Gut Health Impacts Endometriosis
The Microbiome’s Role in Endometriosis
By Dr. Laura M. Brown, ND
Endometriosis is a chronic and often painful condition in which tissue similar to the uterine lining grows outside of the uterus. It affects approximately 10% of women of reproductive age and is a significant contributor to infertility.
Symptoms and Impact
Common symptoms of endometriosis include pelvic pain, painful menstruation, pain during intercourse, pain during bowel movements, painful urination, fatigue, depression, and gastrointestinal complaints resembling irritable bowel syndrome (IBS), such as bloating, constipation, diarrhea, and abdominal discomfort.
The Microbiome Connection
Emerging research suggests that inflammation and immune dysregulation associated with an imbalanced microbiome may play a key role in the development and progression of endometriosis—and could also present a promising target for treatment. Women with endometriosis tend to have a higher abundance of pathogenic bacteria in their oral, vaginal, cervical, and gut microbiomes.
The Role of Infections
Evidence also points to a link between infections and endometriosis. A large cohort study involving more than 140,000 women found a three-fold increase in the risk of developing endometriosis among those with a history of pelvic inflammatory disease (PID), and a two-fold increase among those with a history of lower genital tract infections. Bacterial contamination of menstrual blood, particularly by toxin-producing bacteria, may also contribute to inflammation and abnormal tissue development.
Estrobolome and Estrogen Re-circulation
Endometriosis is an estrogen-driven condition. Certain gut bacteria produce enzymes such as β-glucuronidase and β-glucosidase, which can promote the reactivation and re-circulation of estrogen that the body originally intended to eliminate. This may lead to a state of estrogen dominance, potentially exacerbating endometriosis symptoms and progression. The collection of microbial genes involved in estrogen metabolism is referred to as the estrobolome. Liver support, through diet, lifestyle and plant-based medicines can help
Viral Triggers and Chronic Inflammation
Persistent viral infections may also contribute to the inflammatory environment seen in endometriosis. Viruses such as human papillomavirus (HPV), HIV, hepatitis B and C viruses (HBV and HCV), and Epstein-Barr virus (EBV) are known to create chronic immune activation and may induce genetic and epigenetic changes associated with endometriosis.
Diet and Microbiome Health
Nutritional choices significantly influence inflammation and the health of the microbiome. Reducing intake of red meat and conventional dairy—which can promote estrogen production—may help lower oxidative stress. A diet rich in anti-inflammatory and microbiome-supporting foods can be particularly beneficial.
Summary
By addressing inflammation, estrogen balance, and microbial health, patients may experience relief from symptoms and improved overall well-being. Naturopathic medicine offers much by the way of pain management, hormone balance, detoxification, healing the gut and balancing the microbiome, laboratory testing for nutritional deficiencies and microbiome analysis, anti-viral and anti-bacterial treatments, nutritional and lifestyle advice.
References:
Abulughod, N., Valakas, S., & El-Assaad, F. (2024). Dietary and Nutritional Interventions for the Management of Endometriosis. Nutrients, 16(23), 3988. https://doi.org/10.3390/nu16233988
Cuffaro, F., Russo, E., & Amedei, A. (2024). Endometriosis, Pain, and Related Psychological Disorders: Unveiling the Interplay among the Microbiome, Inflammation, and Oxidative Stress as a Common Thread. International journal of molecular sciences, 25(12), 6473. https://doi.org/10.3390/ijms25126473
Uzuner, C., Mak, J., El-Assaad, F., & Condous, G. (2023). The bidirectional relationship between endometriosis and microbiome. Frontiers in endocrinology, 14, 1110824. https://doi.org/10.3389/fendo.2023.1110824
