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  • Nicole Cozean, PT, DPT, WCS

Endo and GI Symptoms

As we've reported in a previous article, GI symptoms like bloating, nausea, constipation and diarrhea are actually more common than pain with endometriosis. Just like pelvic pain with endo, these GI symptoms don't seem to be directly related to the location or severity of endometriosis lesions.

GI Symptoms of Endometriosis - PelvicSanity

Recent research out of Sweden has provided more insight about these GI symptoms with endometriosis. First, they confirmed what previous research had shown - more than 85% of women with endometriosis reported gastrointestinal complaints within the last year. They evaluated whether factors like the menstrual cycle, location of lesions, or treatment factors had an effect on these common symptoms.

Women with endometriosis were significantly more likely to experience bloating and flatulence, constipation, abdominal pain, and urgency of defecation than controls.

Conflicting Diagnosis

Despite having similar symptoms, these women were given many different diagnoses. Less than 25% had been told their symptoms were due to endometriosis. IBS had been diagnosed in another 25%, while 30% hadn't been given a diagnosis at all. Other common medical terms used were gastritis, sensitive stomach/bowels, chronic constipation, reflux, stress, or bowel spasm.


In evaluating women with endometriosis, the researchers found that there was very little correlation between the menstrual cycle and GI symptoms. In fact, only nausea and vomiting were increased with menstruation, and only in the minority of patients (just 7.3%) with bowel-associated endometriosis lesions.


Just under 20% of patients reported being treated with opioids. Constipation, bloating, flatulence, and urgency of defecation were all associated with opioid treatment, suggesting that medicating for pain can have negative consequences on the GI symptoms associated with endo.

Opioids for Endometriosis

Treatment with GnRH

GnRH (Gonadotropin-releasing hormone) is a common hormonal treatment for endometriosis. Several studies have reported that GnRH treatment can significantly exacerbate gastrointestinal symptoms. Follow-up studies have reported patients treated with GnRH were still experiencing significantly higher abdominal pain at 5-year follow up appointments.


Research is showing there is a complex relationship between endometriosis, pelvic pain, and gastrointestinal symptoms. Standard treatments for pelvic pain and endo, like opioids and GnRH, may exacerbate GI symptoms and cause additional problems. Even treatments not evaluated in this study such as NSAIDs or over the counter pain relievers can damage the gut lining and cause digestive issues, especially when used for a prolonged period of time. Some specialists suggest that the chronic inflammation and damage to the gut environment or microbiome, can also cause some digestive disorders such as SIBO (small intestine bacterial overgrowth) which can contribute to the symptoms that often accompany endometriosis. A holistic view of the condition should take into account pain, infertility, and the GI symptoms associated with endometriosis.

Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.

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