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Endometriosis & Gut Health

by | Mar 20, 2024 | gut health, IBS, Women's health | 0 comments

March is Endometriosis awareness month, so I thought I’d spend some time shedding light on this condition that affects so many people. This blog explores Endometriosis, and how it’s related to gut health.

What is Endometriosis?

Endometriosis is a common gynaecological condition which affects 1 in 10 women in the UK. Despite how common the condition is, and increasing awareness, it still takes an average of 8 years to get diagnosed.

Endometriosis is a chronic inflammatory condition. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, commonly on the ovaries, fallopian tubes, and other pelvic organs. This tissue then behaves similarly to the lining of the uterus, thickening, breaking down, and bleeding with each menstrual cycle. However, because it has no way to exit the body, it becomes trapped, leading to inflammation, scar tissue formation, and pain.

How does it affect your gut health?

Endometriosis and irritable bowel syndrome (IBS) have a lot of cross over. Due to hormonal fluctuations and the inflammatory mechanism, both conditions can share similar symptoms. Which can make it quite challenging to distinguish between the two conditions. For example, hormonal fluctuations in individuals with Endometriosis can affect their gastrointestinal motility and sensitivity. This then leads to IBS-like symptoms. Recent literature suggests that those suffering with Endometriosis are three time more likely to also have IBS symptoms.

Symptoms of Endo

  • Abdominal bloating and/or visible distention
  • Painful periods
  • Heavy periods
  • Anaemia
  • Pelvic and back pain
  • Pain when opening your bowels
  • Constipation and/or Diarrhoea
  • Nausea
  • Fatigue

Additionally, this condition can affect mental health. Including stress, low mood, and anxiety, which can, in turn, trigger IBS symptoms.

Due to the cross over of the conditions, Endometriosis can often be missed.

Endometriosis UK has a helpful ‘Pain & Symptoms Diary’ that can be good to do before seeing your doctor: https://www.Endometriosis-uk.org/visiting-your-doctor

Treatment

Unfortunately, currently there is no known cure for Endometriosis. Therefore, the treatment available aims to improve the symptoms of this condition.

It is important to be seen by a specialist gynaecologist and have access to a multidisciplinary team (MDT). This will help optimise your treatment.

This treatment may include hormonal therapy, pain relief or surgical removal of the affected tissue. 

Diet

It’s important to note that there is no diet which will cure Endometriosis. However, there is growing research regarding dietary patterns which could help manage Endo symptoms.

  • A diet rich in plants: Make sure to incorporate a diverse diet rich in plants (fruits, vegetables, wholegrains, nuts, seeds, and pulses). This helps support our digestive and gut health, but it also can help manage our hormones and Endo pain. Plants contain chemicals called polyphenols which are protective and anti-inflammatory. They also help recycle oestrogen in the gut, which helps manage hormone levels.
  • Anti-inflammatory Foods: Certain foods can help reduce the inflammation in our body. Examples of this are fatty fish (salmon, mackerel), leafy greens (spinach, kale), berries, nuts (walnuts, almonds), seeds, and Soy foods (tofu, tempeh, edamame beans)
  • Omega-3 Fatty Acids: We ideally want more of Omega-3 than Omega-6; this is because Omega-3 can also be anti-inflammatory, whereas too much Omega-6 can have the opposite effect. Foods which are rich in Omega-3 include fish, nuts & seeds (flaxseeds, chia seeds, and walnuts), rapeseed or linseed oil, soya & soya products, and micro-algae.
  • Plant-Based Proteins: Choosing plant-based protein sources such as beans, lentils, tofu, and tempeh over red meat can reduce inflammation and support hormonal health.

What if there is IBS crossover?

This is where it is important to work with a Gastrointestinal Dietitian, who is familiar with Endometriosis. The diet needs to be manipulated specifically to the symptoms.

There is evidence around the low FODMAP diet and Endometriosis, especially in those with more diarrhoea & bloating. Research has found that those with Endometriosis are more likely to be constipation prominent, in which case the low FODMAP diet could worsen the situation. Constipation and bloating may need a different diet that works to optimise and regulate bowel movements.

It’s important to note, that if the low FODMAP diet is explored. This is not a long-term diet. Being on this diet long-term is very restrictive and can worsen gut health and symptoms. It’s important to work with a dietitian, who will guide someone through reintroducing FODMAPs taken out whilst managing symptoms.

Gut-Brain Axis

Those experiencing Endometriosis often suffer with persistent pain or discomfort daily, which impacts various aspects of life including mood, relationships, and overall quality of life. This distress can influence the gut through the gut-brain axis. Practices such as breathing exercises, yoga, or mindfulness have been shown to help with that gut-brain connection and gut symptoms.

Supplements

Certain supplements can help toward symptoms. It’s important to discuss these supplements with a professional to find out what dose you should be taking and whether it’s the right supplement for your symptoms. Too little may not be enough, but too much of certain supplements could be toxic.

  • NAC (N-Acetyl Cysteine)
  • Omega-3
  • Vitamin D
  • Fibre-supplements
  • Probiotics

Takeaway Message

Dietary choices can significantly impact the management of Endometriosis symptoms, particularly when integrated with other lifestyle adjustments.

A registered dietitian who specialises in gastroenterology can offer personalised guidance tailored to individual requirements.

References

Ek, M., Roth, B., Ekström, P., Valentin, L., Bengtsson, M., & Ohlsson, B. (2015). Gastrointestinal symptoms among endometriosis patients–A case-cohort study. BMC women’s health, 15, 59. https://doi.org/10.1186/s12905-015-0213-2

Mardon, A. K., Leake, H. B., Hayles, C., Henry, M. L., Neumann, P. B., Moseley, G. L., & Chalmers, K. J. (2023). The Efficacy of Self-Management Strategies for Females with Endometriosis: a Systematic Review. Reproductive sciences (Thousand Oaks, Calif.), 30(2), 390–407. https://doi.org/10.1007/s43032-022-00952-9

Moore, J. S., Gibson, P. R., Perry, R. E., & Burgell, R. E. (2017). Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. The Australian & New Zealand journal of obstetrics & gynaecology, 57(2), 201–205. https://doi.org/10.1111/ajo.12594

Nabi, M. Y., Nauhria, S., Reel, M., Londono, S., Vasireddi, A., Elmiry, M., & Ramdass, P. V. A. K. (2022). Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Frontiers in medicine, 9, 914356. https://doi.org/10.3389/fmed.2022.914356

Salmeri, N., Sinagra, E., Dolci, C., Buzzaccarini, G., Sozzi, G., Sutera, M., Candiani, M., Ungaro, F., Massimino, L., Danese, S., & Mandarino, F. V. (2023). Microbiota in Irritable Bowel Syndrome and Endometriosis: Birds of a Feather Flock Together-A Review. Microorganisms, 11(8), 2089. https://doi.org/10.3390/microorganisms11082089

Vennberg Karlsson, J., Patel, H., & Premberg, A. (2020). Experiences of health after dietary changes in Endometriosis: a qualitative interview study. BMJ open, 10(2), e032321. https://doi.org/10.1136/bmjopen-2019-032321

Yalçın Bahat, P., Ayhan, I., Üreyen Özdemir, E., İnceboz, Ü., & Oral, E. (2022). Dietary supplements for treatment of Endometriosis: A review. Acta bio-medica : Atenei Parmensis, 93(1), e2022159. https://doi.org/10.23750/abm.v93i1.11237