Are Endometriosis, Adenomyosis, and PCOS Autoimmune Conditions?

By Our Daughters Foundation

More and more women are asking an important question: Could my hormone-related illness also be connected to my immune system?

Conditions like endometriosis, adenomyosis, and polycystic ovary syndrome (PCOS) are often discussed in the context of reproductive health or hormonal imbalance. But researchers are beginning to explore deeper connections—specifically, whether autoimmunity plays a role in these diseases.

Let’s break down what the science says—and what questions remain unanswered.

Are Endometriosis, Adenomyosis, and PCOS Autoimmune Conditions?

By Our Daughters Foundation

More and more women are asking an important question: Could my hormone-related illness also be connected to my immune system?

Conditions like endometriosis, adenomyosis, and polycystic ovary syndrome (PCOS) are often discussed in the context of reproductive health or hormonal imbalance. But researchers are beginning to explore deeper connections—specifically, whether autoimmunity plays a role in these diseases.

Let’s break down what the science says—and what questions remain unanswered.

What Is Autoimmunity?

The immune system is designed to protect the body from threats like viruses and bacteria. But in autoimmune diseases, the immune system becomes misguided and starts attacking the body’s own cells and tissues.

Common autoimmune conditions include:

• Lupus

• Rheumatoid arthritis

• Hashimoto’s thyroiditis

• Multiple sclerosis

Symptoms vary widely, but many autoimmune conditions involve chronic inflammation, pain, fatigue, and a pattern of flare-ups.

The Immune System and Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus—causing pain, inflammation, and sometimes infertility. While its exact cause is still debated, many researchers believe that the immune system fails to clear out these rogue cells effectively.

Several studies have found:

• Women with endometriosis often have higher levels of inflammatory markers, like cytokines and prostaglandins.

• Natural killer (NK) cell activity is lower in women with endometriosis, impairing the immune system’s ability to destroy misplaced cells.

• There are elevated autoantibodies in some patients, suggesting an autoimmune component.

Some scientists now consider endometriosis to be a non-classical autoimmune disease—showing many features of one without meeting all diagnostic criteria.

Further reading:

• NIH - Immune dysfunction in endometriosis: https://pubmed.ncbi.nlm.nih.gov/30664929/

• Cleveland Clinic - Endometriosis and the Immune System: https://health.clevelandclinic.org/endometriosis-and-the-immune-system/

What About Adenomyosis?

Adenomyosis is sometimes called the "sister disease" of endometriosis. It occurs when endometrial tissue grows into the muscular wall of the uterus. It's less studied, but immune abnormalities have also been observed.

Research is still emerging, but here’s what we know:

• Women with adenomyosis show immune cell changes and chronic inflammation within the uterus.

• Some studies report increased macrophage and mast cell activity—cells involved in both immune defense and inflammation

• The condition often coexists with endometriosis, raising questions about shared immune pathways.

While it’s too early to label adenomyosis an autoimmune disorder, it may involve an immune imbalance that contributes to symptoms.

Further reading:

• Frontiers in Immunology - Immunopathogenesis of Adenomyosis: https://www.frontiersin.org/articles/10.3389/fimmu.2021.796273/full

PCOS and Autoimmune Overlap

Polycystic ovary syndrome (PCOS) is primarily known as a hormonal disorder involving androgen excess and insulin resistance. However, there’s growing interest in its immune connections, especially in women with chronic inflammation or thyroid issues.

Emerging links include:

• Hashimoto’s thyroiditis (an autoimmune thyroid disorder) is more common in women with PCOS.

• Inflammatory markers like C-reactive protein (CRP) are often elevated in PCOS patients.

• Some PCOS patients have anti-ovarian antibodies, suggesting potential autoimmunity.

Still, the autoimmune theory is more speculative in PCOS than in endometriosis.

Further reading:

Further reading:

• Journal of Clinical Endocrinology & Metabolism - PCOS and Autoimmune Disease: https://academic.oup.com/jcem/article/106/9/e3536/6280755

Why Does This Matter?

If immune dysfunction is part of the puzzle, treatment strategies may need to shift. Many women with endometriosis, adenomyosis, or PCOS are treated solely with hormone suppression—but if autoimmunity is involved, we may also need to address inflammation, gut health, and immune regulation.

There’s also hope that newer treatments—like immunomodulatory therapies or even personalized nutrition and lifestyle interventions—could improve outcomes when tailored to the immune system’s role.

Bottom Line

We don’t yet have all the answers, but the research is evolving. Endometriosis, adenomyosis, and PCOS may not be traditional autoimmune diseases—but they often coexist with immune dysfunction, and the overlap deserves attention. At Our Daughters Foundation, we believe in honoring women’s voices, advocating for deeper research, and pursuing whole-body solutions.

If you’ve experienced overlapping conditions like endo, thyroid disease, or unexplained inflammation—you’re not alone.

What Is Autoimmunity?

The immune system is designed to protect the body from threats like viruses and bacteria. But in autoimmune diseases, the immune system becomes misguided and starts attacking the body’s own cells and tissues.

Common autoimmune conditions include:

• Lupus

• Rheumatoid arthritis

• Hashimoto’s thyroiditis

• Multiple sclerosis

Symptoms vary widely, but many autoimmune conditions involve chronic inflammation, pain, fatigue, and a pattern of flare-ups.

The Immune System and Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus—causing pain, inflammation, and sometimes infertility. While its exact cause is still debated, many researchers believe that the immune system fails to clear out these rogue cells effectively.

Several studies have found:

• Women with endometriosis often have higher levels of inflammatory markers, like cytokines and prostaglandins.

• Natural killer (NK) cell activity is lower in women with endometriosis, impairing the immune system’s ability to destroy misplaced cells.

• There are elevated autoantibodies in some patients, suggesting an autoimmune component.

Some scientists now consider endometriosis to be a non-classical autoimmune disease—showing many features of one without meeting all diagnostic criteria.

Further reading:

• NIH - Immune dysfunction in endometriosis: https://pubmed.ncbi.nlm.nih.gov/30664929/

• Cleveland Clinic - Endometriosis and the Immune System: https://health.clevelandclinic.org/endometriosis-and-the-immune-system/

What About Adenomyosis?

Adenomyosis is sometimes called the "sister disease" of endometriosis. It occurs when endometrial tissue grows into the muscular wall of the uterus. It's less studied, but immune abnormalities have also been observed.

Research is still emerging, but here’s what we know:

• Women with adenomyosis show immune cell changes and chronic inflammation within the uterus.

• Some studies report increased macrophage and mast cell activity—cells involved in both immune defense and inflammation

• The condition often coexists with endometriosis, raising questions about shared immune pathways.

While it’s too early to label adenomyosis an autoimmune disorder, it may involve an immune imbalance that contributes to symptoms.

Further reading:

• Frontiers in Immunology - Immunopathogenesis of Adenomyosis: https://www.frontiersin.org/articles/10.3389/fimmu.2021.796273/full

PCOS and Autoimmune Overlap

Polycystic ovary syndrome (PCOS) is primarily known as a hormonal disorder involving androgen excess and insulin resistance. However, there’s growing interest in its immune connections, especially in women with chronic inflammation or thyroid issues.

Emerging links include:

• Hashimoto’s thyroiditis (an autoimmune thyroid disorder) is more common in women with PCOS.

• Inflammatory markers like C-reactive protein (CRP) are often elevated in PCOS patients.

• Some PCOS patients have anti-ovarian antibodies, suggesting potential autoimmunity.

Still, the autoimmune theory is more speculative in PCOS than in endometriosis.

Further reading:

Further reading:

• Journal of Clinical Endocrinology & Metabolism - PCOS and Autoimmune Disease: https://academic.oup.com/jcem/article/106/9/e3536/6280755

Why Does This Matter?

If immune dysfunction is part of the puzzle, treatment strategies may need to shift. Many women with endometriosis, adenomyosis, or PCOS are treated solely with hormone suppression—but if autoimmunity is involved, we may also need to address inflammation, gut health, and immune regulation.

There’s also hope that newer treatments—like immunomodulatory therapies or even personalized nutrition and lifestyle interventions—could improve outcomes when tailored to the immune system’s role.

Bottom Line

We don’t yet have all the answers, but the research is evolving. Endometriosis, adenomyosis, and PCOS may not be traditional autoimmune diseases—but they often coexist with immune dysfunction, and the overlap deserves attention. At Our Daughters Foundation, we believe in honoring women’s voices, advocating for deeper research, and pursuing whole-body solutions.

If you’ve experienced overlapping conditions like endo, thyroid disease, or unexplained inflammation—you’re not alone.

Join Us: Make a Difference Today

Your support can transform lives. Every donation helps us fund research, advocate for better care, and provide essential grants to women facing debilitating conditions.

Join Us: Make a Difference Today

Your support can transform lives. Every donation helps us fund research, advocate for better care, and provide essential grants to women facing debilitating conditions.

© Our Daughters Foundation - All Rights Reserved

Adhesions and Surgery

The Hidden Struggle: Adhesions & Surgery 

July 13, 20253 min read

The Hidden Struggle: Adhesions, Scar Tissue, and the Surgery Dilemma Facing Women with Endometriosis and Adenomyosis

By Our Daughters Foundation

Adhesions and Surgery

What are Adhesions? Adhesions are internal bands of scar tissue that form between organs and tissues, often after inflammation, infection, or surgery. Instead of healing cleanly, the body’s natural repair process sometimes causes tissues to stick together—like a web of internal glue. For women with endometriosis or adenomyosis, adhesions are more than just a medical term—they’re an often invisible, persistent source of pain.

Why Do They Form? Any pelvic or abdominal surgery can trigger adhesion formation. During healing, the body releases fibrin, a protein that acts like a sealant. Ideally, this dissolves after healing. But in some women, especially those with endometriosis or a history of inflammation, fibrin turns into permanent scar tissue—resulting in adhesions. Studies suggest that 55–100% of women undergoing pelvic surgeries form adhesions, and this rate increases with repeat procedures.

The Dilemma: Surgery Can Help… But Also Hurt Here lies the painful paradox: the most effective treatment for endometriosis-related pain is excision surgery. For adenomyosis, hysterectomy is often the only lasting relief. Yet these same surgeries often result in new adhesions—which can cause ongoing or even worsening pain.

Some women experience significant symptom relief after surgery. Others are left feeling frustrated, wondering why the pain persists. It’s not always due to the disease returning. Sometimes, the culprit is scar tissue itself.

Do Some Women Form More Adhesions Than Others? Yes. Risk factors for developing adhesions include: - Multiple prior surgeries - Endometriosis or chronic pelvic inflammation - Diabetes or poor wound healing - Longer or more invasive surgeries - Surgical techniques that involve more tissue handling or foreign materials

Unfortunately, there’s no test to predict who will develop adhesions. Some women are simply more prone due to individual biology and inflammatory response.

Are There Ways to Prevent Adhesions? There’s no guaranteed prevention, but surgeons can reduce risk by: - Using minimally invasive techniques (like laparoscopy) - Gentle tissue handling and reduced bleeding - Applying adhesion barriers (gels or membranes like Seprafilm, Hyalobarrier, or 4DryField®)

While promising, these barriers are not foolproof. Some studies report modest benefits, while others show significant reductions in adhesion formation when combined with expert surgical techniques.

The Cycle of Surgery and Scar Tissue This creates a cruel cycle for many women: 1. Disease causes pain 2. Surgery offers hope 3. Surgery causes scar tissue 4. Scar tissue causes pain 5. Repeat surgery may be needed

It’s no wonder women often feel stuck. Do they pursue another surgery and risk more adhesions? Or live with pain that doesn’t go away?

What About Non-Surgical Options? While no medication currently reverses endometriosis or adhesions, some women find relief through: - Physical therapy focused on pelvic floor and scar tissue mobilization - Anti-inflammatory diets - Nerve modulators for pain management - Gentle movement therapies like yoga

Still, these are supportive—not curative.

So What Is the Choice? There is no one-size-fits-all answer. For some, surgery brings significant relief. For others, it leads to more pain. This is why informed, compassionate, and expert care is critical. Women should expect: - Honest conversations about the risks of adhesions - Skilled excision surgeons who understand and minimize trauma - Follow-up care that addresses the whole body, not just the disease. Ultimately, we need better understanding of why endometriosis lesions and adenomyosis forms to begin with and a way to treat it before it causes the complications of chronic pain, infertility, & systemic inflammation. We need to get to the origin of disease.

References for Further Reading: - Liakakos T. et al., Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Digestive Surgery. 2001. - Oboh A., Trehan AK. Pelvic adhesion formation at second-look laparoscopy. Gynecol Surg. 2007. - Cochrane Review: Barrier agents for adhesion prevention in gynaecologic surgery. - Korell M. et al., Adhesion formation after endometriosis surgery. J Minim Invasive Gynecol. 2006. - Humaidan P. et al., Efficacy of starch-based adhesion barrier in gynecologic surgery. 2021.

endometriosisadenomyosissurgeryadhesionsscar tissue
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