EP.395/ What Does the Latest Research Tell Us About Endo Belly and the Microbiome of People With Endo?
Because I am still recovering from covid, today’s episode is a short bite sized episode looking at what the recent research is telling us about the endo belly and the gut microbiome of people with endo. I won’t be doing deep dives into the research and what these mean for us practically, but if you’d like me to in the future, let me know!
Okay, so first up a 2023 study found that typically, endometriosis patients who experience gastrointestinal symptoms report:(1)
Bloating
Constipation
Diarrhoea
Acid reflux
Abdominal pain
Pain with bowel movements
Gas
Nausea
Vomiting
A 2017 study looked at patients with IBS alone, or IBS and endo, and found that pain during sex, pain that spreads to other areas and bowel symptoms that worsen around menstruation are more common in those with both.(2)
So, let’s look further at that IBS piece…
A 2022 systematic review and meta-analysis (3) found that:
Endo patients were three times more likely to have IBS than those without.
Combined, around 23.4% (roughly 1 in 4) endometriosis patients had IBS.
Across the individual studies, the percentage of patients with endo and IBS varied from about 10.6% to 52%.
Two other systematic reviews and meta-analyses from 2020 and 2021 also found a two to three fold risk of IBS in endo patients.(4)
Some may argue that these high IBS numbers are because many of us were misdiagnosed with IBS when we actually had endo, but whilst it is common for people with endometriosis to be misdiagnosed with IBS, a 2008 case-control study of 5540 endometriosis patients, found that those with an existing endometriosis diagnosis were 2.5 times more likely of also receiving an IBS diagnosis in comparison to the control group.(5)
So now let’s move onto the microbiome alterations in endometriosis.
A 2026 Systematic review found:(6)
Patients and animals with endo have a higher Firmicutes to Bacteroidetes ratio (which is suggestive of dysbiosis), reduced bacterial diversity, reduced beneficial bacteria, and elevated levels of gram-negative and opportunistic bacteria such as E.coli and Shigella. These elevations have not just been found in the gut microbiome, but in the reproductive tract also.
These changes were associated with:
Higher β glucuronidase activity (which recirculates waste oestrogen)
Higher circulating oestrogen levels
Lower levels of short chain fatty acids (which provide anti-inflammatory benefits and may be protective against endo, I have linked in the show notes to my series on this)
Pro-inflammatory pathways
Endo stage and pain severity
Infertility
Additionally, the dysbiosis was found to be more severe in those with IBS like symptoms.(7)
So, how does this relate to endo belly?
At present, a 2023 narrative review revealed that researchers believe nerve sensitisation, pelvic floor dysfunction, microbiome dysbiosis, the influence of hormones on motility and the microbiome, dysregulation of the enteric nervous system and vagus nerve, and nutrition are all potential causes of the endo belly.(8)
If you’d like to learn more about the gut microbiome and endo, please go ahead and binge on my podcast, because I talk a lot about the gut throughout my show!
If you have endo belly, SIBO or IBS symptoms, and you feel like you need help getting them and your general endo symptoms under control, you can book in to work with me one on one. If you’re on a budget, you can book in a single session or a double session, but if you’d like my most comprehensive and tailored coaching support, I’d suggest my six or 12 session coaching package, where we work together over six to 12 months. To mark the midway year point, I am currently offering £500 off the 12 month package or £250 off the six month package, when you book in this July. I’ve linked to my coaching page in the show notes, but you can also reach out to me directly on hello@thisendolife.com
References
1) https://pmc.ncbi.nlm.nih.gov/articles/PMC10316551/
2) https://pubmed.ncbi.nlm.nih.gov/28303579/
3) Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses - PMC
4) https://pubmed.ncbi.nlm.nih.gov/32949284/, https://pubmed.ncbi.nlm.nih.gov/32004880/, https://pmc.ncbi.nlm.nih.gov/articles/PMC10316551/
5) https://pubmed.ncbi.nlm.nih.gov/18715239/
6) https://pmc.ncbi.nlm.nih.gov/articles/PMC12942269/
7) https://www.mdpi.com/2076-2607/11/8/2089
8) https://www.mdpi.com/2077-0383/12/22/7176#B44-jcm-12-07176
Podcast links
Beta-glucuronidase:
https://www.theendobellycoach.com/podcast/sibo-gut-dysbiosis-elevated-oestrogen
Short chain fatty acids:
https://www.theendobellycoach.com/podcast/endometriosis-short-chain-fatty-acids
https://www.theendobellycoach.com/podcast/endometriosis-propionate-acetate
https://www.theendobellycoach.com/podcast/endometriosis-butyrate
Tools and treatments:
https://www.theendobellycoach.com/podcast/phgg-endo-belly-sibo-ibs
https://www.theendobellycoach.com/podcast/endometriosis-ibs-psyllium-husk
https://www.theendobellycoach.com/podcast/kiwis-for-constipation
https://www.theendobellycoach.com/podcast/flax-chia-constipation
Need more help or want to learn how to work with me?
Ways to work with me:
One to one coaching info and application
Endo Sessions: Single and mini-package one to one endo coaching
SIBO Sessions: Single and mini-package one to one SIBO coaching
Live and Thrive with Endo 2.0 DIY online course
Masterclasses in endo nutrition, surgery prep and recovery and pain relief
This EndoLife, It Starts with Breakfast digital cookbook
Affiliate Partnerships
mBIOTA -mBIOTA Elemental is the next generation of the elemental diet and is developed with leading gastroenterologists and food scientists. It’s both clinically effective and easy to drink. And for eligible United States customers, mBIOTA Elemental can be purchased with Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) funds. You can learn more about the formula at mbiota.com and get 20% off with code ENDOLIFE (all caps). Code is valid for the two-week protocol and until June 14th.
Mira - Mira is an at-home hormone testing device for every day use. Use this link and code 2DUFFJESS20 to get 20% off the device and any future wand orders.
Tempdrop- Track fertility effortlessly with Tempdrop’s Wearable Sensor. Get 15% off with code: ENDOLIFE
Free resources:
This podcast!