able to continually grow and expand their reach, forming endometrial lesions all over the pelvic cavity and in other parts of the body.

In addition to having increased inflammation and immune dysfunction around displaced endometrial tissue, it seems women with endometriosis are also at a greater risk of allergies, asthma, hypersensitivity across organ systems, and autoimmunity.

why hormones make things worse

So if endometriosis truly is an immune issue, why do hormones get such a bad rep? This is because hormones do play a big, possibly secondary role in the development of endometriosis.

As a result of the inflammation we see, the endometrial tissue upregulates an enzyme called aromatase which increases levels of estrogen. Higher estrogen levels cause displaced endometrial tissues to grow even bigger than they were before. To make matters worse, this tissue also seems to be unresponsive to progesterone, allowing estrogen to circulate unchecked. Progesterone is a hormone incredibly important for proper immune function, and as a result the immune system undergoes even further dysfunction.

Confusing I know. But to sum up, endometriosis is a breakdown of immune function, hormone synthesis, and healthy communication between our immune system and hormones. This is why the basis of most endometriosis treatments are aimed at reducing estrogen levels.

why not targeting your immune system is a mistake

Fortunately or unfortunately, endometriosis is a condition where the symptoms don’t align with the severity of the disease itself. There are many women with stage 4 endometriosis with little to no symptoms, and there are many women with stage 1 endometriosis with very severe symptoms.

Why does this matter? It matters because even though you might experience an improvement in symptoms from treating ‘estrogen dominance’, the disease could still be progressing if you’re not targeting the immune system, and you’ll have no way of knowing. Moreover, if you’re only treating estrogen dominance, the moment you stop treatment, your symptoms are likely to return. Since we know endometriosis is also an immune issue, not just a hormonal one, failing to simultaneously treat the immune system is synonymous to filling a bucket with holes in the bottom.

Progression of endometriosis can be serious. Untreated or improperly treated endometriosis could lead to invasion of endometrial tissue onto other structures causing bowel dysfunction, urinary dysfunction, sexual dysfunction, and infertility to name a few. So if you’re suffering from endometriosis, do yourself a favour and see a doctor who understands the many potential causes of this condition and is willing to work with you on your immune system in addition to your hormones.

naturopathic treatment for endometriosis

Despite the lack of understanding on endometriosis, there is still a lot that can be done from a naturopathic perspective. Proper diet, supplementation, working on the immune system, managing inflammation, and yes, balancing hormones all play a role in improving symptoms and preventing the progression of this condition. Endometriosis can be stubborn, but not all hope is lost!

If you want to learn more about how Naturopathic Medicine can help support endometriosis, click here.