Please visit our PCOS page for more on integrative PCOS care. 

Integrative Endometriosis Treatment

Endometriosis is a complex and often poorly understood disease affecting 1 in 10 people assigned female at birth —  that’s TEN percent of the female (and some of the gender non-binary) population, or roughly 176 million people across the globe.Typically, it takes an average of 7 to 10 years after onset of symptoms for a person to receive an accurate diagnosis of endometriosis, leaving many patients suffering with excruciating pain, fatigue, and other “mysterious” symptoms and no answers. Even after many conventional treatment interventions, endo has a high recurrence rate. We believe that people living with endo deserve better.  Read more about Dr. Merritt’s story with endometriosis. 

Your symptoms are real.

You deserve to be heard.

You deserve to live well and thrive.

Endo is a complex disease in which tissue that is similar to (but not the same as) the endometrial lining is found outside of the uterus where it does not belong. Often though of as “that thing that causes period pain,” when we take a closer look, the symptoms of endo actually reach far beyond just “bad periods.” Commonly misdescribed as a “hormonal condition,” the latest research instead suggests endo is more accurately described as an immune related disease which is highly influenced by hormones — not the other way around. This is to say, endo is complex, and therefore requires a unique and thoughtful approach to treatment.

Understanding Endo

What causes endometriosis? Unfortunately, we just don’t know for sure (yet!), but there is some pretty compelling research emerging pointing leading the endo community to the brink of a new frontier — one in which we see endo as an immune related disease. If someone has been diagnosed with endometriosis, then we can usually expecting to find the following:

1. A genetic predisposition. The role of genetics and endometriosis is becoming more clear. We know that endo tends to run in families. 
2. Epigenetic triggers. Research is pointing to epigenetic influences — the study of how one’s environment may significantly influence genetic expression — plays a significant role in the development of endo. It’s been said that “genetics load the ‘gun,’ but environmental influences pull the trigger.”
3. Hormonal sensitivities. Endometriosis is infamous for the hormonal drama that we often see with it — PMS, mood swings, awful periods, weight struggles, acne, to name a few. Estrogen sensitivity is a cornerstone of the disease, and often endo patients have unique needs to efficiently metabolize estrogen appropriately. 
4. Immune dysfunction (and probably gut issues). This is listed last, but is perhaps the most important piece. As we learn more about the immune system’s role in endometriosis, it will have significant implications for how to best manage the disease. There is much to say here about auto-immune tendencies, and the role of the gastro intestinal tract. 

Endo + Chronic Inflammation

In a healthy, normally functioning body, the immune system turns on when it identifies an invader, some kind of “non-self” pathogen. It addresses whatever issue(s) the immune system has identified, and then calms down again and continues surveying until the next trigger is identified.

For people living with endo, however, it seems their immune systems has gone rogue and is essentially “stuck” in the “on” position, trying (and failing) over and over again to clear endometrial lesions that it has identified as a problem or a “pathogen” from various parts of the body — usually in the pelvis.

The person with endometriosis has an immune system that can’t clear endometrial lesions, but it IS able to recognize that it’s a problem, and so continues trying to get rid of it. In fact, research has shown that people with endometriosis tend to have significantly altered immune markers, often having reduced natural killer cell (the pathogen destroyer cell) activity, reduced macrophage and phagocytosis (defense cell) activity, altered T cell (immune regulator) activity, increased inflammatory cytokine (cell signaling) activity and elevated prostaglandins (inflammatory hormone like substances).

A common complication of living with chronic inflammation is that over time, it will lead to scar tissue. This is an issue that people living with endo often face after years the disease impacting their body, especially in the more advanced stages of endo. Similar to what happens when you have a pimple or a bug bite that you pick at, and pick at, and (dang it, listen to that little voice in your head telling you stop stop picking!), continue picking at, eventually, as a way of protecting you from further injury, it will scab over and scar.

In some cases, scar tissue can be so severe that it interferes with the function of other organs, like the bowel, and require radical interventions like bowel resection surgery and/or removal of some or all of the reproductive organs (aka partial or total hysterectomy).  

Addressing the immune system is a critical component for integrative treatment of endometriosis. This is where looking at gut health, health history and and family history become essential.

Endo + the Gut

One of the cornerstones of treating endometriosis (and often the piece that gets overlooked) is addressing the root of gastrointestinal issues. “Endo belly,” where a person with endometriosis experiences extreme bloating and discomfort, often to the point of looking several months pregnant, is very common, and usually not well understood, both by providers and those living with the issue.

Two of the most common gut issues that we see in endo patients are dysbiosis (aka bacterial imbalances, most commonly seen in the gut, but also may effect the pelvic cavity, vagina and other mucosal areas like the sinuses) and intestinal permeability (aka leaky gut).

We often see dysbiosis show up as Small Intestine Bacterial Overgrown (SIBO), an all too common occurrence in people with endo — this is often a big part of the “endo belly” bloat that is so common for endo patients. Bacterial imbalances in the stomach and large intestine are also common and must be treated for the endo patient to feel better.

Interestingly, research has shown that people with endo tend to have more “gram negative” bacteria in their system, bacteria like e-coli, for example. In fact, there have been several studies showing that often people with endo have pathogenic levels of bacteria in their pelvic cavity, which, researchers theorize, may have been translocated from dysbiosis in the gut. Dysbiosis engages the immune system and can contribute to chronic inflammation, essentially “adding gas to the fire” for endo patients.

Addressing intestinal permeability (leaky gut) is also an essential piece of effectively treating the endo patient. A recent study came out showing that there is a strong connection between endometriosis and “leaky gut syndrome.” People with endometriosis are more likely to have leaky gut (in fact, we’ve never met an endo patient who didn’t have some degree of leaky gut). Leaky gut is especially problematic for endometriosis patients because it significantly contributes to chronic inflammation and is well recognized as playing a big role in immune related diseases — leaky gut wreaks havoc on the immune system. 

The good news is, we can heal the gut! And when we heal the gut, we lay the foundation to help the rest of the body heal from endometriosis.