When I first started Roots to Leaves, I was lucky enough to have 3 women ready and eager to work with me.
The surprising part?
All 3 of them happened to either be struggling with or had a previous diagnosis of endometriosis.
So pretty early on in my career, endo became a major focus of my work.
It’s a condition that is so common, yet so misunderstood.
We have such little research, limited dialogue, and even less understanding of how to address it beyond the standard “birth control or surgery” approach.
But here’s what we do know:
💛 Endometriosis is not “just painful periods.” It’s a full-body, systemic condition that impacts hormones, digestion, and immune function. While pain is a big part of it (70% of women with chronic pelvic pain have endometriosis for example) it is characertized by so much more.
💛 Surgery and hormonal bc are not the only options. While it’s helpful in some cases, focusing on root-cause support can lead to real symptom relief without invasive procedures. Again, for some people, this may be unavoidable, but for many we can get relief in other ways too.
so whether you’ve been diagnosed with endometriosis or have a rising suspicion, consider this your crash course👇
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. This tissue can attach to the ovaries, fallopian tubes, bowel, bladder, and even more distant organs.
While it's often framed as a “reproductive health issue,” endometriosis is way more complex.
It’s a condition that impacts the immune system, nervous system, and hormonal balance, making it a full-body issue — not just a “bad period” problem.
Unlike conditions with clear causes, endometriosis is multi-faceted. This means the experience of endo can look completely different from person to person.
I’ve seen clients where endometriosis presents primarily as IBS-like symptoms.
Another client experienced severe ovulation pain but had no issues with her period.
Another didn’t even know she had endometriosis until she started trying to conceive
The exact drivers of endometriosis aren’t fully understood, but there are a few theories that lead the way
This theory suggests that during menstruation, some menstrual blood flows backward through the fallopian tubes and into the abdominal cavity instead of exiting through the vagina.
This backward flow may deposit endometrial cells outside the uterus, where they attach to the ovaries, pelvic walls, and surrounding organs.
While retrograde menstruation does happen in many people (it’s actually considered somewhat normal), the question is why only some women develop endometriosis from it 🤔
In theory, if the immune system is working properly, it should "clean up" these misplaced cells.
But if the immune system is compromised, it may fail to remove them, allowing the endometrial-like tissue to grow, thrive, and create chronic pain and inflammation.
Now while the Retrograde Menstruation Theory is widely cited, it doesn’t explain every case of endometriosis, especially since endo lesions have been found in places like the lungs and brain — areas where menstrual blood couldn’t possibly flow.
This is why other theories, like immune dysfunction, cellular metaplasia, and genetic predisposition, are also considered.
and, it’s likely that multiple factors are at play, not just one.
Here are some other major factors we know play a role in endo:
🔸 Chronic Inflammation: Persistent inflammation promotes the growth and spread of endometrial-like tissue. 🔸 Immune Dysfunction: The immune system struggles to "clean up" misplaced endometrial tissue, allowing it to stay active in places it doesn't belong. Endometriosis is linked to chronic, low-grade inflammation, where immune cells like macrophages and cytokines stay in a constant state of activation. 🔸 Estrogen Dominance: Excess estrogen relative to progesterone can "feed" the growth of endometrial lesions. 🔸 Gut Dysbiosis: Imbalances in the gut microbiome are linked to systemic inflammation and poor estrogen detoxification.
So we’re still working to understanding how and why endometriosis occurs - but with the information above, we can take steps to support it
Iron is an important mineral in the body but it also contributes to oxidative stress and inflammation.
When endometrial tissue breaks down (just like the uterine lining does during menstruation), it releases iron.
Excess iron = more oxidative stress = more tissue damage = more inflammation = more pain.
All of which can also lead to worsened endometrial growth.
Excess iron can also feed pathogenic gut bacteria (like Firmicutes), disrupt gut balance, and worsen gut-driven estrogen recirculation.
The solution though isn’t to cut out iron but to support iron balance.
This is where copper and vitamin A (retinol) play a crucial role. Copper activates ceruloplasmin, which mobilizes iron so it doesn’t get "stuck" in tissues, while retinol supports ceruloplasmin production. Without enough copper and retinol, iron stays trapped, creating more damage.
So rather, if you have endo, getting a full iron panel done and bringing in copper and vitamin A rich foods become key.
How is Endometriosis Diagnosed?
Unlike PCOS, where criteria like bloodwork and symptoms can help with diagnosis, endometriosis requires laparoscopic surgery to be officially diagnosed.
This is because imaging tests like ultrasounds or MRIs often miss endometriosis, especially when the tissue is microscopic or located in “hidden” areas like the bowels or bladder.
However, if you experience cyclical pain, digestive issues, or pain with sex, it could be clues to talk to your doc about endo.
Because it impacts multiple organs, endo symptoms are often misdiagnosed as IBS, interstitial cystitis, or "just bad periods." Advocate for yourself if you know something is off.
What Are the Symptoms of Endometriosis?
While some women experience excruciating period pain, others may feel fine during their period but experience pain during ovulation or digestion issues that seem "random."
Here’s a look at the most common symptoms:
severe abdominal or pelvic pain
back pain
pain on intercourse
pain with bowel movements or urination
pelvic burning
referred pain, especially shoulder blades or top of collar bone
PMS
painful periods
heavy periods
clots with period
IBS like symptoms
bloating (often called Endo Belly)
Your Starter Kit
The most common courses of care for endo include hormonal birth control (to suppress ovulation and reduce pain), pain medications(like NSAIDs), and in more severe cases, laparoscopic surgery to remove endometrial lesions.
While these treatments can provide relief, functional approaches focus on reducing systemic inflammation, supporting estrogen detoxification, and strengthening immune function to address the deeper imbalances driving endo growth and pain.
let me be clear first - I have many friends and clients who have undergone surgery or take hormonal bc for their endo. This is not a “wrong” approach and each woman has to make a choice that makes sense for their body and their comfort. With that, we’re just offering other tools to consider as well
Diet Recs for Endometriosis
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