The Overlap Between Endometriosis and IBS
Endometriosis is a female health condition where endometrial tissue (tissue found inside the uterus) grows outside of the uterus, in places such as the outer uterine walls, bowels, and pelvis. This abnormal growth of tissue can lead to an inflammatory response, and symptoms can include:
- Painful intercourse
- Chronic pelvic pain
- Painful periods
- Uncomfortable, difficult, or painful bowel movements
Endometriosis is an estrogen dependent condition, and therefore presents differently during different phases of a woman’s menstrual cycle. It is particularly painful during the times when women produce the least estrogen (ie, during menstruation).
Endometriosis is a highly misdiagnosed and underdiagnosed condition, with diagnostic time taking more than 11 years on average in the United States.
Connecting endometriosis and IBS
In recent years, researchers and health professionals are beginning to see a strong correlation between endometriosis and irritable bowel syndrome. Interestingly, women make up the majority of patients with IBS, at a ratio of about 2:1 to men. With endometriosis being a condition specific to women, studies are beginning to look at the connection between these 2 populations.
There are certainly some strong similarities between the presentations of these 2 conditions. Both IBS and endometriosis involve immune activation and nervous system changes, specifically the presence of visceral hypersensitivity, which is a heightened sensitivity to pain in the body’s internal organs. Studies show that up to half of the women with IBS report that their digestive symptoms, particularly abdominal pain, worsen during their periods. While this can be because of hormonal changes, endometriosis can also be frequently implicated. This begs the question: Are your gut symptoms resulting from IBS or endometriosis or both?
It is likely that many female patients diagnosed with IBS could have endometriosis, especially those that report more abdominal pain, bloating, gas, and bowel changes at the time of their period. However, endometriosis is not always considered as a differential diagnosis for IBS and is likely often missed in patients who present with both IBS and endometriosis-like symptoms.
What are the treatment options for endometriosis?
Unfortunately, the majority of current studies are focused on women that are already known to have endometriosis, rather than women who have IBS and could potentially have endometriosis. One promising link between these two conditions is that women with endometriosis who also have IBS-like symptoms generally see a reduction in digestive issues when treated for endometriosis.
Treatment options for endometriosis include:
- Laparoscopic surgery. This involves removal of sections of endometrial implants from internal organs and can be done in mild to moderate cases of endometriosis.
- Medical therapy. Depending on the individual, a doctor may prescribe gonadotropin-releasing hormone (GnRH) agonists or specific contraceptives that work to cease a woman’s period, inducing artificial menopause. This significantly reduces symptoms of endometriosis.
- Natural menopause. After menopause, endometriosis symptoms generally lessen or even disappear. Many women with IBS also note improved digestive symptoms after menopause.
Both medical and surgical treatments have been shown to improve IBS-like symptoms in women with endometriosis, further supporting the fact that these two issues often go hand-in-hand for women.
Can diet help with endometriosis?
Since IBS symptoms have shown improvement via endometriosis therapies for many women, it is also worth looking at whether the reverse is also true. Can the low FODMAP diet for IBS also improve endometriosis?
One study reported that women with both IBS and endometriosis saw greater than 50 percent 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.
Connecting the dots
To summarize, we still don’t know that much about the links between endometriosis and IBS and there is still lots to learn!
If you feel endometriosis could be related to your symptoms of IBS, consider tracking your symptoms alongside your menstrual cycle for a few months - how do your symptoms change during your cycle? What type of symptoms do you experience? Do you experience painful periods or painful intercourse?
If this sounds like you, talk to your doctor about getting screened for endometriosis. Consider working with a dietitian as well, as a low FODMAP diet and/or other dietary interventions may help to alleviate your symptoms as well.
Do you live with any sleep disorders (eg. insomnia, RLS, sleep apnea) in addition to IBS?