Endometriosis and Hormones
If you have endometriosis, you have likely been told some version of this: “It’s hormonal.”
That’s true. But it is also incomplete.
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows outside the uterus. These implants respond to hormonal signals, especially estrogen. That hormonal response is a major driver of pain, inflammation, and disease progression.
Let’s break this down clearly. You deserve clarity, not confusion.
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows outside the uterus.
The Hormone Connection: Why Estrogen Matters
Endometriosis is considered an estrogen-dependent condition.
Estrogen stimulates endometrial-like tissue to grow and thicken. In women with endometriosis, this tissue outside the uterus also responds to estrogen. Each cycle, it can become inflamed and irritated. That inflammation triggers pain, scar tissue, and sometimes organ dysfunction.
But here is what is important to understand:
It is not simply “too much estrogen.”
It is often a combination of:
Estrogen dominance relative to progesterone
Local estrogen production within endometriosis lesions
Chronic inflammation
Immune system dysfunction
Research shows that endometriosis implants can actually produce their own estrogen through increased aromatase activity. This means the lesions can help sustain themselves even when circulating estrogen levels are not high.
That is why some women still experience symptoms even on hormonal therapy.
Progesterone Resistance: The Other Side of the Equation
Progesterone normally counterbalances estrogen. It stabilizes the uterine lining and reduces inflammatory signaling.
Many women with endometriosis demonstrate what we call progesterone resistance. Their tissue does not respond appropriately to progesterone’s calming effects. This imbalance allows estrogen-driven growth and inflammation to continue.
This is one reason progestin therapy helps some women, but not all.
Hormones matter. But inflammation, immune response, and genetics matter too.
How Hormonal Fluctuations Affect Symptoms
Symptoms often worsen:
Before menstruation
During menstruation
Around ovulation
Why? Because estrogen and prostaglandins fluctuate dramatically during these phases. Prostaglandins increase uterine contractions and pain. In women with endometriosis, the inflammatory response is amplified.
Common symptoms include:
Severe menstrual pain
Pain with intercourse
Chronic pelvic pain
Pain with bowel movements
Infertility
Medical Treatment Options: Hormonal Suppression
The primary goal of medical therapy is to reduce estrogen stimulation and suppress ovulation.
Here are the most common options:
1. Combined Oral Contraceptives
These suppress ovulation and stabilize hormone fluctuations.
Pros:
Often reduce menstrual pain
Can regulate cycles
Non-surgical
Cons:
Do not remove lesions
Symptoms may return after stopping
Possible side effects: nausea, mood changes, blood clot risk in some women
2. Progestin Therapy
Includes oral progestins, injections, or hormonal IUDs.
Pros:
Can thin endometrial tissue
Often reduces bleeding and pain
IUD option provides local effect
Cons:
Breakthrough bleeding
Mood changes
Not effective for everyone due to progesterone resistance
3. GnRH Agonists and Antagonists
These suppress ovarian estrogen production, creating a temporary low-estrogen state.
Pros:
Can significantly reduce pain
May shrink lesions
Cons:
Menopause-like side effects: hot flashes, bone loss
Not a long-term solution without add-back therapy
Symptoms may return when discontinued
Hormonal treatments manage symptoms. They do not cure endometriosis.
That distinction matters.
Surgical Treatment Options
Surgery is often recommended when:
Pain is severe and persistent
Hormonal therapy fails
There is organ involvement
Infertility evaluation requires it
There are two primary surgical approaches:
1. Ablation (Cauterization)
Lesions are burned or destroyed at the surface.
Pros:
Shorter operative time
Widely available
Cons:
Does not remove deep disease
Higher recurrence rates
Pain often returns
2. Excision Surgery
Lesions are cut out completely, including deeper infiltrating disease.
Pros:
Removes visible disease
Lower recurrence rates compared to ablation
Often better long-term pain relief
Cons:
Technically complex
Requires a highly trained surgeon
Higher upfront cost
Surgical risks such as bleeding, infection, organ injury
Excision is generally considered the gold standard for moderate to severe disease when performed by an experienced specialist.
But surgery is not a simple yes or no decision.
What Women Should Consider Before Surgery
Here are key questions to ask:
Is my surgeon fellowship-trained in excision surgery?
How many endometriosis surgeries do they perform each year?
What is their recurrence rate?
Will other specialists be present if bowel or bladder involvement is found?
What is the recovery timeline?
You should also consider:
Your age
Fertility goals
Severity of symptoms
Impact on work and daily life
Financial implications
Surgery can provide meaningful relief. It can also involve recovery time, cost, and emotional strain.
For some women, it is life-changing. For others, symptoms gradually return.
This is not failure. It is the nature of a chronic condition.
Can a Hysterectomy Cure Endometriosis?
This is one of the most misunderstood topics.
Removing the uterus does not remove endometriosis outside the uterus. If ovaries remain, estrogen production continues. Even if ovaries are removed, residual implants can still persist in some cases.
Hysterectomy may reduce bleeding and uterine pain, especially if adenomyosis is present. But it is not a guaranteed cure.
Women deserve full informed consent before making that decision.
A Whole-Person Approach
Hormonal management and surgery address structural disease. But many women benefit from additional support:
Anti-inflammatory nutrition
Pelvic floor physical therapy
Pain management strategies
Mental health support
Financial planning for chronic care
Health and wealth are deeply connected here. Chronic illness affects career paths, savings, and long-term stability. Planning matters.
The Bottom Line
Endometriosis is driven in part by estrogen. But it is also fueled by inflammation, immune dysregulation, and progesterone resistance.
You deserve to understand your options. You deserve a treatment plan that aligns with your goals, your body, and your future.
If you are struggling with persistent pelvic pain, do not normalize it. Start documenting your symptoms. Schedule a consultation. Advocate for yourself.
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Medical Disclaimer: The information provided in this blog is for general educational and informational purposes only and is not intended as, nor should it be considered, medical advice. This content does not establish a physician-patient relationship and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter. If you think you may have a medical emergency, call your doctor or emergency services immediately.
