Endometriosis and Inflammation: What’s the Connection?

Endometriosis is often talked about as a reproductive disease. But research increasingly paints a more complex picture—one involving hormones, the immune system, inflammation, oxidative stress, and even the gut microbiome.

So how are these systems connected?

Endometriosis Is More Than a Hormonal Condition

Endometriosis is an estrogen-dependent, chronic inflammatory disease in which tissue similar to the lining of the uterus grows outside the uterus.

Estrogen plays an important role, but hormones aren't acting alone. Researchers have also identified changes in immune activity and inflammatory signaling in people with endometriosis.

Around endometriotic lesions, immune cells and inflammatory molecules can contribute to an environment that may help sustain inflammation, pain, and disease progression.

That has led researchers to look beyond the reproductive system—including at what's happening in the gut.

What Does the Gut Have to Do With Endometriosis?

Your gut is home to trillions of microorganisms collectively known as the gut microbiome. When that microbial community becomes imbalanced, it's often called gut dysbiosis.

Research has found differences in the gut microbiomes of people with endometriosis compared with those without the disease. Scientists are now investigating whether those changes could influence inflammation, immune function, and even estrogen metabolism.

One proposed pathway involves the intestinal barrier. Certain changes in the microbiome may affect the integrity of that barrier and increase exposure to bacterial products that can activate inflammatory immune responses.

In other words, the gut may be capable of influencing inflammation far beyond the digestive tract.

The Gut Can Influence Estrogen, Too

Here's where things get especially interesting.

Part of the gut microbiome is sometimes referred to as the estrobolome—the collection of microbial genes involved in metabolizing estrogen.

Certain gut bacteria produce enzymes that can influence whether estrogen is eliminated from the body or reactivated and returned to circulation. Because endometriosis is an estrogen-dependent disease, researchers are investigating whether changes in the gut microbiome and estrobolome could potentially influence the hormonal environment associated with endometriosis.

The science is still emerging, but it highlights just how interconnected our body systems really are.

Could It Create a “Perfect Storm”?

Possibly—but we don't yet know which comes first.

Researchers are exploring a potential cycle:

Gut dysbiosis → altered immune and inflammatory signaling → changes in estrogen metabolism → an environment that may help sustain endometriosis and inflammation.

At the same time, endometriosis itself may affect the gut and microbiome.

Rather than thinking of dysbiosis as the cause of endometriosis, it may be more useful to think about a potentially bidirectional relationship—one in which the gut, immune system, hormones, and inflammation can influence one another.

That's the “perfect storm” researchers are beginning to unravel.

Why This Matters

For those of us at Serae, this research reinforces something we believe strongly:

Women's bodies don't operate in silos.

Our founder, Carly Roland, has lived with endometriosis for more than a decade. Her experience with symptoms extending far beyond her reproductive system helped inspire Serae's whole-body approach to women's wellness.

Endometriosis is complicated, and there is still so much we don't understand. But research into the connections between the gut, immune system, inflammation, oxidative stress, and hormones is helping build a much more complete picture of the disease—and of women's health as a whole.

Sources

Association between endometriosis and gut microbiota: systematic review and meta-analysis. Frontiers in Microbiology, 2025.

Gut Microbiota Alterations and Reproductive Tract Dysbiosis in Endometriosis: A Systematic Review.

Could the estrobolome have a role in endometriosis pathogenesis and infertility? A systematic review.

These statements have not been evaluated by the Food and Drug Administration. This content is for educational purposes and is not intended to diagnose, treat, cure, or prevent any disease.