Rosie Letts

Endometriosis is a reproductive disorder, where endometrial cells which are usually found in the lining of the womb, implant themselves elsewhere in the body. During your monthly, your hormones fluctuate, which stimulates these endometrial cells to grow, and then break down and bleed as they would in the lining of the womb. This blood has nowhere to escape, leading to inflammation, pain, and the formation of scar tissue.

Approximately 10-15% of all premenopausal women have endometriosis, but despite this, the topic of how endometriosis develops remains controversial. It is clear that endometriosis is fuelled by a dominance of the hormone oestrogen, however growing research suggests that there is an auto-immune aspect to the condition.

As endometriosis manifests itself in a variety of ways and shares symptoms with other conditions, diagnosis can be difficult and often delayed.  Recent research shows that there is now an average of 7.5 years between women first seeing a doctor about their symptoms and receiving a firm diagnosis. The only definitive way to diagnose endometriosis is by a laparoscopy – an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel. The surgeon uses the camera to see the pelvic organs and look for any signs of endometriosis.

What causes endometriosis?

Science still can’t give us a definitive answer. There are several theories about the cause of endometriosis, but none fully explains why the condition occurs. It is likely that a combination of the following factors are to blame: 

Retrograde menstruation:

Normally your menstrual blood would journey through the cervix and vagina when you have your period but in retrograde menstruation it flows back through the fallopian tubes and into the pelvic cavity. Endometrial cells are carried in the blood and can stick to the pelvic walls and surfaces of pelvic organs. These cells grow during each menstrual cycle but can’t exit the body during your period. This blood accumulates causing inflammation and pain(5). Whilst retrograde menstruation happens, to some degree, in almost all women, not all women develop endometriosis. So, could some women’s immune systems, which would normally deal with these rogue cells, be dysfunctional and allow lesions to form?(2) Many women with endometriosis appear to have reduced immunity to other conditions, but it is not known whether this contributes to endometriosis or whether it is as a result of endometriosis.

Oestrogen dominance:

I think it would be more accurate to say that hormonal imbalance exacerbates endometriosis, rather than causes it. One of oestrogen’s jobs is to increase endometrial cell reproduction(6) which would make sense given that a robust endometrium is essential for pregnancy. If menstrual blood containing oestrogen is in inappropriate situ, the cells increase in numbers, creating endometriosis related lesions. So we need to consider balancing our oestrogen levels … enough for a healthy reproductive cycle but without excess circulating in our bodies. More on this approach in my next article ‘Nutritional approaches to managing endometriosis’.

Unbalanced gut bacteria: 

A new study suggests that an imbalance in the bacteria in the gut and genitals is associated with endometriosis. Researchers found a complete lack of one bacterial family, Atopobium, in those with moderate to severe endometriosis whilst levels of Gardnerella, Streptococcus, Escherichia, Shigella, and Ureoplasma, all of which contain potentially pathogenic species, were increased(12). There is a possibility that the bacteria were influencing the immune system thereby creating inflammation. So looking after your gut bacteria may be of real importance.

Going on to link your gut bacteria with oestrogen levels and endometriosis, research has shown that an imbalance in gut bacteria leads to increased oestrogen levels which may be a driver in endometriosis by stimulating growth of endometriotic cells and the inflammatory activity in them.

Leaky gut:

New research has noticed a strong correlation between intestinal permeability (leaky gut) — a condition in which bacteria and toxins pass through the intestinal wall and into the bloodstream—and the presence of endometriosis. The reality is that all autoimmune conditions are rooted in bacterial dysbiosis and leaky gut. In my experience as a practitioner, I always start by working on gut health, because you can never dismiss the role of digestion when trying to balance out hormones. The reality is you can take all the hormone-balancing supplements you want but if your digestion is struggling in any capacity, then trying to gain balance will be a challenge. 

If you’re in any doubt about a diagnosis, contact your GP because 30-50% of women with endometriosis will also suffer from infertility.(7)

Rosie Letts


How is endometriosis treated?

Sadly there’s no cure and the medical interventions don’t always solve the problem. Your GP may consider offering you pain killers, the oral contraceptive pill or a laparoscopic procedure (key hole surgery) to remove the lesions(5). In my opinion, the most effective approach to chronic pain management associated with endometriosis combines traditional medical and surgical treatments with complementary therapies provided by a multidisciplinary team. This is likely to include acupuncture, massage, physiotherapy and of course, nutritional therapy.

In my next article Nutritional approaches to managing endometriosis we explore simple dietary adjustments that can make a big difference to your quality of life as an endometriosis sufferer.

You can check out the references here: 


On Saturday 25th July, Rosie’s partner Andy tragically passed away. He wasn’t ill and his passing has come as a devastating blow to all of his family and friends. Rosie will be taking compassionate leave to look after their children. She hopes to return to private practice when her children start school in September.

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