Endometriosis is often reduced to hormones, however we know that it goes far beyond just that. There is an important connection between the health of the gut microbiome and endometriosis.
Endometriosis can play a role in digestive symptoms such as bloating, diarrhea, or constipation. At the same time the gut is also influencing some of the inflammatory and hormonal patterns that contribute to endometriosis as well.
Your gut, immune system, and hormones are constantly communicating. When gut function is disrupted, it can influence inflammation, immune signaling, and how your body processes and eliminates estrogen.
This tells us that gut health is an important piece to consider when looking at the bigger picture. Let's talk more about why.
1. Digestive Health
Endometriosis symptoms don't always stay confined to the pelvis.
Many people with endometriosis also experience digestive symptoms, including:
Bloating and abdominal distension
Constipation or diarrhea
Nausea
Painful bowel movements
Changes in digestion throughout the menstrual cycle
Some of these symptoms may be related to endometriosis itself, particularly when lesions or adhesions affect structures around the bowel.
Others may overlap with conditions such as irritable bowel syndrome, altered gut motility, or small intestinal bacterial overgrowth (SIBO) that can happen alongside endometriosis.
2. The Histamine Connection
Histamine is a chemical messenger involved in immune responses, inflammation, and several other processes in the body.
Your body naturally produces histamine, and certain gut bacteria can also produce it. You also have enzymes, including diamine oxidase (DAO), that help break down histamine, particularly in the digestive tract.
When histamine production and breakdown become imbalanced, some people experience symptoms such as flushing, itching, headaches, digestive discomfort, or heightened sensitivity to certain foods.
The key piece to know here is that estrogen and histamine can influence one another.
Estrogen can affect mast cell activity, and mast cells release histamine and other inflammatory mediators. This creates a potential feedback loop in which hormonal fluctuations and inflammatory signaling may influence one another.
Some people also notice that symptoms associated with histamine become more pronounced around ovulation or menstruation, when hormone levels are changing.
Gut health may be one part of this picture. Certain bacteria can produce histamine, while constipation and changes in gut function may affect how the body handles histamine.
Nutrient status also influences the DAO activity in the gut too.
This is one reason gut support may be worth exploring when digestive symptoms occur alongside food sensitivities, headaches, flushing, or cycle related flares.
3. Estrogen Clearance and the Gut
Estrogen isn't just about how much your body produces. It's also about how your body metabolizes and eliminates it. Your liver processes estrogen, and some of those metabolites are transported into the gut for elimination through bowel movements.
This is where the gut microbiome comes in.
Certain gut bacteria produce an enzyme called beta-glucuronidase, which can deconjugate estrogen metabolites. This can allow some estrogen to be reabsorbed rather than eliminated in stool. When beta-glucuronidase activity is increased, it may influence estrogen recycling.
Bowel regularity, gut microbial balance, adequate fiber intake, and overall digestive function all contribute to healthy elimination.
For someone experiencing heavy or painful periods, particularly when these symptoms occur alongside constipation or other digestive concerns, it may be worth looking at the broader picture of hormone metabolism and gut function.
4. Gut Dysbiosis, LPS, and Inflammation
Your gut is home to microorganisms that help regulate digestion, immune function, and interactions with the rest of your body. But when the microbial environment becomes imbalanced, certain bacterial products can contribute to increased inflammatory signaling.
One example is lipopolysaccharide (LPS), a component of the outer membrane of certain dysbiotic bacteria.
When the intestinal barrier is compromised, LPS can cross into circulation and activate immune responses. This may contribute to inflammation beyond the gut itself.
Research has identified elevated LPS in the pelvic environment of people with endometriosis. This reinforces an important point that the gut and the immune system don't operate in isolation from the reproductive system.
5. Endometriosis and Recurring SIBO
SIBO, or small intestinal bacterial overgrowth, occurs when excessive bacteria are present in the small intestine. It can contribute to bloating, abdominal discomfort, gas, and changes in bowel habits. These symptoms can overlap considerably with endometriosis.
The relationship can also become complicated when symptoms repeatedly return after treatment.
Endometriosis may contribute to pelvic adhesions or changes in anatomy that affect bowel function in some people. Pain, altered motility, and other underlying digestive issues may also complicate recovery from recurring symptoms.
If symptoms persist or return, it's worth reassessing the underlying contributors rather than assuming the same issue needs to be treated repeatedly.
Endometriosis is a complex condition involving more than one system in the body.
Hormones, immune signaling, inflammation, gut function, and the nervous system all interact. Looking at these connections can help identify additional areas that deserve attention.
At The Funk'tional Nutritionist, our 1:1 1:1 Functional C.A.R.E Method™ takes a personalized, whole body approach to connecting the dots between your symptoms, gut health, hormones, nutrition, and overall health. If you are looking to take that deep dive to understand how your gut health may be impacting your symptoms you are in the right place!
