The Immune and Digestive Systems with Endometriosis

If you’d like to read Part 1 in this series – The Symptoms and Causes of Endometriosis – start here.

The immune system and Endometriosis:

The immune system has 2 main parts ? Innate and Adaptive.

Innate?immune cells should be cleaning up the misplaced endometrial cells, but with endometriosis this isn?t happening, allowing lesions (tissue damage) to develop.

Adaptive?immune cells are “overactive” in women with endometriosis, creating an inflammatory state.

Regulatory T-cells (part of the adaptive immune system) that regulate the development of autoimmunity and dampen down an overactive immune response are reduced in women with endometriosis.

Progesterone should suppress the overactive Adaptive immune system, but with endometriosis there is reduced progesterone sensitivity. This means progesterone does not have the anti-inflammatory effect it normally exerts.

Within the peritoneal cavity (the largest “space” in the body that contains organs up to and including the liver, and the reproductive system) of women with endometriosis there is an altered immune environment. This results in a reduced ability of the immune system to clear of menstrual tissue and an increase in inflammatory cytokines (chemical messengers). Regulatory cells are decreased, wound healing is affected and auto-antibodies (antibodies against our own tissue, such as those that characterise autoimmune disease) are present.

Women with endometriosis have been shown to have an increased amount of gram negative bacteria (E. coli is an example of this type of bacteria) in the lining of the uterus (endometrium). These produce toxic lipopolysdaccharides (LPS) that are known to promote immune dysfuction and inflammation.



Autoimmune conditions and endometriosis are highly correlated, with endometriosis sufferers being more likely to have autoimmune conditions such as rheumatoid arthritis, lupus, MS, Hashimoto?s, etc, than those without endometriosis.

Auto-antibodies to the endometrium have been reported in a number of studies, although it is unclear whether underlying autoimmunity triggers the endometriosis, or endometriosis triggers an autoimmune response.

This high presence of auto-antibodies and the resulting inflammation may be the cause of endometriosis related infertility that can persist even after the lesions have been removed.


Digestive issues and endometriosis:

Approx. 80% of women with endometriosis also have IBS.

Endometriosis lesions and adhesions can occur on the bowel causing mechanical digestive problems, leading to constipation, pain, bloating, poor nutrient absorption. This occurs in 10% of women with endometriosis.

Even for those without bowel endometriosis, lesions and adhesions can create locations for pathogens – including parasites and bacteria ? to thrive. This can lead to bloating and other digestive problems.

The inflammatory cycle created by endometriosis can lead to IBS symptoms such as diarrhoea and intestinal cramping.

Digestive issues caused by incorrect diet can also worsen endometriosis symptoms.

Intestinal permeability (often a precursor to autoimmunity) promotes inflammation, which worsens endometriosis and IBS symptoms. Can be aggravated by NSAID use (i.e. asprin, ibuprofen, etc), gut dysbiosis and an inflammatory diet

Constipation pre-period reduces the capacity for oestrogen clearance via the bowel, can be aggravated by analgesics such as codeine, pathogenic bacteria, poor diet, dehydration, adhesions, etc.


Inflammatory processes

What all these factors have in common is that they create, are created by, or perpetuate an inflammatory state. A certain amount of that is out of our control, such as exposure to environmental toxicants (“dioxins”) inside the womb, there’s nothing we can do about that. But what we can do is reduce the amount of inflammatory stressors we expose ourselves to on a daily basis, and in my case that relates to diet and lifestyle.

The next part in this series will address ways we can reduce inflammation using diet and lifestyle.

If you’d like my help in managing endometriosis, autoimmunity or any other inflammatory disease, through diet and lifestyle, please email me at