Endometriosis Awareness Month

Doesn’t it seem like “the gut” is implicated in pretty much every health condition? Well, endometriosis is no exception! 

In fact, March is Endometriosis Awareness Month

I have heard endometriosis described as the incredibly common disease… you have never heard of — which captures it perfectly. 

Endometriosis affects an estimated 1 in 10 women during their reproductive years (between the ages of 15 to 49), which is approximately 176 million women worldwide. 


That it takes a woman an average of 9 years to get an accurate diagnosis from the onset of symptoms, which commonly includes gynecological complaints, such as:

  • painful menstrual cramps
  • heavy menstrual bleeding
  • bleeding between periods
  • pain with intercourse
  • association with uterine fibroids

But, what is Endometriosis?

Endometriosis is typically a non-cancerous gynecological condition, but it can reportedly cause a significant amount of pain for the sufferer. 

It is an inflammatory disease in which tissue, very much like the type that grows inside the uterus – grows outside of it, forming lesions that are often found in clusters, called endo implants. 

This tissue responds to the hormone fluctuations that dictate the menstrual cycle in the same way it would if it were found inside the uterus. However, unlike the uterine lining (the endometrium), this tissue can’t break down and shed at the end of a cycle – which normally marks the period. 

So, instead, it causes inflammation, leading to scar tissue buildup over time. This results in many symptoms, including extreme pain both during and outside of the regular menstrual cycle. 

My Personal Connection With Endometriosis

On a personal note, it was my own extended battle with this condition that spurred on my passion for nutrition and led me down my current career and business path. (Most people don’t know that!)


After years of terrible pain, missing school and work, and being told at 20 that if I didn’t have a baby then, that I never would due to the infertility issues I would likely face as a woman with endometriosis — I went ahead with surgery in my early twenties. 

Unfortunately, like many women, my surgery was not successful, and I continued to live with chronic and severe pain. 

Looking for other options in the face of the failed surgery, I ordered a book on “nutrition & endometriosis” and started researching diet and lifestyle changes. 

Then, several months later, I thankfully started to heal. But I now realize that this is not always the outcome for many women who are suffering — as I did for all those years.

Shortly after that, I found myself preparing to apply for graduate school in clinical nutrition and officially kick started my career in this field, dedicating myself to women’s health and nutrition – which I’ve been doing for over 10 years now!

As painful as this experience has been, both physically and emotionally, I am thankful for the critical role it played in awakening my deep passion for all things nutrition. 

But also how nutrition, as part of a holistic approach to health optimization could help women, just like me, with various hormone imbalances, including endometriosis. 

“On a personal note, it was my own extended battle with this condition that led me down my current career and business path. As painful as this experience has been, both physically and emotionally, I am thankful for the critical role it played in awakening my deep passion for all things nutrition.”  – Stacy Roy, MS, CNE, BCHN

Symptoms of Endometriosis: Extreme Bloating and “Endo Belly”

Along with extreme pain, fatigue, infertility (endo is one of the leading causes), and heavy menstrual bleeding, endometriosis can also cause gastrointestinal symptoms, such as:

  • Pain with bowel movements and urination
  • Nausea and vomiting
  • Constipation and/or diarrhea
  • Bloating (sometimes extreme, even giving the appearance of being pregnant)

While rarely talked about, “endo belly” is a term sufferers of this condition have been known to describe the uncomfortable, often painful, and extreme bloating they experience.

Those with this condition are also more prone to small intestinal bacterial overgrowth (SIBO), which may also lead to extreme bloating, further contributing to “endo belly”.

The Endometriosis – SIBO Connection

Included in the Mayo Clinic’s list of causes of SIBO: 

  • Complications after abdominal surgery
  • Certain medical conditions, like Crohn’s disease, radiation enteritis, scleroderma, celiac disease, diabetes or other conditions that can slow movement (motility) of food and waste products through the small intestine 
  • Structural problems in and around your small intestine, including scar tissue (intestinal adhesions) that can wrap around the outside of the small bowel

Additionally, research indicates that, in a group of 50 women diagnosed with endometriosis, 40 also had SIBO. In this case, it is thought that the inflammation induced by endometriosis can alter the gut microbiome, often leading to SIBO, among other pervasive digestive problems like IBS.

“In one key study, a full 90% of women with endo presented with GI symptoms—and, it is important to note, only 7.6% of the women had [endo] implants on the bowel itself. 

Thus, some experts say, the diagnosis of GI disorders, especially SIBO, in the appropriate setting, should trigger consideration for the possibility—if not the likelihood—of endometriosis as an underlying cause.”  – Stephanie Eckelkamp, Health & Nutrition Editor, MBG Health

But, what exactly is SIBO?

As I wrote in this article, SIBO is a condition when bacteria (or other microorganisms, good or bad) grow out of control in the small bowel/intestine, which should remain relatively low in bacterial count, as compared to the colon (or large bowel/intestine).

Colonization of this area also ends up damaging the cells lining the small intestine otherwise known as “leaky gut” (or increased intestinal permeability), which also impairs the digestive process and overall absorption of nutrients.

This can exacerbate nutritional deficiencies and allow toxins, pathogens and undigested protein molecules to enter the bloodstream that, in turn, cause widespread inflammation, food sensitivities, autoimmune disorders, and other undesirable immune reactions.

Read more HERE about the symptoms of Small Intestinal Bacterial Overgrowth.

Supporting Digestive Health When You Have Endometriosis

Recent research indicates that the gut’s role, specifically the gut microbiome, may be an important factor that needs to be explored in much greater detail as it pertains to endometriosis. [1]

Working with a nutritional professional, who is also experienced in functional medicine, is a good place to start as they can create a diet plan customized to your health and needs AND they can also order the proper tests – and analyze them for you. (Sort of like a health detective!) 

They can also help to identify nutrient deficiencies and other imbalances within the body and, again, help you implement a customized protocol, as needed for your specific health issues.

Tips to minimize digestive symptoms associated with Endometriosis – and to ease the discomfort of “endo belly”:

  • Anti-inflammatory eating plan, and other dietary measures, such as:
    • increasing soluble fiber intake (to prevent constipation), and reducing or eliminating sugar, gluten, dairy & soy
  • Low FODMAPs, especially if SIBO is indicated (but only short term)
  • High-quality supplements: curcumin, omega-3 fatty acids, evening primrose oil, and those for liver support (e.g. NAC, DIM, calcium D-glucarate, and other estrogen detoxifiers)
  • Blood sugar balance
  • Castor oil packs
  • Avoid xenoestrogens
  • Peppermint and/or ginger tea after eating

And lastly, probiotics have also been found to positively impact endometriosis and its associated digestive complaints. 

One study found that the specific strain, Lactobacillus gasseri OLL2809, significantly improved reported pain in endometrial patients compared to placebo after 12 weeks. [2]

But, be sure to check with a qualified health practitioner when implementing any of these or other suggested supplements and nutritional protocols that have a therapeutic indication.

Do you suffer from endometriosis and/or SIBO (or other persistent gastrointestinal issues)?

Need help navigating all of the confusing information on the web and what course of action may be right for you, as an individual?


Nicole Jardim, The Period Girl: Living With Endometriosis The Real Causes + Natural Solutions

MBG Health: Constipation, SIBO, and other GI Issues Can Be a Red Flag for This Condition

Johns Hopkins Medicine / Health / Conditions: Endometriosis

Healthline: What is Endo Belly, and How Can You Manage It?

Mayo Clinic / Diseases & Conditions: Small Intestinal Bacterial Overgrowth (SIBO)

[1] Integrative Medicine, A Clinician’s Journal, December 2014 (Journal): Part 1 – The Human Gut Microbiome in Health and Disease
[2] Cytotechnology, March 2011 (Journal): Lactobacillus gasseri OLL2809 is effective especially on the menstrual pain and dysmenorrhea in endometriosis patients: randomized, double-blind, placebo-controlled study