There is no denying that endometriosis is a painful and frustrating condition affecting around 2 to 10% of American women between ages 25 and 40. Characterized by severe cramps, abnormal menstrual flow, and pain during intercourse, endometriosis can also significantly impact one’s fertility. 

Endometriosis occurs when tissue similar, but not identical, to the lining of the uterus is found elsewhere in the body. This can then cause inflammation, scarring, and painful cysts. If that wasn’t aggravating enough, the abnormal tissue buildup can also block the fallopian tube, therefore preventing the egg and sperm from fertilizing, making pregnancy that much more difficult. 

Another common symptom for those with endometriosis is something called “endo belly.” Endo belly presents as a swollen abdomen resulting from a buildup of inflammation and gas typically before or during your period. This particular symptom might suggest that endometriosis causes weight gain, but as with most medical cases, the explanation isn’t so simple. 

Rescripted spoke with Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist with CCRM Fertility in Boston, to help us better understand endometriosis symptoms like endo belly, and how weight gain can be an indirect result of this chronic illness.

woman holding her endo belly

Can endometriosis cause weight gain?

That’s a tricky question. Officially, the answer is no: “There is no current scientific evidence that endometriosis itself causes weight gain,” says Dr. Ryniec. But, she continues, “Those with endometriosis do often report weight gain and ‘endo belly’ or bloating as some of their symptoms.”

Let me guess, you’re even more confused by that answer, right? That’s completely understandable, so let’s break things down even further: To put it simply, endometriosis doesn’t directly cause weight gain, but several aspects of the condition can “make someone believe endo is the culprit,” says Dr. Ryniec. For example, “endometriosis can cause inflammation which can lead to bloating, fluid retention, and GI symptoms.” Weight changes can also result from altered hormone environments or hormonal therapies (“especially those that induce a menopausal-like state”). Finally, Dr. Ryniec says weight gain can occur if endometriosis symptoms start affecting your day-to-day life: Pain and inflammation can lead to decreased physical activity, and poor lifestyle habits can arise if your mental health is impacted.

Due to common symptoms like pain, inflammation, and bloating, “endometriosis may make it more difficult to lose weight” as well, says Dr. Ryniec.

woman suffering from endometriosis pain

So how can I avoid weight gain if I have endometriosis?

If you have endometriosis, it can sometimes feel like you’re trapped in a vicious cycle of pain and endo belly – and the last thing you want to do is think about a healthy diet and exercise. Dr. Ryniec advises “avoiding endometriosis triggers, as that can worsen inflammation and symptoms, as well as cause more bloating and lead to decreased activity.” Endometriosis triggers can include stress, not getting enough sleep, and ingesting caffeine, alcohol, or red meat.

“I encourage people to consider seeking evaluation and treatment with a nutritionist who specializes in endometriosis or women’s nutrition to help identify food triggers and what to avoid vs. what to include to stay healthy,” says Dr. Ryniec. “Focusing on protein, healthy fats, and fiber and avoiding highly processed foods can be a good place to start though. 

Is there anything I can do about endo belly?

Unfortunately, the severe bloating that manifests as endo belly and facial puffiness “can absolutely be mistaken for weight gain in the case of endometriosis,” says Dr. Ryniec. These are common endometriosis symptoms, “given that inflammation from endometriosis in the pelvis and abdomen can irritate the GI system.” To combat these significant appearance changes, she recommends avoiding inflammatory foods like caffeine, alcohol, sugary drinks, fatty meats, and ultra-processed foods. She also suggests considering a low FODMAP diet, which eliminates foods containing sugars that may cause intestinal distress. Be sure to speak with your health provider before making any substantial changes though, especially regarding the low FODMAP diet. This is a temporary regimen used to figure out which foods are problematic, so taking a DIY approach isn’t advisable. 

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woman examining her endo belly in the mirror

If you have endometriosis and feel that you’re struggling with your weight, or are just uncomfortable from all the bloating, rest assured that you’re not alone. If you're uncertain about having endometriosis, consider exploring ReceptivaDx. This endometrial biopsy test, adopted by over 400 IVF centers, can identify both symptomatic and asymptomatic endometriosis.

Also, make an appointment with your physician to express your concerns, and they can advise you on the best course of action. Should you need further guidance on avoiding triggers and non-inflammatory foods, request a referral to a nutritionist.

Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.