Endometriosis is a gynecological condition where tissue similar to the endometrium (the lining of the uterus) grows outside of the uterus, most commonly on the ovaries, fallopian tubes, and tissue around the uterus. This tissue buildup leads to inflammation and can cause severe pelvic pain, especially around the time of menstruation. Many women with endometriosis experience abdominal bloating and believe their stomach appears larger due to the condition. Here we’ll explore the link between endometriosis and stomach bloating, and provide an overview of endometriosis symptoms, causes, and treatment options.
What is Endometriosis?
Endometriosis impacts around 1 in 10 women of reproductive age. However, many women suffer symptoms for years before getting a diagnosis. The main symptoms of endometriosis include:
- Painful periods
- Pelvic pain between periods
- Pain during or after sex
- Painful bowel movements
- Fatigue
- Bleeding between periods
- Infertility
In endometriosis, tissue similar to the endometrium grows in abnormal locations like the ovaries, behind the uterus, on the bowels, and sometimes as far away as the lungs and brain. This tissue bleeds and sheds each month just like the uterine lining, but it has no way to exit the body.
This leads to inflammation, the formation of scar tissue (adhesions), and cysts called endometriomas. Adhesions can distort the pelvic area and attach organs like the ovaries to each other. Endometriosis lesions and adhesions are thought to be responsible for the severe cramping and pelvic pain that many women with endometriosis experience.
What Causes Endometriosis?
The exact cause of endometriosis is unknown, but researchers have several theories:
- Retrograde menstruation – Some menstrual blood flows backwards into the abdomen instead of out of the body. This may implant endometrial tissue outside of the uterus.
- Transformation of cells – Cells near the endometrium may transform into endometrial-like tissue.
- Stem cells – Stem cells from bone marrow or other sources may develop into endometrial tissue.
- Immune system issues – Problems with the immune system may allow endometrial tissue to implant and grow outside the uterus.
- Genetics – Endometriosis runs in families, suggesting a potential genetic component.
Other factors like environmental toxins and hormones may also play a role. While the exact cause remains unclear, most experts believe retrograde menstruation plays a major part.
Does Endometriosis Cause Abdominal Bloating?
Many women with endometriosis do report increased abdominal bloating, along with what feels like a swollen or enlarged stomach. Approximately 27-50% of women with endometriosis experience abdominal bloating.
There are several reasons why endometriosis may lead to stomach bloating:
Inflammation
Chronic inflammation is a hallmark symptom of endometriosis. This inflammation occurs both around endometrial lesions and more generally within the pelvis and abdomen. For some women, this inflammation extends up into the stomach area, leading to a feeling of bloating along with pain and tenderness.
Adhesions
The scar tissue (adhesions) that accumulates with endometriosis can wrap around the intestines and restrict their mobility. Researchers believe this restriction can lead to abdominal bloating, similar to what happens in a bowel obstruction.
Bowel Endometriosis
Somewhere between 3-37% of women with endometriosis have lesions on the bowel itself. This is called bowel endometriosis. These lesions can make the bowel rigid and narrow, resulting in constipation, bloating, diarrhea, pain, and nausea. Bowel endometriosis may be especially likely to cause abdominal bloating.
Hormonal Changes
The hormonal fluctuations involved in the menstrual cycle impact fluid retention and constipation. Since endometriosis is an estrogen-driven condition, the high levels of estrogen women experience before their periods may worsen PMS symptoms like bloating.
Dietary Changes
Some women with endometriosis find that reducing gluten, dairy, and other potentially inflammatory foods improves their symptoms. However, dietary restrictions can also lead to bloating when reintroducing eliminated foods. The low fiber content of some elimination diets may also worsen constipation.
Endometriosis Treatment Options
While there is no known cure for endometriosis, many women successfully manage their symptoms and improve quality of life using the following treatment approaches:
Pain Medication
Over-the-counter pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) can help relieve cramping and pelvic pain. Prescription medications like NSAIDs or opioids offer additional pain relief for moderate-severe symptoms.
Hormonal Birth Control
Birth control pills, the patch, the vaginal ring, and the Mirena IUD release hormones that prevent ovulation and slow endometrial tissue growth. Many women experience relief from pelvic pain and cramping while using hormonal contraception.
Progestin Therapy
Progestins can help thin endometrial lesions and prevent further growth. They are often effective at reducing pain from endometriosis.
GnRH Agonists
GnRH agonists lower estrogen levels, essentially inducing temporary menopause. This stops menstruation and endometrial tissue growth, relieving pain. Due to significant side effects, treatment usually lasts just 3-6 months.
Aromatase Inhibitors
Aromatase inhibitors block the enzyme that produces estrogen within endometriosis lesions themselves. This lowers inflammation and halts tissue growth.
Laparoscopic Surgery
Surgeons can remove endometriosis lesions and scar tissue using minimally-invasive laparoscopic surgery. This is often an effective long-term solution, especially for severe cases unresponsive to other treatments. However, the endometriosis may return after surgery for some women.
Hysterectomy
A hysterectomy (surgical removal of the uterus) provides permanent relief by eliminating periods, but endometriosis can still return in remaining tissue. Hysterectomy has significant side effects and is generally a last resort treatment.
Managing Endometriosis Bloating
While treating the underlying endometriosis should resolve abdominal bloating for many women, additional tips can help reduce swelling and discomfort:
- Avoid gassy, high FODMAP foods that tend to cause bloating like beans, dairy, onions, broccoli, and wheat.
- Stay hydrated to prevent water retention and constipation.
- Limit salt, which promotes fluid retention.
- Take over-the-counter GasX or activated charcoal capsules to decrease trapped intestinal gas.
- Consider probiotic supplements to support healthy digestion.
- Ask your doctor about prescription medications to reduce bloating and swelling.
- Wear loose, comfortable clothing.
- Try relaxation techniques such as yoga, meditation, or massage.
- Apply a heating pad to provide relief during bloating episodes.
Tracking symptoms in an endometriosis journal can help identify triggers to avoid. Let your doctor know if abdominal bloating persists despite lifestyle changes and treatment.
When to See a Doctor
Contact your gynecologist right away if you experience:
- Severe pain that interferes with daily activities
- Inability to pass stool or gas
- Fever, vomiting, or other signs of infection
- Bloating along with weight loss
- Difficulty eating or drinking
- Blood in stool or urine
These symptoms may indicate complications that require prompt medical care. Most importantly, make an appointment if endometriosis symptoms are impacting your quality of life. You don’t have to suffer in silence—effective treatment options are available.
The Bottom Line
Endometriosis can often cause abdominal bloating, making your stomach appear swollen and distended. Inflammation, adhesions, bowel lesions, hormones, and dietary changes may all contribute to bloating. Treating the underlying condition should provide relief in many cases. Lifestyle measures can also help manage endometriosis bloating episodes when they occur. Speak with your doctor if you regularly experience a bloated or enlarged stomach around your period. An endometriosis diagnosis allows access to treatment options that can minimize pain and swelling.
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Conclusion
Many women with endometriosis experience abdominal bloating and feel their stomach is distended or swollen, especially around their periods. Inflammation, adhesions, bowel involvement, hormones, and dietary factors may all contribute to endometriosis bloating. Treating the underlying condition is key, and lifestyle changes can provide additional symptom relief. However, severe or persistent stomach swelling requires medical attention to rule out complications. If endometriosis is impacting quality of life, don’t delay seeking help—various effective treatment options are available.