Endometriosis-GUT connection

Endometriosis is a chronic inflammatory condition affecting 10% of reproductive aged women. Genetics, environmental factors, and immune system all appear to contribute to its development. The hallmark symptoms of uterine cell mis-location to areas outside the uterus is in response to the woman’s hormonal cycle of growth and bleed, sparking pain and inflammation. “Retrograde Menstruation”, is a theory that helps explain the migration of cells via the fallopian tubes into the pelvic cavity. Endometrial debris outside the uterus triggers the immune system resulting initially in low-grade inflammation, but over time, chronic inflammation and immune dysregulation may result. However, if 80% of reproductive aged women experience retrograde menstruation and only 10% experience endometriosis, what other factors are involved?

Is there a GUT health connection to endometriosis?

Over 70% of the immune system resides in the gut. Dysregulation or imbalance in the microbiome affects the function of a large part of the immune system. Endometriosis is made worse by immune dysregulation which promotes increased adhesion (attachment), angiogenesis (growth) and scarring. Lower levels of Lactobacillus and Lachnospiraceae Ruminococcus in the gut means lower levels of the anti-inflammatory short chain fatty acids. Increased bacterial vaginosis-related bacteria and other opportunistic pathogens are found in those who suffer with endometriosis. Furthermore, there is increased peritoneal amounts of Pseudomonadaceae producing arylsulfatase, a steroid precursor that catalyzes estrone sulfate to estrone, a weak estrogen. It is well known that prolonged exposure to the environmental toxin, estrogen is correlated with the occurrence of endometriosis. Evidence of microbial translocation to the pelvic cavity may originate from the gastrointestinal tract and female genital tract via lymphatics and bloodstream. Further evidence of a microbial link to endometriosis is the prevalence of anxiety and depression in those with endometriosis. The gut-brain axis or link of anxiety and depression to alterations in the microbiome and the hormone-gut link both help support the involvement of gut dysbiosis with the condition of endometriosis.

Diagnostics in Endometriosis

Early detection of endometriosis may allow for intervention and reduce the intensity of pain, scarring and inflammation. Markers for enodmetriosis include serum cancer antigen 125 (CA125), neutrophil-to-lymphocyte ratio (NLR), cytokines, etc., and microbial signatures of the gut, cervix and peritoneal cavity. The role of the microbiome goes Beyond Digestion. A healthy microbiome affects the health of our mind, body and soul. Stool analysis (gut marker) of lower levels of bacteria like Lactobacillus and Lachnospiraceae Ruminococcus and higher levels of Pseudomonadaceae might help contribute to trends towards future diagnostics of endometriosis.

You might like this new film on endometriosis. Through the lens of endometriosis, a disease that affects 1 in 9 women, the film shows how women are often dismissed, discounted & disbelieved. From societal taboos and gender bias to misinformed doctors and profit-driven healthcare, the film reveals how millions are effectively silenced and how, by fighting back, they can improve healthcare for all women.


Huang, L., Liu, B., Liu, Z., Feng, W., Liu, M., Wang, Y., Peng, D., Fu, X., Zhu, H., Cui, Z., Xie, L., & Ma, Y. (2021). Gut Microbiota Exceeds Cervical Microbiota for Early Diagnosis of Endometriosis. Frontiers in cellular and infection microbiology, 11, 788836. https://doi.org/10.3389/fcimb.2021.788836

Jiang, I., Yong, P. J., Allaire, C., & Bedaiwy, M. A. (2021). Intricate Connections between the Microbiota and Endometriosis. International journal of molecular sciences, 22(11), 5644. https://doi.org/10.3390/ijms22115644