Let’s Talk ‘Endo Belly’: The forgotten symptom of endometriosis

Let’s explore some of the potential causes and triggers of the aptly named ‘endo belly’.

pregnant woman sitting on bed and reading book

Endometriosis is a symptom-spanning condition – from chronic pain to fatigue; the list is endless (1). If you’re a #endowarrior, one of the symptoms you may know all too well is the colloquially named ‘endo belly’, in which painful, sudden bloating can flare, creating a ‘pregnant-like’ shape (1). Studies highlight the unpredictability of flares can negatively affect self-esteem, warping our sense of self by living in a body that does not look as it usually does (2). This can be painful and distressing for those navigating day-to-day life with an ever-changing health condition (3).

Our knowledge of endometriosis is limited due to various reasons (underfunded female health research, diagnostic issues, dismissal of women’s health, etc.) and research regarding ‘endo belly’ is scarce, resulting in neither an understanding of the cause nor sufficient support options to help improve it (4, 5). While this may seem disheartening if we consider what we currently know of endometriosis and its impact on the body, we can start to suggest tips that may help ease it – or at least help prepare you for your next flare. 

First, let’s talk about the potential triggers or causes: stress, inflammation, and gut health.

1. Stress

Stress’ impact on the body and mind spreads far and wide, influencing not only our focus, blood pressure, and sleep; but also our gut health, immune health, and more (6, 7). This is because of the sex hormone cortisol, released by the adrenals when stressed, inducing multiple biological reactions (7). Glucose becomes readily available to cells and is released back into the blood, inflammatory cascades are triggered (8), and reproductive functions are suppressed so that energy is preserved (9) – to name a few. This can impair digestion and cause the development of bloating, IBS-type symptoms, and mood changes commonly present with ‘endo belly’ (1).

2. Inflammation

Inflammation is associated with the development and progression of endometriosis for varying reasons (10). The condition is regularly considered oestrogen dominant, known to induce inflammatory cascades, impair metabolic pathways, hormone regulation, cellular function, and more (10). Prostaglandins are an inflammatory cytokine found at higher levels in endometriosis and are considered the cause of pelvic pain in many cases (11). A further issue is the damage this can cause to our gut microbiome (12). Most of our immune cells are stored in the gut, and when they release more pro-inflammatory cells than anti-inflammatory ones, our gut microbes (bacteria) can become disrupted (1). Without healthy gut microbes, our digestion can become impaired, our energy levels can start to dip, and our mood can be affected (12) – all commonly associated with an ‘endo belly’.

3. Gut Issues

When triggered by stress and inflammatory issues, our gut health can take a hit (12). This is because our gut is host to billions of microbes which help regulate numerous pathways, including energy, digestive function, and hormone regulation (12). If our microbes become dysbiotic (the ‘bad’ bacteria are overpopulating the ‘good’), our digestion can become uncomfortable and excess gas can build along the digestive tract (12). This can lead to prolonged bloating states with constipation and diarrhoea, leading to discomfort (1).

So, what does this mean for endo belly?

Well, while we may lack definitive answers to our endo belly questions, these suggested theories can help to inform our health management plans. Stay tuned for next week’s blog post exploring support options in more detail… but in the meantime, why not try the following:

  • Try stress reduction techniques like deep breathing or journaling
  • Include anti-inflammatory nutrients like omega-3, fibre, vitamin C, and more in your diet
  • Eat mindfully to reduce digestive discomfort and help reduce the effect of cortisol on the gut

If you’re looking for further support, please feel free to get in touch via my contact page, or email me at jgreen.nutrition@gmail.com.

  1. Luscombe GM, Markham R, Judio M, Grigoriu A, Fraser IS. Abdominal bloating: an under-recognized endometriosis symptom. Journal of Obstetrics and Gynaecology Canada. 2009 Dec 1;31(12):1159-71.
  2. Mills J, Shu C, Misajon R, Rush-Privitera G. ‘My body is out to wreck everything I have’: a qualitative study of how women with endometriosis feel about their bodies. Psychology & Health. 2023 May 24:1-9.
  3. Mechsner S. Endometriosis, an Ongoing Pain—Step-by-Step Treatment. Journal of Clinical Medicine. 2022 Jan 17;11(2):467 https://www.mdpi.com/2077-0383/11/2/467 
  4. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E. ESHRE guideline: endometriosis. Human reproduction open. 2022 Jan 1;2022(2):hoac009.
  5. Hudson N. The missed disease? Endometriosis as an example of ‘undone science’. Reproductive biomedicine & society online. 2022 Mar 1;14:20-7.
  6. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI journal. 2017;16:1057.
  7. Gubert C, Kong G, Renoir T, Hannan AJ. Exercise, diet and stress as modulators of gut microbiota: Implications for neurodegenerative diseases. Neurobiology of disease. 2020 Feb 1;134:104621.
  8. Thau L, Gandhi J, Sharma S. Physiology, cortisol.
  9. Karunyam BV, Karim AK, Mohamed IN, Ugusman A, Mohamed WM, Faizal AM, Abu MA, Kumar J. Infertility and cortisol: a systematic review. Frontiers in Endocrinology. 2023;14.
  10. García-Gómez E, Vázquez-Martínez ER, Reyes-Mayoral C, Cruz-Orozco OP, Camacho-Arroyo I, Cerbón M. Regulation of inflammation pathways and inflammasome by sex steroid hormones in endometriosis. Frontiers in endocrinology. 2020 Jan 29;10:935.
  11. Chopyak VV, Koval H, Havrylyuk A, Lishchuk-Yakymovych K, Potomkina H, Kurpisz MK. Immunopathogenesis of endometriosis–a novel look at an old problem. Central European Journal of Immunology. 2022 Jan 1;47(1):109-16.
  12. Ustianowska K, Ustianowski Ł, Machaj F, Gorący A, Rosik J, Szostak B, Szostak J, Pawlik A. The role of the human microbiome in the pathogenesis of pain. International Journal of Molecular Sciences. 2022 Oct 31;23(21):13267.
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