The No Fluff Guide to Endo

20.03.2025 9 Minutes

AKA What Your Doctor Didn't Tell You (But Should Have)!

Endometriosis is more than “just bad periods.” It’s a whole-body inflammatory disease affecting the immune, nervous, gut, and reproductive systems. Yet, most people still don’t understand the reality of living with it.

At Endo45 x Hello Period, we’re cutting through the BS and breaking down real answers to the biggest questions about endo - without the misinformation or outdated medical takes. Just what’s evidence backed and practitioner supported.

So let’s get into it.👇

Q1: How Do I Know If I Have Endo?

The gold standard for diagnosis is a laparoscopy, but waiting years for surgery isn’t an option for most of us. Here’s what to look for now:

🚨 Red Flags – If you have more than one, take action!

Pain that stops you in your tracks – especially before/during periods.
Painful sex – sharp, deep pain that lingers.
Stabbing rectal pain or bowel issues – especially around your cycle.
Extreme fatigue – not just “being tired,” but full-body exhaustion.
Heavy, clotty periods – that wipe you out or lead to Anemia.
Unexplained gut issues – bloating, constipation, nausea, IBS-like symptoms.
Pain in weird places – sciatic pain, rib pain, shoulder pain that flares with your cycle.
Infertility struggles – trying for over a year with no success.

🟠 Orange Flags – Keep an eye on these symptoms:

Spotting between cycles.
Frequent UTIs or bladder issues that seem to come and go.
Migraines that flare with your period.
Skin rashes or random new allergies (endo has immune links!).

Sound familiar? It’s time to advocate for yourself. Endo is progressive - early intervention matters.

Q2: How Does Endo Mess With My Periods?

There’s a huge difference between a normal period and an endo period. If yours comes with crippling pain, nausea, heavy bleeding, and gut issues, that’s a red flag.

Endo periods are:

Wildly different for everyone – some have heavy, irregular periods, some barely bleed at all.
Period pain can be widespread – pelvis, bowels, bladder, back, even down to your legs and nerves.
Can cause cyclic gut issues – bloating, constipation, diarrhea, nausea, or "endo belly."
Migraines, dizziness & extreme fatigue – inflammation & hormone swings can wreck your energy.
Unpredictable spotting or prolonged bleeding – your cycle can be very erratic.
Pain isn’t just during your period – for some, it lingers all month long.

If your period pain is ruling your life, that’s NOT normal. You deserve to know why.

Why is endo pain so brutal?

Estrogen-sensitive lesions react to hormonal changes, triggering inflammation and making pain worse.
Endo tissue releases prostaglandins during your period, increasing cramping & nerve sensitivity.
Chronic inflammation extends pain beyond your period - for some, it’s an all-month thing.
Nerve activation - endo lesions can literally rewire pain pathways, making your body hypersensitive.

Endometriosis vs. Adenomyosis - What’s the Difference?

Endometriosis = tissue grows outside the uterus.
Adenomyosis = tissue grows INTO the uterine muscle.
Adenomysis:

Floods periods with clots as the uterus struggles to contract properly.
Causes deep, squeezing cramps - like a vice grip inside your pelvis.
Uterus physically enlarges - making you look or feel bloated.

Can you have both? Yep, many people with adenomyosis also have endo - so if your period is a nightmare mix of heavy bleeding and chronic pain, it’s worth investigating both.

Painful, heavy, irregular periods aren’t something to “just deal with.” If your doctor tells you it’s “just part of being a woman”, fire them and find someone who actually understands endo.

Q3: How Do I Get Diagnosed?

Endometriosis diagnosis is oftne a maze, not a straight line. Most people wait years for answers, jumping between doctors, before finally getting a diagnosis. Here's how the tests work - and what to watch out for.

Navigating Ultrasounds

A pelvic ultrasound is often the first stop in the endo-detection journey. But here’s the truth: While it’s great at ruling out fibroids, cysts, or other masses, it’s not definitive for endometriosis. A "normal" ultrasound result does NOT mean you don’t have endo.

Transvaginal Ultrasound (TVUS) – A Closer Look

How it works: A slim probe is inserted into the vagina to provide high-resolution imaging of the pelvic organs.
What it detects:

Endometriomas (ovarian cysts caused by endo).
Deep infiltrating endo (D.I.E.) in the bowel, bladder, or uterosacral ligaments - but only if done by an expert.
Limitations: Can miss superficial endo, adhesions, and smaller lesions.

Dynamic Endometriosis Scan (DEC) – The Advanced Option

How it works: Assesses organ mobility and tissue interactions, which can indicate scar tissue and adhesions.
What it detects:

Endometriomas & D.I.E.
Adhesions (which can’t be seen on standard ultrasounds).
Limitations: Not widely available - requires a highly skilled sonographer.

Before accepting a “no endo” result, ask:

Was the scan done by a specialist in endometriosis imaging?
Was it reviewed by an experienced radiologist?
Would a second opinion or referral be beneficial?

Beyond Ultrasounds: Next-Level Diagnostic Tools

MRI – A Deeper Look

When to consider: If ultrasounds are inconclusive or you need a non-invasive option.
What it detects:

Deep infiltrating endo in hard-to-see areas (bowel, diaphragm).
Signs of adhesions, such as “fat stranding” or “loss of fat planes.”

Limitations:

Doesn’t detect superficial endo.
Lacks the real-time, dynamic assessment that a DEC scan provides.

A negative MRI doesn’t rule out endo - it just means you might need better imaging or a skilled interpreter.

Laparoscopy: The Gold Standard for Diagnosis

If you need definitive answers, laparoscopic surgery is currently the only way to get them.

How it works:
A tiny camera is inserted into the abdomen through small incisions to visualise and biopsy endometriosis tissue.

Strengths:

Can provide a definitive diagnosis (if performed by an expert).
Allows for simultaneous excision of lesions - so if it’s there, it can be removed in the same procedure.

Limitations:

Requires anesthesia & carries risks (scarring, complications).
Not all surgeons are skilled in full excision - some may only "burn off" lesions, leaving disease behind.

Before undergoing a laparoscopy, ask your surgeon:

Will lesions be left in place? (If yes, you may need a second surgery.)
Will lesions be removed completely? (Incomplete removal = recurrence.)
Is the surgeon a specialist in endometriosis excision? (A single, well-planned surgery gives the best outcome.)

What’s on the Diagnostic Horizon?

Endometriosis remains notoriously hard to diagnose - but that’s starting to change. New advancements could eliminate years of misdiagnoses and give people answers sooner.

The most promising breakthrough for NZ & Australia?

Biomarker Testing in Blood – Identifying proteins linked to endo through advanced proteomics studies already underway. This could mean earlier, non-invasive diagnosis.

Diagnosing endometriosis shouldn’t take years, but the system still has gaps. If one test doesn’t provide answers, keep pushing. A negative scan doesn’t mean nothing is wrong - it just means you need a better tool or a better-trained expert.

Q4: What Can I Do to Help My Symptoms?

Doctors love prescribing painkillers, the Pill, or surgery - but what else actually helps? Here’s where to start:

1️⃣ Remove Controllable Stressors

Stress fuels endo like petrol on fire. Chronic stress ramps up pain & inflammation, making symptoms worse.

Biggest endo stressors:

Caffeine – Spikes cortisol & estrogen.
Alcohol – Blocks liver detox, raises estrogen.
HIIT workouts – Overstresses your nervous system.

Swap for: Decaf or matcha, lower-impact movement (walking, yoga), and gut-friendly drinks.

2️⃣ Balance What You Can’t Control (Hack Your Nervous System)

If quitting your job and moving to a stress-free paradise isn’t an option (we wish 🙃), try Vagus Nerve Activation to reset your fight-or-flight mode.

Quick hacks to calm the endo-farm:

Deep belly breathing (5 mins)
Mediation (ideally unguided)
Singing, humming, or gargling (stimulates vagal tone)
Slow, mindful movement (walking, stretching, yoga)

3️⃣ Give Your Body What It Needs (Test, Don’t Guess!)

Chronic inflammation + fatigue? You’re probably low in key endo-nutrients.

Get these tested & supplement wisely:

Zinc – Regulates immunity, hormones and brian fog.
Iron – Prevents anemia & crushing fatigue.
B12 & Folate – Essential for energy and hormone balance.
Magnesium – Calms nervous system and reduces cramps.
Vitamin D – A powerhouse anti-inflammatory.

If you’re running on empty, no amount of “pushing through” will fix it.

4️⃣ Heal Your Gut (Because Endo & Gut Health Are BFFs)

Gut health is everything when it comes to endo. A flourishing digestive system = superhero immune system with detox superpowers.

Eat more:

Leafy greens (spinach, kale)
Cruciferous veg (broccoli, brussels sprouts)
Nuts & seeds (chia, flaxseeds, walnuts)
Fermented foods (kimchi, sauerkraut, coconut yogurt)

The worst gut destroyers? Alcohol, processed meat and packaged food, A1 milk protein (for some), and low-plant diets and unchewed food!

5️⃣ Ditch Endocrine Disruptors (Your Body Will Thank You)

Endocrine Disrupting Chemicals (EDCs) mess with your hormones and are linked to endo creation and fuel growth.

Hidden in plain sight you’ll want to ditch:

Plastic food containers & water bottles
Scented candles, perfumes, & most beauty products
And switch those non-organic tampons to reusable period products

Swap for: Glass or stainless containers, fragrance-free, organic or MADE SAFE products, filtered water and organic food when possible.

Q5: Why Me? The Precursors to Endometriosis

Endometriosis is a perfect storm of genetics, immune dysfunction, inflammation, and environmental triggers. Some people have endometrial-like cells in their body that stay dormant. Others? Those cells turn into rouge ‘endo-like’ invaders.

How do ‘endo-like’ cells turn into endometriosis?

These cells have a heightened response to estrogen, causing uncontrolled growth.
They also show progesterone resistance, meaning they don’t slow down like normal endometrial cells should.
They evade cell death and trick the immune system into not destroying them.
They can self-heal, making them almost immortal.
They can move, spread, and infiltrate tiny spaces - which explains why adenomyosis occurs within the uterine wall.

And then, your immune system is supposed to clear these rogue cells out - but instead, it lets them thrive. Confused it supplys them with oxygen and blood supply, allowing them to grow into endometriosis lesions. Then when it does wake up and start fighting back, it’s inflammatory attack leads to scar tissue, adhesions, and more pain.

What causes cells to go ‘endo-like’?

When the body is under constant attack from toxins, stress, poor gut health, and environmental triggers, it creates the perfect conditions for endo to grow.

Epigenetics: Some people inherit endo-related gene mutations, like BCL6, which causes progesterone resistance, and NPSR1, which is linked to pain and inflammation. But genes alone don’t cause endo - they need an environmental trigger to activate them.
Toxins: Common toxins like dioxins, BPA, and phthalates (found in plastics, food packaging, and personal care products) increase estrogen dominance, block normal cell death, and trigger chronic inflammation, making it easier for endo cells to take hold and spread.
Endotoxins: When bacterial endotoxins leak from your gut into the bloodstream, triggering immune dysfunction and chronic inflammation, which encourages cells to become ‘endo-like’.
Inflammatory Lifestyle: A high-stress, inflammatory lifestyle - poor diet, sleep deprivation, alcohol, and chronic stress - can increase estrogen production by up to 48 times, spike cortisol (keeping you in survival mode), and trigger oxidative stress, making endo lesions more aggressive.

Translation? Endo thrives when the body is inflamed, overloaded with toxins, and the immune system is hijacked by everything life throws at us. Understanding what systems are in the driver's seat can help you take control.

So… Why Me?

Endo isn’t random. It’s the result of genetics, inflammation, immune dysfunction, and environmental triggers all colliding.

If you have a genetic predisposition, your lifestyle and environment determine if endo takes hold.
If you live in a high-toxin, high-stress world (like we all do), you’re creating the perfect endo storm.
If your immune system is struggling, it won’t recognise and fight off rogue endo-like cells.

Endo isn’t your fault - but understanding your unique root causes helps you take back control.

Want to reduce inflammation and get ahead of endo? Start by fixing your gut, balancing stress, and cutting out unnecessary toxins.

Stop Just Surviving. It’s Time to Thrive.

Endo isn’t just about managing pain - it’s about taking back control. No more outdated, one-size-fits-all approaches. You deserve real answers and real solutions.

Want expert-backed tools at your fingertips?

Endo45 gives you:
✅ Evidence-based strategies for real relief.
✅ Symptom tracking to pinpoint triggers & trends.
✅ A roadmap from Endo Warrior to Endo Thriver.

Endo45 gets you EndoFit™ - where endo is understood, under control and YOU are unstoppable.

📢 Join the movement. Take control. Let’s change the endo game.

📲 DOWNLOAD ENDO45 NOW

For article references please see https://www.endo45.co.nz/references