Like we covered before, the original (and somewhat now outdated) thoughts around the causes of endometriosis was that it was purely hormonal and that drove treatment strategies such as hormonal birth control and estrogen suppression. While endometriosis is very much an estrogen-dependent condition, to simplify the condition in that regard makes a treatment strategy too singular.

I also don’t want to ignore the fact that hormonal treatment strategies have relieved the chronic pelvic pain of many, many women who suffered for an average of 10 years before being diagnosed—what I’m proposing is a multifactorial approach for women who don’t tolerate hormonal birth control, who have future fertility goals, or who just want to take on their endometriosis head on.

So let’s break down how estrogen is involved in endometriosis and how this piece of the pie should be treated! 

RELATED: Is there an association between endometriosis and autoimmunity?

What is endometrial tissue?

Maybe you didn’t know, but your uterus has multiple different layers. The same layer that contracts when you have period cramping is not the same as the layer that bleeds every month. The endometrial layer is the layer that sheds once per month for women to have a menstrual period. After you bleed, the layer thickens over the next 2 weeks mostly in part due to estrogen in a woman’s bloodstream.

One would think that endometrial tissue that is outside of the uterus (aka Endometriosis) would act the same if not very very similar to the endometrial tissue that lives in its normal habitat (aka inside your uterus). In fact, they may look the same under a microscope, but the way they act is very different. 

RELATED: Having heavy periods with lots of clots? Ask for these 4 tests, stat.

Ways endometrial lesions act different hormonally than regular endometrial tissue

1. Endometrial lesions outside the uterus can create their own source of estrogen. Researchers have found that the hormone estrogen was high in biopsy (or samples) of the endometrial lesions, but the serum values of estrogen in the patient were not elevated. This finding demonstrates something I’ve seen again and again in clinical practice—“estrogen dominance” without any evidence of such in a woman’s blood work. With the endometrial lesions creating their own source of estrogen, and having a dense network of estrogen receptors, it’s a recipe for lesion growth, increased pain, and increased inflammatory response in the local endometriotic tissue.

2. Endometrial tissue outside of the uterus may have the same estrogen receptors as, say, your breast tissue, but when they’re found in the endometrial lesions, they create a stronger estrogenic effect than other estrogen-sensitive tissues (i.e. your breast tissue). Not only that, but researchers are finding that there are additional estrogen receptors in endometrial lesions that aren’t found in other estrogen-sensitive tissues—creating a triple whammy. 

3. You may have heard the term “hormone balancing” and know that it refers to the balance of estrogen and progesterone in the body that leads to a harmonious menstrual cycle. You can visualize that progesterone is the cooling, calming partner that helps balance out estrogen’s hot, proliferative ways. For women experiencing traditional menstrual cramping, progesterone support (through prescription or herbal support) can provide some measure of relief. However, researchers have found that endometrial lesions outside the uterus don’t have the same progesterone receptors that are found inside the uterus, meaning that our usual therapies for pelvic cramping just won’t work the same. 

RELATED: Breaking down estrogen—what it is, what it does, and why it’s not just a villain in your hormonal story.

So what does this mean to treat endometriosis? 

It means we need to treat the hormonal disruptions of endometriosis differently than traditional hormone concerns. This looks like a multi-pronged approach, which is also tailored to your specific symptoms, your labwork, and your needs. It’s just another reason why personalized medicine, which we provide at MIMC, can be key to alleviating your symptoms and getting to the root of your health concerns.

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.