Hey guys,

Jena here. It's Endometriosis Month this March. It is so important for me to be able to help, support, and empower other women around the world living with and healing from endometriosis - particularly after all I have been through & how much I have learned on my journey.

For those of you who aren't familiar, endometriosis is a condition that 10-15% of reproductive-age women (and 70% of women who suffer from chronic pelvic pain) suffer from. 

It's considered to be an inflammatory condition/disease where the endometrium (the inner uterine lining) and endometrial-like tissue starts to grow outside of the uterus (where it is not supposed to grow) and thickens, hardens into lesions, grows onto, and attaches to, other areas in the pelvis. The follow-on impacts can be pretty major - including having to live in a lot of chronic and unpredictable pain - but it is a multifactorial and multifaceted condition meaning that different women present with a wide variety of other symptoms and manifestations of the condition. 

There are a number of 'traditional' risk factors associated with the onset and severity of endometriosis. These are: being a woman of Asian ethnicity, excessive estrogen exposure, and a low body mass index. 

However, the big news and advancements in the holistic health and healing world (which are starting to filter out in the scientific community through peer-reviewed research) is that it is now thought that endometriosis may be a condition driven by something deeper. 

Increasing research points to the connection between a dysbiotic (out of balance) microbiome and the onset and severity of endometriosis. On top of this, alternative theories also suggest that bacterial infections may drive the condition too - and that retrograde flow (keep reading to find out more) may also support the onset of the condition too.

In this blog, we're going to be looking at the fascinating theories coming out of root-cause medicine and how these may be able to help endo sufferers in their quest for health.

So, let's get into it...

Endometriosis Root Cause Theory #1 - Retrograde Menstruation

Before we get into microbial and bacterial imbalances, let's look at retrograde menstruation.

At the moment 'retrograde menstruation' is one of the more substantial theories on the development of endometriosis.

And what is retrograde menstruation? It is the idea that your menses (period flow) can move in the wrong direction - and have damaging repercussions.

When this happens, it is thought that this retrograde flow of blood may transport fragments of cells from the endometrium (the innermost lining layer of your uterus) back through the fallopian tubes and into the peritoneal cavity (the space between the peritoneum that surrounds your abdominal wall and the peritoneum that surrounds your internal organs).

In short? The retrograde menstruation theory works on the basis that your period flow is moving in the wrong direction - and this transportation of cell fragments upstream and into the peritoneal cavity is thought to lead to the fragments implanting into the endometrial tissue. Once implanted, they can then start to form the characteristic lesions that endometriosis is known so well for.

There is a lack of clarity around this theory because some claim that, to some extent, all women experience retrograde menstruation to differing degrees. It is, however, thought that having a smaller cervical opening may increase the risk of this menstrual retrograde and this has been supported by a study that showed that women with blocked Fallopian tubes do not experience retrograde menstruation at all.

For now, we will keep our eyes open for any new research coming out on retrograde menstruation and see how these play out.

Endometriosis Root Cause Theory #2 - Endometrial Stem Cell Recruitment

The Endometrial Stem Cell Recruitment theory on endo is another hypothetical explanation for how and why endometriosis might be triggered in those who suffer.

The endometrial stem cell recruitment theory involves the theory of the movement of stem cells from the bone marrow. Stem cells are basically the building blocks of the body and are the 'cells from where all other cells are generated'. Stem cells are mostly created and housed in the bone marrow of our bodies.

Recent molecular and genetic findings (when looking at endometriosis vs. the development of normal endometrium) has suggested that these stem cells, usually intended to regenerate the uterus after the period, may become overactive and when they move and are mixed with other hormones, may lead to the generation of new blood vessels.

The creation of these new blood vessels and the implantation of these in the uterine wall may lead to the development of an environment that supports the growth of lesions that are so common with endometriosis.

Endometriosis Root Cause Theory #3 - Bacterial Contamination

Now, onto one of the most exciting current research areas - bacterial contamination and dysbiosis of the microbiome across the body.

Gut health is just the starting point for the health world to begin to understand the importance of balanced bacterial microbial growth within the body and how when this is out of balance, there can be major repercussions and ramifications / follow on impacts. 

Today, the gut microbiome isn't our only microbiome - although it does get most of our attention.

Our mouth, our cervix,  uterus and our vagina all have their own associated colonies and communities of bacteria in their own individual microbiomes - and these often get overlooked.

So what is the connection between the microbiome and bacterial contamination?

Good question.

A recent systematic review has provided support for this 'bacterial contamination theory' where it concluded that 'the microbiome may be involved in the pathogenesis of endometriosis. This review is not alone - and there are an increasing number of other studies looking into the bacterial contamination theory and how dysbiosis of the microbiome may have an impact on the pelvic region.  

A recent review called the 'Bacterial contamination hypothesis: a new concept in endometriosis' called it a 'complex bidirectional interaction between endometriosis and the microbiome', and other studies have also investigated the effect of E2 and LPA on pelvic inflammation and the growth of endometrial cells. A number of studies are also looking at the combined effect between 17β-estradiol (E2) (part of the group of sex steroids called estrogens) and lipopolysaccharide (LPS) on pelvic inflammation and growth of endometriotic cells.

To understand what and why the researchers are digging into, you need to understand a little more about lipopolysaccharide (LPS). Also known as 'bacterial endotoxin', these LPS are actually an inflammatory meditation because they are thought to regulate the Toll-Like receptor 4 (TLR4) mediated growth of endometriosis. However, LPS is considered to be 'endotoxic' and found on the cell walls of gram-negative bacteria that live within us; it is also thought to be potentially immunogenic, meaning that it can promote a strong immune response within the body - likely leading to the overstimulated immune response that so many people with endometriosis are familiar with.

Patients with endometriosis have high levels of immune mediators, which is thought to be due to the body improperly clearing ectopic tissue. On top of this, women with endometriosis have reduced T regulatory cells, creating an immunosuppressive environment that allows for endometriotic lesions to survive.

So, high LPS may trigger an overactive immune response?

Yes, but it doesn't end there. Let's take this back to the bacterial contamination hypothesis,

Studies have shown that LPS levels were found to be 4 - 6 times higher in the period of patients with endometriosis, peaking during menstruation. 

This supports scientific findings that suggest that menstrual blood in those suffering from endometriosis was highly contaminated with gram-negative bacteria like E.coli and other microbes.

What this means is that many studies are starting to conclude that there may well be a connection between levels of gram-negative bacteria within the body and increased levels in those who have endometriosis.

Endometriosis Root Cause Theory #3 - The estrobolome

So, what about the traditional estrogen theories? Do we put them to bed?

Good question - and the short answer is no. Because while it may not be as a solely important theory as it used to be, it's fascinating to understand how the traditional estrogen theories tie into the newer research on the estrogen-microbiome connection (known as the 'estrobolome').

It is thought that the estrobolome, if imbalanced, can also drive the development of endometriosis - so the estrogen connection definitely should not be disregarded.

The reason for this? Some bacteria in the gut (particularly if over colonizing and taking more power than they should) have the power to disrupt estrogen in the gut. This can, in turn, reverse phase 2 detoxification (when the lever attaches to toxins to render it less harmful and prepare to remove it from the body).

What this means is that it can take estrogen (and other toxins) that has been marked for exit and excretion from the body and allow them to enter back into circulation in the body, actually increasing the load of estrogen in the body (and the toxin levels more generally) - thus further triggering and promoting the conditions most appropriate for endometriosis growth.

So, these root cause theories. What are our takeaways?

The first thing to note is to keep an open mind with the breadth of research that is coming out related to endometriosis. Research is coming hard and fast, and over the next few years, we will start to see a lot more precise answers.