Endometriosis, Gallstones, and Referred Right-Shoulder Pain

Watch the original video on TikTok

Full transcript of the original video, lightly edited for readability.

I wanted to talk about endometriosis and gallstones. So I've been getting a lot of messages about this specific issue, so I figured, why not make a video about it? So before anyone twist this, I want to make this explicitly clear. I am not saying that there's clinical data that shows that endometriosis directly causes gallstones. What I am saying is this. I'm in a very privileged position that I get to talk to a mass amount of endo warriors. And when you understand disease pathology, that is endometriosis, you start to notice that these mechanisms start to overlap.

So once again, this keeps pointing back to the same thing, that endometriosis is not just a pelvic disease, it is a systems disease. So let's get into it. Let's talk about the gallbladder. You see, the gallbladder stores bile. Biles digest fat, but they also play a role in cholesterol handling, hormone clearance, and digestive function. Most gallstones are cholesterol stones. That means that bile becomes too saturated with cholesterol. The gallbladder does not empty it properly, so crystals start to form. And eventually those crystals can become stone.

So this isn't just a gallbladder issue. This starts to affect liver metabolism, biochemistry, gut motility, and inflammation. So what conditions also involve hormones, inflammation, gut symptoms, immune dysfunction, and estrogen sensitivity? Endometriosis. And this is where you're going to start to see that connection. One of the biggest bridges here is estrogen. Estrogen is known to increase cholesterol secretion. Into bile. So when estrogenic activity goes up, bile can become cholesterol rich, which increases the chances of cholesterol crystals forming. And that matters because endometriosis is deeply tied to estrogen signaling.

But I don't want you to think about this in a. In a basic way. I'm not just talking about blood estrogen and endometriosis. The issue is often localized estrogen production, increased aromatase activity, and estrogen receptor behavior. Additionally, we're looking at progesterone resistance, inflammation. That starts to feed this hormonal loop. So when a woman can. So a woman can be told your hormones are normal, while her localized tissue at the environment is still behaving extremely estrogenically. And that is the difference between when you look at a lab and you start to come up, map out the symptoms.

Symptoms are always key. Let's talk about the progesterone. Like I said, progesterone can slow gallbladder emptying. In plain English, the gallbladder may not squeeze as efficiently. And if the bile sits in there too long, it can become sludge, and sludge can become stones. This is one of the reasons gallstones are more common in women, especially during reproductive years or in, like, pregnancy. Now connected to endometriosis and adenomyosis, these diseases already involve abnormal hormone response, specifically progesterone resistance. Many women are also placed on hormonal therapies.

This can affect digestion, birth control. Won't is not just a sex hormone. It functions in various things. So if an endo warrior develops gallbladder issues, I'm not Necessarily saying that endometriosis caused it, but I. All I'm saying is that there's definitely a high correlation between endometriosis and gallstone development. So you must ask, what is progesterone doing here? What is happening to the bile flow? What's happening to gut motility? Is there inflammation involved? And these are smart questions to ask that will help identify the problems, because there is always a simpler truth.

Now let's bring in inflammation. Endometriosis is inflammatory via cytokines and various other chemicals that we've talked about. Chronic inflammation directly affects digestion. It can also affect liver signaling and bile acid metabolism. It can also affect insulin sensitivity and metabolic function. So, again, the body is not separated into specialties. The pelvis, liver, gallbladder, hormones, immune system, all of these systems are talking to each other. They're not isolated. If the pelvis is chronically inflamed, the gut is irritated, digestion becomes sluggish, estrogen metabolism is altered, and bile flow becomes poor.

You cannot pretend that these systems have nothing to do with each other. That's just not how the body works. But here's where we need to start, to look a little bit deeper. There's something called gallbladder endometriosis, but this is extremely rare. Okay? This is separate from gallbladder stones. These are the cases where endometriosis starts to get involved in the gallbladder. But this is incredibly rare. Even for the women that I've talked to, this is not something you see, if ever. Maybe one out of the tens.

Of thousands I've ever had conversations with. If you haven't endometriosis and you also have a gallbladder symptoms, you should think beyond basic explanations, because the mechanisms do overlap. Here's another important piece. Sometimes what feels like gallbladder pain may not be gallbladder pain at all. It may be diaphragmatic endometriosis. And endometriosis can involve the diaphragm, especially on the right side. So this may actually feel like gallstones. That's an important key note, because what happens is that it can irritate the phrenic nerve and cause pain in areas like the right upper abdomen, under the ribs, the shoulder, the chest, upper back.

And guess what? That can look a lot like gallbladder pain. Especially if you go to the E R. They're gonna start to look at your gallbladder. So this is something that must be known. So if a woman says, my gallbladder hurts around my period, or my right shoulder hurts with my cycle, or my ribs hurt before or during menstruation, that pattern does matter. Typical. Typically gallbladder. Gallbladder. Gallbladder pain often flares after fatty meals. But endometriosis related diverticular pain may flare with the menstrual cycle.

So both can exist. A woman can have gallstones and endometriosis. But the timing gives us clues. Is it food trigger? Think gallbladder. Is it cycle trigger? Think diaphragmatic or thoracic endometriosis. Okay, these are crucial things that you guys must be able to highlight and identify to help you push forward in your journey with endometriosis.