Hidden Hormone Imbalances That Make Endometriosis Symptoms Worse

If you have endometriosis and feel like your hormones are completely out of control, you're not imagining it.

Maybe your doctor looked at your labs and said everything's "normal." Maybe you tried birth control, hoping for relief, and got almost nothing. 

Maybe you're doing everything right… eating well, resting when you can, following all the wellness advice to balance your hormones… and still, the pain, bloating, fatigue, mood swings, and unpredictable cycles run your life.

Here's the truth almost no one tells you…

Hormone imbalances don't cause endometriosis, but they absolutely can influence how intense your symptoms feel. And the hormone imbalances driving your pain? They rarely show up on basic labs., because let’s be real, more often than not, this is what your doctor is ordering for you.

And they’re often not viewed through 

Let me walk you through the ones I see over and over in the endo world—and why they matter so much.

First, let's clear up a myth: Endo is not a hormone problem or a reproductive disease.

Endometriosis is inflammatory. It's immune-driven. It affects your gut, your nervous system, your detox organs, your minerals, your blood sugar, your whole life.

Hormones don't cause endo. But they can amplify the inflammation, the pain, the flares.

Think of hormones as the fuel that can turn the fire up—or down.

1. Poor estrogen metabolism (aka why "estrogen dominance" isn't the full story)

This is one of the most misunderstood pieces of endo care.

Having estrogen isn't the issue (unless it truly is in excess). The real problem is when your body struggles to break it down and clear it out via your liver / bile / poops.

If your liver is overloaded, if your gut is inflamed, has a lot of gut bacteria that makes it harder to clear estrogen from your gut (this is why I LOVE running GI maps on my clients) or if you're constipated, this means estrogen can hang around longer than it should. And that can make your symptoms feel worse.

You might notice heavy bleeding, clotting, intense PMS, bloating that won't quit, migraines, breast tenderness, or maybe your only symptoms is unexplained infertility.

But when you can support how your body regulates estrogen, you can improve your symptoms!

2. Low progesterone

Inflammation, stress, nutrient deficiencies, chronic pain, or nearing perimenopause—they can all disrupt ovulation or lead to low levels of it. And when you're not ovulating consistently, progesterone stays low. Cortisol and progesterone are made from the same building blocks, so during times of stress, your body is hunting resources away from progesterone production to cortisol. 

This can worsen how we feel because progesterone helps us counteract symptoms of estrogen dominance. Because estrogen dominance doesn’t just mean high estrogen. It can also mean you have normal estrogen levels and low progesterone.

Low progesterone can look like: spotting before your period, irregular cycles, anxiety that comes out of nowhere, trouble sleeping, painful periods, mood swings that feel impossible to manage.

Progesterone is calming for the body too, meaning it can help with mood and sleep.  When it's low, everything feels harder. Unless you are someone who is progesterone intolerant, but we aren’t diving into that in this blog.

3. High or low cortisol 

Almost every woman with endo I work with is living in survival mode OR burnout—whether she realizes it or not.

High cortisol and adrenaline increase pain sensitivity. They worsen gut issues, ramp up inflammation, create pelvic floor tension. They also wreck ovulation. And low cortisol can leave you feeling exhausted all the time with endometriosis.

If you feel wired and exhausted at the same time, if you crash after meals, if you’re always tired or always crave salt, if your body feels like it's always bracing for the next wave of pain… this can be a sign of high or low cortisol,

And it’s important to talk about it because cortisol levels impacts so many of our other hormones like insulin, progesterone, estrogen, etc

4. High Insulin

Insulin plays a huge role in balancing your blood sugar levels. If it is all over the place, your cortisol follows and this can drive systemic inflammation leading to pain. This can also lead to higher estrogen and lower progesterone too, all of which can also drive pain.

This shows up as: crushing fatigue, relentless cravings, afternoon crashes, anxiety, flares that seem to come out of nowhere, histamine reactions

5. Under-active Thyroid

A sluggish/under-active thyroid  is one of the most overlooked driver of endometriosis symptoms.

So many endo patients have thyroid symptoms years before it shows up on standard labs. And many doctors are only checking a TSH or free T4 when we need to be looking at a full panel to see where the imbalance lies with our thyroid if we have one.

An underactive thyroid can look like: constipation, unexplained weight changes, cold hands and feet, hair shedding, water retention, brain fog, low mood, heavy bleeding that won't let up.

Poor thyroid function slows digestion and detox, which makes estrogen metabolism even harder. Everything is all connected and that’s why endometriosis requires a full body approach.

Why basic hormone labs miss all of this

A single blood test only captures one moment in time. It doesn't show how your body is using or clearing hormones. It doesn't show your cortisol rhythms, your estrogen breakdown pathways, or the nutrient deficiencies making everything harder. And like I’ve said a few times, more often than not, we struggle to get a thorough lab panel.

This is why tests like the DUTCH, GI Map, or HTMA can be so revealing. They show patterns that basic labs never catch...stress patterns, mineral depletion, gut infections, low stomach acid/ poor absorption, estrogen metabolism issues, digestive dysfunction feeding inflammation.

None of these tests diagnose endo. But they help explain why your symptoms feel so unbearable.

So what actually helps balance hormones with endo?

Real hormone support for endo has to include the whole body. That means:

• Supporting your gut and improving digestion
  • Keeping blood sugar stable throughout the day
  • Restoring depleted minerals
  • Helping your liver process and clear hormones
  • Regulating your nervous system (not just "managing stress")
  • Supporting ovulation
  • Using the right testing to guide your plan—not guessing

These steps help calm inflammation at the root. They create a foundation that actually supports pain relief.

You've been given part of the story for years. No one explained why your labs look normal while your body feels anything but.

There are real reasons your symptoms are so loud. And there are real solutions that go beyond birth control and surgery.

You deserve care that treats your whole body.. not just the lesions.

If you're ready for personalized support and crave a plan that finally looks at the full picture—your hormones, your gut, your minerals, the patterns keeping your symptoms stuck, DM me on IG to chat about what this could look like for you!

To stay connected if you’re not ready for all that is by tuning into the Radiate with Rita Podcast + my weekly Radiate + Thrive newsletter where I drop tips about managing endo + chronic illness, how I navigate my own journey, recipes + all the things to make your journey a little easier! Subscribe to Radiate + Thrive here!

If you are about to have surgery for endo and you want to know how to support your body PRE and POST surgery, snag my free Pre and Post-Op Endo Surgery Checklist.