In the first part of this series, we explored what endometriosis can feel like, why diagnosis is often delayed, and what is happening in the body from a medical perspective. While our last post covered the basics, this post is aimed at diving deeper to give you an understanding of the many contributing factors that can cause endometriosis to develop in the first place.Ā Ā
While no single cause fully explains endometriosis, research increasingly points to a combination of hormonal, immune, inflammatory, genetic, and environmental factors. From a naturopathic perspective, this is often referred to as a root cause approach ā looking beyond the presence of lesions alone and examining the broader systems in the body that may contribute to the development and progression of the condition. By understanding these underlying factors, clinicians can better tailor strategies to support hormonal balance, reduce inflammation, and improve overall health.Ā
Estrogen Dominance and Hormone Metabolism
Endometriosis is widely considered an estrogen-dependent condition, meaning estrogen plays a central role in stimulating the growth and survival of endometrial-like tissue outside the uterus. Many individuals with endometriosis show signs of altered estrogen metabolism, where the body either produces excess estrogen or has difficulty properly breaking it down and eliminating it.
In the context of endometriosis, lesions themselves can produce estrogen through increased activity of an enzyme called aromatase, creating a local environment that further fuels inflammation and lesion growth. In addition to this pattern of estrogen excess, progesterone resistance can develop. This is where tissues become less responsive to the balancing effects of progesterone, allowing estrogen-driven processes to dominate.
One way that Naturopathic Doctors use this information to support patients with endometriosis is by supporting estrogen clearance pathways. This can look like reducing toxic load (removing or reducing things that put strain on the liver), using medicinal herbs to support estrogen clearance, improving overall liver health and detoxification, and supplementing specific nutrients that help clear estrogen in the liver.Ā
Traditional Chinese Medicine (TCM) practitioners also integrate this information when treating conditions like endometriosis, where estrogen dominance is understood through the lens of yin and yang balance. In this framework, endometriosis is often associated with patterns such as blood stagnation, qi stagnation, and imbalances between yin (cooling, nourishing energy) and yang (active, warming energy). When circulation of qi and blood becomes impaired, pain and stagnation can develop in the pelvic region. TCM interventions aim to restore balance and improve circulation using approaches such as acupuncture, herbal medicine, and dietary therapy. These treatments are often used to promote healthy menstrual flow, reduce pain, and support overall hormonal regulation, complementing other integrative strategies for managing endometriosis.
Inflammation as a Driver
Chronic inflammation is a hallmark of endometriosis and plays a major role in symptom development and disease progression. Inflammatory molecules such as prostaglandins and cytokines are often elevated in the pelvic fluid of individuals with endometriosis. These inflammatory signals can increase pain sensitivity, stimulate the growth of lesions, and contribute to the formation of scar tissue.
Over time, ongoing inflammation can also affect the nervous system, leading to central sensitization, where the brain and spinal cord become more responsive to pain signals. This may help explain why some individuals experience persistent pain even when visible disease appears minimal.
Reducing systemic inflammation is often a key goal in managing endometriosis and may involve dietary strategies, lifestyle interventions, and targeted therapies that support the bodyās natural anti-inflammatory pathways.
The Microbiome and the Estrobolome
As with nearly every process in the body, the gut microbiome plays an important role in hormone regulation. While overall microbiome health is key in reducing systemic inflammation, there is a specific group of bacteria within the gut called the estrobolome, which has recently been identified in helping to regulate the metabolism and recycling of estrogen in the body.Ā
When the gut microbiome becomes imbalanced (a state sometimes referred to as dysbiosis), it may alter how estrogen is processed and eliminated. Certain gut bacteria produce enzymes that can reactivate estrogen in the intestines, allowing it to be reabsorbed into circulation rather than excreted. This process may contribute to higher circulating estrogen levels, potentially influencing estrogen-dependent conditions such as endometriosis.
The estrobolomeās influence on estrogen metabolism may also indirectly affect progesterone resistance. Elevated systemic and local estrogen levels can suppress progesterone receptor expression and function, contributing to the reduced responsiveness of endometrial and endometriotic tissue to progesterone. Additionally, estrobolome-driven estrogen excess can contribute to the proinflammatory environment that is characteristic of endometriosis.Ā
Immune Dysfunction
The immune system is another important piece of the endometriosis puzzle. Under normal circumstances, immune cells help identify and clear abnormal tissue from the body. However, research suggests that in individuals with endometriosis, immune surveillance may be altered.
This means that endometrial-like cells that reach the pelvic cavity through processes like retrograde menstruation may be more likely to implant and survive, rather than being cleared by immune cells. At the same time, immune cells in the pelvic environment may release inflammatory signals that further support lesion growth and pain.
This altered immune response helps explain why endometriosis behaves not only as a hormonal condition but also as an immune-mediated inflammatory disease.
Environmental Toxin Exposure
Environmental factors are also being explored as potential contributors to endometriosis. Certain chemicals found in plastics, pesticides, personal care products, and industrial pollutants can act as endocrine-disrupting chemicals (EDCs), meaning they can interfere with normal hormone signaling in the body.
Compounds such as dioxins, bisphenol A (BPA), and certain phthalates have been studied for their potential links to estrogen-related conditions. These chemicals may mimic estrogen, alter hormone metabolism, or influence immune and inflammatory pathways as a whole.
While research in this area is ongoing, reducing exposure to common endocrine disruptors may be a helpful strategy for overall hormonal health. Below are a few strategies for reducing toxin exposuresĀ
- Choose glass or stainless steel food containers instead of plastic
- Minimize plastic use with hot foods
- Never microwave plasticĀ
- Choose cleaner personal care productsĀ
- Wash fruits and vegetables thoroughly to reduce pesticide residue, or choose organic when possible
- Use a high-quality water filter to reduce contaminants in drinking water
- Avoid synthetic fragrances in products such as candles, air fresheners, and laundry detergents
- Ventilate your home regularly to reduce indoor air pollutants
- Limit the use of non-stick cookware that may contain PFAS (āforever chemicalsā) and consider alternatives like stainless steel or cast iron
Stress and Cortisol Imbalance
Chronic stress can also influence hormonal and inflammatory pathways in the body. When the body experiences prolonged stress, the hypothalamicāpituitaryāadrenal (HPA) axis becomes activated, leading to increased production of cortisol and other stress hormones.
Over time, disruptions in this system can affect immune regulation, inflammation, sleep quality, and hormone balance. Chronic stress may also heighten pain perception by influencing the nervous system and central pain processing pathways.
For individuals living with a chronic condition like endometriosis, stress can be both a cause and a consequence of ongoing symptoms. Supporting nervous system regulation through practices such as restorative movement, mindfulness, adequate sleep, and stress-management strategies can be an important component of a comprehensive care plan.
Looking Ahead
Endometriosis is a complex condition, and its development is rarely explained by a single factor. Instead, it is likely the result of interconnected hormonal, immune, inflammatory, microbial, and environmental influences. Taking a root cause perspective allows clinicians to explore these systems more deeply and develop individualized strategies that support the body as a whole.
If you suspect you may be experiencing symptoms of endometriosis or are looking for additional support in managing the condition, speaking with a qualified healthcare provider can help you explore the options available to you. Are you curious about how a naturopathic approach to endometriosis may be able to help you? Book a free consultation today!Ā
Disclaimer: The content provided on this blog is intended for informational purposes only and should not be construed as medical advice. While we strive to present accurate and up-to-date information, the field of naturopathic medicine is continually evolving, and individual health circumstances vary. Therefore, the information herein may not apply to your specific health situation.
Please be aware that engaging with this blog does not establish a doctor-patient relationship. For personalized medical advice, diagnoses, or treatment plans, we recommend scheduling a consultation with a qualified naturopathic physician or other licensed healthcare provider.
In the event of a medical emergency, contact emergency services immediately.
Ā
References
Endometriosis Is a Chronic Systemic Disease: Clinical Challenges and Novel Innovations.
Lancet. 2021. Taylor HS, Kotlyar AM, Flores VA.
The New England Journal of Medicine. 2020. Zondervan KT, Becker CM, Missmer SA.
Endometriosis and Ovulatory Menstruation: Beyond the Sampson Principle.
The Journal of Clinical Investigation. 2025. Bulun SE.New
Molecular Nutrition & Food Research. 2024. Kumari N, Kumari R, Dua A, et al.
Estrobolome: Is There a Missing Link?.
The Journal of Steroid Biochemistry and Molecular Biology. 2026. Benagiano G, Pluchino N, Archer D, Stanczyk FZ.New
Ā