Endometriosis and Your Gut: It’s All Connected

If you have endometriosis, you’re probably all too familiar with the intense pelvic pain, heavy periods, and fatigue that often come with it. But what about bloating, gas, constipation, or diarrhea? It’s all too common for those dealing with endometriosis to also suffer from persistent digestive issues.

The truth is, endometriosis doesn’t just affect the reproductive system—it has a huge impact on gut health. The inflammation, adhesions, and hormonal imbalances caused by endometriosis can mimic IBS symptoms and even contribute to bacterial imbalances in the gut, leading to SIBO.

So allow me to break down how this all connects and how you can start feeling better.

What Is Endometriosis?

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. This tissue responds to hormonal fluctuations just like the lining inside your uterus, meaning it thickens, breaks down, and bleeds during the menstrual cycle—but with no way to exit the body. This leads to chronic inflammation, pain, and scar tissue formation.

The most common symptoms of endometriosis include:

Severe pelvic pain, especially around your period
Heavy or irregular periods
Fatigue
Infertility
And digestive symptoms like bloating, constipation, diarrhea, or nausea

Because of how close the reproductive organs are to the digestive system, it’s no surprise that these last issues are a major—but often overlooked—symptom of endometriosis.

How Endometriosis Can Look Like IBS

Many people with endometriosis first get diagnosed with Irritable Bowel Syndrome (IBS) because the most noticeable symptoms are bloating, irregular bowel movements, and abdominal pain. Since there’s no test for IBS, and it is instead diagnosed by symptoms alone, it’s easy to mistake endometriosis-related gut issues for IBS.

Some of the reasons endometriosis can so closely mimic IBS include:

Inflammation Irritates the Gut: Endometriosis can lead to chronic inflammation, which affects digestion and can lead to bloating, cramping, and discomfort—just like IBS.
Adhesions Can Slow Digestion: Scar tissue from endometriosis can form around the intestines, altering their movement and leading to constipation, bloating, or pain with bowel movements.
Nerve Sensitivity Increases Pain: Both endometriosis and IBS can cause the nerves in your abdomen to become extra sensitive, making gas and bloating feel more painful than they should.
Hormonal Imbalances Affect Digestion: Too much estrogen can slow gut motility, leading to constipation or bloating, while progesterone fluctuations can actually cause diarrhea.

Because of these overlapping symptoms, many people are treated for IBS for years before discovering the real problem was endometriosis all along.

How Endometriosis Can Lead to SIBO

Beyond mimicking IBS, endometriosis can actually contribute to the development of SIBO (Small Intestinal Bacterial Overgrowth), which is another common cause of IBS symptoms.

SIBO starts when bacteria that should stay in the large intestine migrate into the small intestine, where they ferment food too early, leading to:

Severe bloating
Gas and belching
Constipation, diarrhea, or both
Abdominal pain
Food intolerances

So how does endometriosis set the stage for SIBO?

Slower Gut Motility: The chronic inflammation, adhesions, and hormonal imbalances from endometriosis can slow down digestion. When food moves too slowly through the gut, bacteria have more time to overgrow.
Impaired Migrating Motor Complex (MMC): The MMC is responsible for "cleaning waves" that clear bacteria out of the small intestine. If digestion is sluggish due to endometriosis-related inflammation or nerve dysfunction, bacteria stay put and multiply.
Abdominal Surgery and C-Sections: If you’ve had surgery to diagnose or treat endometriosis, or a C-section, scar tissue can alter the gut’s normal movement and increase the risk of SIBO.
Immune System Dysfunction: Endometriosis is linked to immune dysregulation, which can weaken the gut’s ability to control bacterial populations.

If you’ve been treating IBS for years but still struggle with bloating and unpredictable digestion, it’s worth investigating whether endometriosis and SIBO are part of the bigger picture.

So What’s Next?

If you’ve been struggling with gut issues that haven’t improved with standard IBS treatments, and especially if you also experience pelvic pain or hormonal symptoms, it might be time to take a closer look at endometriosis. Proper assessment is the most important first step.

If you’d like to learn more about getting assessed for endometriosis, IBS, or SIBO, how these conditions are so closely related, or how naturopathic medicine can help, you can book an appointment with me.