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When Endometriosis Triggers IBS Symptoms

Feature, Gut Health & IBS, Women's Health | March 2, 2020

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Our registered dietitians at Ignite Nutrition specialize in a number of topics, with two of them being gut health and women’s health – and often these two areas actually overlap with our patients! For many women, symptoms of irritable bowel syndrome worsen during menstruation, which can of course be VERY frustrating on top of already dealing with “that time of the month.”

In particular, women with a condition called endometriosis have a high likelihood of experiencing digestive issues. Today we will review the connection between endometriosis and irritable bowel syndrome – and how nutrition plays a role in both conditions! Let’s get started.

What is Endometriosis?

Endometriosis is a condition where tissue typically only found inside the uterus starts to grow outside of the uterus, implanting itself on organs nearby. It can start to extend to places such as the outer uterine walls, ovaries, fallopian tubes, pelvis and bowels – which makes sense that it can then affect bowel function!

Endometrial tissue is the part of a woman’s uterus that responds to hormonal changes during the menstrual cycle. It thickens and then gets expelled from the uterus during a woman’s period.

Similarly, the excess endometrial tissue growing outside the uterus also responds to estrogen, thickening each month, and bleeding internally during menstruation. This creates a lot of inflammation and pain for most women who have it. It is particularly painful during the times when women produce the least estrogen – ie. during menstruation.

Symptoms of endometriosis can include:

  • painful intercourse
  • chronic pelvic pain
  • back pain
  • painful periods, severe menstrual cramping
  • uncomfortable, difficult, or painful bowel movements

Diagnosing Endometriosis

Because of the non-specific nature of endometriosis symptoms, it can take a long time to properly identify what is happening with women who have this condition. Studies report that diagnostic time can be more than 11 years on average in the United States. Needless to say, endometriosis is a highly misdiagnosed and under-diagnosed condition.

If you experience symptoms similar to those listed above, it is important to mention this to your family doctor. Some tests that may be conducted to identify and diagnose endometriosis include:

  1. Internal exam – with consent, your family physician or gynecologist may perform an internal exam to assess for tender areas, lumps, or areas that are particularly painful
  2. Pelvic ultrasound – This can detect endometrial implants on a few key areas in the lower abdomen, including the pelvis, ovaries and rectum
  3. Laparoscopy – A laparoscopy is a procedure in which small incisions are made in the abdomen and a camera is inserted to view the internal organs and assess for endometriosis.

 Additionally, women who report significant intestinal-related pain and changes in bowel habits are often diagnosed with irritable bowel syndrome and treated accordingly – although it is possible their symptoms are a result of endometriosis rather than IBS.

black and white photo of a person holding their abdomen. There is a red colouring around their abdomen.


Connecting Endometriosis and IBS

These two conditions certainly have some strong similarities. In particular, both endometriosis and IBS activate the immune system and generally present with something called visceral hypersensitivity. This is defined as a heightened sensitivity to pain in the body’s internal organs – causing small sensations to feel like large and painful sensations in the body. With IBS, visceral hypersensitivity can make “normal” digestion feel uncomfortable, which often leads to abdominal pain and cramping.

For many women, this heightened sense of digestion is increased even further with IBS. Studies show that up to half of women with IBS report that their digestive symptoms, particularly abdominal pain, worsen during their periods. While this can be because of hormonal changes, it is also interesting to note that women with IBS outnumber men with IBS 2 to 1. With endometriosis being a condition specific to women, studies are beginning to look at the connection between these two populations.

While we don’t know the exact connection between these two conditions yet, it is likely that some female patients diagnosed with IBS could actually have endometriosis – or may even have both. If you notice worsened abdominal pain, bloating, gas, and bowel changes at the time of your period, it is a good idea to bring this up with your doctor and discuss your options.

Treating Endometriosis

There are a few treatment options for endometriosis, with some being more accessible than others. A gynecologist or your family physician will help to determine the best treatment options for you based on your symptoms and medical history.

The main treatment options for endometriosis include:

1. Pharmacological pain management – As a first line treatment, physicians often work to relieve the pain of endometriosis by using over the counter or prescription pain solutions.
2. Medical hormonal therapy – Depending on the individual, a doctor may prescribe gonadotropin-releasing hormone (GnRH) agonists or combined oral contraceptives that actually stop ovulation, therefore decreasing symptoms of endometriosis.
3. Laparoscopic surgery – This involves removal of sections of endometrial implants from internal organs and can be done in mild to moderate cases of endometriosis. A specialist will determine whether surgery is appropriate based on the location and severity of the endometrial tissue.
4. Natural menopause – After menopause, endometriosis symptoms generally lessen or even disappear. Many women with IBS also note improved digestive symptoms after menopause.

At this point in time, most research on women with endometriosis does not claim that the women also have a diagnosis of IBS. However, it is extremely promising that women with endometriosis who also have IBS-like symptoms (ie. abdominal pain, gas, bloating, poor bowel function) generally see a reduction in digestive issues when treated for endometriosis as well!

Diet and Endometriosis

Aside from the treatments listed above, food can also play a major role in reducing symptoms associated with endometriosis, particularly in those that have digestive symptoms. In particular, the strong correlation between endometriosis symptoms and IBS symptoms has piqued the interest of researchers who specialize in IBS. The big question they are now asking is this: Can the low FODMAP diet for IBS also improve endometriosis?

One study reported that women with both IBS and endometriosis saw greater than 50% improvement in bowel symptoms on the low FODMAP diet. This is likely because the low FODMAP diet is associated with less visceral hypersensitivity, which is a symptom of both IBS and endometriosis.

In our practice, we are seeing the same thing. Women who report worsened abdominal pain, bloating, and bowel changes during their periods often respond quite well to a diet low in fermentable carbohydrates and this is a great place to start. However, every case is unique, and it is best to get the help of a digestive health dietitian when following the low FODMAP diet.

Key Takeaways for Endometriosis and Gut Symptoms

  • Endometriosis symptoms can be similar to symptoms of IBS
  • We still don’t fully know the connection between endometriosis and IBS
  • Treatment options include medications, surgery, and hormone therapies
  • Digestive symptoms often improve for women who are treated for their endometriosis
  • Following a low FODMAP diet is also shown to help reduce digestive symptoms of endometriosis

Do you feel like endometriosis could be related to your IBS symptoms? If so, talk to your doctor about getting screened for endometriosis. Schedule an appointment with one of our gut health dietitians to learn more about how a low FODMAP diet and/or other dietary interventions may help to alleviate your symptoms.

Additionally, it can be helpful to track your symptoms alongside your menstrual cycle for a few months. Consider the following: How do your symptoms change during your cycle? What type of symptoms do you experience? Do you experience painful periods or painful intercourse?

black and white photo of a person holding their abdomen. There is a red colouring around their abdomen.

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  1. Aragon M. & Lessey B.A. (2017). Irritable bowel syndrome and endometriosis: twins in disguise. Greenville Health System, 2(1): 43-50.

  2. Moore J.S. et al. (2017). Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP diet. Obstetrics & Gynaecology, 72(8): 475-477.

  3. Endometriosis (2018). Royal College of Obstetricians & Gynaecologists. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-endometriosis.pdf