Is it possible that not only are our gut microbes linked to immunity, mental wellbeing and weight gain, but they also play a role in endometriosis and the intense pain it can cause?
Endometriosis is where womb-like tissue grows elsewhere in the body, such as on the bowel, ovaries or pelvis walls – each month, this tissue reacts as if it’s in the womb – thickening, breaking down and often bleeding. But this blood has no easy exit route and can become trapped, causing intense inflammation and pain.
Now it’s emerged that women with the condition often have a distinct make-up in their gut microbiome, the community of microbes found there.
This suggests that having more or less of specific bacteria could influence the risk of developing endometriosis – and offers the possibility that manipulating the make-up of gut microbes may help ease some of the symptoms.
In fact, scientists are already running trials with endometriosis patients exploring how probiotics (beneficial bacteria), prebiotics (food sources for beneficial bacteria) and dietary changes might rebalance the gut microbiome, reduce inflammation and alleviate their pain.
The finding may ultimately lead to new treatments for this and other pain-related conditions – which would be a breakthrough.
Scientists now believe that the reason endometriosis pain can be so intense is that the immune system and hypersensitive nerve cells in the spinal cord amplify it.
But the gut microbiome may have a role here – by influencing how our nerves handle pain.
Scientists are running trials with endometriosis patients exploring how probiotics, prebiotics and dietary changes might reduce inflammation and alleviate pain, writes DR EMILY LEEMING
The gut is packed with nerves that connect directly to the brain through the vagus nerve, a major nerve which runs from the brain down to the gut – the thinking is that gut nerves help shape how we feel and respond to pain.
And this is where gut microbes come in. This was highlighted in a 2017 study with mice, published in the journal eLife, which showed that changes in the gut microbiome impact brain areas linked to pain – essentially the molecules produced by some gut microbes could worsen pain, while molecules produced by others could improve it.
Findings like these have led to human trials of probiotics in conditions similar to endometriosis, which show a modest but meaningful reduction in pain.
The link between endometriosis and the gut has been suspected for a while – not least because women with endometriosis are three times more likely to have IBS (another often painful condition) than those without it, according to a 2023 review in the journal Frontiers in Medicine.
This is likely to be due to the fact that some of the same genes are involved in both conditions – including those controlling inflammation and hormones such as oestrogen.
Increasingly scientists are investigating how diet may play a part in endometriosis. Diet can, after all, alter the gut microbiome by providing the nutrients that beneficial microbes need to thrive, which in turn supports a healthier immune response and may reduce pain signals.
It’s an emerging area and I’m not claiming that your diet will eradicate the pain – but there’s a chance it will help dial down some of the severity. It could also reduce chronic inflammation, improve gut health and boost overall wellbeing, which may help with other symptoms too.
Here are some foods to include in your diet (if you have endometriosis or any chronic pain condition) – and what to avoid.
COOK WITH NATURE’S IBUPROFEN
Olive oil contains oleocanthal, a compound that reduces inflammation in a way similar to ibuprofen, by blocking inflammatory enzymes, reported a 2005 study in the journal Nature.
While it didn’t look at endometriosis specifically, these anti-inflammatory effects could help ease inflammation-related pain in endometriosis. The study noted that consuming around 50g (about four tablespoons) of extra-virgin olive oil daily would provide a small, regular dose of oleocanthal.
Extra-virgin olive oil is expensive and if cost is a concern, you can alternate with other anti-inflammatory options such as rapeseed, flaxseed or avocado oils.
FISH FOR PAIN RELIEF
Women with endometriosis who took 2000mg of omega-3s daily over two months experienced improvements in their levels of pain and quality of life, reported the journal PLOS One in 2020.
That’s likely due to the anti-inflammatory effect of omega-3s – inflammation can raise levels of prostaglandins, chemicals that can trigger painful menstrual cramps and irritate nerves, making pain worse.
Regularly eating oily fish such as salmon, mackerel and sardines, could provide similar benefits, with a portion of oily fish two to three times a week providing a similar level of omega-3s.
POP A PROBIOTIC?
There are lots on the market but one that has been tested on those with endometriosis specifically is Lactobacillus gasseri OLL2809. In a three-month study published in 2011 in the journal Cytotechnology, patients taking this experienced less menstrual pain and cramping than those on a placebo, with no side effects.
Research (so far only on animals) suggests this probiotic may also boost inflammation-fighting immune cells. Check with your GP before you start, particularly if you take regular medication.
SIP PEPPERMINT TEA
A common symptom for women with endometriosis is bloating – around 96 per cent experience it, according to a 2009 study in the Journal of Obstetrics and Gynaecology Canada.
This is likely due to inflammation and irritation from the build-up of tissue in the abdominal area caused by the condition.
Peppermint oil capsules that contain menthol – a natural antispasmodic – can be effective: menthol relaxes the bowel muscles, helping to ease cramps, bloating, and gas.
These capsules are available over the counter; the usual recommendation is to take one capsule three times a day, about an hour before meals. Peppermint tea, though lower in menthol, may offer mild relief – two or three cups daily may provide some gentle relief for bloating.
AND DON’T FORGET FERMENTED FOOD
Fermented foods such as yoghurt and kimchi can help the gut grow more beneficial bacteria and may help lower inflammation generally in the body, reported the journal Cell in 2021.
While direct studies on endometriosis are lacking, this finding is promising as endometriosis often involves chronic inflammation.
Adding fermented foods such as yoghurt, kefir, sauerkraut and kimchi to your diet could support gut health and potentially ease some endometriosis symptoms.
Try stirring sauerkraut through brown rice; using kimchi as a topping for scrambled eggs or stir-fries; and enjoy yoghurt or kefir as a breakfast.
…BUT AVOID ONIONS
Avoiding certain FODMAPs – fermentable sugars found in foods such as onions, garlic, wheat, beans and certain fruits may help ease the gut symptoms of endometriosis.
A low-FODMAP diet is a short-term plan to help identify personal triggers – cutting out then gradually reintroducing a range of foods. A small 2023 study in the journal Human Reproduction found that following a low-FODMAP diet could significantly relieve pain and improve quality of life for women with endometriosis by reducing gut-related symptoms.
Many people think gluten is the main trigger for their endometriosis symptoms, but it’s more likely to be FODMAPs and these are often found in gluten-containing foods. However, because some FODMAPs still support your gut microbiome, this approach is complex, so ideally seek the help of a dietitian before you try this.
