There is a strong association between gastrointestinal symptoms and endometriosis and ‘sister’ condition, adenomyosis.
The classic understanding of endometriosis and adenomyosis is as causes of painful periods (dysmenorrhoea), however, this is not commonly the main symptom and in many cases it may not be a symptom at all. The majority of women may present with primarily gastrointestinal symptoms, rather than painful periods. Gastrointestinal symptoms are nearly as common as gynaecological symptoms in women with endometriosis. I see many women who have been investigated for IBS and other gastrointestinal disorders first by a gastroenterologist and often diagnosed with IBS or no diagnosis at all. These women often have persistent symptoms despite dietary changes.
Endometriosis and adenomyosis can cause the following gastrointestinal symptoms:
– Severe bloating or known as ‘endo belly’
– Alternating bowel habits (constipation/diarrhoea)
– Rectal pain with opening bowels (dyschezia)
– Rectal or PR bleeding
– Upper GI symptoms (nausea, dyspepsia, epigastric pain, gastoparesis)
These symptoms may be more pronounced around menses, but not always.
Having gastrointestinal symptoms does not mean that endometriosis is growing directly into the bowel. It may relate to location of disease or surrounding adhesions. The more likely biology behind the symptoms includes hormonal influence (estrogen dominance, progesterone resistance), inflammatory mediators (prostaglandins, cytokines, interleukins), gut-microbiome disruption and nervous system changes (highly innervated lesions and interaction with the nervous system). All of this can cause the gastrointestinal symptoms and chronic pain sensitisation.
The above insight explains why endometriosis lesion size does correlate with symptoms, and why surgery alone fails to resolve GI symptoms, particularly where pain sensitisation and bowel dysfunction has already developed.
👉 The take-home message is that a clinician must consider endometriosis and adenomyosis can masquerade as gastrointestinal conditions. They must be considered in the differential diagnosis in women with a cluster of these symptoms, particularly, where symptoms are not explained by gastrointestinal investigations and dietary modifications.
Useful resources:
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2009.01030.x
https://pubmed.ncbi.nlm.nih.gov/38513981/
The above information is the professional opinion of Dr Kiran Atmuri, Specialist Obstetrician & Gynaecologist (FRANZCOG, MBBS, BCom/BSc, GCertClinTeach). While every effort is made to ensure information is accurate and reasonable, the information does not take the place of guidelines from professional bodies, an individual’s own research and consultation with a healthcare professional. There is no acceptance of liability for any injury, loss or damage caused by use of the information provided on this website.