The Gut-Endometriosis Connection: Exploring Intestinal Permeability, LPS, and Microbiome in Endo
Have you noticed a link with your gut symptoms and your endometriosis symptoms?
This has been on my mind for a while as I’ve noticed more and more of my gut patients over time report a diagnosis of endometriosis and get great improvement in their endo symptoms with working on their gut health.
Endometriosis is a complex and (very) often excruciating condition that affects millions of people with uteruses worldwide. While conventional medicine offers various treatments, there is growing interest in exploring the potential link between gut health and endometriosis. The current research is shedding light on endo and dispelling outdated ideas that endometriosis is a “hormonal” issue. The current evidence suggests that intestinal permeability, lipopolysaccharides (LPS) and the microbiome are likely key drivers of endometriosis, and that endo is much more of an “inflammatory” and potentially auto-immune condition.
Understanding Intestinal Permeability
Intestinal permeability, commonly referred to as "leaky gut," is a term used to describe a condition where the lining of the intestines becomes more permeable than usual. This allows substances such as toxins, undigested food particles, and bacterial by products to “leak” into the bloodstream, triggering an immune response and potentially leading to system wide inflammation [1].
Research has indicated that endometriosis sufferers may exhibit increased intestinal permeability compared to those without the condition. A study published in the Journal of Clinical Gastroenterology in 2020 found that people with endometriosis had higher levels of zonulin, a marker of intestinal permeability, suggesting a compromised gut barrier [2]. This finding indicates that healing and maintaining a healthy gut may play a role in managing endometriosis symptoms.
Lipopolysaccharides (LPS)
Lipopolysaccharides are toxins produced by certain types of bacteria commonly found in the gut. In individuals with leaky gut, increased levels of LPS can enter the bloodstream, triggering an immune response and promoting inflammation. Patients with endometriosis exhibit abnormal intestinal permeability and elevated plasma levels of lipopolysaccharides (LPS). Studies have suggested that LPS may contribute to the development and progression of endometriosis by promoting inflammation and the formation of endometrial lesions [3].
Microbiota Dysbiosis
Alterations in the gut and vaginal microbiomes have been observed in people with endometriosis. Research indicates differences in the diversity and composition of the gut microbiota between endometriosis patients and healthy individuals [4]. Similarly, an imbalanced vaginal microbiome, characterised by decreased Lactobacillus species, has been associated with endometriosis [5, 6]. These microbiome disruptions can have an impact on immune function, inflammation, and disease progression.
Microbiome & Inflammation
Both the gut and vaginal microbiomes can influence system-wide inflammation, which is often elevated in endometriosis. Disruptions in the microbiota (microbiome) can lead to the production of pro-inflammatory metabolites and affect immune responses. Chronic inflammation is believed to play a significant role in the development and progression of endometriosis.
Modulating the Microbiome: Naturopathic and Herbal Medicine approaches aim to support a healthy microbiome to manage endometriosis. Strategies include:
Consuming a diverse and fibre-rich diet: Fiber acts as a prebiotic, supporting the growth of beneficial bacteria in the gut.
Probiotics and fermented foods: These can help restore and maintain a healthy balance of gut and vaginal microbiota as well as help to reduce inflammation.
Avoiding unnecessary antibiotics: Overuse of antibiotics can disrupt the microbiome. Use them judiciously under medical guidance, and work to prevent disruption of the microbiome by taking pre and probiotics both whilst taking antibiotics and for some time afterwards.
Stress management: Chronic stress can negatively affect the microbiome and inflammation in general. Incorporate stress-reduction techniques into your lifestyle.
Understanding the complex relationship between the microbiome and endometriosis is still evolving. Further research is needed to establish specific causal relationships and develop targeted interventions.
Outdated Ideas: It's important to acknowledge that previous theories attributing endometriosis solely to hormonal imbalances or retrograde menstruation are now considered outdated. While these factors may contribute to the condition, the holistic perspective of naturopathic medicine recognises the interplay between multiple systems in the body, including the gut.
Promoting Gut Health for Endometriosis
If you're seeking to improve gut health to potentially alleviate endometriosis symptoms, consider the following strategies:
Nourishing your gut with a balanced diet: Focus on a whole foods diet, including plenty of fruits, vegetables, lean proteins, healthy fats, and fibre. Avoid inflammatory foods such as processed sugars, refined foods, and inflammatory oils avoiding too much omega 6 and hydrogenated oils.
Reducing inflammation: Include anti-inflammatory foods like turmeric, ginger, oily fish, green leafy vegetables and polyphenols in your diet. Consult a healthcare professional regarding targeted supplements such as omega-3 fatty acids or curcumin.
Support gut flora: Probiotics, prebiotics and fermented foods, such as yoghurt, sauerkraut, and kimchi, can help promote a healthy balance of gut bacteria.
Stress management: Chronic stress can negatively impact gut health. Engage in stress-reducing activities like meditation, yoga, time in nature and regular exercise.
[1] Fasano, A. (2012). Leaky gut and autoimmune diseases. Clinical Reviews in Allergy & Immunology, 42(1),
[2] Porpora, M. G., Brunelli, R., Costa, G., Imperiale, L., Krasnowska, E. K., Lundeberg, T., ... & Piccione, E. (2016). A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-Based Complementary and Alternative Medicine, 2015. doi: 10.1155/2015/292951.
[3] Porpora, M. G., Koninckx, P. R., Piazze, J., Natili, M., & Colagrande, S. (1999). Correlation between endometriosis and pelvic pain. Journal of the American Association of Gynecologic Laparoscopists, 6(4), 429-434. doi: 10.1016/S1074-3804(05)80013-8.
[4] Jiang I, Yong PJ, Allaire C, Bedaiwy MA. Intricate Connections between the Microbiota and Endometriosis. International Journal of Molecular Sciences. 2021; 22(11):5644. https://doi.org/10.3390/ijms22115644
[5] Mary E Salliss and others, The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain, Human Reproduction Update, Volume 28, Issue 1, January-February 2022, Pages 92–131, https://doi.org/10.1093/humupd/dmab035
[6] Chen, C., Song, X., Wei, W. et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun 8, 875 (2017). doi: 10.1038/s41467-017-00901-0
