Endometriosis and the Bacterial Contamination Hypothesis - A must read for those with Endo!

March is Endometriosis Awareness Month, and we thought it a perfect time to shed a little more light on the recent research around this horrific condition, affecting 1 in 10 women.

If you haven’t read our previous blogs on endometriosis, here’s a quick synopsis:

  • Endometriosis is a disease where the endometrial lining, which is only supposed to grow in the uterus during the menstrual cycle, grows outside of the uterus. These are called endometrial plaques.

  • Endometrial plaques can affect organs within the pelvic cavity, including the bowel wall and even the lungs.

  • Endometrial plaques are affected by hormone fluctuations that occur with the menstrual cycle. Estrogen surges in the first half of the cycle are what cause the lining of the uterus to thicken, and for those with endometriosis, for the endometrial plaques to thicken.

  • During menstruation, the fall in estrogen triggers the shedding of the uterine lining, and for those with endometriosis, the subsequent bleeding of the endometrial plaques.

  • Endometriosis is often misdiagnosed as Irritable Bowel Syndrome.

  • It takes on average 7-10 years to be diagnosed with endometriosis (We believe the fact that we are conditioned to believe that painful periods are normal is a big part of this…)

The usual mainstream route of treatment for endometriosis sufferers is the use of the combined oral contraceptive pill. This is recommended under the belief that endometriosis is a hormonal condition ONLY, which recent research shows is not the case.

In fact, this study shows that there is insufficient evidence for the use of the combined oral contraceptive pill for management of pain associated with endometriosis (and, it’s worth mentioning that some of the data from trials were not able to be used confidently in this study as they were massively influenced by pharmaceutical companies).

Recent research shows that there are many significant links to the development and progression of endometriosis that fall well outside of the endocrine (hormone) system.

The Bacterial Contamination Hypothesis

This is a new hypothesis surfacing from researchers in Japan, that link higher levels of bacterial endotoxins in the menstrual blood and peritoneal fluid of women with endometriosis. Endotoxins are essentially poisons that are produced from bacteria and other micro-organisms (as well as plants and animals!). These endotoxins cause inflammation within the body, and as we already know, endometriosis is an inflammatory disease. This is the research, and it’s fascinating.

Studies show that women with endometriosis have a high level of gram-negative bacteria in the microbiome (microbial ecosystem) of the pelvis. This explains why some women experience relief of their endometriosis symptoms (and IBS) with the use of specific antibiotic therapy.

It also brings in the immune dysfunction link to endometriosis that has been in the spotlight of investigation around endometriosis for a little while now.

These gram-negative bacteria that are in higher levels in women with endometriosis produce a toxin called LPS (lipopolysaccharide), which stimulates the immune system to do what the immune system is great at… producing inflammatory chemicals.

The increased presence of LPS due to the increased gram-negative bacteria in the pelvis instigates immune dysregulation (which is why endometriosis has been questioned to be an autoimmune condition for a little while… but, really, autoimmune confirmation or not, immune dysregulation is a pretty big kicker in driving unnecessary inflammation that wreaks havoc on all systems in the body).

Note: There’s a HELL of a lot to understand about the pelvic and vaginal microbiome, and hold your horses, because we’ll have an awesome article coming out about this next month.

How is the bacterial contamination occurring?

Great question! I’m glad you asked…

The main reason one would expect to see bacteria within the pelvis that isn’t supposed to be there is because the bacteria has been translocated (eg moved) from its original native environment.

And, as always, we come back to the gut!

Dysbiosis is an imbalance of healthy bacteria within the microbiome of particular areas in the body. Our gut, intestines, colon, bladder and vagina all have their own microbiome AKA ecosystem of microbes that keep the system healthy. Studies have shown that those with endometriosis have dysbiosis, which makes sense considering the Bacterial Contamination Hypothesis.

Dysbiosis can occur from several different factors.

A few that we see a lot of in the clinic are:

  • Small Intestinal Bacterial Overgrowth (which makes one sensitive to FODMAP foods, and has a range of symptoms from IBS to acne)

  • High stress… yes, the s-word. Elevated stress hormones increase permeability of the gut lining and also have a significant impact on the microbiome.

  • Intestinal hyperpermeability (a condition where the mucosal lining of the gut is weakened, allowing translocation of bacteria to different areas of the abdominal/pelvic cavity and increased immune function due to food proteins entering the abdominal cavity and sparking an immune response)

  • Irritable Bowel Syndrome (more research is required to understand whether Endometriosis causes/aggravates IBS or vice versa but dysbiosis is a huge factor of IBS, and we know that FODMAP diet therapy for women with IBS and endometriosis has a greater success rate than for those with IBS alone). Note that FODMAP therapy is predominately successful because it gives the gut time to heal, reducing intestinal hyperpermeability. FODMAP foods are also fuel for bacteria that are present in Small Intestinal Bacterial Overgrowth.

So, there’s a lot more than hormones involved in Endometriosis.

What we can gain from this information is that in treating endometriosis, one has to look at the person as a WHOLE, and work to

  • regulate the immune system

  • reduce bacterial endotoxin exposure with antimicrobial therapies

  • and treat the gut to reduce bacterial translocation to the pelvis.

Reducing inflammation overall is an incredibly important part of endometriosis management, and of course, working with bringing a balance to progesterone and estrogen to reduce the hormonal surges that worsen the presentation of endometriosis. It’s important to understand, however, that the inflammatory drivers of endometriosis are multi-faceted, and all of them deserve their own attention and focus.

Do you think the combined oral contraceptive pill does that?

And, please don’t misinterpret that we are 100% in support of women making informed decisions around the use of hormone therapy like the pill, ESPECIALLY when it actually makes a difference to their quality of life… but we have never found that an informed decision has been made when it comes to the management of Endometriosis.

Most women are told that the pill will “regulate their hormones“ (which is total BS, and here’s another blog on that…) and that this is what is required for the management of Endometriosis.

We hope that this article is a slap in the face to that massively misguided and frankly negligent theory, in the face of all the research.

If you’d like to explore the many facets involved in Endometriosis with one of our team, you know where we are… and you may enjoy some of our other blogs on women’s health.