Can endometriosis cause weight gain?

Affecting roughly 10% of reproductive-age women in the world, endometriosis is a complex condition often associated with chronic pain and irregular periods [1]. And although these are some of the most common symptoms of the disorder, some women also find themselves struggling with weight management.

But does endometriosis actually cause weight gain? Well, the answer isn't exactly clear-cut.

Read as we do a deep dive into the connection between endometriosis and weight, and share our weight loss tips to help you reach your goals in a steady, sustainable way.

What is endometriosis?

Endometriosis is a chronic condition where endometrium-like tissue grows outside of the uterus, in places like the fallopian tubes, ovaries and pelvis.

Because it is not where it is supposed to be, when it eventually sheds, this tissue has nowhere to go. When this happens, inflammatory cells are also released, causing a number of common endometriosis symptoms, like cramps and bleeding (more on this shortly).

The reason behind this condition is yet to be confirmed by scientists.

However, some agree that the retrograde menstruation theory is to blame here. According to this theory, every time a woman menstruates, some of the blood and lining flows back into the fallopian tubes and pelvis — hence the name, 'retrograde menstruation' — where the tissue can begin to grow. But again, the science is still out on this one.

What are the symptoms of endometriosis?

Everyone experiences endometriosis differently but there are a few telltale signs associated with the condition, including:

• Period cramps that feel like you're being stabbed multiple times
• Heavy and long periods that typically last over 5-7 days
• Pain during or after sex
• Pain with urination or bowel movements
• Blood in your urine
• Chronic pelvic pain
• Chronic fatigue
• Trouble conceiving after trying for 12 months
• Anxiety or depression

Can endometriosis cause rapid weight gain?

You've likely noticed that we didn't mention 'weight gain' in the section above, about common endo symptoms.

The truth is that not all women who have endometriosis experience weight gain, and there's no consensus on whether or not there is a direct link between endometriosis and weight gain (rapid or otherwise).

Plus, some people with endometriosis experience gastrointestinal symptoms, like nausea and diarrhoea, which can affect their desire to eat and lead to unintentional weight loss [2].

Having said that, there are a few hypotheses on how endometriosis can indirectly lead to weight gain:

Hormonal imbalance

Endometriosis is an oestrogen-dependent condition. This means that its symptoms may get worse when levels of oestrogen are higher.

With some research suggesting that having too much of this hormone is associated with having a higher BMI, there is a possibility that hormonal fluctuations lead to weight gain [3]. There is, however, still conflicting evidence about the link between oestrogen and weight gain.

Certain medications

If you're taking hormonal medications to manage your endometriosis symptoms, like the contraceptive pill, IUD or vaginal ring, that may also be impacting your weight.

While studies have shown that gaining weight due to hormonal contraception is unlikely [4], medications like these can affect your appetite, making you feel hungrier than usual and potentially causing you to eat more.

Pain and low energy levels

Endometriosis pain can be quite severe, and paired with fatigue, it can impact your ability (and motivation) not only to work out but to do simple, everyday activities. As your lifestyle becomes less active, the weight can start to accumulate.

Does endometriosis cause a belly pooch?

Another reason why you might feel like you've put on a few kilos as a result of endometriosis — and one we didn't mention above — is the fluid retention and bloating that often come with the condition.

This bloating is commonly known as 'endo belly' and it can look like a belly pooch. On top of the visibly (and severely) swollen abdomen, which can last hours, days or even weeks, endo belly is often accompanied by invisible symptoms, including nausea, pain after eating, vomiting, constipation, and diarrhoea.

Although there isn't an official treatment for endo belly, there are things you can do to find some relief, like using a hot water bottle on the area, taking a warm bath, and trying yoga poses that help open up the pelvic area.

Does having endometriosis make it harder to lose weight?

Everybody is different, but some women with endometriosis can struggle to lose weight for the reasons we mentioned before: the pain which makes exercising a lot more challenging, the hormonal imbalances, the side effects of medications, the endo belly that is still there even when you're doing everything right — there can definitely be more hurdles to weight loss when you're also dealing with endometriosis.

That's not to say that you can't achieve and maintain a healthy weight, but we'll get to that soon.

Can removing endometriosis help with weight loss?

When it comes to treating endometriosis surgically, there are typically two options available: laparoscopy and hysterectomy.

The first one is minimally invasive, suitable for mild to severe cases, and is a keyhole surgery where the surgeon removes or destroys the endometrial tissue that has grown outside of the uterus. Hysterectomy is usually a keyhole surgery as well, but it is a permanent decision to remove the uterus (and sometimes the ovaries and fallopian tubes), so it may not be the first course of action suggested by your doctor.

As for the big question — can endometriosis surgery help with weight loss — the answer is that it might, because it minimises symptoms like pain and abdominal bloating.

But, once again, more evidence is needed.

Plus, hysterectomy has previously been linked to a higher risk of weight gain, particularly in premenopausal women who've had both their ovaries removed, compared to those who haven't had the surgery [5].

You'll have noticed by now that 'lack of research' and 'it depends' are common themes when it comes to endometriosis (and women's reproductive health, for that matter [6]). We know this can be frustrating as you search for answers about your health, but the more we talk about these issues, the more we'll incentivise change.

How can I lose weight with endometriosis?

Now, for the good news: losing weight when you have endometriosis can be challenging, but that doesn't mean it's impossible. Here are our top tips:

Eat anti-inflammatory foods

A healthy and balanced diet is important to anyone wanting to lose weight. For those with endometriosis, it can be a good idea to stock up on anti-inflammatory foods, as these will fight the inflammation that is believed to cause endo belly. Some good examples are:

• Salmon
• Sardines
• Nuts and seeds
• Avocado
• Olive oil
• Dark leafy greens

As for what to remove from your diet, your doctor may also suggest you try an elimination diet, where you cut out certain foods from your diet and then reintroduce them, in an effort to pinpoint what triggers your bloating.

However, as a general, you want to steer away from processed foods, red meat, alcohol, trans fats, and sugary snacks and drinks. Some women have also reported that minimising their intake of gluten, dairy, soy and coffee has helped reduce symptoms [7].

Increase your fibre intake

A high-fibre diet can help reduce excess oestrogen [8], while also improving your digestive health and making you feel fuller for longer, which will help your weight loss efforts. Some fibre-rich foods to include in your diet are:

• Whole grains like brown rice and quinoa
• Fresh fruit like raspberries and blueberries
• Legumes like lentils and black beans
• Brussel sprouts
• Chia seeds
• Broccoli
• Sweet potato

A supplement like Juniper's Daily Fullness + Digestion Blend can also help you increase your fibre intake. Add it to your food or drinks 1-3 times a day to start feeling lighter and satisfied.

Just make sure not to add too much fibre into your diet too quickly, as doing so can result in digestive issues like gas and bloating. To prevent that from happening, keep it to 1 extra serving of 5 grams of fibre a day.

Move more (but at your own pace)

We know that exercising when you have endometriosis isn't always easy. But there are many ways to exercise — it doesn't have to mean going for a 10K run or lifting heavy at the gym (unless that's what you enjoy!).

Something as simple as walking every day can help you burn more calories, with one study suggesting that doing around 10,000 steps a day is linked with improved weight loss [9]. Pilates can also be a great way to tone up, as well as swimming.

Even incidental exercise — the physical activity that you slowly build up over the course of the day, as you naturally go about your life — can help, whether that is through carrying your groceries to and from the car, walking to work, taking the stairs, or even just dancing around to your favourite song.

Choose a type of movement you enjoy, go at your own pace and, if needed, talk to your doctor about ways to manage the pain, and you'll be more likely to actually maintain your new fitness routine.

Approach weight loss holistically

Weight loss takes time and it often requires several lifestyle changes, not only around nutrition and exercise but also sleep, stress, and more. Kickstarting this journey towards better health can be daunting, but with the right support system, it doesn't have to be.

Juniper's Weight Reset Program takes a holistic approach to weight loss, giving you all the tools you need to achieve your weight goals and maintain them in the long run.

Designed by Australian health practitioners and dietitians, the program includes health coaching and tracking, groundbreaking treatments and a community of like-minded women to support you in your goals.

Discuss alternative treatment options with your doctor

If you believe your medication is the culprit of your weight gain, talk to your doctor about switching to a different one.

You can also bring up the topic of surgery, especially if you're struggling with severe pain or your symptoms are seriously affecting your well-being. Together with your doctor, you can make an informed decision about whether or not that is the appropriate route for you.