If you follow me, you may have realized I’ve been, well, unfollowable for the past year or so. Why? Well, one reason is that I had a baby … I don’t think I ever mentioned that. So meet Nola!

The other reason is that I’m writing a book. A big book, an interesting book, a book all about the science of endometriosis. While we do need more research, you may be surprised just how much we DO know about endo, what endo even is, or how it behaves.

So, to celebrate the fact that I’m ALMOST DONE writing this monolith (yaaaay!!!), I wanted to celebrate with a cliff notes version of an answer to the question: what is endometriosis, really?

Endometriosis: an inflammatory disease rooted in immune dysfunction

Endometriosis is an inflammatory disease rooted in immune dysfunction. It’s no simple hormonal disease, period problem, or “woman’s issue,” although it’s most often portrayed as such.

Inflammation is the driving force behind endometriosis. Not only is chronic, localized inflammation one driver in creating an endo-like cell, but it’s also the major driver of establishing lesions, then progressing those endo lesions after establishment. Scar tissue, adhesions, pain? Yah, all the result of an intense, prolonged inflammatory attack without end. Again, why the goal in addressing endometriosis is to slash the inflammation.

Understanding Inflammation Causes Endometriosis

Inflammation is not something you get. It’s something your immune system does, and without it, you would die. Really? Yes. Inflammation is akin to your immune system’s “attack dogs,” protecting your body by inflaming any area that is damaged or contaminated by pathogens. Inflammation is a mean bugger, and it can d-e-s-t-r-o-y intruders. Cut finger while cutting chicken? Attack dogs arrive to destroy any e.coli that may have been introduced. Got a bad case of Covid? Attack dogs heat up the body with a fever to destroy as many viral pieces as possible. Inflammation is like our ancestral antibiotic, you want that inflammation or, well, a shady food-stand quesadilla may be your demise.

If you’re interested, I have a whole post on what inflammation is here.

Inflammation is also used to clear up normal bodily issues. You know when you work out, and your muscles are sore? It’s because they’re inflamed, thanks to your immune system cleaning up shop. Basically, working your muscles hard slightly damages the tissues, so your immune system comes in to clean up the scene (damaged cells prompt inflammation to arrive), then the immune system helps repair the muscles so they’re stronger. Yah, your immune system does a lot more than most of us realize!

In this way, you have a little bit of inflammation working throughout your body at all times. Totally normal, and you should be thankful for it (you know, so you live into old age without dying from that thorn in your finger). But inflammation is only meant to be short-lived. Attack dogs beat up e.coli, then settle back in their kennel for a nap. Attack dog induce fever to kill off pathogens, then go home for a break. Muscles are sore for a day, then they’re stronger. Your immune system is wise and skilled, correctly managing its function and knowing when to attack, when to rest, and when to heal.

So what makes endometriosis an inflammatory disease rooted in immune dysfunction?

In the case of endometriosis, inflammation may be necessary for all parts of endo:

1) The creation of an endo-like cell, the first step of endo. (I wrote a blog about this here)

2) How the endo-like cell becomes established as an endo lesion. (I also wrote a blog about this, here)

3) Established endo lesions also then create some inflammatory immune factors as well. And, if they grow or progress, they will damage healthy tissue in their wake which, yes, creates more inflammation.

4) Continued inflammation and oxidative stress is what drives scar tissue, adhesions, organ damage, and endo progression into worse forms of disease.

A Modern Approach to Endometriosis Treatment

When we see inflammation is the driver of disease, we need to address it! Bring down the inflammation, and you may be able to slow or stop disease progression, and retrain the immune system to function more normally again.

So, where is this inflammation coming from? There are two facets: the inflammation associated at the “ground zero” site of your endo lesion, and the body-wide inflammation we have that contributes to immune dysfunction. In the case of endo, we have both, and both need to be addressed.

1) Inflammation at the endometriosis lesion site

Research has uncovered numerous facets about endometriosis-related inflammation in the peritoneal cavity. Some of the biggest culprits may be:

• Bacteria. Oh boy this is a biggie. So big that endo may be described partly a bacterial disease in the future. Pathogenic or opportunistic overgrowths from either your gut or reproductive tract can translocate to your endo and provoke a MEAN inflammatory response - perhaps one BIG reason those attack dogs won’t settle down in your pelvis.

• Estrogen. Obviously a biggie as it’s the only one many of us have heard about. Estrogen signals endo to grow—it’s basically endo-food.

• Iron overload. Basically too much iron-rich blood where it shouldn’t be becomes a provoker. This can be due to menstrual cycles that are heavy, clotted, thick, and looooooong - arriving into your peritoneal cavity through the normal process of retrograde menstruation - as well as to the fact endo lesions slightly bleed with every cycle.

• Free radical damage. An issue associated with too much of an inflammatory immune response. Too much inflammation, too many free radicals, increased tissue damage because of it which invites more inflammation. It’s why the term “antioxidant-rich diet” is your new favorite phrase.

• Increased intra-abdominal pressure and low blood flow. I like to talk about this one a lot on Instagram.

• Oh, and endometriosis lesions! Notice how the lesions are but one of many inflammation-provoking triggers we can address. This is a huge point of the book.

2) Body-Wide Inflammation within the endometriosis body

Addressing the body-wide triggers will take additional sleuthing. While you may have been blaming your endometriosis exclusively for the inflammation coursing through your body, you may actually have tens (or hundreds) of other triggers assaulting your body everyday. Indeed, most people today are dealing with many inflammatory triggers that are constant - eventually becoming too much for the body to bear.

What are some examples of everyday issues that may be contributing to chronic inflammation? Here are some commonly reported ones that you may be able to relate to: gut issues, poor sleep, poor diet, chemicals in body care/home/cleaning/food, chronic stress, sedentarism, etc etc etc (etc x 1000). Oh, and endometriosis. That’s because, in the grand scheme of things, we often have 99 inflammatories and endometriosis lesions are just one.

Here’s an image to help depict this two pronged approach:

A Better Understanding of The Immune Component

When I was deep in my endo gloom, I felt like I tried everything I had read about endo. I detested my “rampaging estrogen” that I thought was creating my endo misery.

That’s until I stumbled on the fact that endometriosis was an immune-related issue, steeped in inflammation. It’s not autoimmune, it’s not cancer, and it’s not acne, but it behaves similarly to all three. And when I started down that avenue of healing, things did start shifting. When we approach our disease in the correct way, the correct types of healing we need can occur.

Does it involve surgery? Depending on you, it could be “definitely yes”, “maybe”, or perhaps a simple “no”.

Answering questions like these is why I’m so excited for the release of my new book, Heal Endo: An Anti-Inflammatory Approach to Endometriosis. The goal? To really understand endometriosis, and then create a new plan to heal from it.