A change is coming for endometriosis treatment. Until now, the clinical approach has been surgery followed by hormonal suppression with the hormonal birth control or other drugs. Going forward, the approach will shift to anti-inflammatory and immune-modulating treatments. That’s because there is growing evidence that endometriosis is not primarily a hormonal condition. It is autoimmune.

[For a 2019 update of this content, read Endometriosis? Treat the Immune System.]

The autoimmune connection is explored in detail in the 2012 paper: “Is there an association between autoimmunity and endometriosis?” After an extensive literature review, the authors conclude that endometriosis fulfils most of the classification criteria for autoimmune disease including blood markers of inflammatory cytokines and tissue-specific autoantibodies. They make the point that endometriosis frequently occurs with other autoimmune conditions such as autoimmune thyroid disease and inflammatory bowel disease.

Pharmaceutical immune treatment for endometriosis may still be a few years away. Fortunately, natural immune-modulation is already at hand. I have used it with my endometriosis patients for many years.

What is endometriosis?

Endometriosis is a painful gynecological condition in which tissue that is similar to endometrial tissue grows outside of the uterus. The most common site is the ovaries (resulting in a type of ovarian cyst called endometrioma or chocolate cyst). Lesions also occur on the Fallopian tubes, pelvic ligaments, and on the outside of the uterus, bowel and bladder. Active lesions are hormone-sensitive, so they swell and then bleed with each menstrual cycle. This causes pain, scar tissue, and heavy clotted periods. It can cause infertility.

Why does it happen?

We don’t yet know exactly how endometrial tissue enters the pelvis. We used to think it was from retrograde flow back out through the Fallopian tubes, but now many experts now dismiss that theory. Instead, they think the tissue may be laid down before birth.

Regardless of how the tissue gets outside of the uterus in the first place, what really matters is how the immune system then responds. In a normal situation, the immune system stays calm and does not react to the endometrial tissue. In the case of endometriosis, something different happens. The immune system makes inflammatory cytokines and auto-antibodies that inflame the lesions and promote their growth.

Known reasons for this aberrant immune response include exposure to environmental toxins such as dioxins and bacterial endotoxins (lipopolysaccharides) such as those from intestinal bacteria.

I look forward to future research about the endometriosis-autoimmune connection.

Natural treatment of endometriosis

The following treatments work because they normalize immune function, and thereby reduce inflammation.

Avoid A1 dairy. Holstein cow’s milk contains a powerfully inflammatory protein called A1 casein that causes immune problems in some people. My clinical experience is that most endometriosis-sufferers improve when they stop having normal dairy products. Goat and sheep dairy (A2 casein) are usually okay. Please see What Dairy Does to Periods. Consider avoiding gluten. Like A1 casein, gluten is immune-disruptive for some people. It improves after twelve months on a gluten-free diet. Avoiding gluten can also improve intestinal permeability (see next point). A gluten-free diet is certainly worth trying, especially if you test positive for gluten antibodies on a blood test. Repair intestinal permeability. Intestinal permeability or leaky gut drives autoimmune conditions such as thyroid and inflammatory bowel disease, so it makes sense that it drives endometriosis. Treatments for intestinal permeability include a gluten-free diet and supplementation with zinc and the herbal medicine berberine. Turmeric is a powerful anti-inflammatory and immune-modulating herbal medicine. A 2012 animal study demonstrated that turmeric can promote regression of endometriosis lesions. The authors went on to propose turmeric (curcumin) as a novel anti-endometriotic medicine. Selenium and zinc are important immune-modulating nutrients and may be deficient in women with endometriosis.

Conventional treatment of endometriosis

Surgical excision of the lesions is helpful, especially for women who are trying for pregnancy. Other treatments can then be used to prevent recurrence. Micronized progesterone inhibits the growth of endometriosis lesions and has fewer side effects than the progestins of birth control. Hormonal birth control suppresses hormones and prevents the hormonal stimulation of endometriosis lesions.