Endometriosis is a complex condition where tissue similar to the lining of the uterus grows outside of it, often causing pain, inflammation, and, in some cases, fertility challenges. It affects millions of women worldwide, yet key questions about its cause and classification remain—one of the most common being: Is endometriosis an autoimmune disease?
Currently, endometriosis is not classified as an autoimmune condition. Autoimmune diseases occur when the immune system mistakenly attacks the body’s own healthy tissue. While endometriosis shares some features with autoimmune disorders, like chronic inflammation and immune system dysfunction, researchers haven’t confirmed a direct autoimmune mechanism.
That said, the immune system likely plays a role. Ongoing studies suggest that immune dysregulation may contribute to the development or progression of endometriosis, and this area of research is growing.
Why Endometriosis Isn't Classified as an Autoimmune Disease
Endometriosis shares several features with autoimmune diseases, but it isn’t currently classified as one. While immune dysfunction clearly plays a role, it doesn’t meet all the criteria that define autoimmune conditions.
In autoimmune diseases, the body produces antibodies that directly attack healthy tissue. In endometriosis, the immune system doesn’t seem to attack the body—it simply fails to recognize and remove tissue growing in places it shouldn’t. The result is a kind of immune passivity, not aggression.
How Endometriosis Differs From Typical Autoimmune Disorders
Autoimmune conditions like lupus or rheumatoid arthritis are marked by:
- Specific autoantibodies targeting the body’s own proteins
- Systemic inflammation affecting multiple organs
- Predictable patterns of immune activation and flare-ups
Endometriosis, on the other hand:
- Doesn’t involve known autoantibodies
- Causes localized inflammation, typically around endometrial implants
- Involves immune suppression or dysfunction, not active immune attack
These differences help explain why endometriosis falls outside the autoimmune category, even though the immune system is clearly involved.
The Role of the Immune System for Endometriosis Patients
Research shows that there is a link between endometriosis and altered immune responses. Natural killer (NK) cells—which normally help clear abnormal tissue—don’t function as effectively. Inflammatory molecules like cytokines and growth factors are often elevated, creating an environment where endometrial implants can grow and persist.
This immune imbalance is one reason endometriosis can be so persistent and hard to treat. It also helps explain why anti-inflammatory strategies are increasingly being used alongside hormone therapy.
What This Means for Treatment
Hormonal therapies remain a mainstay of treatment, but immune-targeted approaches are gaining ground.
For example, medications like Orilissa reduce estrogen levels, which can help calm immune-related inflammation. Some clinics are also exploring immune-modulating therapies as part of a broader care strategy.
Understanding the immune component of endometriosis doesn’t change the diagnosis, but it may help guide more effective treatment plans, especially for those who don’t respond well to hormones alone.
Autoimmune-Like Features in Endometriosis Tissue
Endometriosis tissue doesn’t just grow in the wrong places—it also behaves abnormally. Under the microscope, this tissue shows signs that resemble autoimmune activity: chronic inflammation, immune cell infiltration, and elevated inflammatory markers.
Endometrial implants interact with the immune system in ways that suggest active immune dysfunction. Instead of being cleared, the tissue releases signals that confuse or misdirect immune cells. This breakdown in immune surveillance allows the tissue to persist and spread.
Researchers have found that:
- Inflammatory proteins like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are often elevated in endometriosis tissue, markers also seen in autoimmune conditions.
- Signs of oxidative stress are common, further fueling inflammation. This may help explain why antioxidant-based therapies sometimes offer symptom relief.
Immune Abnormalities Beyond the Pelvis
Although endometriosis isn’t classified as an autoimmune disease, the immune system does behave differently in many patients. Some develop antibodies against endometrial tissue, though these aren't the same autoantibodies used to diagnose classic autoimmune diseases.
Studies have also identified:
- Altered B-cell and T-cell responses, which may enable the survival of misplaced tissue.
- Changes in regulatory T-cells—important for preventing overactive immune responses—suggest a broader immune imbalance.
- Systemic immune changes detectable through blood work, reinforcing the idea that endometriosis affects more than just the pelvic region.
Chronic Inflammation
Inflammation plays a central role in endometriosis. It contributes directly to symptoms like pelvic pain, fatigue, and bloating, and it helps drive disease progression by supporting tissue growth and scarring.
The inflammatory response:
- Promotes nerve growth, which can increase pain sensitivity.
- Damages surrounding tissues and contributes to the formation of adhesions and scar tissue.
- Creates a cycle that fuels further inflammation and endometrial implant survival.
Managing inflammation is a key part of treatment. NSAIDs (like ibuprofen or naproxen) help many women, while hormone therapies and newer medications may target specific inflammatory pathways.
Some patients also explore anti-inflammatory diets or supplements, though the effectiveness of these varies from person to person.
The Connection Between Endometriosis and Autoimmune Disorders
Women with endometriosis are more likely to develop autoimmune diseases than the general population. This isn’t just a coincidence—research suggests overlapping genetic and immune system factors that may predispose individuals to both.
Dr. Jackie Wong explains how endometriosis is linked to higher rates of conditions like inflammatory bowel disease (IBD), celiac disease, multiple sclerosis (MS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA).
While the risk increase isn’t dramatic, it’s consistent enough that clinicians now consider it in long-term care plans.
Why These Conditions Overlap
There are a few possible reasons for this connection:
- Shared genetic variants: Certain genes seem to increase susceptibility to both endometriosis and autoimmune diseases.
- Chronic inflammation: The persistent inflammation seen in endometriosis may prime the immune system for broader dysfunction.
- Hormonal and environmental triggers: Stress, infections, and hormone fluctuations may contribute to disease onset in genetically predisposed individuals.
This overlap has clinical implications. For example, some leading endometriosis centers now screen for autoimmune markers and symptoms as part of routine evaluation and care.
Endometriosis and Specific Autoimmune Conditions
Inflammatory Bowel Disease (IBD)
Endometriosis and IBD—particularly Crohn’s disease and ulcerative colitis—often coexist. Both involve chronic inflammation and may cause overlapping symptoms like abdominal pain, bloating, and irregular bowel habits. Distinguishing between the two is essential, especially since treatments can interact. Coordinated care between gynecologists and gastroenterologists is usually necessary.
Lupus (Systemic Lupus Erythematosus or SLE)
SLE and endometriosis share immune irregularities and hormonal influences. Fatigue, joint pain, and systemic inflammation are common in both. Hormonal treatments used in endometriosis, such as estrogen-based therapies, must be carefully managed in patients with lupus, as they may increase flare risk.
Rheumatoid Arthritis (RA)
RA and endometriosis both involve inflammatory processes, though they affect different tissues. Some women with endometriosis experience joint pain unrelated to RA, while others develop true inflammatory arthritis. Accurate diagnosis is essential, especially since some endometriosis medications can influence joint symptoms.
Celiac Disease
Celiac disease occurs more frequently in women with endometriosis. Both conditions involve immune dysregulation, and some patients report symptom improvement in both after adopting a gluten-free diet. While dietary changes aren’t a cure, they may help manage inflammation in some individuals.
Multiple Sclerosis (MS)
Though the link between MS and endometriosis is still being studied, some patterns are emerging. Both conditions involve immune dysfunction and disproportionately affect women. In cases where both are present, managing immune triggers and coordinating care across specialties is especially important.
What This Means for Ongoing Care
If you have endometriosis, it’s worth being aware of the potential for overlapping autoimmune conditions. That doesn’t mean you’ll develop one, but recognizing symptoms early can lead to faster diagnosis and more effective treatment.
Clinicians increasingly recommend a whole-body approach to care. That may include periodic screening for autoimmune markers, tailored medication strategies, and closer collaboration between specialists.
Rethinking Endometriosis Through an Immune Lens
Endometriosis research is evolving. What was once considered a strictly gynecological condition is now understood to involve systemic immune dysfunction. That shift is reshaping how researchers approach diagnosis, treatment, and long-term care.
Advances in genetics and immune profiling are helping explain why some women develop endometriosis while others don’t. Women's health researchers now focus on identifying specific immune patterns that could lead to earlier and more accurate diagnoses, without the need for invasive procedures.
Global collaboration is a key part of this progress. Research institutions are pooling data to uncover patterns that smaller studies may miss. These partnerships are accelerating discoveries that could directly improve care.
Historically, endometriosis has been underfunded relative to other conditions affecting similar numbers of people. That’s beginning to change, thanks to sustained advocacy and patient-led campaigns. Increased funding is allowing researchers to explore the immune system’s role in endometriosis more deeply, and with better tools for a more accurate understanding.
Why Ongoing Monitoring Matters
When endometriosis is understood as a condition involving the immune system, routine monitoring becomes more important. Care shouldn’t stop at managing pelvic symptoms.
- Autoimmune screening: Simple blood tests can detect early signs of related autoimmune conditions like thyroid disease or rheumatoid arthritis. These are common in women with endometriosis and can be easier to manage when caught early.
- Mental health: Chronic pain and immune dysfunction can affect mood, memory, and concentration. Regular mental health check-ins should be part of comprehensive care.
Where Reproductive Health Research Is Headed
Researchers are focused on tailoring treatment to each individual to improve patient outcomes. Immune profiling may soon help predict which therapies will be most effective for a particular patient, reducing the need for trial-and-error treatment plans.
Another area of focus is the development of non-invasive diagnostics. Scientists are working to identify biomarkers—immune-related signals in blood or urine—that could diagnose endometriosis without surgery. These tools are still in development, but early results are encouraging.
New treatments are also on the horizon. Instead of broadly suppressing hormones or inflammation, future therapies may target the specific immune pathways involved in endometriosis. Early trials suggest these targeted treatments may offer relief with fewer side effects.
What the Latest Research Means for Women's Health Issues and Autoimmune Risk
The question of whether endometriosis is an autoimmune disease doesn’t have a simple answer. While it doesn’t meet all the criteria for classic autoimmune conditions, it does involve significant immune dysfunction. That connection is changing how the medical community understands, diagnoses, and treats the condition.
For many women, this research confirms what their symptoms have long suggested: endometriosis affects more than just the reproductive system. Its links to systemic inflammation and autoimmune risk point to the need for broader, more integrated care, not just symptom management.
Recent advances in immune research are starting to reshape treatment options. Targeted therapies focused on immune pathways may improve symptom control while reducing side effects. Less invasive diagnostic tools are also in development. Together, these innovations have the potential to improve patient outcomes and reduce time to diagnosis.
As research continues, the goal is simple: better tools, better treatments, and better outcomes for women living with endometriosis.
You deserve health information you can trust. Join Roon and connect with vetted experts, not internet opinions.
Frequently Asked Questions (FAQ):
What autoimmune disease is associated with endometriosis?
Women with endometriosis are at higher risk for autoimmune conditions like rheumatoid arthritis, lupus, and multiple sclerosis.
What type of disease is endometriosis?
Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus. It can cause pain, scarring, and fertility problems.
What are the top 3 autoimmune diseases?
Rheumatoid arthritis, lupus, and type 1 diabetes are among the most commonly recognized autoimmune conditions.
Does endometriosis affect your immune system?
Yes, endometriosis can affect the immune system by causing immune system imbalances and is linked with an increased risk of autoimmune diseases.
