A note from Alice:
For years I dealt quietly with heavy periods, pain, bloating and IBS symptoms. They combined to be at times debilitating. I was lucky to get a diagnosis of endo and really good advice on how to manage my gut health. One of these pieces of advice was to try psyllium husk. That was a game-changer and the reason why I started No.2 Good Gut Fibre. Since then I have made it my mission to share my experience, and ask others to do the same in service of helping people feel less lonely in their health.
Last month I got chatting with naturopath, nutritionist and herbalist Tayla Wiehahn, at an expo. She was checking out our stall as she was pleased to see a clean high psyllium husk fibre supplement that actually tasted good! When we got talking I found out that Tayla volunteers with Insight Endometriosis. I was interested in her perspective as a naturopath, nutritionist and herbalist so suggested she write something for our Journal.
Check out the Q&A below to find out more about why gut health and endo are so closely linked, and what actually helps. If you're after more support, there are some brilliant organisations out there supporting women with endo. I've added the links below the references. Please also visit your doctor or chosen health professional if you have any concerns about your health.
What is endometriosis and how common is it?
Endometriosis is a chronic condition that affects approximately 1 in 9 women, girls and those assigned female at birth in Aotearoa New Zealand. That's at least 130,000 kiwis!
It's a condition where tissue similar to the uterine lining (a.k.a. the menstrual lining) grows outside of the uterus. This abnormal tissue sticks itself to the outsides of the uterus, ovaries or nearby organs like the bowel and bladder. The problem with endometriosis tissue is that it behaves much like the menstrual tissue on the inside of the uterus - it grows and sheds throughout a female's menstrual cycle. However, unlike menstrual tissue, it has no external location to 'shed' to, and can generate significant inflammation just by its presence. As you can probably imagine, this can result in sometimes severe and chronic pain.
Pelvic pain during, and in between, menstrual periods is the most common symptom of endometriosis; however, it is also associated with a myriad of other symptoms that affect a person's well-being. Such as:
- Heavy periods
- Irregular periods
- Infertility
- Sleep difficulty
- Chronic fatigue
- Brain fog
- Back pain
- Nausea
- Fluid retention
- Mood swings related to your period
- Digestive issues related to your periods (abdominal bloating, irregular bowel motions, stomach pain, food sensitivities)
- Poor mental health
- Pain with sexual intercourse
- Pain with urinating or bowel movements
- Impaired ability to perform everyday activities, such as walking, standing, sitting, playing sports
A lot of people with endo also deal with IBS-type symptoms - bloating, irregular bowel motions, pain. From a naturopath's standpoint, why do these two conditions overlap so much, and where does gut health fit into managing endo symptoms overall?
They sure do. In fact, up to 90% of people living with endometriosis report experiencing some kind of digestive issue, with bloating being the most common one that seems to get progressively worse around menstruation. This is casually referred to as "endo belly".
You're actually about three times more likely to be diagnosed with IBS if you have Endometriosis, compared to people without it. Here are a few reasons why these conditions share overlapping symptoms:
- Chronic inflammation. Both IBS and endometriosis generate significant inflammation in the body. Chronic inflammation from endometriosis can disrupt the barrier and function of your gastrointestinal tract.
- Sensitive nerves. Endometriosis lesions can sometimes grow close to, or directly on, the bowel. Even without that, the nerves in your pelvis and bowel are closely linked, so ongoing pelvic inflammation can make the bowel more reactive.
- Hormones and your gut microbiome. Remember how I said that endometriosis lesions grow and shed in response to the menstrual cycle's fluctuating hormones? Well, most people don't know this, but your levels of circulating oestrogen (one of these fluctuating sex hormones) are partially controlled by the trillions of bacteria living in your gut, known as your 'gut microbiome'. In other words, your gut bugs help maintain a healthy circulating amount of oestrogen. When gut health is off, circulating oestrogen levels can change, which in turn could affect endometriosis and your bowel movements.
So, because endometriosis and gut health are so closely linked, looking after your gut isn't just about reducing bloating, it's part of supporting your endometriosis symptoms overall.
Fibre gets mentioned a lot in gut health advice, but why is it specifically important for people with endo? Does it do anything beyond 'regularity'?
Adequate dietary fibre is particularly important for people with endo. Remember those gut bugs we talked about, the ones that help manage your circulating oestrogen? Fibre is basically their food to keep them healthy. The more good fibre you feed them, the better they're able to do that job of keeping your oestrogen levels balanced.
Fibre also feeds your gut bacteria in a way that produces compounds called short-chain fatty acids (SCFA). These help calm inflammation and keep your gut lining strong. Since chronic inflammation drives many endo symptoms, a well-fed gut microbiome plays a protective role in your overall inflammation and hormone balance.
For people who are worried they may have endo where would you recommend they start in finding info or help?
If some of those symptoms jump out to you, and you think, "Huh, this sounds familiar...", it may be time to check in with a health professional.
It can be helpful to bring some information with you to share with your doctor, too. My advice would be to track your menstrual periods on an app for at least 3 months, and keep a journal detailing your symptoms, when in your menstrual cycle you experience them, how severe they are (keep a score out of 10), and how they impact your daily life.
For example:
Cycle Day 2: Pain 8/10 severity; called in sick to work. Feels like waves of stabbing, sharp pains in my lower pelvis. Medication used: 2 paracetamol and 2 ibuprofen. No effect. Diarrhoea and stomach pain all day.
Tracking your symptoms like this may seem over the top, but it is incredibly valuable information to share with your health care provider. This information could help your doctor refer you to the right services so you can get the support you need.
If you are a little uncertain or want to find out more about your journey with endometriosis, there are also some awesome organisations out there for you to connect with. I actually volunteer at one right here in Aotearoa. It's called Insight Endometriosis.
Can you tell me more about Insight Endometriosis?
Insight Endometriosis is a not-for-profit organisation that supports, educates and advocates for people with endometriosis, those with suspected endometriosis, and the whānau and loved ones of those with endometriosis.
They have a fantastic online hub of resources where you can learn more about the condition, what to do if you suspect you have it, how to navigate the New Zealand healthcare system, and how to support yourself using diet and lifestyle techniques.
Insight Endometriosis also has a free, online support service available. You can connect with one of the support volunteers on the team who can guide you in the right direction, offer helpful resources or even just share experiences.
References:
Velho, R. V., Werner, F., & Mechsner, S. (2023). Endo Belly: What Is It and Why Does It Happen?-A Narrative Review. Journal of clinical medicine, 12(22), 7176. https://doi.org/10.3390/jcm12227176
Maroun, P., Cooper, M. J., Reid, G. D., & Keirse, M. J. (2009). Relevance of gastrointestinal symptoms in endometriosis. The Australian & New Zealand journal of obstetrics & gynaecology, 49(4), 411–414. https://doi.org/10.1111/j.1479-828X.2009.01030.x
Ellis, K., & Wood, R. (2024a). A decade to wait: Update on the average delay to diagnosis for endometriosis in Aotearoa New Zealand. Australian and New Zealand Journal of Obstetrics and Gynaecology, 64(5), 524-529. https://doi.org/https://doi.org/10.1111/ajo.13836
Johnson, N. P., Hummelshoj, L., Adamson, G. D., Keckstein, J., Taylor, H. S., Abrao, M. S., Bush, D., Kiesel, L., Tamimi, R., Sharpe-Timms, K. L., Rombauts, L., Giudice, L. C., & Consortium, W. E. S. S. P. (2017). World Endometriosis Society consensus on the classification of endometriosis. Human Reproduction, 32(2), 315-324. https://doi.org/10.1093/humrep/dew293
Other Endometriosis support and resources can be found here:
