Endometriosis is a condition characterized by the growth of tissue similar to the lining of the uterus outside the uterus itself. For many with this condition, managing symptoms like chronic pain and fatigue leads to exploring various supportive strategies. Research is now uncovering a connection between the health of the gut and the severity of endometriosis symptoms. This emerging science suggests the state of our digestive system can influence the biological processes underlying this condition.
The Shared Role of Inflammation and the Immune System
Endometriosis is widely recognized as a disease fueled by chronic inflammation. The misplaced endometrial-like tissue responds to hormonal cycles, leading to localized inflammation that can also contribute to a broader, system-wide inflammatory state. The intestines are a major hub for the body’s immune system, containing a vast network of immune cells.
An imbalanced gut microbiome, often called dysbiosis, can disrupt this delicate equilibrium. When beneficial bacteria diminish and less helpful organisms proliferate, it can trigger an immune response that is not always confined to the gut, leading to systemic inflammation. For individuals with endometriosis, this gut-derived inflammation can compound the pre-existing inflammatory environment created by the lesions, as immune cells release inflammatory molecules that add to the body’s total inflammatory load.
The Gut’s Influence on Estrogen Levels
Endometriosis is an estrogen-dependent condition, meaning its growth is stimulated by this hormone. The gut plays a part in regulating the body’s estrogen levels through a collection of gut microbes known as the estrobolome. These bacteria produce an enzyme called beta-glucuronidase, which affects estrogen that has been processed by the liver for excretion.
Normally, the liver conjugates, or deactivates, estrogen before it is sent to the gut to be eliminated. However, certain bacteria within the estrobolome can produce beta-glucuronidase, which reverses this process. This enzyme deconjugates the estrogen, reactivating it and allowing it to be reabsorbed into the bloodstream, which can elevate the total amount of circulating estrogen.
If the balance of gut bacteria is skewed towards those that produce high levels of beta-glucuronidase, more estrogen is likely to be reactivated and reabsorbed. This increase in systemic estrogen can then fuel the growth of endometrial-like tissue, potentially intensifying symptoms. Research has noted that the feces of endometriosis patients often show an increase in bacteria, like certain strains of Escherichia coli, that produce this enzyme.
Intestinal Permeability and Endometriosis
Another mechanism linking the gut to endometriosis involves the integrity of the intestinal barrier, a concept often referred to as intestinal permeability or “leaky gut.” The lining of our intestines is designed to be a strong barrier, selectively allowing nutrients to pass into the bloodstream while keeping harmful substances and microbes contained. When this lining becomes compromised, tiny gaps can form between the cells, increasing its permeability.
This allows substances that should remain in the gut to “leak” into the general circulation. One of the most studied of these substances is lipopolysaccharide (LPS), a component of the outer membrane of certain bacteria. LPS is an inflammatory trigger, and its presence in the bloodstream signals a threat to the immune system. The body mounts an immune and inflammatory response to this bacterial component, which can amplify the chronic inflammation already present due to endometriotic lesions.
Dietary Strategies for Gut and Endometriosis Support
Given the connections between gut bacteria, estrogen, and inflammation, dietary choices can be a practical tool for support. The goal of a targeted diet is to foster a healthy gut microbiome, strengthen the intestinal barrier, and help manage the body’s inflammatory response. This approach focuses on nourishing the body rather than acting as a treatment or cure.
Incorporating a wide variety of high-fiber plant foods is a foundational step. These foods provide prebiotics, which are food for beneficial gut bacteria. High-fiber plant foods include:
- Fruits
- Vegetables
- Whole grains
- Nuts
- Seeds
Including fermented foods such as yogurt, kefir, and sauerkraut can also introduce beneficial microbes, known as probiotics. It may be beneficial to limit foods that can disrupt gut health and promote inflammation, like highly processed foods, excessive sugar, and certain unhealthy fats.