Endometriosis: A Layered, Root-Cause Approach to Treatment

Endometriosis affects an estimated 1 in 10 women of reproductive age, yet it remains one of the most underdiagnosed and undertreated conditions in women's health. The average time to diagnosis is still measured in years, not months, and many patients are told their pain is normal long before anyone investigates further.

At Origins Integrative Health in Portland, we view endometriosis as a multisystem condition, not just a gynecological one. Effective care means looking at the layers underneath the diagnosis: immune function, inflammation, gut health, hormonal balance, and in some patients, histamine regulation. Addressing these layers alongside conventional treatment can meaningfully improve quality of life, even when surgery or hormonal therapy is also part of the picture.

What Is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. This tissue responds to hormonal cycles the same way the uterine lining does, leading to inflammation, scarring, and adhesions.

Common symptoms include:

Painful periods that may not respond well to standard pain medication
Chronic pelvic pain, not limited to menstruation
Pain during intercourse
Digestive symptoms, including bloating, constipation, or diarrhea
Fatigue
Infertility or difficulty conceiving

Diagnosis typically requires imaging and, in many cases, laparoscopic surgery, but a root-cause approach can begin well before or alongside a formal diagnosis.

The Layers of Endometriosis: A Functional Medicine Perspective

Endometriosis doesn't develop from a single cause, and it doesn't respond to a single intervention. We look at several interconnected layers that often drive symptom severity and disease progression.

Layer 1: Hormonal Imbalance

Endometriosis is fundamentally estrogen-dependent. Endometrial-like tissue outside the uterus responds to estrogen the same way the uterine lining does, which is part of why symptoms often track with the menstrual cycle.

Contributing factors may include:

Relative or absolute estrogen excess
Impaired estrogen clearance through the liver and gut (the estrobolome)
Progesterone resistance, which has been documented in endometrial lesions
Disrupted communication along the hypothalamic-pituitary-ovarian axis Hormonal evaluation may include estradiol, progesterone, and markers of estrogen metabolism, with treatment tailored to support healthy estrogen clearance and progesterone balance.

Layer 2: Inflammation

Endometriosis is increasingly understood as an inflammatory disease, not just a hormonal one. Lesions themselves generate inflammatory cytokines, and this local inflammation appears to drive both pain and disease progression, creating a cycle that can be difficult to interrupt without addressing inflammation directly.

A functional approach may include:

Anti-inflammatory nutrition, with attention to omega-3 fatty acids and reduced inflammatory triggers
Targeted supplementation, such as curcumin, omega-3s, or NAC, where evidence supports their use
Identifying and reducing individual inflammatory triggers, including food sensitivities

Layer 3: Immune Dysregulation

A healthy immune system should recognize and clear endometrial-like tissue outside the uterus. In endometriosis, this surveillance appears to be impaired, allowing lesions to implant, grow, and evade clearance. Some research also points to associations between endometriosis and autoimmune conditions, suggesting shared immune dysregulation in at least a subset of patients.

We may assess:

Markers of immune and inflammatory activity
Gut-associated immune function, given how closely gut health and immune regulation are linked
Stress physiology, since chronic cortisol dysregulation can impair immune surveillance over time

Layer 4: Gut Dysbiosis

The gut-hormone connection is significant in endometriosis. An imbalanced gut microbiome can impair estrogen metabolism and clearance, potentially contributing to the estrogen excess that drives lesion growth. Gut dysbiosis is also linked to increased intestinal permeability, which can perpetuate systemic inflammation.

Many patients with endometriosis also experience overlapping digestive symptoms, sometimes leading to a mistaken diagnosis of irritable bowel syndrome before endometriosis is identified.

Stool testing to assess microbial balance and gut inflammation
Probiotics and prebiotic fiber to support a healthy estrobolome
Addressing intestinal permeability and gut barrier integrity
Dietary strategies tailored to digestive symptoms and food sensitivities

Layer 5: Histamine and Mast Cell Involvement

In a subset of patients, histamine and mast cell activity appear to play a role in endometriosis-related pain and inflammation. Mast cells have been identified within endometriotic lesions themselves, where they may contribute to local inflammation, nerve sensitization, and pain signaling. Some patients with endometriosis also report symptoms consistent with histamine intolerance or mast cell activation, such as flushing, hives, or symptom flares with high-histamine foods.

This layer doesn't apply to every patient, but for those with overlapping histamine-related symptoms, addressing it can meaningfully reduce pain and inflammatory flares. Support may include:

A trial of a low-histamine approach to assess symptom response
Mast cell-stabilizing nutrients and botanicals
Identifying and reducing histamine-liberating triggers
Addressing underlying gut and immune contributors, since histamine regulation is closely tied to both

Neural Injection Therapy for Scar Tissue and Pelvic Pain

Many patients with endometriosis have had one or more laparoscopic surgeries to remove lesions or adhesions. While surgery can provide significant relief, surgical scars can create what's known as interference fields: areas where disrupted nerve signaling continues to generate pain or sensitivity long after the tissue has healed.

Neural therapy uses a gentle injection of a local anesthetic into the scar to help reset nerve function and reduce this disrupted signaling. For endometriosis patients, this can be a useful adjunct therapy to help:

Reduce pain originating from surgical scars
Calm overactive nerve signaling that contributes to chronic pelvic pain
Support better tissue mobility after laparoscopic procedures
Reduce inflammation in and around scar tissue

This isn't a replacement for surgical or hormonal management of endometriosis, but it can be a valuable piece of a broader pain management plan, particularly for patients whose pain persists or recurs after surgery.

Bringing the Layers Together No single layer fully explains endometriosis, and no single treatment resolves it. The goal of a layered approach is to identify which of these systems are most active in your case, so that treatment addresses the underlying drivers rather than managing symptoms alone.

A personalized plan at Origins Integrative Health may include:

Comprehensive hormone and inflammatory marker testing
Gut health assessment and microbiome support
Targeted nutrition and supplementation
Mast cell or histamine support, when relevant
Neural therapy for post-surgical scar pain
Coordination with surgical or hormonal management when needed

Ready to Get to the Root of Your Symptoms?

If you're living with endometriosis, chronic pelvic pain, or symptoms that haven't been fully explained, you deserve a care plan that looks at the whole picture. Our naturopathic doctors at Origins Integrative Health can help you understand which layers are driving your symptoms and build a plan to address them.

Schedule a consultation today to get started.

Book a visit with Dr. Carly here or call the clinic at 503-314-2176