Endometriosis is a tricky diagnosis to get. While it impacts around 176 million people across the globe, endometriosis also takes an average of 10 years and eight doctors to be diagnosed. It can also be the cause of unexplained infertility, which is a whole separate can of worms.

But what IS this slippery disease and why does it occur? 

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What is endometriosis – how did this happen?

Endometriosis is an inflammatory condition in which endometrial-like tissue (similar to the tissue that lines the uterus and is shed during menstruation) is found in other places in the body. It usually involves the ovaries, the bowel, or the tissue lining your pelvis, though sometimes it can spread beyond the pelvic region, including, but not limited to, the appendix, diaphragm, and lungs.

The cause of endo is another gray area. One possibility is that endometrial-like tissue was accidentally deposited during fetal development onto other organs or on other tissues in the body.

There is also evidence that endometriosis could be caused by menstrual flow that is escaping the uterus (retrograde menstrual flow) and depositing on the surrounding tissues, creating lesions. 

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Previous + outdated thoughts on factors that affect endo

It has been theorized that endo was solely hormonal in nature. With that in mind, treatment approaches were set up to suppress hormone production after surgical cauterization of the endometriosis lesions. 

While the surgical intervention done by an experienced endometriosis surgeon can be extremely beneficial, it may not be 100% curative or the lesions may develop again (especially if they’re caused by retrograde menstruation).

Which has led to updated theories on endo: it’s not merely hormonal.

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Current thoughts on factors that affect endo

The current developments in endometriosis research show that endo is actually a multifactorial condition, which is possibly impacted by these multiple factors all at once. These factors include:

• hormonal,
• nervous system involvement,
• inflammation driven reactions,
• influences from your microbiome,
• genetics and epigenetic factors, and
• immune system reactions. 

Autoimmunity + endometriosis: is there a connection?

The connection between autoimmunity and endometriosis is still being researched to fully understand, but what we do know is that a holistic view of endo requires taking a look at or treating the immune system. This may not look like direct immune system treatment (i.e. with vitamin C, zinc, or other immune system supporters), but it’s key to start treating all the other underlying conditions that affect the immune system (i.e. Hashimoto’s, chronic infections, mold toxicity, heavy metal loads, and much more).

What we know right now is that while it’s not uncommon to have retrograde menstrual flow (a potential contributing factor to endo), a select group of women who have a multitude of underlying factors might have additional internal reactions. Their immune systems “see” this menstrual flow outside the uterus and thinks, “this is not supposed to be here—we must attack!” 

Then, the immune system creates both a wide-spread and localized attack on these endometrial cells, starting the cycle of inflammation, pain, lesion growth, and hormonal disruptions. Once the endometrial cells implant into tissue (like your abdominal wall, bowels, ovaries, or bladder), your immune system now has a lasting ‘foreign invader’ to attack on a daily basis.

Another factor? The uterus actually has a microbiome of its own. Some of those microbiome residents will travel with the menstrual blood outside of your cavity and also act as a foreign invader for your immune system to react to. Talk about firing up autoimmunity!

All this doesn’t mean hormones aren’t a major factor in endometriosis. We know the hormonal aspects contribute, as estrogen can stimulate the immune system to create even more of a reaction (a good thing generally, but here it becomes too much!). 

It can feel like with endometriosis you’re constantly playing a game of whack-a-mole, trying to find a treatment that works (whether that be birth control, pain relievers, estrogen modulators, etc). A holistic approach isn’t considered easier, but it IS systematic, organized, and has a plan to address and uncover all aspects of your body.

Taking a multifactorial approach to endometriosis whether you’re pre-surgical, not considering surgery, or post-surgical and still having symptoms can be like taking on a full time job—but finding a partner to help and lead you through the discovery process is what can help ensure success.

Dr. Cassie Wilder

Dr. Cassie Wilder is a registered Naturopathic Medical Doctor (NMD) and founder of MIMC. Her passion is empowering her patients through education, understanding, and support through their healing journey. After graduating from Iowa State University with a Bachelors of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine & Health Sciences, a fully accredited and nationally recognized institution in Phoenix, AZ. During her clinical training, she received extensive hands-on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue.