A naturopath's update on period pain, endometriosis and the gut

Simone Jeffries B HSc. (Naturopathy) | Manly, Sydney Northern Beaches | Blog updated February 2026

Severe pain with your period? You might have endometriosis.

Endometriosis was first recognised and described 300 years ago, but it remains significantly under diagnosed and under researched. According to Endometriosis Australia (2023), around 1 in 7 Australian women are estimated to have the condition – and the average time between first symptoms and a confirmed diagnosis is still 6 to 8 years (AIHW, 2023).

Part of that delay in diagnosis is because period pain has long been normalised and dismissed. But a significant part is also practical: confirming endometriosis requires a laparoscopy, which is a surgical procedure. For many women, particularly younger women, this isn’t accessible because of cost, the invasiveness of the procedure, or because their pain hasn’t been considered severe enough to warrant surgery. Many women live with endometriosis symptoms for years before anyone suggests a formal investigation.

If you’ve found your way to this blog, you may already have a diagnosis – or you may be in that in-between space of strong suspicion but no confirmed answer yet. Both are completely valid starting points for naturopathic support.

In recent years, research into endometriosis has shifted considerably. We now have a much clearer understanding of what drives the disease at a biological level, and that opens up more targeted approaches to managing it. This blog covers what I discuss with my clients when we’re looking at endometriosis together.

A note before we begin: naturopathic support works best alongside your GP, gynaecologist, or pelvic physiotherapist, not instead of them. I’ll say more about that at the end. it has been an under undiagnosed and under researched female inflammatory condition since then. Until now.

Fortunately, a few new areas of research are shedding some light on how naturopaths can best support women with endometriosis to reduce pain levels and improve their fertility.

Endometriosis is an extremely painful reproductive condition

If this is your first time reading about endometriosis, here is a simplified explanation of what’s happening in the body.

Endometriosis is a condition where tissue similar to the lining of the uterus grows in places outside the uterus. This most commonly happens in the pelvis – on or around the ovaries, fallopian tubes, bladder, and bowel. Each month, this tissue responds to your hormones in a similar way to the uterine lining: it thickens, then breaks down. But because it has nowhere to leave the body, it causes localised inflammation, and over time, scarring and adhesions (where tissues stick together).

Common symptoms include:

• Painful periods, sometimes severe

• Pelvic pain outside of menstruation

• Pain during or after sex

• Painful bowel movements or urination, particularly around your period

• Bloating, fatigue, and digestive symptoms

What's normal period pain?

1.5% of hospitalisations of women of reproductive age are related to endometriosis. These statistics tell us that this relatively unknown condition is quite widespread. In my clinic I see women from the ages of 16 to 46 who are seeking relief from endometriosis, either because they don't want to continue to experience pain, or because they are hoping to fall pregnant in the near future.

Most women agree that period pain is uncomfortable or even painful. Many women with endometriosis suffer with their pain for a long time without seeking help because our society has normalised period pain. I have previously written a blog to discuss the type of period pain that is normal, and what is considered severe, so please refer to this as a starting point if you're wondering if you might have endometriosis.

However, pain levels don’t always reflect how extensive the endometriosis is. Some women with significant disease have mild symptoms. Others with minimal visible tissue have severe pain. This inconsistency is one of the reasons diagnosis is so often delayed, and it’s one reason pain alone isn’t a reliable measure of how your treatment is progressing.

New research and it's impact on the way I support women with endometriosis:

There is still so much research to be done on endometriosis before we can understand exactly what causes it and why some women get it and others don't. In the past the focus of naturopathic support has been on pain management and tissue healing, however due to exciting recent studies, our options for working with women with endometriosis have expanded.

For a long time, endometriosis was largely understood as a hormonal condition – driven by estrogen, managed by suppressing it. The picture is now understood to be much more complex. Naturopathic doctor and author Lara Briden, who has worked with endometriosis patients for over 25 years, describes it this way: endometriosis is an inflammatory disease that’s affected by hormones, but it is not caused by hormones. At its core, it appears to be a disease of immune dysfunction.

There are several interconnected drivers. Below I’ve summarised the ones I discuss with my clients, and which I find the most relevant in our work together.

1. Endometriosis, the gut, the microbiome, and a toxin called LPS

In my clinical experience, gut health is the first thing I focus on when working with endometriosis. As naturopathic doctor Lara Briden puts it: step one is to fix the digestion. Everything else builds from there.

Research has identified a bacterial toxin called lipopolysaccharide - or LPS for short – as a possible contributing factor in the immune dysfunction that drives endometriosis. LPS is produced by certain bacteria in the gut and reproductive tract, and in the presence of estrogen, it appears to activate a type of immune cell in the pelvis in a way that worsens endometriosis.

In plain terms: when there is bacterial imbalance in the gut or vaginal tract, the toxins those bacteria produce can make their way into the pelvis and trigger an immune reaction that worsens endometriosis.

Where does this bacterial imbalance come from? Two pathways have been identified in recent research. The first is dysbiosis of the vaginal microbiome – a disruption to the normal bacterial balance in the vagina, which can allow problematic bacteria to migrate upward into the uterus. The second is via the gut, where increased intestinal permeability (sometimes called leaky gut) allows bacterial toxins to pass through the gut wall and into the bloodstream.

For a long time, the association between endometriosis and gut symptoms was assumed to run one way: that endometriosis causes digestive problems. But research now suggests it may also work in the other direction, with gut dysbiosis and intestinal permeability driving or worsening endometriosis.

Women with endometriosis are significantly more likely to have SIBO (small intestinal bacterial overgrowth) or IBS (irritable bowel syndrome). SIBO is a condition where bacteria that should be further down the digestive tract grow in the small intestine, causing bloating and irregular bowels, and according to recent research may also produce LPS that contributes to inflammation elsewhere in the body, including the pelvis.

To identify what’s actually happening in the gut, I use a stool test called the GI Map. This gives me specific, measurable data on the types and levels of bacteria present, intestinal permeability, and markers of gut inflammation. Where SIBO is suspected, I also use SIBO breath testing.

A study published in 2018 found the menstrual blood of women with endometriosis had more E.coli than women without endometriosis and suggested that the bacteria may have translocated from the gut to the pelvis. The study also found that the protective vaginal bacteria Lactobacillus was reduced in women with endometriosis.

Where there are signs of vaginal dysbiosis – particularly reduced Lactobacillus levels – I also use a vaginal microbiome panel. These tests tell me which bacteria are overgrown or missing, so I can select the right herbal antimicrobials, probiotics, and dietary changes for your particular situation.

I was trained in SIBO assessment and management by Dr Nirala Jacobi, one of Australia’s leading SIBO practitioners, and in vaginal microbiome health by Dr Moira Bradfield. I also currently consult at the My Vagina clinic alongside naturopath Jessica Lloyd – now in my fifth year there – which gives me ongoing, hands-on clinical experience in vaginal microbiome analysis and working with pelvic pain, that directly informs how I approach endometriosis.

2. The immune system is involved in endometriosis

Supporting a healthy immune system is now one of our primary aims when trying to improve endometriosis.

In most women, retrograde menstruation – where menstrual blood flows back through the fallopian tubes into the pelvic cavity – occurs without issue. The immune system quietly clears the displaced tissue. In women with endometriosis, this clearance may not happen effectively. Researchers have been working to understand why.

A 2018 study published in Japan found that immune dysfunction is likely central to how endometriosis establishes and progresses. There is also a meaningful genetic overlap between endometriosis and autoimmune conditions such as coeliac disease, rheumatoid arthritis, inflammatory bowel disease, and autoimmune thyroid disease. This suggests a shared underlying pattern in immune regulation, rather than endometriosis being a purely reproductive condition.

This discovery means dietary and lifestyle strategies that help with autoimmune conditions may also have a place in managing endometriosis. In my consultations, I look at what might be provoking immune activation – food intolerances, gut dysbiosis, leaky gut, bacterial toxins – and address those directly.

I mix up individualised herbal remedies for each client to support your immune system and the factors that might be driving immune system activation.

3. Estrogen and progesterone - the role of hormones in endometriosis

Estrogen stimulates endometrial tissue. The higher your estrogen levels, the more actively the endometrial tissue outside the uterus can grow and cause inflammation. For women with endometriosis, elevated estrogen generally means heavier, more painful periods.

For women in perimenopause: as progesterone naturally declines relative to estrogen in the early stages of perimenopause, endometriosis can flare. If your symptoms have worsened in your 40s, this hormonal shift is worth exploring further. You can read more in my Ultimate Guide to a Natural Perimenopause.

As a naturopath, I look at supporting estrogen clearance through the liver and bowel (regular daily bowel motions matter here – constipation allows estrogen to be reabsorbed rather than excreted), reducing estrogen-stimulating triggers such as endocrine-disrupting chemicals found in certain plastics and synthetic fragrances, and supporting progesterone through herbal medicine where appropriate.

Histamine is also worth knowing about here. Histamine – a compound involved in immune responses and also found in many foods – stimulates estrogen production. Estrogen in turn promotes histamine release. For some women with endometriosis, this loop contributes to symptoms worsening around ovulation or in the week before their period. I have written a separate blog about the estrogen-histamine connection if you want to read more about this.

4. Food intolerances and dietary triggers

Because endometriosis shares features with autoimmune conditions, it can respond to dietary approaches commonly used in autoimmune management. The two dietary proteins most frequently associated with endometriosis are:

Dairy: Removing dairy is often the first dietary change I suggest. Many women I work with have long suspected dairy doesn’t agree with them, and removing it can be a useful first step.

Gluten: Gluten can increase intestinal permeability, which as discussed above may be a contributing factor in endometriosis. If you’re thinking about removing gluten, it’s worth having a coeliac test with your GP first. You need to be eating gluten for the test to give an accurate result, and knowing whether you have coeliac disease changes how strictly gluten needs to be avoided going forward.

When you work with me, we can make dietary changes at a pace that feels manageable to you – with the aim of embracing an anti-inflammatory style of eating over time.

5. Nickel allergies are a risk factor for endometriosis

A large study conducted over 11 years with approximately 5,000 female participants in South Korea found that nickel allergy is a statistically significant risk factor for endometriosis. Lara Briden also highlights this finding in her clinical framework, noting it as evidence of a shared immune pattern – the same underlying immune vulnerability that makes a woman reactive to nickel may also be relevant to endometriosis.

Nickel is found in jewellery, some skin and body care products, and a range of foods. I now ask routinely about reactions to metal jewellery or belt buckles. If there’s a pattern, reducing dietary nickel and reviewing personal care products is a sensible step.

What to expect when we work together

When I work with a client who has endometriosis – whether they have a formal diagnosis or are working from a strong clinical picture – I’m looking at the full picture: gut health, vaginal microbiome, hormonal balance, immune function, histamine, and dietary triggers. The aim is to understand which of these drivers is most active for you, and to address them directly.

Advanced gut and vaginal microbiome testing is central to my work with endometriosis clients. The GI Map gives me specific data on gut dysbiosis, intestinal permeability, and inflammation markers. The vaginal microbiome panel tells me about Lactobacillus levels and the presence of problematic bacteria. From there, I can be precise about which herbal antimicrobials, probiotics, and dietary changes are most likely to help you specifically.

Every herbal formula I prescribe is individually designed and formulated – a liquid blend made for you based on your test results and symptom picture. This is quite different from a standard off-the-shelf supplement protocol.

It’s also worth being realistic about timelines. Endometriosis is a complex, long-term condition and naturopathic support is not a quick fix. In my experience, it takes around 6 months to start joining all the dots and seeing meaningful improvements. But along the way, there are often earlier wins – gut symptoms, bloating, irregular bowels, and vaginal symptoms can all improve as we address the underlying bacterial and digestive drivers, and that itself can have a significant impact on quality of life.

I encourage all my endometriosis clients to be working with their GP, gynaecologist, and pelvic physiotherapist alongside our work together. Naturopathic support is one piece of a broader picture, and I find the best outcomes come when women have good medical support in place as well.

Client experience

“I started seeing Simone after practically giving up on hope. I had seen over 30 different Western and natural practitioners over the span of 8 years. I lived with debilitating daily pelvic pain secondary to endometriosis. Within 4 months of seeing Simone my life had completely changed. My gut health has improved drastically and I can now include a much wider range of foods. My pelvic pain and period pain have improved drastically as well. I now have periods with practically no pain and no longer need anti-inflammatories. I recommend Simone to every woman I come across who is struggling with similar issues. The gut and vaginal microbiome tests were so worth it. I am forever grateful for her help.” 

- Phoebe, endometriosis client

“Endometriosis has multiple underlying drivers. Addressing the gut, the microbiome, estrogen clearance, and immune function in a coordinated way is where I see the most meaningful and lasting improvements for my clients.”

- Simone Jeffries, Naturopath (BHSc), Sydney Northern Beaches

Let's work together!

If you have endometriosis – or suspect you might – and want to explore the gut, microbiome, and hormonal drivers covered in this blog, a consultation is a good place to start. We can go through your history, talk about whether testing is appropriate, and put together a plan that’s specific to you.

I consult in person at my clinic in Manly on Sydney’s Northern Beaches, and via telehealth across Australia.

Book a consultation here.

Simone :)

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Hi! I'm Simone Jeffries. I am a naturopath, nutritionist, herbalist and certified wellness coach. I am also a foodie and an advocate for a whole food diet.

I love to support you with hormonal conditions, histamine intolerance and vaginal imbalances.

I welcome clients to consult with me at my clinic in Manly on Sydney's Northern Beaches, and online from anywhere in Australia.

The information in this blog is from my Bachelor of Health Science degree, experience from working with women in my clinic, and continuing research.

This blog is for information only and not intended to take the place of medical advice. Please seek assistance for any medical concerns.

References and further reading

Endometriosis Australia (2023). About Endometriosis. endometriosisaustralia.org

Australian Institute of Health and Welfare (2023). Endometriosis in Australia 2023. aihw.gov.au

Briden, L. (2024). Endometriosis podcast and practitioner framework. larabriden.com

Kobayashi H et al. (2018). A role of lipopolysaccharide (LPS) in endometriosis. Journal of Reproductive Immunology.

Moradi et al. (2022). Endometriosis-associated Symptoms and Diagnostic Delay. Journal of Obstetrics, Gynecology and Cancer Research.

Kim et al. (2015). Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study.