When Mast Cells Meet Endometriosis: A Deeper Look at Pain, Inflammation & Treatment Options
Written by Arabella Richards | Balance By Bell Naturopathy
For many women, endometriosis is more than just a “painful period”, it’s a chronic inflammatory condition that can affect every aspect of life. While endometrial lesions are the hallmark feature, the severity of pain doesn’t always match the extent of visible lesions. One increasingly understood player in this complex picture? Mast cells, the immune cells best known for their role in allergic reactions, but with a growing body of evidence pointing to their significant role in endometriosis-related pain and inflammation.
Mast Cell Activation: An Underappreciated Aggravator
Mast cells live in all vascularised tissues, but they’re particularly concentrated along environmental barriers such as the skin, respiratory tract, gastrointestinal tract, and importantly, the female reproductive tract. In women with endometriosis, mast cells have been found within endometrial lesions themselves, where they’re loaded with inflammatory mediators like histamine, prostaglandins, leukotrienes, and neurotransmitters.
These mast cells are easily triggered by local and environmental factors, including oestrogens (both naturally occurring and synthetic xenoestrogens, such as BPA found in plastics). Once activated, they release their inflammatory payload and stimulate nearby nerve fibres, causing amplified pain and inflammation. This can lead to a vicious cycle: pain triggers more mast cell activation, which in turn recruits more inflammatory cells and increases nervous system sensitivity over time, a process known as central sensitisation.
Why Pain Feels Worse Than It “Should”
Endometriosis pain can feel out of proportion to the extent of lesions. That’s because pain isn’t solely dependent on lesion size, it’s also about how deep lesions are, how close they are to nerves, and how many degranulated mast cells are present. Over time, this chronic inflammation and nerve involvement creates a pain experience that is not just physical but also neurological, explaining why conventional pain relief can often fall short.
Could Dairy Be Making Things Worse?
Emerging evidence and clinical experience suggest that dairy products may exacerbate mast cell activation and worsen endometriosis symptoms in some individuals. Dairy proteins, especially casein, can trigger immune responses in susceptible individuals. Additionally, many dairy products contain histamine or stimulate histamine release, which can increase inflammation and worsen symptoms in those with mast cell sensitivity. For women with endometriosis and suspected immune involvement, trialling a dairy-free diet can be a powerful tool in reducing systemic inflammation and pelvic pain.
Microbial Imbalances: The Forgotten Driver
Adding another layer of complexity, recent research reveals that gut and vaginal dysbiosis (imbalances in healthy bacteria) may drive chronic inflammation and hormone dysregulation in endometriosis. Women with endometriosis have been shown to have higher levels of pathogenic bacteria like E. coli and reduced levels of beneficial Lactobacillus in the reproductive tract. These harmful microbes can stimulate inflammation and even increase oestrogen levels via β-glucuronidase activity, further fuelling lesion growth and pain. β-glucuronidase activity means that Oestrogen is re-absorbed into the blood-stream, rather than excreted via stool.
One long-term study in Denmark followed over 37,000 women and found that women with endometriosis were 50% more likely to develop inflammatory bowel disease, highlighting the strong gut-reproductive system connection.
Natural Strategies to Calm Mast Cells, Soothe Pain & Restore Balance
At Balance by Bell Naturopathy, it’s important take a systemic approach to managing endometriosis that targets both immune dysfunction and microbial imbalances. Here are some of my favourite evidence-based tools:
1.
Stabilising Mast Cells with Phytonutrients.
Quercetin: A plant polyphenol that reduces mast cell degranulation and histamine release, while calming inflammation.
Bromelain: An enzyme with anti-inflammatory benefits shown to reduce lesion-related inflammation by inhibiting pro-inflammatory cytokines and signalling pathways.
Combining these ingredients may support those experiencing deep inflammatory and neurogenic pain, especially when accompanied by heightened histamine or allergy-like responses.
2.
Managing Chronic Inflammation & Pain.
Curcumin (from turmeric): Shown to reduce lesion growth by reducing inflammation, oxidative stress, and angiogenesis. Some studies suggest that curcumin can also inhibit endometrial cells by reducing excess oestrogen.
Devil’s Claw & Jamaica Dogwood: Known for their powerful anti-inflammatory and neural pain-relieving properties, especially helpful for stabbing pelvic pain and dysmenorrhea.
This combination can be strong choice for women managing chronic inflammation, nerve sensitivity and tissue damage associated with endometriosis.
3.
Addressing Central Sensitisation.
For women with long-standing or widespread pain, nervous system sensitisation becomes a key factor.
Magnesium Bisglycinate: Supports nerve health, calms muscle tension, and improves sleep.
Corydalis & California Poppy: Effective herbal analgesics that target pain and reduce hypersensitivity.
These nutrients and herbs are gentle on the system but effective in helping to break the pain cycle and reduce systemic nervous system reactivity.
4.
Targeting Microbial Dysbiosis.
Treating gut and vaginal dysbiosis is essential in calming systemic inflammation and reducing pathogenic load.
Punica granatum (Pomegranate): Disrupts bacterial biofilms and reduces gram-positive bacteria.
Nigella sativa, Myrrh, and Oregano Oil: All shown to have broad-spectrum antimicrobial activity against pathogens such as E. coli, Candida, and Staphylococcus These herbs stimulate microbial self-destruction, support healthy immune responses, and rebalance the vaginal and gut microbiome.
5.
Dietary Interventions.
The removing of dairy and gluten can have a substantial influence of pain reduction and bloating (a common symptom associated with endometriosis).
Gluten has been linked to inflammation, and some studies have shown that women with endometriosis who follow a gluten-free diet report reduced pelvic pain and bloating. Gluten can increase Zonulin levels in the gut, a marker that indicates intestinal inflammation and permeability.
As previously mentioned, dairy can also contribute to inflammation and digestive discomfort in sensitive individuals by stimulating mast cell activity, which in turn releases histamine, a compound that can exacerbate bloating, cramping, and overall inflammatory responses.
Final Thoughts
Endometriosis is a multifaceted condition that demands an equally comprehensive treatment strategy. Mast cell activation, microbial imbalance, hormonal dysregulation, and nervous system sensitisation all play a role in the chronic pain and systemic inflammation many women experience.
At Balance by Bell Naturopathy, I tailor each protocol to the individual, addressing underlying drivers rather than masking symptoms. If you’re struggling with endometriosis and want support that looks at the whole picture, let’s work together to create a treatment plan that helps you feel more in control, supported, and well.
Love, Bell
Abulughod, N., Valakas, S., & El-Assaad, F. (2024). Dietary and Nutritional Interventions for the Management of Endometriosis. Nutrients, 16(23), 3988.
Arablou, T., & Kolahdouz-Mohammadi, R. (2018). Curcumin and endometriosis: Review on potential roles and molecular mechanisms. Biomedicine & Pharmacotherapy, 97, 91-97.
Fiorillo, M., Neri, B., Mancone, R., Russo, C., Iacobini, F., Schiavone, S. C., & Biancone, L. (2024). Inflammatory Bowel Disease and Endometriosis: Diagnosis and Clinical Characteristics. Biomedicines, 12(11), 2521.
Zhang, Y., Cao, H., Yu, Z., Peng, H. Y., & Zhang, C. J. (2013). Curcumin inhibits endometriosis endometrial cells by reducing estradiol production. Iranian journal of reproductive medicine, 11(5), 415.