Endometriosis Symptoms: Gut Connections and How to Heal Naturally

An Overview of Endo Symptoms and Natural Solutions Supported by Science

• What Is Endometriosis?|
• Endometriosis Symptoms|
• Causes of Endometriosis|
• Natural Treatments for Endometriosis|
• You Have Options|

It takes women an average of four to 11 years to get a diagnosis of endometriosis from the time their symptoms begin to manifest [1].

This delay in diagnosis likely results from several causes: 

1. Symptoms of endometriosis mimic the symptoms of many other conditions, making it difficult to identify.
2. We lack a biomarker or test that can clearly diagnose endometriosis, and diagnosis is typically confirmed with a laparoscopy — a potentially costly surgical procedure.
3. Most doctors truly want to help their patients, but some don’t have as much awareness around the signs of endometriosis and may misdiagnose a woman with another hormone-related condition. And unfortunately, there are still cases where some doctors simply believe their patients are overreacting or inaccurately reporting their symptoms, leading to an incorrect diagnosis.

The more women are aware of endometriosis symptoms, the better they can advocate for themselves and get proper treatment for the condition. 

In this article, we’ll discuss an overview of what endometriosis is; the symptoms of endometriosis, including its relationship to IBS and pelvic floor dysfunction; potential causes of endometriosis; and natural treatment options for endometriosis, including diet, supplementation, physical therapy, and more. 

An Overview: What Is Endometriosis? 

Endometriosis is an estrogen-dependent, chronic inflammatory disease where tissue similar to the lining of the uterus implants on organs outside of the uterus. While there are multiple theories around potential causes of the condition, endometriosis is primarily thought to be caused by the backward movement of menstrual flow (retrograde menstruation). The most common place for endometriosis to occur is the ovaries, although it can occur in other parts of the reproductive organs like the fallopian tubes, and even outside of the pelvic cavity, including the bowel (bowel endometriosis).

Endometriosis affects 10-15% of women of reproductive age and can result in many symptoms such as pelvic pain, difficulty getting pregnant (infertility), pain during sexual intercourse, and painful periods [2]. Bloating associated with endometriosis, sometimes referred to as “endo-belly,” is an underappreciated and underrecognized symptom of endometriosis, and its cause is poorly understood. Endo-belly may be related to inflammation or increased gut sensitivity. 

Endometriosis also has a significant overlap with irritable bowel syndrome (IBS). Both conditions can have similar symptoms and disease mechanisms, and women with endometriosis have a twofold to threefold increased risk of having IBS [3].

Another characteristic of endometriosis is pelvic floor dysfunction, which involves abnormal functioning of the muscles of the pelvic floor [4]. A few common signs of pelvic floor dysfunction include constipation, bloating, and painful sex.

Gut health is also connected to endometriosis. Women with endometriosis have been shown to have decreased diversity of their gut bacteria compared to healthy women [5]. Additionally, dysbiosis, leaky gut, and chronic inflammation appear to be common with endometriosis [6].

Endometriosis Symptoms

Endometriosis symptoms vary widely, and the condition may also be asymptomatic. Many women don’t know they have endometriosis until they undergo evaluation for fertility. Infertility is the most common symptom of endometriosis, occurring in 90% of women with the condition [7].

Other common endometriosis symptoms include [1, 2, 8]:

• Painful intercourse (dyspareunia)
• Painful menstruation/menstrual cramps (dysmenorrhea)
• Bleeding between periods
• Irregular menstrual cycles
• Painful urination
• Painful bowel movements
• High pain sensitivity
• Chronic pelvic pain
• Chronic lower back pain
• Uterine masses/cysts (endometrioma)
• Constipation
• Bloating

Another type of endometriosis is bowel endometriosis, which can mimic the symptoms of IBS or inflammatory bowel disease (IBD). These symptoms can include pain, diarrhea, constipation, painful bowel movements, painful intercourse, bloating, blood in the stool, pain while sitting, and in rare cases, bowel obstruction.

Endometriosis and IBS

Women with endometriosis are two to three times more likely to develop IBS than women without the condition, even if it doesn’t involve the bowel [3, 9].

Commonalities between the two conditions include chronic low-grade inflammation, activation of mast cells, stimulation of pain receptors, dysbiosis, and leaky gut [10].

A literature review stated that bowel endometriosis symptoms can also mimic that of IBS due to involvement of the enteric nervous system, the part of the autonomic nervous system located in the gastrointestinal tract [11]. So, it’s important to get an accurate diagnosis with clinical evaluation.

However, this tells us that some of the methods we would use to treat IBS may also be helpful for endometriosis symptoms, including lowering inflammation, correcting dysbiosis, and sealing a leaky gut.

Endo-Belly (Bloating)

Bloating associated with endometriosis seems to be an underappreciated symptom that as many as 96% of women experience, according to one study [12].

The cause of this bloating is still unknown, but may be due to inflammation and dysregulation of the enteric nervous system. 

Another study found that visceral hypersensitivity (increased pain sensitivity of the abdominal organs) is common in endometriosis. Visceral hypersensitivity has been proposed as a cause of bloating and abdominal distension [13, 14].

In bowel endometriosis, bloating may also be caused by large nodules in the colon [15]. However, this isn’t the primary cause in most endometriosis patients where the main organs affected are the ovaries, instead of the large intestine [7].

Whatever the cause, endo-belly is a significant and hallmark symptom of endometriosis for many women.

Pelvic Floor Dysfunction

Pelvic floor dysfunction (PFD) is another symptom of, and contributor to, endometriosis.

PFD occurs when the pelvic floor muscles are either too weak, too tight, or uncoordinated, causing pain, discomfort, incontinence, GI distress, and other issues in the pelvic area.

A few specific signs of PFD are:

• Constipation 
• Bloating 
• Painful sex 
• Thin/narrow stools 
• History of abdominal surgeries or trauma
• Recurrent yeast infections 
• Low back pain 
• Frequent/painful urination

A 2021 observational study wanted to see if women with endometriosis had altered function of their pelvic floor muscles compared to women without endometriosis. Eighty women with deep infiltrative endometriosis who were receiving hormonal therapy for pain and 80 women without endometriosis had their pelvic floor muscles assessed for pain and contraction/relaxation abilities.

The results showed that women with endometriosis had a significantly greater presence of pelvic floor dysfunction and trigger points (sensitive areas of tight muscle fibers) than women without endometriosis [16]. The women with endometriosis had a significantly greater presence of overactive muscles, and four in 10 had inappropriate pelvic muscle contraction.

Learning to relax and control the muscles of the pelvic floor may help women with endometriosis have less pelvic pain and less pain with sexual intercourse.

Causes of Endometriosis

The cause of endometriosis is unknown, however the prevailing theory is that it’s caused by retrograde flow of menstrual blood (backwards into the pelvis instead of outside of the vagina). There are other theories, but no single theory explains all types of endometriosis.

However, we know that the body requires the female sex hormone estrogen to produce endometrial tissue. High estrogen production has been consistently observed in endometriosis patients, and excess estrogen contributes to the pain and inflammation associated with endometriosis [17].

Furthermore, oxidative stress, free radicals, inflammation, having high estrogen and/or low progesterone, genetics, epigenetics, and environment all appear to play a role in the development of endometriosis [1].

Other risk factors for developing endometriosis include: 

• Being younger than 12 years of age at first period
• Menstrual periods that last less than 26 days
• Heavy menstrual bleeding
• Chemical exposure (since certain chemicals can mimic estrogen in the body).

Natural Treatments for Endometriosis

Standard treatment options for endometriosis include nonsteroidal anti-inflammatory drugs, birth control pills or other hormonal contraceptives, and hormonal treatments like gonadotropin-releasing hormone (GnRH) ​​and progestins. Laparoscopic surgery is also common to remove endometrial lesions, especially when there’s severe pain involved and concern for the pelvic organs.

But you don’t need to jump to surgery, or even medication, right away. There are many natural treatment options for endometriosis, including diet, supplements, different types of exercise and physical activity, manual physical therapy, and acupuncture.

Diet

There’s a decent amount of research showing that diets like the Mediterranean diet, a gluten-free diet, and a low FODMAP diet improved symptoms in women with endometriosis. These improvements included decreased pain, improved GI response, and better overall well-being [18].

A gluten-free diet for 12 months in 295 women was associated with significant improvement in pain in 75% of participants. A significant improvement in quality of life was also observed in all women. However, it’s important to note that the study didn’t look at what these women were using to replace items with gluten in their diet, which may also have contributed to their well-being [18].

In an observational study, women with endometriosis and IBS were significantly more responsive to a four-week low FODMAP diet compared to women with IBS alone.

In a study with 68 women, following a Mediterranean diet for five months was associated with a significant improvement in general pain and condition [18].

Vitamins and Supplements 

Certain vitamins and supplements like vitamin C, vitamin E, vitamin A, fish oil, quercetin, turmeric, and methyl-folate (vitamin B9), among others, helped improve symptoms of endometriosis.

A 2021 clinical trial randomly assigned 60 women with confirmed endometriosis to take vitamin C (1,000 mg/day), and vitamin E (800 IU/day) or placebo for eight weeks. The results showed that the vitamin C/E group had a significant reduction in oxidative stress markers, pelvic pain, pain during menstruation, and pain during sexual intercourse compared to placebo [19].

Alongside an elimination diet, endometriosis patients took fish oil, quercetin, niacin, methyl-folate, turmeric, and parthenium (an herbal supplement) for three months. These patients had a significant improvement in endometriosis symptoms and laboratory parameters compared to a second group (taking only linseed oil and methyl-folate) and placebo.

If you want to explore supplementation as part of your endometriosis treatment, it’s worth working with a knowledgeable healthcare professional to help you explore the different options available. 

Probiotics

Knowing the connection between endometriosis and gut health, probiotics may be a helpful treatment option.

A randomized clinical trial sought to find out if probiotics could be beneficial for endometriosis patients. Thirty-seven women who had previously undergone laparoscopic surgery for stage III or IV endometriosis were randomly assigned to receive a Lactobacillus probiotic or a placebo for eight weeks. The results showed that the probiotic group had a significantly greater decrease in menstrual pain and overall pain during eight weeks of treatment compared to the placebo group. However, pain during sexual intercourse and chronic pelvic pain scores were not significantly different between groups [20].

Another clinical trial attempted to evaluate the effects of probiotics on endometriosis pain. Sixty-two women with endometriosis were randomized to receive a Lactobacillus probiotic or a placebo for 12 weeks. The results showed that the probiotic group had significantly less menstrual pain after eight and 12 weeks, compared to placebo [21].

Physical Activity and Exercise

Physical activity like cardio exercise and stretching have mixed reviews on their effectiveness for relieving endometriosis pain, but yoga specifically appears to have significant benefits. 

Two hours of Hatha yoga, meditation, and standard medical therapy twice a week for eight weeks was associated with a significantly lower degree of daily pain than the control group. There was also a significant improvement in well-being and body image in the yoga group [22].

Physical Therapy 

One study attempted to see if manual physical therapy could improve endometriosis symptoms. Thirty-two women with endometriosis underwent 20 total hours of manual physical therapy that was designed to address adhesions and restrictions in soft-tissue mobility in the abdomen and pelvic floor. The subjects were analyzed six weeks after treatment was completed and the results showed that manual physical therapy significantly improved sexual function, pain during sexual intercourse, and pain during menstruation [23].

Note: If you want to pursue PT for pelvic floor dysfunction, it’s important to see a physical therapist who specializes in the condition.

Acupuncture

A systematic review and meta-analysis examined research about the effectiveness of various complementary and alternative therapies for endometriosis. A total of 385 women were involved in the included studies and the results showed that acupuncture was associated with a significant reduction in pelvic pain in endometriosis patients [24].

You Have Options for Treating Endometriosis Symptoms Naturally

If you have endometriosis, there are many natural treatment options and combinations to try, alongside medication or not. Symptoms like endo-belly and pelvic floor dysfunction are not only treatable, but improving them by addressing gut health or working with a pelvic floor PT may also improve other endometriosis symptoms like pelvic pain and heavy periods. 

If you want to learn more about gut health and its connection to women’s health, check out my book, Healthy Gut, Healthy You.

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