Robin's Short Version

Endometriosis affects an estimated 1 in 10 women and girls of reproductive age, yet diagnosis still takes an average of 7–10 years.
Two non-invasive tests recently backed for early NHS use could help move diagnosis beyond the old “surgery or nothing” model, though neither is FDA-cleared in the US yet.
There is no single cure, but investigating pelvic pain, supporting digestion and estrogen metabolism, reducing inflammation, limiting endocrine disruptors, and discussing progesterone support can make symptoms far more manageable.

Here's what's wild: an estimated 1 in 10 women have endometriosis. It still takes 7 to 10 years, on average, to get diagnosed. And the official “gold standard” test has been exploratory surgery.

If your periods have ever taken you out for a day (or more) — that's not normal, and it's exactly the kind of pattern I'd want to map to your labs. Let's figure out what's going on →

This week: what we actually know about endometriosis, the two new non-invasive tests just backed by UK regulators, and the functional medicine protocol I use with patients — because there's real hope here, even though we need a lot more research.

The Estrobolome Reset

If you have any signs of estrogen dominance — heavy periods, bad PMS, endometriosis, fibroids — start here: fix your gut's ability to clear excess estrogen.

25–35g fiber/day (beans, chia, berries, leafy greens)
A probiotic + calcium D-glucarate (500mg, 2x/day) — together they stop your gut from recycling estrogen back into your bloodstream instead of excreting it

What to know: it's common, poorly understood, and possibly immune-related

❌ The old assumption: Endometriosis is “just” period pain, and the only way to diagnose it is surgery.

✅ The new reality: An estimated 1 in 10 women and girls of reproductive age have endometriosis — about 190 million people worldwide.¹ And diagnosis no longer requires surgery first — updated European guidelines now say imaging plus symptoms should come first, with laparoscopy reserved for unclear cases.²

❝ It still takes an average of 7 years to get diagnosed. Not because we lack answers — because we've relied on surgery to get them.

How it develops

The leading theory: menstrual blood flows backward through the fallopian tubes and implants in the pelvis — “retrograde menstruation,” recently confirmed with DNA evidence.³ But that happens in ~90% of all women. Something else has to go wrong — immune cells failing to clear the stray tissue, inflammatory signaling turning it into something that survives and grows.⁴

Not officially autoimmune — but your immune system is involved

It's not classified as an autoimmune disease. But a 2025 study found women with endometriosis have roughly 2x the odds of also being diagnosed with an autoimmune condition — RA, Hashimoto's, lupus, MS — within two years.⁵ Researchers are increasingly calling it a systemic inflammatory disease, not just a “period problem.”

Two new tests might finally end the surgery requirement

In July 2026, UK regulators (NICE) greenlit two non-invasive tests for early NHS use: a saliva test (Ziwig Endotest, 97% sensitive / 94% specific) and a gut-electrical-activity test (EndoSure, 91–96% both).⁶ Neither is FDA-cleared in the US yet — but it's the first real crack in “surgery or nothing.”

What to do: a real protocol, and hope

1️⃣ Get a doctor who will actually investigate.

Start with an OB-GYN who takes chronic pelvic pain seriously and pushes for imaging instead of “let's wait and see.”

This is exactly what we do at Parsley — we quarterback the workup and build the protocol below alongside your conventional care. Let's get you answers →

2️⃣ Fix digestion first — this is where the estrobolome protocol lives.

Your gut bacteria can “reactivate” estrogen your liver already packaged for excretion, sending it back into circulation.

25–35g fiber/day — binds excess estrogen before bacteria can reactivate it
A probiotic to rebuild Lactobacillus/Bifidobacterium
Calcium D-glucarate, 500mg twice daily — directly blocks the enzyme (beta-glucuronidase) responsible for reactivating estrogen
If bloating or constipation are prominent, ask about a SIBO breath test — one 2025 study found overgrowth in 92% of endo patients vs. 83% of controls.⁷
The goal: a bowel movement every single day

3️⃣ Target estrogen metabolism with specific supplements.

Indole-3-carbinol, 200–400mg/day (I use Meta I-3-C). Best human data of the group — shifts estrogen toward its weaker, safer metabolite.⁸
Vitamin B6, 50–100mg/day — a direct cofactor for progesterone production
Vitamin D — get tested. Most women with endo run low; if you're deficient, 2,000–5,000 IU/day with K2 to get into range.⁹
Omega-3s, 2g/day — the exact dose used in the only placebo-controlled trial that showed pain reduction.¹⁰
Magnesium glycinate, 200–400mg at night — baseline metabolic support

4️⃣ Try a targeted elimination diet — it's a diagnostic tool, not a fad.

This isn't really about dairy specifically. Cutting inflammatory foods — gluten (highly inflammatory for some people), dairy, and whatever else you're individually reactive to — is genuinely well-evidenced for lowering systemic inflammation, even though the research specific to endometriosis is still slim. I've seen it make a real difference in my patients: one did a strict Whole30 and her symptoms completely resolved.

I don't actually recommend Whole30 itself — it's too restrictive to sustain long-term. What I use instead: a personalized, targeted elimination diet.

Cut the usual suspects (gluten, dairy, plus whatever shows up on food sensitivity testing) for 4–6 weeks, then reintroduce one at a time so you actually learn your triggers instead of avoiding everything forever.

5️⃣ Cut your endocrine disruptor exposure.

Dioxins and PCBs are one of the few confirmed environmental risk factors for endometriosis.

Swap plastic containers and wrap for glass; never microwave in plastic
Skip receipts and canned food when you can (both common BPA sources)
Choose “fragrance-free” over “unscented” for personal care — fragrance is where phthalates hide
Filter your water — reverse osmosis or a filter certified to remove PFAS and atrazine

6️⃣ Ask your doctor about progesterone support.

Progestin-only pills, vaginal progesterone, or oral micronized progesterone can meaningfully reduce pain. The catch: continuous progestin suppresses ovulation, so if you're trying to conceive, this has to be timed very precisely with your doctor — not used straight through the cycle.

The goal: none of this cures endometriosis. But layered together, it's taken patients from debilitating pain to fully manageable — and in some cases, symptom-free.

The Momgevity Files

I'm back after a week off! Sometimes you just have to say F it and give yourself a break. That's what I did last week, during our first week in Spain on family vacation. I was exhausted: an overnight flight with two kids passed out on top of me, an unexpected reroute and extra flight through Madrid to reach our beach destination, a major presentation due for Parsley, and, well, life life-ing.

But writing this newsletter brings me immense joy — it's not a chore — which is a lesson in longevity itself. We all need to step outside our routine sometimes and give ourselves grace when it's all too much. I give you full permission to do this! And I'd also say: if more of your life feels like a have-to than a want-to, it's time to reassess how you're spending your time.

I'm spending my time here in Spain in a state of what I call healthy-lazy. There are regular naps. I'm doing some DIY yoga and digging a workout they have here called Primal Moves — it's super hard and energizing. But I'm not walking much. There's zero cardio. I'm letting the sun and the sea tire me out instead. I've gone to the gym to lift exactly once, and I don't think I'll go back.

On the food front, it's so easy to eat well here. It's also easy to not eat well, if I choose. But I'm choosing well, because that's what makes me feel most alive when I travel. I'm loving all the produce, cheeses, and sea creatures — everything local and organic — and the change of flavor pace from my last few New England summers is very welcome.

On the head-and-heart front, for once my husband isn't working remotely, and I'm mostly signed off from Parsley too — being six hours ahead is really helping with that. The past six summers in Massachusetts have honestly been very plugged-in. Instead, we're having deeper conversations, spending more time together as a family, and I'm getting to write and process life's big movements with a level of space, quiet, and focus I rarely get at home, or even on other vacations.

Slowing down doesn't always mean doing nothing. Slowing down can mean allowing yourself to focus on the things that matter. In my two weeks of healthy-lazy, I'm putting my attention exactly where it's most deserved: my family and my health — which is deeply productive, both for life right now and for my healthspan down the road. It's great to put gas in the tank. It's even better to slow down and look up to see where you're going.

One more thing…

If you think you might have endometriosis — or you've had symptoms for years without answers — book a consult with a Parsley clinician. We'll help you build the diagnostic and treatment plan above, tailored to you.

References

Originally published in the Off Script newsletter. Join Robin’s readers for weekly functional medicine insights.

As always, this newsletter is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any health decisions or changes to your treatment plan.