Endo belly refers to the severe abdominal distention or bloating that occurs in patients with endometriosis. It can not only take a significant physical toll but also has psychological impacts. Nutrition, lifestyle, and, in some instances, medications can help with the management of symptoms.
Endometriosis is a common condition affecting about 10% of women and can present as pelvic pain, painful periods, and infertility. “Endo belly” is a common and often distressing symptom of endometriosis characterized by significant abdominal bloating and discomfort, especially before or during menstruation.
Among those with endometriosis, bloating coupled with pain occurs due to multiple factors, including inflammation, hormonal fluctuations, and often dietary choices and stress. Understanding these underlying mechanisms is key to effectively managing and relieving this challenging condition.
Here’s what you’ll learn about endo belly in this article:
- Root causes of endo, including Inflammation and irritation resulting from endometrial-like tissue growing outside the uterus.
- Factors that can make endometriosis bloating worse, such as food choices and lifestyle habits.
- Why symptoms tend to get worse when a woman eats a poor diet, is stressed, and is suffering from gut dysbiosis, SIBO, and IBS.
- How endo belly can be managed with treatment options like medications, an anti-inflammatory diet, supplements, heat, and natural remedies to reduce pain.
What Is “Endo Belly”?
Endo belly is short for endometriosis belly, which describes abdominal swelling and discomfort that can sometimes be severe. Many people experience bloating before their period, but in the case of endo belly, the symptoms are much more severe and can span a longer duration during the cycle.
While every person experiences endometriosis differently, some describe the digestive distress that it causes to be “debilitating,” so much so that it can lead to being doubled over in pain.
Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside of it, often leading to painful, heavy periods as well as other symptoms, including those affecting digestion — such as symptoms of IBS like constipation and gas. It can also lead to trouble getting pregnant, low sexual satisfaction, and general discomfort.
Endo affects as many as 10% of women in their reproductive years. Inflammation and high estrogen levels are known to stimulate endometriosis and make abdominal pain and discomfort from factors such as fluid retention and swelling worse.
Recognizing Endo Belly Signs and Symptoms
Endo belly symptoms can arise during endometriosis flare-ups or may be persistent through most of the cycle.
Endo belly is characterized by symptoms including:
- Severe bloating and swelling that is noticeable, often sudden, and intense. People with endometriosis describe the severity as “looking several months pregnant.”
- Gastrointestinal discomfort, including stomach pain, constipation, nausea, lack of appetite, and/or diarrhea
- Pelvic pain or cramps, which often intensify when a woman has her period
- Feelings of fullness even without consuming a large meal
- Limited mobility in the abdomen and feelings of “stretching”
- Clothing discomfort and tightness due to abdominal swelling
Symptoms among endometriosis patients can vary with endo belly being one symptom of endometriosis. Other common endometriosis symptoms include painful periods, pain with sex, lower back pain, difficulty or pain with urination or bowel movements, fatigue, and menstrual cramps that can begin before the period and continue after.
Causes of Endo Belly
What's the connection between a bloated stomach and endometriosis? Endo belly is primarily caused by the inflammation and irritation resulting from endometrial lesions growing outside the uterus.
This aberrant tissue can cause a chronic inflammatory response, leading to swelling, bloating, and other gastrointestinal symptoms. Additionally, endometriosis can lead to scar tissue and adhesions that can disrupt normal digestive function.
Here's more about how the endo belly develops and why.
Inflammation and Irritation
Endometriosis causes endometrial-like tissue to grow outside the uterus, often on the ovaries, fallopian tubes, and tissues lining the pelvis. This tissue behaves like the endometrial lining inside the uterus, thickening, breaking down, and bleeding with each menstrual cycle.
However, with endometriosis, the displaced tissue has no way to exit the body and can lead to ovarian cysts, irritation, and inflammation of surrounding tissues. This contributes to the bloating and pain known as endo belly. It also generally makes the abdomen sensitive and leads to painful sensations.
Scar Tissue and Adhesions
As a response to inflammation, the body may form scar tissue and adhesions, which can cause organs to stick together. This can lead to a pulling sensation in the pelvis and abdomen, as well as pain and the bloated appearance associated with endo belly.
Hormonal Fluctuations
Endometriosis is exacerbated by hormonal changes, particularly high levels of estrogen. These hormonal fluctuations can influence fluid retention and digestive processes, further contributing to bloating and abdominal discomfort.
The endometriosis implants respond to estrogen in the same way the endometrial tissue (lining of the uterus) does to estrogen—it grows and bleeds with the cycle.
Small Intestinal Bacterial Overgrowth (SIBO)
Research has shown that there are often significant differences in the gut microbiota composition between healthy individuals and those suffering from either endometriosis or IBS. Intestinal dysbiosis and permeability appear to be common in all three of these conditions, which makes sense considering that gut dysfunction triggers inflammatory reactions and initiates immune responses.
Small Intestinal Bacterial Overgrowth (or SIBO) is an overgrowth of bacteria in the small intestine that can lead to severe bloating, sometimes along with other digestive issues. The connection between endometriosis and SIBO is not entirely clear-cut, but several theories and observations can help explain why women with endo may be more prone to developing SIBO, as well as IBS (irritable bowel syndrome) and other gastrointestinal issues.
Gut Motility
In some cases, endometriosis can affect the muscles and nerves in the gut, potentially leading to reduced gut motility. This creates a vicious cycle that may worsen endo, as it slows down the movement of the digestive tract, creating an environment conducive to bacterial overgrowth.
Inflammatory Process
Endometriosis is associated with inflammation and changes in the immune system, which can affect the body's ability to regulate bacteria in the gut. An impaired immune response in the gut may fail to keep bacterial growth in check, leading to SIBO.
Invasive Surgery
Surgeries like hysterectomy or those involving the removal of endometrial lesions can alter the anatomy and function of the gastrointestinal tract, potentially predisposing to SIBO.
Medication Use
The frequent use of certain pain medications, such as opioids, in managing endometriosis pain can affect bowel function. These medications can slow down gut motility, increasing the risk of SIBO.
Dietary Choices
Women with endometriosis often modify their diets to manage symptoms, which can inadvertently affect beneficial bacteria. For instance, diets high in certain carbohydrates or lacking in diversity may create an environment for bacterial overgrowth.
Gastrointestinal Symptoms
The proximity of endometrial-like tissue to the intestines can disrupt normal bowel function. Endometriosis can affect the bowels, leading to symptoms like constipation, diarrhea, bloating, and painful bowel movements.
These digestive symptoms are associated with IBS, which is common among women with endometriosis. One study found a strong connection between women with endometriosis and IBS; those with endometriosis were 3.5 times more likely to have received a diagnosis of IBS compared to women without endo.
Related: Endometriosis and IBS Connection
Factors That Can Worsen Endo Belly
While the factors below don't typically directly cause endo belly, they can worsen it and make discomfort more severe.
Dietary Choices
Certain foods can exacerbate bloating and gastrointestinal discomfort, including among both women with and without endometriosis. For example, a woman can have endometriosis and a digestive condition at the same time, such as a food intolerance, which is one reason that addressing dietary choices is so important.
Foods that can worsen stomach bloating include:
- Those that are high in FODMAPs (certain types of carbohydrates that are difficult to properly break down).
- Gluten
- Dairy
- Highly processed foods such as deli meats, fried foods, sugary snacks, trans fats, and fast foods with additives
- Soy products
- Fatty meat
- Caffeine
- Alcohol
Menstruating
The symptoms of endo belly often worsen during menstruation due to increased inflammation and hormonal changes. Even among women without endometriosis, bloating and stomach cramps prior to menstruation or during a woman's period are common for these same reasons.
High Levels of Stress
Stress and impaired mental health can exacerbate endometriosis symptoms, including painful bloating. Stress hormones, such as cortisol, and high levels of anxiety can influence inflammation and impact gut health, often leading to increased bloating and discomfort.
Too Much or Too Little Physical Activity
While gentle exercise can be beneficial, extreme or intense physical activity might exacerbate endo belly symptoms in some individuals.
On the other hand, being sedentary can make bloating and digestive symptoms worse as it slows down circulation and tends to make digestion slower and “sluggish.”
Gut Microbiome Imbalance
An imbalanced gut microbiome, known as dysbiosis, is thought to negatively affect digestion and exacerbate bloating and gastrointestinal symptoms associated with endo belly. Within the gut live beneficial bacteria (commensal) and potentially pathogenic bacteria that need to live in balance. When there is an imbalance in these organisms, dysbiosis occurs and with it, unwanted symptoms and disease can arise.
The gut microbiome can become imbalanced due to infections (such as food poisoning), a poor diet, low intake of essential nutrients and probiotics, stress, and overuse of medications such as antibiotics. All of these factors may worsen endometriosis symptoms.
A balance of bacteria and microorganisms is essential for healthy gut and immune function, as well as optimizing inflammation.
Probiotics have been shown to help with reducing inflammation and modulating the immune system. By reducing inflammation and supporting digestion, probiotics may help reduce pain and discomfort in endometriosis patients. Because of this gut-endometriosis connection, Women's Probiotic for endometriosis may offer relief.
| Evidenced Based Ways to Decrease Endo Belly Naturally | How to Implement |
| Anti-Inflammatory Diet | Emphasis on whole foods that include cold water fish, variety of vegetables and fruit, nuts and seeds, healthy fats Reduction of refined grains, sugars, ultra processed foods Anti-inflammatory diet recipe guide |
| Probiotics | Women’s Probiotic, which contains spore-based organisms, lactobacillus species, antioxidants, and prebiotics for comprehensive gut support |
| Herbal teas | Ginger, turmeric, and peppermint tea |
| Nutritional and Herbal Supplements | Balance Women’s Hormone Support Omega Plus Magnesium Plus |
| Stress Reduction | Tai chi, yoga, meditation, acupuncture, journaling |
| Exercise | Pilates, gentle stretching, strength training, walking, swimming |
| Vitamin D | Sunlight exposure Foods: fatty fish, fortified foods, mushrooms Vitamin D3/K2 supplement |
Treatment Options for Endo Belly
A holistic approach that includes medical treatment, dietary modifications, stress management, and appropriate physical activity can often help to alleviate endometriosis belly symptoms. It's also important to work with healthcare professionals who understand endometriosis and can provide tailored advice and treatment options.
In most cases, managing endo belly involves a multifaceted approach, addressing both the symptoms and the underlying endometriosis itself. Here are treatment options to consider if you're suffering from digestive issues due to endometriosis.
Treatment Options for Endo Belly Include:
- Medications like oral contraceptive pills, Lupron, progestins, NSAIDs, and other pain medications
- Surgical excision of endometrial lesions
- Anti-inflammatory diet
- Lifestyle therapies like stress reduction, castor oil packs, exercise, and acupuncture
- Supplements to manage gastrointestinal discomfort, estrogen metabolism, and inflammation, as well as those that provide antioxidants
Let’s explore these in more detail.
Medications and Surgery
In addition to tackling endometriosis naturally with diet and lifestyle changes, medications and surgery to remove endometrial lesions may be needed to address severe endometriosis symptoms. Talk to your healthcare provider about endometriosis treatment options based on your symptoms and history.
In cases where endometriosis surgery is indicated, other therapies and treatments that we'll discuss here can also be added to help manage the condition effectively.
Birth control pills, GnRH agonists, progestins (synthetic progesterone), and other hormonal treatments may help manage endometriosis symptoms by regulating or suppressing the menstrual cycle and estrogen production.
Over-the-counter pain medications such as ibuprofen can also be used to manage pain and discomfort, although they might not necessarily address bloating. Because of the negative impact on gut health, NSAIDs, such as ibuprofen, can make endo belly symptoms worse. If you're taking them consistently or going above the recommended dose, talk to your provider about options.
Anti-inflammatory Diet
Consuming foods that reduce inflammation and keep estrogen levels within the normal range is helpful for managing endometriosis symptoms. For help starting an anti-inflammatory diet, grab a free copy of my Hormone Balancing Meal Plan and Recipe Guide.
Anti-inflammatory foods to emphasize in your diet include:
- Vegetables like leafy greens, peppers, carrots, etc.
- Fruits like berries, oranges, and others
- Omega-3-rich foods like salmon and sardines
- High-fiber foods (as long as they are well-tolerated), such as fruits, vegetables, legumes, nuts, seeds, and whole grains
- Healthy fats, such as omega-3 and monounsaturated fats, found in oily fish, nuts, seeds, avocados
- Magnesium-rich foods, which can help relax muscles, such as leafy greens, dark chocolate, legumes, nuts and seeds
- Zinc-rich foods such as poultry, grass-fed meat, and shellfish
- Fermented foods like sauerkraut, kimchi, and yogurt
If you're struggling with endo belly, avoid or greatly limit these foods and beverages:
- Alcohol
- Coffee and caffeine
- Sugary drinks like soda, energy drinks, and bottled, sweetened teas and juices
- Foods made with sugar and refined grains, like desserts, most cereals, etc.
Some people with endometriosis find relief by following a “no CRAP diet” (no caffeine, refined sugars, alcohol, or processed foods) as well as a low FODMAP diet, which reduces certain carbohydrates that can cause bloating, gas, and pain. A low FODMAP diet excludes foods high in certain types of sugars and fibers, including:
- Milk and dairy products
- Foods made with wheat
- Most beans and legumes
- Cruciferous veggies like broccoli, cauliflower, and Brussels sprouts
- Foods made with artificial sweeteners and some preservatives, coloring agents, and additives
In one study, those with endometriosis and IBS reported more than a 50% improvement in symptoms after 4 weeks on the low FODMAP diet. While that is promising, the underlying issues should be addressed as a low FODMAP diet is not only restrictive but can potentially lead to increased emotional stress and gut dysbiosis if practiced for too long.
Additionally, some research has suggested there is a reduced risk of developing endometriosis later in life among adolescents who regularly consume yogurt.
Lifestyle Therapies
Considering that stress and inflammation can make endo bloating worse, habits and exercises that help to manage these factors are often helpful for reducing pain and getting digestion back on track. I suggest trying these remedies to help soothe a bloated, painful abdomen:
- Gentle exercise, such as yoga, pilates, cycling, and walking
- Heat therapy, such as applying a heating pad to the abdomen while lying down to reduce pain
- Acupuncture to deal with stress and discomfort
- Meditation and breathing exercises to help you relax more easily
- Physical therapy, especially with a therapist who is knowledgeable about pelvic pain, to help address discomfort
- Therapy or counseling if you're struggling with anxiety, embarrassment, or high amounts of stress
- Castor oil packs; while lacking scientific evidence, many women anecdotally report relief when using them. Here's how to use a castor oil pack.
Supplements for Endo Belly
Certain supplements may help support overall hormonal and digestive health while helping you to cope with the effects of endo belly. It is important to keep in mind that supplements are used as an adjunct therapy to nutrition, lifestyle, medications, and surgery to help holistically manage endometriosis.
Supplements that may help alleviate endo belly:
- Omega-3 fatty acids
- Probiotics
- Magnesium glycinate
- Vitamin D
- Vitamin B6
- Sulforaphane
- Resveratrol
- DIM
- Chaste tree berry (Vitex)
- Polygonum
- Calcium d-glucarate
Supplements to Help Manage Pain and Discomfort
Addressing the underlying inflammation is key in reducing endometriosis bloating and symptoms of endo belly. The following supplements have been shown in the research to be beneficial adjunct therapies in managing endometriosis belly.
Omega-3 fatty acids
Research suggests that omega-3s can potentially reduce pain intensity and duration of endo symptoms due to how these fats work to modulate pain pathways and decrease the production of inflammatory substances that exacerbate discomfort.
These healthy fats, the same kinds found in my Omega Plus formula, are known for their anti-inflammatory properties, ability to support normal immune function, and their positive effects on moods and pain.
With endometriosis, an immune system imbalance and inflammation can contribute to the persistence of endometrial-like tissue outside the uterus, but omega-3s may help modulate the immune response, potentially reducing the growth and spread of endometrial lesions. Omega-3s may also help improve energy levels and overall mental well-being, which commonly suffer among those with endo.
Magnesium glycinate
This form of magnesium can help with muscle relaxation and reduce spasms and cramps, which are often experienced by those with endo. Magnesium inhibits inflammatory prostaglandins and is known for its role in reducing menstrual cramps.
Magnesium Plus formula contains magnesium glycinate which can be beneficial in maintaining a healthy mood, sleep, and hormone balance and reducing certain painful endo symptoms.
Probiotics
As discussed earlier, probiotics are “friendly microbes” that are helpful for restoring gut health, improving immune function, and regulating digestion. Studies indicate that probiotics, such as Lactobacillus strains, can help diminish inflammation, regulate the immune system, and assist in estrogen metabolism.
Through their anti-inflammatory properties and facilitation of digestive health, probiotics have the potential to alleviate endo belly pain and discomfort. Given the established connection between gut health and endometriosis, the utilization of a Women's Probiotic may provide a viable source of relief.
Vitamin D
While there have been mixed outcomes in vitamin D research related to endometriosis, a recent meta-analysis suggested that vitamin D supplementation may be an important therapy in the management of endometriosis.
Vitamin D plays an important role in reducing inflammation and immune system modulation, which may make it an important nutrient to consider in endometriosis care.
When supplementing with vitamin D3, it is recommended to couple it with vitamin K2 to enable proper calcium integration into the bones rather than soft tissues.
N-acetylcystiene (NAC)
NAC is an amino acid that has been shown to reduce endometriosis pain and endometriomas (cysts on the ovaries). Additionally, it has the potential to reduce the estrogen available to endometrial lesions, decreasing their growth and proliferation.
NAC is a precursor to glutathione, a potent antioxidant. As discussed previously, antioxidants can aid in the management of endometriosis related symptoms.
This is the NAC formula I utilize in clinical practice.
Green Tea, Ginger Tea, and Herbal Teas
Green tea contains natural anti-inflammatory compounds that may help alleviate endo cramps and discomfort.
Other teas, such as those made with ginger root, can also help naturally dull pain and alleviate digestive discomfort. Peppermint tea has been used for centuries to reduce an upset stomach or cramping.
Turmeric, which can be used to make an antioxidant-rich tea, is helpful for fighting inflammation, oxidative stress, and adhesions that can contribute to endo.
Supplements to Support Estrogen Balance and Metabolism
The scientific evidence has shown certain nutrients and herbs to be beneficial in supporting estrogen metabolism, which may offer relief to those struggling with endometriosis bloating.
Based on the evidence, Balance Women’s Hormone Support was formulated to have each of these ingredients.
Vitamin B6
Vitamin B6 aids in the metabolism of estrogen into its inactive form. In addition, it is an essential part of creating anti-inflammatory prostaglandins, which may inhibit the growth of endometriosis.
Sulforaphane
Sulforaphane is a compound found in cruciferous vegetables that has gained attention for its potential benefits in managing endometriosis. Research suggests that sulforaphane may help reduce inflammation, oxidative stress, and the growth of endometrial tissue outside the uterus, offering support for managing various endo symptoms.
Resveratrol
Resveratrol acts as a potent antioxidant, which can protect cells and tissues from oxidative stress and inflammation, which are two contributing factors to endo symptoms.
It also helps inhibit prostaglandin synthesis, further contributing to its anti-inflammatory effects. Prostaglandins are responsible for menstrual cramps, which is why regulating them can reduce pain.
Resveratrol may also have an inhibitory effect on endometriosis cell development; however, more human trials are needed to fully understand its benefits as an adjunct therapy in the treatment of endometriosis.
DIM (Diindolylmethane)
DIM (Diindolylmethane) supports the metabolism of estrogen and helps the body convert aggressive forms of estrogen into less potent ones, reducing estrogen's stimulatory effects on endometrial tissue. This can contribute to alleviating endometriosis symptoms by regulating estrogen activity.
One study found that among those with endometriosis, pelvic pain, and bleeding were significantly reduced in those taking a DNG (Dienogest)-DIM combination therapy compared to DNG alone. Dienogest is a common progestin prescription for the management of endometriosis that has the side effect of irregular bleeding. This study demonstrated that with the addition of DIM, both the number and duration of bleeding episodes were greatly improved.
Chaste Tree Berry (Vitex)
Chaste tree berry is known for its ability to help modulate estrogen due to its influence on the pituitary gland, which, in turn, helps regulate the balance between estrogen and progesterone. It may also modify estrogen receptor activity in a way that favors endometriosis. This can be particularly beneficial for women with endometriosis as it helps mitigate the effects of excess estrogen.
Polygonum
Polygonum is another herb that can help reduce inflammation and regulate hormonal imbalances by modulating estrogen receptor activity. It has the potential to reduce the symptoms of estrogen dominance, such as heavy menstrual bleeding and pelvic pain, which are often associated with endometriosis.
Calcium d-Glucarate
Calcium d-Glucarate is a compound that promotes the proper elimination of excess estrogens from the body, aiding in the detoxification of estrogen metabolites and reducing estrogen’s effects on tissues affected by endometriosis.
B vitamins (including B6, B12, and folate)
B vitamins play a role in proper cell differentiation and the metabolism of estrogen. Ensuring that cells in the endometrial tissue develop and function correctly can help reduce the abnormal growth seen in endometriosis.
Other Causes of a Bloated Belly
A bloated belly can be caused by a variety of factors besides endometriosis. Here are some common causes of abdominal bloating:
- Digestive disorders: Conditions like Irritable Bowel Syndrome (IBS), Crohn's disease, ulcerative colitis, and celiac disease can cause significant bloating, along with other gastrointestinal symptoms.
- Food intolerances and sensitivities: Lactose intolerance, gluten sensitivity, and other food allergies or intolerances can lead to stomach bloating when consuming certain foods.
- Overeating: Consuming large meals can stretch the stomach and lead to discomfort, especially if the meal includes lots of sugar, salt, and fat.
- Gas-producing foods: Certain foods like beans, lentils, whole grains, certain vegetables (like broccoli, cabbage, and onions), and carbonated beverages are known to produce excess gas. Many of these are FODMAP foods that people with SIBO and endometriosis may avoid or limit to feel better.
- Alternative sweeteners: Some alternative sweeteners found in sugar-free foods and drinks can cause bloating and gas, particularly sugar alcohols like erythritol or mannitol.
- Constipation: Difficulty with bowel movements can cause a feeling of fullness in the abdomen.
- Gastroesophageal Reflux Disease (GERD): This condition, which involves acid reflux and heartburn, can also cause bloating.
- Hormonal fluctuations: Women may experience bloating during different phases of their menstrual cycle due to hormonal changes, particularly around menstruation.
- Fluid retention: Conditions like liver disease, kidney problems, or heart failure can cause fluid retention in the body, leading to bloating.
- Medications: Certain medications, including some pain relievers, antidepressants, and iron supplements, can cause bloating as a side effect.
Key Takeaways on Endo Belly Causes and Treatments
Managing endometriosis bloating requires patience and a personalized approach. Endo belly, while challenging, can often be managed with a combination of medical treatments, nutritional adjustments, home remedies, and supplements.
Remember, every individual's experience with endometriosis and its related symptoms is unique. Understanding your body's responses and working closely with healthcare professionals is also crucial to finding relief and improving your overall well-being.
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