For many people living with endometriosis, the physical pain of the condition is only one part of the story. Digestive symptoms like bloating, constipation, diarrhoea, and abdominal discomfort are surprisingly common and often dismissed as unrelated.
However, growing evidence reveals a strong relationship between endometriosis and gut health, particularly conditions like Irritable Bowel Syndrome (IBS) and even Inflammatory Bowel Diseases (IBD) like Crohn's Disease and Ulcerative Colitis. In fact, individuals with endometriosis are significantly more likely to also be diagnosed with IBS and women with endometriosis are up to 50% more likely to suffer from IBD!
But is it always a matter of two separate issues? Or could gut-related symptoms be part of the bigger endometriosis picture?
When Endometriosis and IBS Overlap
Abdominal pain, bloating, irregular bowel habits, and nausea—these are hallmark symptoms of IBS. But they’re also commonly reported by people with endometriosis. This similarity in presentation often leads to misdiagnosis or delayed diagnosis, especially when the root cause is not clearly understood.
In some cases, what’s labelled as IBS may actually be digestive symptoms driven by underlying endometriosis. In others, both conditions coexist, possibly due to shared triggers within the body.
What’s Driving the Gut-Endometriosis Connection?
Recent research has begun to uncover several mechanisms that link endometriosis and gastrointestinal dysfunction. These include:
Ongoing Inflammation
Both endometriosis and IBS are associated with chronic low-grade inflammation. In endometriosis, inflammation fuels the growth of abnormal tissue outside the uterus. In the gut, it can disrupt digestion, alter gut lining integrity, and increase sensitivity to certain foods.
Histamine & Mast Cell Activity
People with endometriosis may be more prone to histamine intolerance, where the body reacts to foods high in histamine or triggers like stress and hormones. Mast cells—immune cells involved in allergic reactions—can become overactive in both endometriosis and IBS, contributing to bloating, cramps, and cyclical digestive issues.
Gut-Brain Communication Issues
The gut-brain axis is a bidirectional communication system between the digestive tract and the nervous system. In people with chronic pain or hormonal imbalance, this system can become overreactive, leading to hypersensitivity in the gut and exaggerated pain responses commonly seen in IBS and endometriosis.
Microbiome Imbalances and Leaky Gut
Disruption to the gut microbiome (known as dysbiosis) and increased intestinal permeability (“leaky gut”) are often present in people with endometriosis. These imbalances can worsen systemic inflammation, disrupt hormone metabolism, and interfere with the body’s natural detox pathways.
When Endometriosis Affects the Bowel Directly
In more advanced cases, particularly with deep infiltrating endometriosis, the disease may affect the bowel, rectum, or surrounding structures. Scar tissue or adhesions can form, causing:
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Pain during bowel movements
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Sluggish digestion or constipation
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Cramping that intensifies around menstruation
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Conditions like Small Intestinal Bacterial Overgrowth (SIBO)
Yet, digestive symptoms can also appear in people with no visible intestinal lesions. This points again to a broader systemic cause—highlighting the role of inflammation, immune response, and gut dysfunction in symptom development.
Is It Really IBS Or Could It Be Endometriosis?
In many cases, gut symptoms appear years before an endometriosis diagnosis is made. In teens and young adults, these may present as:
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Persistent abdominal discomfort
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Nausea or food sensitivities
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Non-cyclical pelvic pain
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Fatigue and digestive irregularities
Unfortunately, these signs are often mistaken for IBS or functional gastrointestinal disorders, delaying proper investigation and intervention. Over time, unchecked endometriosis can lead to adhesions, pelvic scarring, ovarian damage and reduced fertility. There is even an increased risk of nervous system hypersensitivity, known as central sensitisation.
This reinforces the importance of early identification and a whole-body approach to care.
Let’s Support Both Gut and Hormonal Health!
The good news? The tools used to support gut health often overlap with those that relieve endometriosis symptoms making naturopathic treatment especially effective in managing both.
A holistic plan typically includes:
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Balancing Histamine & Calming the Immune Response
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Restoring Microbial Balance
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Improving Motility & Reducing SIBO Risk
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Soothing the Gut Lining
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Regulating the Gut-Brain Connection
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Improving Pain Tolerance and Stress Resilience.
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Targeting Systemic Inflammation
Understanding the link between digestive health and endometriosis opens up new, more effective ways to manage both conditions. By supporting the gut microbiome, calming inflammation, and addressing hormonal imbalances, a naturopathic approach offers a comprehensive strategy for long-term wellness.
Whether you’ve been diagnosed with IBS, IBD, endometriosis or a combo, treating the digestive system as a central player can transform the way your body feels and functions.
You deserve answers and a treatment approach that looks at the whole picture!
