Why Endometriosis Keeps Coming Back (And How to Break the Cycle)

0:00You started to mention some of those things that can get out of balance in somebody's body and influence why they may have endometriosis. And what we're learning is, I think, which is so interesting, is it's not just a disease of the pelvis. It's a systemic disease where we want to think about it really comprehensively and systemically and ask that question why so we can treat our patients individually.

0:40Dr. Mark Hyman:welcome to office hours this is our dedicated one-on-one space to go deeper get clear and explore what truly moves the needle for your health i'm dr mark hyman and each week we're going to pull back the curtain and share the insights the research the lessons that don't always make it into our conversations with guests because at the end of the day you are the ceo of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. This episode is brought to you by Function Health, empowering you to live 100 healthy years with over 160 lab tests at just$365 a year.

1:18Dr. Mark Hyman:Sign up today at functionhealth.com slash mark and use code mark2026 to get$50 towards your membership. Now, if you've ever been told that debilitating period pain is, well, just part of being a woman. I want you to hear this really clearly. It's not. One in 10 women lives with something called endometriosis. And yet it takes an average of seven to 10 years for women to get diagnosed if they have that problem. And during that whole time, lots of women are prescribed birth control, pills, pain medication, till surgery is the only real option. And sometimes surgery is necessary, but nobody really asks the deeper questions.

1:54Dr. Mark Hyman:Why is this happening in the first place? That's what functional medicine is. It's the medicine of why. Not just what disease you have, but why do you have it? And endometriosis isn't just a gynecologic condition. It's not just a uterine condition. It's an inflammatory condition. It's an immune condition. It's a hormonal disorder. And it's also connected to your gut health. It's also connected to how you metabolize estrogen and and even environmental toxins and your blood sugar and stress and your oral health and terrain of your whole body. So today for Endometriosis Awareness Month, I'm joined by my friend and my colleague of decades, decades and decades, Dr.

2:31Dr. Mark Hyman:Elizabeth Boham from the Ultra Wellness Center. It's our practice in Lenox, Massachusetts, where we take care of all sorts of patients, including those who have this condition and many other chronic illnesses. She's an expert in functional medicine. She's an expert in women's health. And together, we're going to go on a deep dive into the root cause of endometriosis. Not just managing the symptoms, but addressing the inflammation, the hormone imbalances, the whole immune dysfunction that drives it. Because severe pain is not normal and it's not fun. And you deserve answers beyond just trying to suppress the symptoms.

3:04Dr. Mark Hyman:So welcome, Liz. Great to see you. Thank you, Mark. It's really great to be with you. And I think this is such an important topic to speak about and really help people understand how we do it differently with functional medicine, not just suppressing symptoms, but asking that question why and looking upstream. And you started to mention some of those things that can get out of balance in somebody's body and influence why they may have endometriosis. And what we're learning is I think, which is so interesting, is it's not just a disease of the pelvis, right? It's like you were saying, it's a systemic disease where when we want to think about it, really comprehensively and systemically and ask that question why so we can treat our patients individually, come up with a personalized plan for why do they have this endometriosis going on and what can we do to help them feel better.

3:58Dr. Mark Hyman:Exactly. Okay. So let's get into it. Like, what is it? Like briefly, like, cause it's a, it's a complicated. So briefly tell us what is endometriosis? Cause it's a big medical word. Most people don't understand it. So tell us what it is. So endometriosis occurs when the cells from the inside of your uterus, that endometrium, leave the uterus and they go into the pelvic cavity or the peritoneal cavity, which is the area outside of the uterus, inside the abdominal area, so to say. and cells get stuck there. These endometrial cells get stuck there and they create inflammation and that can go on to create a lot of pain.

4:42And because this tissue can grow outside of the uterus, it can be around areas of like the fallopian tubes and the ovaries. And so that can impact people's, women's infertility. And so it's been associated with infertility. And it also causes a lot of symptoms, symptoms from pain. And it can cause a lot of digestive symptoms, which can make it somewhat difficult to sometimes diagnose, you know, bloating, constipation, diarrhea. And as I mentioned, infertility. Yeah.

5:16Dr. Mark Hyman:So basically the lining of the uterus, the endometrium gets like deposited around the abdominal cavity on your bladder, on your bowel, on your fallopian tubes, all over the place. And And so when you have your period, it gets activated, right? And so that's kind of what's going on. It's this weird, weird thing that it's like, it's almost like your kidney tissue would get transplanted in other parts of your body, which is kind of a weird thing, but it's, it's really unusual, but it's extremely symptomatic and painful. Yeah. And it's thought that even 10 % of women may be dealing with this and it's tricky to, because it's, it can be tricky to diagnose that it's, it goes often undiagnosed for many years.

5:54And what we know is that when that endometrium, the endometrial cells start to deposit outside of the uterine lining, they create this sort of feed-forward inflammatory cycle. And then those endometrial cells can create, they can actually create their own estrogen through this process of aromatase. And we can talk more about that, but that can then create even more growth. And so it becomes often a vicious cycle, as do a lot of things that happen.

6:25Dr. Mark Hyman:And often we think about it as a gynecologic problem, you know, like it's just a hormone problem. And it is hormonally infected. But there's some evidence that it's an autoimmune disease, right? Can you talk about how the immune system plays a role in this? Absolutely. So we know that a lot of inflammation can occur locally and can create more growth of this tissue and then more inflammation. And so we've got to think about what can be triggering this inflammatory process in the body. And so as we were saying in functional medicine, we go upstream and we say, okay, is that because of issues with dysbiosis or imbalances in the gut microbiome?

7:08Is that because of issues with estrogen metabolism and how we're getting rid of our estrogen? Is it because of issues of inflammation in the whole body or immune dysregulation? And so those are things we've got to ask so we can help that patient feel better.

7:22Dr. Mark Hyman:I find it really fascinating that it's this immune condition because, you know, we think of, you know, the uterus and, you know, your period is mostly hormonally regulated, but it seems that this condition is regulated in large part by the immune system and the gut plays a huge part in this. So can you talk about the whole role of gut health and inflammation and even as a root cause of autoimmune and immune dysregulation? You know, we always say in functional medicine, start with a gut, right? Because so much inflammation and autoimmunity and immune dysregulation can stem from the digestive system.

7:58It can stem because of increased intestinal permeability, because of dysbiosis or imbalances in the gut microbiome, and also because the gut microbiome is really involved in how we metabolize our estrogen. And we know that estrogen can cause endometriosis to become more problematic, right? So we think about the gut for all of those reasons. We know that there's, you know, women with endometriosis have a two to three times higher risk of having irritable bowel disease. So it's really connected with IBS or irritable bowel disease. And we know that women with endometriosis have a higher rate of having food allergies, food sensitivities, non-celiac gluten sensitivity, and even celiac disease.

8:47So there's a lot of connection. And what I thought is so fascinating is this connection with the gut microbiome, but not just the gut microbiome, but they're also looking at the connection between the vaginal and cervical and uterine microbiome influencing risk of endometriosis. So we know that when women have dysbiosis in the vaginal cervical area, that that can be associated with more endometriosis, just like dysbiosis in the gut microbiome is associated with it as well.

9:23Dr. Mark Hyman:Yeah, fascinating. And you use a lot of big words like dysbiosis, that just means like bad bugs in the gut. Like you should have a nice, like, it's like thinking about like weeds in your garden and they do all kinds of nasty stuff. So you want good bugs, not the bad bugs. And you talk about permeability. That's what we call leaky gut where all these bad bugs and food proteins kind of leak in and then your immune system's right there and then it gets triggered and then it creates inflammation. And that means the immune system's constantly activated and that can actually influence the endometriosis.

9:56Dr. Mark Hyman:So do we have any understanding about that mechanism in which the autoimmune regulation, dysregulation from the gut directly plays a role in endometriosis? Well, there's research to show that when there's certain patterns in the gut microbiome that are associated with endometriosis and certain patterns in the gut microbiome that are associated with, or I'm sorry, imbalances in the vaginal microbiome that's associated with it, which is fascinating. We know that there's certain imbalances in the microbiome that trigger more inflammation in the body, both locally and systemically. And so we need to, you know, we're always learning more in this area.

10:36And I know there's more that we need to learn, but that, I think it's a fascinating area and something we can test for, right? We can look at the microbiome. We can look at what balance of bugs somebody has and how pro-inflammatory they are and how likely are they to produce this substance called beta-glucuronidase. And beta-glucuronidase is this enzyme that certain bugs in the gut can produce, and that will result in more estrogen being reabsorbed in the body. I think that's one reason why dysbiosis is associated, but probably not the only reason, that's for sure.

11:16Dr. Mark Hyman:Yeah, I mean, that's an interesting point. So basically, you've got these certain bugs that grow in there and they produce a certain enzyme. And normally when your estrogen is used up in your body or your liver processes it, it packages it up in a little nice package, and then it goes out into your bile and into your digestive tract and you poop it out. But when it hits this enzyme, it's almost like it unwraps the package and you reabsorb the estrogen and you get higher amounts of estrogen. So you've already got this estrogen-dependent tissue, this weird like lining of your uterus that's everywhere in your abdominal cavity, and then you're feeding it with this extra estrogen.

11:48Dr. Mark Hyman:So that's kind of an interesting framework where you can look at how the gut bacteria directly are affecting the hormone regulation, and that gives more growth of these lesions. And then, you know, the whole irritable bowel thing is all connected. And like you said, at Delta Wellness Center, we do test for these things. We test for food sensitivities. We test for the microbiome. We test for bacterial overgrowth and bad bugs in the gut through breath testing. And all of these are incredibly important to figure out what's going on because if you don't look, you won't find it. And then there's a real structured approach to actually healing the gut.

12:21Dr. Mark Hyman:So can you just kind of touch briefly on the approach that we use in functional medicine to repair the gut? Because that often can really even help things like endometriosis. Absolutely. So that 5R approach is kind of the framework for how we deal with problems with the gut and how the gut may be impacting the immune system and hormone balance. And so the first R is remove. And that means you want to remove foods that are causing a lot of inflammation. So, you know, an elimination diet or, you know, a great diet is, Mark, your 10-day detox diet because it's anti-inflammatory. It removes inflammatory foods and it also supports detoxification.

13:02And so, you know, so that type of a diet, that's part of the remove. And if there is dysbiosis, we need to treat it. And so depending on what's going on, you know, what we find, we can treat it with herbs or even prescription medication sometimes or even just things that build up the good bugs of prebiotics, which are phytonutrients and fibers and probiotics sometimes. And so that can help with rebalancing. So remove and then replace. That's, you know, if somebody needs help with digestion, re-inoculate, those are probiotics. Repair, those are things that, you know, help to heal the gut lining and rebalance.

13:42That's really just recognizing the connection between the mind-body connection, right? Really doing things to help with activating that parasympathetic nervous system and calming down the body, which helps the body with healing. So that's that 5R approach. Yeah.

13:57Dr. Mark Hyman:And it can get very granular. Like I remember learning when I first started doing functional medicine about, you know, food is medicine and certain fibers like flaxseeds, like we're a thing. And they really do affect this estrogen metabolism in the gut. And then the isoflavones and soy that doesn't act like an estrogen. It's sort of, it's not fair to say that it, but it does modulate estrogen activity and it actually can help. So you can actually eat certain foods that actually rebuild the normal health of the microbiome, but also specifically target estrogen function and estrogen metabolism, which is interesting.

14:30Those are great examples, Mark. Yeah. Because like you said, they're working from a couple of angles, right? They're feeding the good microbiome, but they're called phytoestrogens, so they can impact the estrogen receptor. And people think or used to worry that that meant they were causing more estrogen in the body. But actually, the opposite is true, right? because it decreases your own estrogen binding to the estrogen receptor, or even those xenoestrogens from binding to that estrogen receptor.

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15:36Dr. Mark Hyman:Get 160 lab tests that show you exactly where you stand with your heart, your hormones, new nutrients, toxins, metabolism, and lots more. All this insight for$365 a year at functionhealth.com. Get your data before life shifts into high gear and make sure your body is ready to move with you. We're going to get to that next. Before we jump to the toxins and the xenoestrogens, I just, you know, I just want to, you know, explain how in functional medicine we're so specific and how we think about things and how we treat people at the Ultra Wellness Center, because it's really different. If you are someone out there listening who's got menstrual issues, cramps, pain, abdominal pain, endometriosis, whether you're diagnosed or not, you know, you're going to get just the standard care, which is here, take the birth control pill or here, you know, just modulate your hormones with this or that, uh, or it will put you into premature menopause.

16:23Dr. Mark Hyman:You know, that's one of the treatments, which is terrible, I think treatment. And, and, uh, and there's some granular things we can do. For example, you mentioned this, this weird enzyme that certain bad bugs make in the gut. Well, if you, you can take an antibiotic sometimes to kill them, but you can also take a probiotic called Saccharomyces biliardae, which is a very specific probiotic that you can take that helps lower the levels of this particular enzyme in the gut and these bacteria that are producing the enzyme. So it gets very specific and very granular. And I think it's very different than what you'd get if you go to a regular OBGYN and try to say, hey, how do I deal with this endometriosis stuff I got?

16:58Dr. Mark Hyman:And that's really the point here is that there's a whole new way of thinking about treating health and disease, not just obviously endometriosis, but pretty much everything. And we're sort of agnostic to disease at the Ultra Wellness Center because it really doesn't matter what you have. We understand the underlying root causes of illness. And even if we've never seen a problem before, we can often help because we are following basic laws of nature, I call the laws of biology that we can apply across any disease. And often they'll work in surprising ways that, I mean, I just, you know, treat some of the ALS and I don't really see many ALS patients, but I was like, okay, well, here's our underlying principles and here's what we can do.

17:35Dr. Mark Hyman:And like, I just got a text from him and he's doing amazing years later, which is, you know, most people would be in a wheelchair by then. So anyway, it's just, it's really exciting to kind of talk about this because people don't really understand that there's a whole new paradigm happening in medicine and science. They're not getting when they go to traditional doctors. And that's, that's why I'm so proud of what we built at the Ultra Wellness Center. So before we go to kind of the next topic, I want to kind of get into the toxin thing. Now you mentioned xenoestrogens, and this is a big one. Xeno means foreign estrogen.

18:02Dr. Mark Hyman:So talk about this idea of estrogen metabolism, xenoestrogens, this whole theory of estrogen dominance, estrogen dysregulation. It's not just about high estrogen. It's this whole mishmash of things going on that creates all these hormonal dysregulations that we can actually do something about, but we have to understand what they are. So can you kind of unpack that for us, Liz, because I know you're really deep in on this stuff. Yeah, absolutely. So xenoestrogens are those toxins in the environment that can impact estrogen levels in the body. They can bind to the estrogen receptor. They influence how estrogen is broken down.

18:37They impact our estrogen levels in the body. And we've been learning a lot about this over the years, right? So BPA is kind of the first xenoestrogen we started to pay attention to, that hard plastic. But we know that xenoestrogens are in lots of chemicals, unfortunately, in our environment, from parabens to phthalates to dioxin, to pesticides, to herbicides, and the hard plastics like BPA. And this is something you want to try to decrease your exposure to as much as possible. But we also have to just work on supporting the body's detoxification system. We know, unfortunately, that sometimes these exposures to these xenoestrogens happened when we were in our mom's belly.

19:29So when we were a fetus or early in life. And that influences our risk of diseases later in life. And sometimes that's frustrating because you feel like, well, what can I do now? But what I always work with women on is, and all people actually, is just whatever we can do to lower our exposure and then support our body's detoxification capacity. And so that really does tie in with estrogen metabolism too, right? So because the way that we break down our estrogen and metabolize it influences how dangerous it is for our body, right? So there's certain types of metabolites of estrogen that are more potentially inflammatory in the body.

20:12And so we can influence that. That's why everybody talks about the glucosinolates or sulforaphane that are in your cruciferous vegetables because they help you. Yeah, exactly. Broccoli, broccoli sprouts, cauliflower, cabbage, Brussels sprouts. They help your body metabolize your estrogen in a healthier way, but we can measure that. And I think that can be really helpful to know why does somebody have this situation that feels like they have too much estrogen in their body and what can we do to manage that? And so we'll look at things like the beta-glucuronidase we were talking about before. We can measure toxin levels.

20:52We can look at how the body is metabolizing estrogen.

20:55Dr. Mark Hyman:Yeah, I think I want to double click on that because this is something very unusual. You know, maybe people heard about poop tests, but, you know, one of the most enlightening things I ever learned about as I was sort of studying hormone metabolism was this whole science, this body of literature that seems seemingly totally ignored by traditional gynecologists that has to do with how your estrogens are metabolized. And there's no such thing as estrogen. They're estrogens and they're all different and they all have different roles. And we can do a 24-hour urine collection and we can see all the different pathways that the estrogen is going down, kind of like a pinball machine, whether it's going down this pathway or that pathway.

21:38Dr. Mark Hyman:And there's estrogens that get produced that are very protective and are protective against cancer. Other ones that are more carcinogenic. and problematic. And there's also a whole set of genetics we can test that are around hormone metabolism and genetics that we can, so we can say, oh, you have this little kind of weak pathway here. We're going to support it in this particular way. And this is where we really talk about personalized medicine, individualized care. It's not something that you get when you go to the regular doctor. So I want people to understand that there is hope and help, but it's hard to find.

22:10Dr. Mark Hyman:And that's why I think, you know, people need to understand that there is a world of functional medicine that there are clinics like ours at the Ultra Wellness Center that do this kind of work. So let's kind of dive into the second piece. We talked about eliminating, you know, all the, you know, household cleaning products, you know, you know, your food, reducing toxic load, makeup, you know, there's a lot of ways. And the Environmental Working Group has a lot of great resources, EWG.org on, on how to actually reduce these exposures. And I'm on the board, but it's really a great resource. And the second is, um, what do you do to support your body's own detoxification pathways.

22:42Dr. Mark Hyman:You mentioned cruciferous vegetables like broccoli, cabbage, collard. What else can we do? Absolutely. So, you know, this is where we try to really increase the amount of fiber somebody has in their diet because fiber is really great for, of course, helping you have regular bowel movements. But those fibers really help bind to toxins and help your body get rid of them. We know even things like good exercise and sweating and sauna use all help your body with mobilizing toxins as well. You need to make sure you're getting enough nutrition, right? So sometimes if we're cutting back on protein or not eating enough, that can influence how well we're able to detoxify.

23:23So, you know, we're really thinking about it from a whole body perspective, you know, regular bowel movements, lots of sweating movement for lymphatic circulation and drinking sufficient water and good healthy water, right? All those things are really important.