Endometriosis as a Systems Disease: What That Really Means

Traditionally, endometriosis was thought of as a purely gynaecological condition. But modern science views it as a systems disease — meaning it involves multiple body systems: hormones, immune function, inflammation, gut and vaginal microbiomes, and even environmental exposures (Giudice et al., 2023, p. 2).

Why this matters:

• Research is shifting away from “just surgery” toward understanding how genetics, immunity, and environment interact.
• Treatment will likely need to be personalized and multi-layered — nutrition, lifestyle, medical, and sometimes surgical.
• This broader lens makes it easier to understand why symptoms vary so widely from woman to woman.
  

Diagnostics: From Surgery to Blood Tests

For decades, the only way to diagnose endometriosis was through laparoscopic surgery. This meant women endured an average 7–10 year delay before getting answers.

Now, a breakthrough: In 2023–2024, Australia adopted the world’s first blood test for endometriosis, based on microRNA biomarkers (Paterson et al., 2024, p. 6).

• It offers a non-invasive way to screen for endometriosis.
• While still in early clinical adoption, it represents a revolution in diagnostics.
• For New Zealand readers, this is highly relevant — as local health systems may soon adopt similar tests.

Other emerging tools include AI-assisted imaging and new biomarker panels (Kaspute et al., 2024, p. 2). Together, these advances may finally reduce the painful diagnostic delays that so many women endure.

Nutrition: What the Research Actually Says

Diet is not a cure — but science shows it matters. A 2024 systematic review found consistent trends (Akgun et al., 2024, p. 4):

• Protective foods: Fruits, vegetables, whole grains, and omega-3–rich foods (fish, flaxseed, walnuts).
  
• Uncertain/mixed: Dairy — some studies show benefit, others neutral.
  
• Risk-associated: High red meat intake, trans fats, and ultra-processed foods.

Takeaway: Anti-inflammatory eating patterns are not only safe but may ease symptoms. This is one area where lifestyle choices can directly support wellbeing, even while research continues.

Biomarkers and Personalised Medicine

Beyond the blood test, researchers are exploring immune markers like the neutrophil-to-lymphocyte ratio (NLR), which correlates with disease severity (Massad et al., 2024, p. 6).

Shafrir and Saunders (2024, p. 8) highlight biomarkers that may one day predict which treatments will work best for each woman — ushering in a future of precision medicine for endometriosis.

Fertility and Endometriosis

Endometriosis is a leading cause of infertility: up to 50% of women with infertility are diagnosed with it (Oskotsky et al., 2023, p. 3).

• Mechanisms: inflammation, scarring, immune dysfunction, disrupted ovarian reserve.
• Surgery to remove superficial lesions can improve fertility in mild-to-moderate cases (Paterson et al., 2024).
• IVF is still possible but may have lower success rates in severe endometriosis.

Takeaway: Endometriosis doesn’t make pregnancy impossible — but it complicates the journey. Early diagnosis and individualised treatment are crucial.

Surgery, Adhesions, and Hysterectomy

Surgery remains an important option for many, but recurrence is common. Adhesion formation after surgery can make things worse — though hyaluronic acid gels are showing promise in reducing recurrence (Adamyan et al., 2024, p. 3).

And what about hysterectomy?

• Evidence is clear: hysterectomy is not a cure (As-Sanie et al., 2025, p. 11; Timkova et al., 2025, p. 5).
  
• Endometriosis can persist even without a uterus, because lesions often live outside it.
  
• Ovarian removal reduces recurrence but comes with serious long-term health risks.

Takeaway: Hysterectomy should be seen as a last-resort option, not a first-line solution.

Environment, Microbiome, and Root Causes

The cause of endometriosis remains a mystery — but research is converging on a multifactorial explanation:

• Retrograde menstruation theory explains how tissue may move backwards into the pelvis.
  
• Immune dysfunction prevents the body from clearing ectopic tissue.
  
• Stem cell theories suggest misplaced endometrial-like cells may implant outside the uterus.
  
• Genetics & epigenetics point to strong heritability.
  
• Environmental toxins (endocrine disruptors in plastics, pesticides, cosmetics) likely contribute (Wu et al., 2024, p. 5).
  
• Microbiome research links vaginal dysbiosis and biofilms with increased gynecological risk (Machado et al., 2025, p. 9).

The truth? Endometriosis is not caused by one thing. It’s the product of genes + hormones + immune system + environment.

Funding Inequities: Cancer vs Endometriosis

Here’s where injustice is stark:

• In the EU, ovarian cancer research received ~47 times more funding than endometriosis over the last three decades, even though both cause similar disability burdens (Eckert, 2025, p. 7).
  
• In Australia, cancer receives hundreds of millions annually, while endometriosis research receives just a few million.

Takeaway: Endometriosis is chronically underfunded relative to its impact. This helps explain why progress has been so slow — and why advocacy is essential.

Hope on the Horizon

Despite decades of neglect, endometriosis research is finally catching up. With:

• Non-invasive blood tests rolling out.
  
• Clearer links between diet and symptoms.
  
• Promising tools like AI diagnostics and biomarkers.
  
• A growing recognition that it is a systems disease requiring systemic solutions.

As a health coach, I see this as both a challenge and an opportunity. The challenge: women still face years of pain and under-recognition. The opportunity: by integrating nutrition, stress reduction, early advocacy, and awareness, we can support health now while waiting for medicine to deliver better answers.

Remember: