DEEP DIVE: ENDOMETRIOSIS
Part 2 - Why Does it Develop
THE MAIN CULPRITS
Immune Dysfunction
Your immune system is supposed to clear this tissue. In endometriosis — it doesn't.
Impaired Oestrogen Clearance
Endometriosis feeds on oestrogen — and when your liver can't clear it and progesterone can't balance it, it has an unlimited supply.
Inflammatory Cycle
Endometriosis doesn't just cause inflammation — it is sustained by it.
Environmental Triggers
The chemicals in your food, packaging, and your personal care products are fuelling this condition.
Stress and the HPA Axis
Chronic stress is not just making you anxious — it is making your endometriosis worse.
Gut Dysbiosis
Your gut is recycling oestrogen back into your bloodstream.
LETS DIVE INTO IT
1.IMMUNE DYSFUNCTION
Healthy Immune System
Tissue grows outside the uterus —> Immune cells recognise it as foreign and sound the alarm —> Natural killer cells move in and destroy the abnormal tissue —> Clean-up cells (macrophages) arrive to clear the debris —> The threat is eliminated before it can establish itself —> ✓ No lesions develop
DYSFUNCTIONAL IMMUNE SYSTEM (ENDO)
Tissue grows outside the uterus —> The tissue sends signals that switch off immune defences —> Immune cells that should destroy it begin protecting it instead —> Tissue attaches, grows, and builds its own blood supply —> Lesions bleed, scar, and spread —> The inflammation this creates weakens immunity further —> ✗ Cycle continues and worsens over time
This immune failure is not random — it is shaped by gut health, nutrient status, stress, and environmental exposures — All of which are modifiable
2.IMPAIRED OESTROGEN CLEARANCE (LIVER)
Phase 1 — Activation
The liver takes used oestrogen and converts it into an intermediate form ready for removal. Think of this as breaking it down into smaller pieces
This process requires B vitamins, magnesium, and antioxidants.
When it is sluggish, oestrogen is not processed efficiently and begins to accumulate.
Phase 2 — Conjugation
The liver packages the broken down oestrogen and tags it for excretion — attaching it to a molecule that makes it water soluble so it can leave the body via bile and stool.
This phase requires B vitamins, glycine, sulphur rich foods, and adequate fibre.
When phase 2 is impaired, even partially processed oestrogen recirculates rather than being excreted.
Both phases are impaired by alcohol, nutrient deficiencies, chronic stress, environmental toxins, medications, and poor diet — all of which are common and largely modifiable.
3.GUT DYSBIOSIS AND THE OESTROBOLOME
The oestrobolome is the collection of gut bacteria responsible for regulating oestrogen metabolism and excretion.
In a healthy gut, oestrogen processed by the liver is excreted via the bowel.
Certain gut bacteria — including Clostridium, Escherichia, and Bacteroides — produce an enzyme called beta-glucuronidase.
In balanced amounts this is normal. But in a dysbiotic gut, an overabundance of these bacteria produces excess beta-glucuronidase — deconjugating oestrogen that has already been packaged for excretion and allowing it to be reabsorbed back into circulation.
Signs your oestrobolome may be dysregulated:
Symptoms that worsen cyclically in line with oestrogen fluctuation
History of antibiotic use
Bloating, constipation, or irregular bowels
Diagnosed dysbiosis or gut conditions
Oestrogen dominant symptoms beyond endometriosis
PMS, heavy periods, breast tenderness
Diet high in ultra-processed food and low in fibre
Chronic stress
Regular or high alcohol intake
4.CHRONIC INFLAMMATION
Endometriosis is not just complicated by inflammation — it is fundamentally sustained by it.
Key inflammatory drivers:
Pro-inflammatory cytokines IL-6, IL-8, and TNF-α are consistently elevated in lesions and peritoneal fluid — driving lesion survival, growth, and immune evasion
Ectopic tissue actively signals immune cells to stop clearing it — allowing lesions to persist unchallenged
Reactive oxygen species activate NF-kB — a core inflammatory pathway keeping the condition active
The pain connection: Chronic inflammation sensitises the nervous system and promotes nerve fibre growth into lesions — amplifying pain signals and contributing to central sensitisation
What sustains it:
Pro-inflammatory diet
Gut dysbiosis
Chronic stress
Environmental toxins
Low omega-3 relative to omega-6
Inflammation promotes lesion growth. Lesion growth drives more inflammation.
5.ENVIRONMENTAL TOXINS
The link between environmental chemical exposure and endometriosis is one of the most compelling and underreported aspects of the condition.
The key offenders:
Dioxins and PCBs - Persistent organic pollutants that accumulate in body fat over a lifetime. Animal studies have demonstrated dioxin exposure alone can induce endometriosis. Women with endometriosis consistently show higher dioxin body burden in research.
BPA and phthalates - Found in plastics, food packaging, and personal care products. Mimic oestrogen at the receptor level — directly adding to the oestrogenic load feeding lesions. Associated with increased endometriosis risk in multiple studies.
Organochlorine pesticides - Have direct oestrogenic activity and are consistently associated with elevated endometriosis risk in the research.
Why this matters: These chemicals accumulate over a lifetime of exposure. They are not cleared quickly — which is why reducing ongoing exposure and actively supporting liver detoxification of existing body burden are both necessary strategies.
Where exposure comes from:
Plastic food and drink containers
Non-organic produce (pesticides)
Personal care and cleaning products
Tap water
Fatty animal products — where persistent chemicals concentrate
Complete elimination is not realistic. Meaningful, consistent reduction is.
6.STRESS AND HPA AXIS DYSFUNCTION
Chronic stress does not just affect your mood — it directly drives the biological environment endometriosis needs to grow.
Chronic stress (including unprocessed trauma) —> Cortisol rises —> NK cells suppressed & Progesterone depletes —> Immune
dysfunction & Oestrogen dominance —> Aromatase activated —> Lesions produce own oestrogen locally —> Lesion growth —> Pain is sustained and can worsen —> Chronic stress LOOP
Unprocessed trauma and the HPA axis
Adverse childhood experiences and unprocessed trauma dysregulate the HPA axis long term — altering cortisol rhythms, heightening inflammatory responses, and priming the immune system toward dysfunction. This is an underacknowledged but clinically significant driver in endometriosis that extends beyond day to day stress.
Central sensitisation
Chronic pain and a persistently activated stress response rewire the nervous system over time — amplifying pain signals beyond the site of lesions. This explains why pain can persist and worsen even after surgical treatment and why the nervous system must be directly addressed as part of management.
Signs your HPA axis may be dysregulated:
Wired but exhausted
Poor sleep or waking unrefreshed
Anxiety or low mood
Afternoon energy crashes
Symptoms that worsen significantly during periods of high stress
Pain that feels disproportionate or widespread
WHAT TO TEST
Immune Dysfunction
Blood testing (NK cell activity, Vit D)
Stool analysis (Secretory IgA)
Impaired Oestrogen Clearance
Blood testing (LFTs, B12, folate)
Urine testing (estrogen metabolite ratios)
Genetic testing (COMT, MTHFR)
Gut Dysbiosis
Comprehensive stool analysis (beta-glucoronidase activity)
Breath testing (SIBO, IMO)
Blood testing
Chronic Inflammation
Blood testing (CRP, ESR, WCC)
Environmental Toxins
HTMA (hair tissue mineral analysis) - heavy metals, mineral depletion)
Urine testing (phthalates, BPA)
Blood testing
Stress and HPA Axis Dysfunction
Salivary testing (cortisol rhythm, DHEA-s)
Blood testing (fasting insulin, sex hormone panel)
Genetic testing (COMT, MTHFR)
Comprehensive testing (often done through a naturopath or integrative GP) can offer significant insight into what is driving your endometriosis. However, these results do not provide pathways to cures. Testing offers insight into how we can help to reduce growth, pain, inflammation and associated symptoms.
Every driver covered in this post is modifiable.
⟶ Part 3 covers the naturopathic approach to management — practical, evidence-informed strategies for addressing each one.
