Endometriosis is a complex and often misunderstood condition said to affect 1 in 10 women worldwide, at least those who have been diagnosed – and it’s likely to impact many more. It’s characterised by the growth of endometrial-like tissue outside of the uterus. This tissue responds to oestrogen and triggers chronic inflammation, pelvic pain, and many other systemic symptoms.
Traditionally, endometriosis has been described as a condition of the reproductive system; however, it is increasingly recognised as a whole-body disease involving the immune system, endocrine system, and nervous system.
As a nutritional and herbal therapist specialising in reproductive health, I have supported many women with endometriosis over the past decade. What I consistently see is that a functional, root-cause approach to endometriosis can offer insights and support that go beyond conventional treatment alone. In this blog, I’ll summarise the approach I’ve found to be most beneficial.
In This Article
- What Is Endometriosis?
- Common Symptoms: Vary So Much
- Is Endometriosis Caused by High Oestrogen?
- The Role of Gut Health
- The Microbiome Beyond the Gut
- Endometriosis as an Immune-Mediated Condition
- The Nervous System and Chronic Pain
- Functional Medicine Testing for Endometriosis
- How Nutritional Therapy Can Help
- Work With Me
What Is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, attaching to organs within the pelvic cavity, including the ovaries, fallopian tubes, bowel, bladder, and pelvic lining. In some rare cases, this tissue has been found in other areas of the body.
These lesions respond to hormonal changes, particularly oestrogen at menstruation, but also at other points in the cycle. This leads to inflammation, pain, and tissue scarring.
While endometrial lesions cause localised pain and inflammation, the condition has a far wider impact on overall health and wellbeing – often resulting in chronic systemic pain, fatigue, immune dysregulation, and gut health imbalances such as IBS.
Common Symptoms: Why They Vary So Much
One of the most confusing aspects of endometriosis is that symptoms don’t always match disease severity. You can have mild (stage 1) endometriosis with severe pain, or more advanced disease with fewer symptoms. It’s an incredibly nuanced condition that requires an individualised approach.
The most common symptoms I see in my clinic:
- Painful periods (dysmenorrhea)
- Chronic pelvic pain
- Ovulation pain
- Pain during sex
- Pain with bowel movements
- Rectal bleeding during menstruation
- Recurrent UTIs
Systemic symptoms often include:
- Chronic fatigue
- Brain fog
- Digestive issues (IBS-like symptoms)
- Widespread inflammation
- A depleted immune system and susceptibility to recurrent infections
This is because endometriosis is fundamentally a chronic inflammatory condition affecting multiple systems throughout the body.
Is Endometriosis Caused by High Oestrogen?
Endometriosis is often described as an oestrogen-dominant condition, but not all women with endometriosis have high oestrogen levels. It’s more nuanced than that, and more closely related to:
- How oestrogen is metabolised
- How effectively it is detoxified and cleared
- The role of the gut microbiome in hormone recycling
Oestrogen metabolism involves multiple pathways – including the liver, genetics, and the gut. This is why a more in-depth investigative approach is needed, and why clinical testing can be so valuable.
Genetic variants play a significant role here. Variants in the CYP19A1 gene, which encodes the aromatase enzyme responsible for converting androgens into oestrogen, have been consistently linked to increased endometriosis risk. Variants in CYP1A1 and CYP1B1 further influence how oestrogen is processed and cleared from the body. Understanding your individual genetic profile can therefore be a powerful piece of the puzzle and one we’ll explore further in the testing section below.
The Role of Gut Health
One of the most consistently overlooked aspects of endometriosis is the role of the gut microbiome in driving both inflammation and hormone regulation.
Clinically, it is rare for me to work with a woman with endometriosis who does not also present with digestive dysfunction – whether that’s bloating, altered bowel habits, or multiple food sensitivities. This is not coincidental.
The gut plays a central role in regulating immune activity, and in endometriosis, we often see signs of immune dysregulation alongside chronic, low-grade inflammation. The intestinal environment becomes a key interface where this imbalance is both generated and perpetuated.
Emerging research suggests that alterations in gut microbial composition, particularly a reduction in beneficial commensal species and an increase in inflammatory or opportunistic bacteria, may contribute to the pro-inflammatory state observed in endometriosis. These microbial shifts can influence cytokine signalling, immune tolerance, and, importantly, the metabolism of circulating hormones.
A critical concept here is the estrobolome – the collection of gut bacteria capable of metabolising oestrogen. When functioning optimally, this system helps regulate the balance between active and inactive oestrogen. However, in the presence of dysbiosis, this regulation can become impaired, leading to increased recirculation of biologically active oestrogen.
This is particularly relevant in endometriosis, where the issue is not excess oestrogen production, but rather inefficient clearance and altered signalling.
Beyond this, we also need to consider intestinal barrier integrity. Increased intestinal permeability as a result of dysbiosis allows bacterial components such as lipopolysaccharides (LPS) to translocate into systemic circulation. LPS is a potent immune activator and has been shown to stimulate inflammatory pathways, including TLR4 and NF-κB, both of which are implicated in the pathophysiology of endometriosis.
This creates a feedback loop in which microbial imbalance drives inflammation, and inflammation further disrupts microbial balance.
The Microbiome Beyond the Gut
While the gut microbiome often takes centre stage, it is only one part of a much broader microbial ecosystem that influences endometriosis.
In recent years, attention has shifted towards the reproductive tract microbiome, including the vaginal and endometrial environments. These microbial communities play a direct role in shaping local immune responses within the pelvis.
In a healthy state, these environments are typically dominated by Lactobacillus species, which help maintain an anti-inflammatory, protective environment. In women with endometriosis, however, studies have demonstrated a shift away from this dominance towards a more diverse and often more inflammatory microbial profile.
The oral microbiome is another area frequently overlooked in clinical practice. Periodontal disease and gum inflammation represent a significant and often silent source of systemic inflammation. The oral cavity is a recognised route through which bacterial endotoxins, including LPS, can enter circulation — particularly in the presence of gum barrier disruption. In women with endometriosis, where systemic inflammation is already heightened, this additional inflammatory input can be clinically significant.
Endometriosis as an Immune-Mediated Condition
Endometriosis is increasingly understood not simply as a hormonal disorder, but as a condition rooted in immune dysfunction.
Under normal circumstances, the immune system identifies and clears ectopic endometrial-like cells. In endometriosis, this process appears to be impaired. Several mechanisms have been proposed, including:
- Reduced activity of natural killer (NK) cells
- Altered macrophage function
- Increased production of pro-inflammatory cytokines
This altered immune environment not only allows lesions to implant and persist but also contributes to the chronic inflammatory profile that characterises the condition. So here we have alterations in immune function alongside ineffective oestrogen clearance, creating the perfect opportunity for abnormal proliferation of endometrial-like tissue (oestrogen is a proliferative hormone) and an inadequate immune response to keep this in check. The perfect inflammatory storm.
The immune system doesn’t function in isolation – its influenced by the microbiome and can be triggered by the nervous system. Dysregulation in one area influences the others, which is why the functional medicine approach to endometriosis considers all bodily systems together.
The Nervous System and Chronic Pain
Pain is a major and often complex feature of endometriosis and perhaps one of the most challenging presentations of this disease, requiring long-term, ongoing support.
Research has shown that endometriotic lesions can, over time, undergo something called neuroangiogenesis, meaning they develop their own nerve supply. These newly formed nerve fibres are highly sensitised and responsive to inflammatory signals, contributing to persistent and sometimes severe pain.
Over time, the impact extends beyond the lesions themselves. Chronic inflammation and repeated pain signalling can lead to central sensitisation – a process in which the nervous system becomes increasingly responsive to stimuli. This can result in pain that is disproportionate to the physical findings and may persist even when lesions are minimal or have been surgically removed.
This also helps explain why many women with endometriosis experience symptoms beyond the pelvis, including:
- Widespread musculoskeletal pain/list
- Fatigue
- Sleep disruption
- Heightened stress sensitivity
From a clinical perspective, addressing endometriosis effectively requires not only reducing inflammation but also actively supporting nervous system regulation and resilience.
Functional Medicine Testing for Endometriosis
One of the key differences in a functional medicine approach is the use of targeted testing to understand each individual’s disease drivers.
Testing may include:
Blood testing
- Hormones – to assess oestrogen levels, progesterone, the oestrogen-to-progesterone ratio, and systemic inflammation’s impact on hormone production
- Thyroid function and antibodies
- Adrenal health
- Nutrient status – particularly B12 and folate for nervous system health, iron levels related to blood loss, and vitamin D as an essential nutrient in immune modulation
- Liver and kidney function/list
Microbiome – gut, vaginal and uterine
- Gut microbiome testing to address dysbiosis and support gut barrier health, reducing systemic inflammation
- Vaginal and/or uterine microbiome analysis- rebalancing the reproductive microbiome can produce remarkable shifts in menstrual symptoms. Women with endometriosis often experience recurrent BV or Candida, and these infections can be hugely debilitating/list
Nutrigenomics testing: A non-invasive test using a cheek swab to assess genetic pathways involved in methylation and hormone metabolism. This test provides data that allows for a highly personalised treatment approach. Your genetics will never change, but we can support their function with the right nutrient cofactors and lifestyle adjustments.
I like to think of this test as a blueprint for your health – something you can refer back to for life. For women with endometriosis, it can provide real clarity around what you, as an individual, should and shouldn’t be doing, particularly when it comes to supplementation.
Note: I never use nutrigenomics as a standalone test. It must be interpreted alongside functional markers such as blood and microbiome testing – without these, we don’t get the full picture.
How Nutritional Therapy Can Support Women with Endo
While conventional treatments focus on symptom management, nutritional therapy for endometriosis looks at:
- Reducing inflammation
- Supporting hormone metabolism
- Restoring gut and microbiome health
- Regulating the immune system
- Supporting the nervous system
This approach aims to address the underlying causes of your symptoms. The beauty of functional medicine is that we can do all of this alongside the medical treatment you are already receiving. So while medical treatment may bring temporary relief, we can be working on the root causes in the background, building longer-term, sustainable results.
Work With Me: A Personalised Approach to Endometriosis
If you are struggling with endometriosis symptoms and feel that you are not getting the answers you need, a more personalised, functional approach may be the way forward.
The types of things we would focus on include:
- In-depth functional testing to form a clear plan
- Personalised nutrition and herbal protocols
- Hormone and gut health support
- Nervous system regulation strategies
Book a Consultation
If you would like to understand more about how this works, I would love to hear from you.
Book in for a free discovery call to find out more – or if you think you’re ready to get started, here’s a link to book a consultation:
