Did you know that ladies generally experience more recurrent pain, more severe pain and longer-lasting pain than men, which severely affects their quality of life? This is due to a combination of factors, including hormonal differences like estrogen fluctuations, higher nerve density, and a greater prevalence of mood disorders such as depression. Women are also more prone to overlapping pain conditions such as dysmenorrhea, endometriosis, irritable bowel syndrome, migraines, and fibromyalgia. Additionally, the brain’s “cells that fire together wire together” mechanism reinforces pain pathways, making chronic pain more persistent and difficult to manage.
Endometriosis affects 1 in 9 menstruating people in Australia, meaning over 1 million are living with chronic inflammatory disease. It is characterised by tissue growth similar to the uterine lining outside the uterus. But this condition isn’t confined to reproductive health alone—it often intersects with digestive issues, one of the most significant being Small Intestinal Bacterial Overgrowth (SIBO).
Emerging research and clinical observations reveal a strong connection between endometriosis and SIBO. Today, we will explore how these conditions are intertwined, why they often appear together, and how a holistic approach can help manage both effectively.
What is Endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, and even the intestines and bladder. It can also be found in muscles, joints, lungs, brain, and eyelids. Those with endometriosis frequently experience intense pelvic pain, heavy menstrual periods, fatigue, and, in some cases, infertility. Most women suffer in silence, which causes even more significant emotional stress. Their intense pelvic pain often leads to disrupted sleep, missed work, and skipped social outings, contributing to feelings of isolation. To date, there is no cure for primary and secondary endometriosis.
What is SIBO?
Small Intestinal Bacterial Overgrowth (SIBO) occurs when bacteria that usually reside in the large intestine start to overpopulate the small intestine. Since the small intestine isn’t meant to host large amounts of bacteria, this imbalance can lead to a range of digestive issues, such as:
- Diarrhea
- Constipation or alternating between both
- Abdominal cramping
- Bloating and excessive gas
- Burping and acid reflux/GERD
- Food sensitivities
- Joint pain
- Skin rashes
- Respiratory symptoms like asthma
The excess bacteria produce gases like hydrogen and methane, leading to symptoms commonly mistaken for IBS. These gases also damage the intestinal lining, potentially causing nutrient deficiencies if left untreated.
SIBO is often misdiagnosed as IBS due to their overlapping symptoms but has a distinct root cause: damage to the migrating motor complex (MMC). Contributing factors include:
- issue scarring and adhesions from surgeries
- Gastroenteritis, which can damage nerves and slow down gut clearance
- Medications like those for GERD/reflux and opioids
- Diets high in simple carbohydrates (sugar)
- Stress leading to low stomach acid (hypochlorhydria)
Addressing these underlying factors is key to effectively managing SIBO.
How Are Endometriosis and SIBO Connected?
Endometriosis and SIBO are linked to inflammation, gut motility, and immune function. Endometriosis is an inflammatory condition that affects the reproductive organs and the digestive system. It often leads to slowed gut motility, creating an environment where bacteria can thrive in the small intestine, resulting in SIBO.
Additionally, adhesions and scar tissue from endometriosis can wrap around the intestines, impairing normal digestion and leading to bacterial overgrowth. The connection between gut and reproductive health is becoming increasingly clear, highlighting the need for a comprehensive approach to managing both conditions.
Symptom Overlap: Why It’s Tricky to Diagnose
Endometriosis and SIBO share many common symptoms—bloating, abdominal pain, and irregular bowel movements. This overlap often makes it difficult to distinguish between the two, leading to misdiagnosis or delayed treatment.
Too often, individuals with endometriosis are told their gut symptoms (otherwise known as endo belly) are unrelated when, in fact, addressing gut dysbiosis and inflammation could be vital to managing their endometriosis symptoms more effectively.
A Holistic Approach to Managing Endometriosis and SIBO
Managing these interconnected conditions requires a comprehensive, holistic strategy that targets inflammation, supports gut health, and balances hormones. Here’s how a naturopathic approach can make a difference:
1. Dietary Changes:
Implementing a low-carbohydrate, low-FODMAP, gluten-free, or low-histamine diet can help manage SIBO symptoms while reducing inflammation. An anti-inflammatory diet rich in omega-3 fatty acids, antioxidants, and nutrient-dense foods and identifying food intolerances can also alleviate SIBO symptoms.
2. Herbal Medicine:
Herbs like curcumin, ginger, and berberine can reduce inflammation and support gut healing. Vitex, magnesium and other herbs may also be included to balance hormones and manage menstrual pain.
3. Targeted Supplements:
Strain-specific probiotics, targeted pelvic floor nerve pain products like PEA and inflammation supplements, digestive enzymes, and dose-specific magnesium are commonly prescribed to support gut health and improve digestion. Women with endometriosis, especially those with the MTHFR gene mutation, often benefit from B vitamins and methylation support. The Pill may also contribute to nutritional deficiencies in vitamins C, D, and E.
4. Hormonal Balance:
Balancing estrogen levels is essential in managing endometriosis. Lifestyle changes, stress management, and nutrients like DIM (diindolylmethane), broccoli seed or Calcium D Gluturate can sometimes be recommended to promote healthy estrogen metabolism.
5. Gut Repair Protocols:
Healing the gut lining with supplements like L-glutamine and zinc carnosine is critical in managing SIBO and preventing recurrence. Addressing leaky gut and supporting the microbiome can also help reduce overall inflammation.
6. Stress and Lifestyle Management:
Chronic stress exacerbates both endometriosis and SIBO. Incorporating mindfulness practices like yoga, regular exercise, and adequate sleep can regulate hormones and improve gut motility.
(Consulting your healthcare practitioner before changing your diet or taking supplements is important because they can assess your individual health needs, identify any potential interactions with medications you may be taking, and provide guidance to the right practitioner brands and dosages tailored to your specific condition. Supplements and dietary changes can have unintended effects, especially if you have underlying health issues or are taking other treatments. By consulting a professional, you ensure that any adjustments made are safe and beneficial for your overall health.)
The Path to Symptom Relief
If you’re experiencing symptoms of both endometriosis and SIBO, it’s essential to seek a treatment plan that addresses both conditions together. While conventional medicine may offer temporary relief, integrating a naturopathic approach that prioritises gut health, inflammation, and hormone balance can provide more lasting results and an improved quality of life.
Conclusion
Understanding the intricate link between endometriosis and SIBO is key to finding effective period pain relief. Addressing gut health alongside managing endometriosis symptoms can significantly improve overall well-being. If you’re struggling with these overlapping conditions, book a consultation with Natalie, who specialises in women’s health and digestive disorders. Working alongside your healthcare team, she can provide you with a personalised, holistic pelvic pain treatment plan. She can provide alternate options for pain relief to NSAIDs (especially if you’re one of the 20% who find these ineffective) or are looking at ways to reduce medication gut irritation side effects such as stomach ulcers.
Finally, if you are looking for medical help, the federal government’s one-stop shop pelvic pain support clinics provide doctors, pelvic floor physiotherapists, and pain psychologists, and they are now available nationwide.
You deserve to feel balanced and empowered in your body, no matter your stage of life. Take the first step toward holistic healing today!
Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare practitioner before changing your health regimen.
References
Petersen, C., & Round, J. L. (2014). “Defining dysbiosis and its influence on host immunity and disease.” Cell Microbiology, 16(7), 1024-1033.
- This article provides insights into how gut dysbiosis can lead to inflammation and systemic issues relevant to the discussion of SIBO and its relationship with endometriosis.
Bouziotas, C., Samartzis, E. P., Noske, A., Fedier, A., Fink, D., & Imesch, P. (2021). “Inflammation and adhesion formation in endometriosis: New insights and therapeutic approaches.” Reproductive Sciences, 28(5), 1424-1435.
- This research discusses the role of inflammation in endometriosis and how it can affect other systems, including the digestive tract.
Ley, C., & Patterson, S. (2017). “Endometriosis and the Gut: Emerging Research on the Link Between the Two Conditions.” Journal of Endometriosis and Pelvic Pain Disorders, 9(2), 73-79.
- This paper explores the growing body of evidence connecting gut health and endometriosis, offering insights into how conditions like SIBO could develop as a result.
Hyman, M. A., & Lipski, E. (2019). “Gut Health and Chronic Conditions: The Role of Intestinal Health in Inflammatory and Autoimmune Disorders.” Functional Medicine, 27(3), 234-245.
- This article highlights the role of gut health in managing chronic inflammatory conditions like endometriosis and explains the need for a holistic approach to treatment.
(2024, August 21). Retrieved from https://www.preventionaus.com.au/article/the-gender-pain-gap-womens-pain-is-being-dismissed-605845
Forsyth, K. S., et al. (2024, February 21). Pain Than Men? Nat Rev Immunol. https://doi.org/10.1038/s41577-024-00996-9
(2024, August 21). Retrieved from www.abc.net.au/news/2024-04-06/tas-endometriosis-service-demand-soars-statewide-six-months/103633364
