Your uterus has three layers to it with the innermost lining known as the endometrium.  The endometrial cells are responsive to estrogen and thicken the lining of your uterus in the follicular phase (first half of your cycle) to prepare for implantation of the embryo, and if you don’t conceive, the endometrial lining is then get shed resulting in your period.  Endometriosis, or fondly known as ‘endo’, is a condition where endometrial tissue is found in places outside of the uterus.  This can be in places such as on the ovaries, fallopian tubes, abdomen, liver, gallbladder, and nose (nosebleeds).

‘Endo’ has historically been associated with estrogen dominance.  Estrogen dominance is where you have an increased amount of estrogen relative to progesterone levels – this can be an absolute increase involving above normal levels of estrogen or just a relative increase compared to progesterone where your estrogen is still normal. Read more on estrogen dominance here. Sometimes however, a woman may present with normal estrogen and progesterone levels but upon running a DUTCH comprehensive hormone test, there is a preference for estrogen to convert to the 16-OH estrone metabolite. This 16-OH form of estrogen is more proliferative and levels may be increased in inflammation. Unfortunately, this is not able to be detected on a blood test so a naturopathic doctor or functional medical doctor are your options for getting a DUTCH test. Ask me for more information on the DUTCH test. 

Interestingly, recent research on endometriosis now states that the disorder is considered an inflammatory disorder that shifts estrogen metabolism rather than just a condition of estrogen excess or estrogen dominance and often more than a simple estrogen detox supplement may be needed. Aside from inflammation favouring proliferative estrogen metabolites, inflammation tends to increase estrogen levels. This is why after the flu, illness, or even getting a vaccine, one may find their next period to be heavier, have more cramping or more clots.  Some experts have even gone as far as deciphering whether endometriosis is an autoimmune condition however whether endometriosis is an autoimmune condition is still undergoing research. A systematic review by Shigesi et al (2019) was conducted which showed four of twenty-six studies that supported a statistically significant association between endometriosis and a few autoimmune conditions. They mentioned the need to consider the co-existence of endometriosis and autoimmune conditions in a woman [2].  More research is needed in this new and emerging area though to investigate whether endometriosis increases the risk of autoimmune conditions or is one of the many products of autoimmune conditions [2].