What Causes Endometriosis? Best & Worst Treatment Options

Last Updated on December 31, 2023 by Richard

Knowing what causes endometriosis should lead us to endometriosis treatment options.  Right? 

So, why does it take years to get diagnosed? 

Why can’t you get treated BEFORE you went through all that pain and misery?  Why don’t the doctors believe you, and they treat you like you’re crazy?

I am not a doctor, or even a woman, but I think I can help answer all those questions, stop the pain, and save your fertility, so that you can enjoy life again.

The Big Mystery About What Causes Endometriosis.

In my humble opinion, there is more than one cause of endometriosis.

The medical profession is always looking for just one cause and just one cure.

Unfortunately, our bodies are much too complicated for that approach.

Because of the many different symptoms and locations of pain, endometriosis is often misdiagnosed as something else.  The difficulty of getting a proper diagnosis is the leading reason why the causes of endometriosis are hard to pinpoint.

In fact, there are only theories about what causes endometriosis.  So, lets take a look at them, and I will give you some endometriosis treatment options.    

In the Beginning There Was…

A healthy baby girl, but then along came puberty and pelvic pains. 

What happened?

Well, the theory is that the baby was born with endometrial cells located outside of the uterus.  Usually that would be anywhere within the pelvic cavity, the fallopian tubes, or the ovaries. 

This is attributed to Müllerian duct remnants (rudimentary reproductive system) that didn’t end up as part of the fallopian tubes or uterus. [2]

Then when the menstrual cycle began, those endometrial cells reacted to the hormones just like the endometrial cells in the uterus do.

So, what would you expect to happen if the endometrial cells thicken and then bleeds during every monthly cycle?  Pain! 

Pelvic pain would start as the endometrial cells thicken, and would get worse during the bleeding.  That is the result of the cells and the blood being where they don’t belong.

The body would recognize that these cells and blood don’t belong wherever they are at, and that the immune system would start to remove them. [5] Well, that could take longer than one menstrual cycle.  So, now you have an ever-increasing problem.

As you have more internal bleeding that the immune system isn’t removing, the surrounding tissues and organs are likely to be impacted in various ways. 

Physical pressure, infection and inflammation come to mind.

Are you starting to see how you could have painful urination, constipation, infertility, unusual bleeding between periods, pain during sex, back aches, and more?  Can you see why doctors might diagnose something other than endometriosis?

Note: According to this theory, these misplaced endometrial cells have been around since birth.  That means that the immune system is not able to remove them, and they will be a problem until you reach menopause.

Keep reading, because I’m going to tell you about those endometriosis treatment options.

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Retrograde Menstruation: Backflushing the Fallopian Tubes.

Sampson’s theory of retrograde menstruation is the most accepted theory of what causes endometriosis.  That’s because it probably happens to all women. [1,2]

Where does that blood go when it backflows through the fallopian tubes?  It goes right into the pelvic cavity, which holds the other reproductive organs, the urinary system, and the large intestine.

The end result is inflammation and scaring, which doctors call adhesions.

If this happens to most, if not all women, then why don’t all women have endometriosis?  Well, our amazing bodies are able to self-heal.  So, it seems logical to me that those with endometriosis have other medical conditions that interfere with that self-healing.

Asian woman contemplates what causes endometriosis
What is the best endometriosis treatment?

I’m not a doctor, so I am only guessing that it is a combination of a weak immune system, and chemicals from food, air, water, and medications.

Coelomic Metaplasia Endometriosis

Metaplasia refers to an abnormal change to a cavity (coelomic) lined by a mesothelium (membrane).  That includes the pelvic cavity and the ovaries. [5]

In other words, mesothelial cells transform into endometrial cells.  Since those

endometrial cells are outside of the uterus, they are now endometriosis cells.

In my non-doctor opinion this doesn’t sound like it would be very common.

This theory is supported by the fact that endometriosis has been found in the brain and a number of organs. [5] However, as I mentioned earlier, this could be the result of the endometrial cells breaking off and being transported by the blood stream.

Cervical Stenosis Endometriosis

During the menstrual cycle the discharged blood passes from the uterus, through the cervix, and into the vagina.  However, when the cervix opening becomes less than 4.5 mm wide, menstrual blood and debris can be retained in the cervix or uterus, and cause endometriosis. [6]

Birth control pills that contain estrogen and progesterone (progastrin) will make the mucus at the cervix thicker which will block sperm from entering the uterus.  The same thing is true for the mini pill which only contains progastrin. [16] Thicker mucus could potentially also prevent the menses blood from exiting the uterus and causing cervical stenosis.

Can Genetics Be the Cause of Endometriosis?

There has been more than one study of twins that seems to validate this theory. [5] If you have read the previous theories on what causes endometriosis, you would understand that you can’t just blame your parents.


Epigenetics is about how environmental factors modify how human genes work. [13]

The genes you get from your parents are chemically modified over time by the ageing process, where you live and what you eat, etc. [11] 

This is a chemical addition to the gene, which does not alter the gene.  That’s similar to putting a motor on a row boat. The row boat has not been altered, but now it acts very differently.

Fortunately, any disease caused by epigenetics, can also be undone – just like removing the motor from the row boat. [13]

There is evidence that epigenetic processes could be one of the many causes of endometriosis. [7]

The menstrual cycle is based upon the increase and decrease of estrogen and progesterone hormones at the proper times and in the proper amounts.

Both estrogen and progesterone have been estimated to increase or decrease the actions of hundreds of genes during the menstrual cycle.

So, it is very possible that epigenetically modified genes are a big factor in what causes endometriosis.

Dioxin and the Other Environmental Toxins

There is some evidence that dioxin, or exposure to other chemicals and pollutants could mess up your immune system and even hormones. [1,7]

Dioxin is created when chlorine is used to make tampons.  So, that would be the method of exposure.

Endometriosis is very closely related to the estrogen hormones.  The estrogen balance during the menstrual cycle could be affected by environmental toxins.

Endometrial Cells Breaking Loose and Metastasizing Just Like Cancer

The way that cancer spreads throughout the body is by breaking loose and being carried by the blood stream (or lymph system) to new locations.

There is evidence that THC (marijuana) and the endocannabinoid AEA are responsible for endometrial cancer cells relocating to new areas.

This theory assumes that non-cancerous cells are able to move in the same way.

For more about this theory read my article: CBD Stops Endometriosis Pain! Can CBD Cure Endometriosis?

An Endocannabinoid Deficiency Is What Causes Endometriosis?   

Some studies indicate that endometriosis is caused by an endocannabinoid deficiency. [8]

The body makes several cannabinoids within (endo) the body.  Cannabinoids are just chemical compounds that send signals through receptors within the body.

The most important endocannabinoid concerning endometriosis appears to be Aarachidonyl ethanolamide (AEA). 

AEA interacts with some of the same receptors as the phyto (plant created) cannabinoids found in marijuana and the industrial hemp plants.

Marijuana and hemp are practically the same, except that industrial hemp only contains trace amounts of THC.  Therefore, hemp won’t get you “high” like THC does.

Marijuana and hemp plants contain 106 cannabinoids (at last count).  THC (Tetrahydrocannabinol) and CBD (cannabidiol) are the two most abundant and most studied cannabinoids.

Cannabadiol (CBD) is made from the flowers, leaves, and stalk of the hemp plant. NOT from the seeds!

Long story short:

AEA interacts with THC and CBD in numerous ways within the body.  CBD is potentially able to correct the endocannabinoid deficiency that is caused in many different ways.

I wrote an article about this titled: CBD Stops Endometriosis Pain! Can CBD Cure Endometriosis?

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#1 Best Theory on What Causes Endometriosis: Uterine Contractions

The uterus is continually contracting in a wavelike muscular contraction fashion (peristalsis).  One of the reasons for this action is to move semen towards the ovary follicle containing an egg. [9,10]

It’s been estimated that these peristaltic uterine contractions happen about every 40 seconds. [10]

Just like any other part of the body that is constantly used, there is going to be some wear and tear.  

Over a long period of time the body isn’t able to repair the damage fast enough.  It is obvious to anyone my age (60+) that the body doesn’t heal as fast anymore.

So, according to this theory, older women are likely to develop endometriosis.

What about the teenagers that get endometriosis?  Don’t they heal fast enough?  Generally, they do, but there are other factors that can overcome the speed of youthful healing.

In the process of healing, estrogen is created, and the uterus is very sensitive to estrogen levels. [10] In fact, oral contraceptives work by regulating estrogen to prevent eggs from being released from the ovaries.

So, now we need to talk about how estrogen and uterine contractions are the causes of endometriosis.

The uterine contractions move the male sperm upwards to the dominate ovary follicle that has developed an egg.  If pregnancy doesn’t occur, then menstruation begins to flush out the unused egg and endometrial lining cells.  Therein lies the problem.

Usually the egg, blood, and endometrial lining cells are flushed out through the cervix.  That is, unless the cervix is blocked, as mentioned previously in the Cervical Stenosis Endometriosis theory.

Even if the cervix is working normally, the uterine contractions are going to try and move the egg and blood upwards towards the ovarian follicles.  That is exactly what happens to probably all women at one time or another.  That’s called Retrograde Menstruation, which I mentioned earlier.

The fact that not all women get endometriosis is proof that the uterine contractions are not usually strong enough or frequent enough to cause Retrograde Menstruation.

That’s where estrogen comes into the picture.

Every uterine contraction produces what is called micro-trauma to the uterine tissues.  The immune system is constantly repairing that micro-trauma damage.  In that healing process estrogen is released. [9]

The extra estrogen over stimulates the ovaries to tell the uterus to contract even more often (hyperperistalsis). [9]

So, now the time between uterine contractions is less than 40 seconds.  Which makes it much more likely that at least some of the blood and endometrial lining cells are pushed back through the fallopian tubes into the pelvic cavity.

I’m sorry to say that this suggests to me, to be another reason for a having a light period.  I’m not a doctor, so that is just a guess.

My Conclusion on What Causes Endometriosis.

In my non-doctor opinion, the over active uterine contractions cause retrograde menstruation.  The retrograde menstruation is caused by increased estrogen activating the ovaries.

The reason that oral birth control pills stops endometriosis is because it lowers estrogen levels.  Obviously if you want to get pregnant, birth control isn’t the answer.  Also, when you stop taking birth control, the endometriosis begins again.

Hormone levels, including estrogen, are constantly being balanced by the endocannabinoid system.  The endocannabinoid system is highly complex, and much of what we know about it has not been proven in human clinical trials.

Nevertheless, CBD is very good at relieving all three types of endometriosis pain.

The Best Endometriosis Treatment Options

The lowering of estrogen will reduce endometriosis symptoms, and can potentially cure endometriosis that is caused by increased uterine contractions.

It is possible that taking CBD (cannabidiol) to relieve the pain symptoms may also correct the cause of endometriosis. 

Defeat Any Endocannabinoid Deficiency with CBD (cannabidiol)

The 106 cannabinoids in CBD Oil from the hemp plant work together to balance all of the tissues, organs, and body systems to create homeostasis.

Homeostasis is the establishment of an optimally functioning body.  In other words – perfect health.

The CBD oil works with the Endocannabinoid System to adjust any imbalances within the body.  That would include any endocannabinoid deficiency, and any over-supply of endocannabinoids too.

Cancel the Effects of Dioxin and the Other Environmental Toxins

Dioxin was causing the egg shells of the American bald eagle to be too thin, which dramatically reduced the survival rate.  Now that paper mills are required to reduce/eliminate dioxins from their waste water, the bald eagles are reproducing again.

Unfortunately, Americans are exposed to many toxins, including dioxins, every day.  All of those toxins interfere with the body creating homeostasis, or what we would call optimal health.

Essentially, anything that enters our body (good or bad) creates chemical reactions, which either makes us healthy or sick by influencing the endocannabinoid system.

By taking full spectrum CBD oil we are also influencing the endocannabinoid system.  We know relatively little about how CBD oil works, but we do know that it works.

Frankenstein Genetic Cures

Although science is now able to create Genetically Modified Organisms (GMO) (food), it is unlawful to genetically modify humans.  However, we can use epigenetics to our benefit instead of making us sick.

Ethically Reprogram Genes with Epigenetics

Basically, this is related to environmental pollution, chemicals in our food, chemicals that we use to clean the house and our bodies.

Diseases such as endometriosis can be caused by modifying our DNA genes.  This is a chemical reaction. 

If you remove yourself from the pollution, your body may be able to heal itself.

Then again, it may need some help.  Especially since we can’t get away from all types of pollution.

There is a lot you can do, but that most people won’t do. 

Such as eating biodynamic food, which is what organic food is supposed to be, but often times isn’t.  It is more expensive, and I’m not a fanatic about it.  However, when grocery shopping, I always take organic food over regular food, and biodynamic over organic if available.

Eat toxin free food to reduce estrogen levels and stop endometriosis.   Full Stride Health .com

Such as eating biodynamic food, which is what organic food is supposed to be, but often times isn’t.  It is more expensive, and I’m not a fanatic about it.  However, when grocery shopping, I always take organic food over regular food, and biodynamic over organic if available.

By the way, I eat at restaurants quite a bit, and I don’t worry about what I eat at a restaurant.  Although some choices are better than others.

Stay away from soy bean products, because they are phytoestrogens that can increase your estrogen levels. [17]

I also try to stay away from synthetic clothing that touches my skin.  There is some evidence that polyester fabric could lower male sperm health.

There is a 2011 study that found most plastics affects estrogen levels.  That includes the water bottles that are sold as bisphenol A (BPA) free. [18]

The theory of epigenetics, as it relates to what causes endometriosis, is based on your environment changing how your genes operate.  This process is called DNA methylation. [11]

During the menstrual cycle, you can have too much methylation (hypermethylation) or too little methylation (hypo methylation).  Either situation can lead to having too much or too little estrogen. [13] It all depends upon which part of the menstrual cycle the methylation occurs.

Having too much estrogen is what causes over active uterine contractions, that result in retrograde menstruation and endometriosis.

So, if you can lower estrogen directly, or increase progesterone, which indirectly lowers estrogen, you can stop endometriosis.

I am not aware of any epigenetic medical treatments for endometriosis other than the proposal to inhibit the activation of the EP2 and EP4 receptors of prostaglandin E2. [12]

So, far I have only found one reference that CBD (cannabidiol) is able to indirectly influence the EP4 receptor of Prostaglandin E2.   That is not much to go on, but further research may provide a better answer.

The Worst Endometriosis Treatment Options

Typically, treatment is based upon symptoms.  However, many women with endometriosis do not have any obvious symptoms.  Usually, these women only find out when they see a doctor, because they are infertile.

  • Oral Contraceptives reduce the chances of getting endometriosis while being used, but can increase the chances of getting endometriosis after you stop using them.

Oral Contraceptives are a combination of estrogen and progesterone (progestin) which stops the egg from being released from the ovary.  It also makes the endometrium lining of the uterus thinner, which hinders the egg from implanting.

  • The Minni Pill Contraceptive.  This only has the progestin, and no estrogen.  It suppresses ovulation most of the time, but not always.  It has fewer of the other side effects caused by estrogen containing contraceptives.
  • Infertility Treatment: There is in vitro fertilization (IVF) and intrauterine insemination, but this does not treat the endometriosis. [1]
  • Laparotomy is a medical exploration to see what the cause of endometriosis is and to determine the best method of treating it.  This is your typical surgery where you are cut open
  • Laparoscopy is surgery that is done through the belly button.  It has been the preferred way of determining if a woman has endometriosis.  At the same time various ways of removing any scars (adhesions) and endometriosis can be removed.  Laparoscopy is expensive and often times the endometriosis comes back.
  • Laparoscopic uterine nerve ablation (LUNA).  This operation removes certain nerves in order to stop chronic pelvic pain.  However, in one study, there was no improvement after then surgery. [15]
  • Laser ablation:  Cysts can be removed by using a laser to evaporate them. 
  • Monopolar electrocoagulation uses an electric current at a high frequency to burn off the endometriosis tissues.
  • Presacral neurectomy.  This surgery removes a group of nerves called the presacral plexus.  What it does, is to cut off the pain signals that would normally be sent to the brain from the uterus.
  • Radical surgery is the partial or complete removal of an organ, such as the ovaries.

Conclusions on Endometriosis Treatment Options.

The main point to be made, is that lowering your estrogen levels is the key to treating and curing endometriosis.

Removing toxins from your life that increases estrogen levels, either directly or indirectly, is the surest way to stop and cure endometriosis.  That requires a lot of dedication and effort that most people simply won’t do.

The next best treatment is using CBD oil to stop the chronic pelvic pain, and potentially stop the growth of endometriosis.

Otherwise you are only left with the standard treatments that doctors prescribe.  The best of those would be the Minni Pill birth control, followed by the standard oral birth control pills.

After that you are only left with surgery options, which no one wants to endure.

References and Resources

[1] Dr. Esther Eisenberg: Taking Aim at Endometriosis.

[2] Endometriosis: Epidemiology, Diagnosis and Clinical Management

[3] Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study.

[4] Coelomic metaplasia theory of endometriosis: evidence from in vivo studies and an in vitro experimental model.

[5] Endometriosis still a challenge.

[6] Stenosis of the external cervical os: an association with endometriosis in women with chronic pelvic pain.

[7] Epigenetics of endometriosis.

[8] The Clinical Significance of Endocannabinoids in Endometriosis Pain Management.

[9] The pathophysiology of endometriosis and adenomyosis: tissue injury and repair.

[10] Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study.

[11] What is epigenetics?

[12] Selective inhibition of prostaglandin E2 receptors EP2 and EP4 modulates DNA methylation and histone modification machinery proteins in human endometriotic cells.

[13] DNA methylation in endometriosis (Review)

[14] Cannabidiol Improves Vasorelaxation in Zucker Diabetic Fatty Rats through Cyclooxygenase Activation.

[15] Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial.

[16] Oral Contraceptives.

[17] Soy and phytoestrogens: possible side effects.

[18] Most Plastic Products Release Estrogenic Chemicals: A Potential Health Problem That Can Be Solved.

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