The Complexity of Endometriosis Weight Gain

Indirect and Direct Causes of Weight Fluctuation From Endometriosis

It’s common for people with endometriosis to feel that they have gained weight. This may be due to water retention from bloating or other causes.

Symptoms of endometriosis include pain, heavy or irregular bleeding, and infertility. Endometriosis can also cause gastrointestinal upset such as diarrhea, constipation, and bloating, commonly referred to as endo belly. A small 2009 study found that 96% of people with endometriosis have experienced bloating in their bellies, as opposed to 64% of those without endometriosis. 

This article will provide an overview of weight gain and endometriosis, including the causes and treatment options. 

Woman analyzing weight while standing on weight scale at home.

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Each month, the ovaries produce hormones that trigger the cells in the uterus lining to swell and get thicker. They then shed during your period (menses).

When endometrial cells grow on other areas of the body, such as the ovaries, fallopian tubes, bowel, bladder, or pelvic area, they form growths that also react to hormone changes.

When endometrial cells in other areas of the body swell and react to hormonal changes, bloating can occur.

Endometriosis Weight Gain: Direct and Indirect Causes 

While some women with endometriosis have reported weight gain and poor body image, there are several factors to keep in mind regarding weight gain and endometriosis.

Not everyone with endometriosis experiences weight gain. Because this condition can cause nausea and gastrointestinal (GI) upset, some people lose weight because they don’t feel well enough to eat. If you have been losing weight unintentionally, talk with your healthcare provider. 

Endo Belly and Bloating

Endometriosis can cause severe bloating, often referred to as endo belly. Both bloating and fluid retention are common symptoms of endometriosis. 

Bloating can lead to weight fluctuation and make it look like you have gained weight. Retaining fluid can make your clothes look and feel differently, too. Bloating is most common right before your period.

The bloating and fluid retention from endometriosis is likely due to the inflammation caused by endometrial growths. It could also be related to constipation.

Hormonal Fluctuations 

Hormonal fluctuations associated with endometriosis may lead to weight gain over time. Endometriosis has been linked to high levels of estrogen in the body. Estrogen is the hormone that causes endometrial cells to swell and thicken every month.

High levels of estrogen can lead to increased bloating and irregular periods. Hormonal fluctuations may also affect your metabolism. Changes in your hormones may lead to weight gain, especially around your abdomen. 

Medication

Some medications that treat endometriosis can cause bloating and weight gain over time. Endometriosis is frequently treated with hormonal birth control medications, such as oral contraceptives, a vaginal ring, or an intrauterine device (IUD)

Studies show that while hormonal birth control may not directly cause weight gain, it can lead to bloating and an increased appetite. This may indirectly lead to weight gain over time.

Hysterectomy 

A hysterectomy is surgery to remove the uterus. Other organs like the ovaries and cervix may also be removed depending on the severity of endometriosis. A hysterectomy is usually reserved for the most severe cases of endometriosis and is not a common treatment. A person cannot become pregnant after a hysterectomy.

People who have a hysterectomy sometimes have a procedure to remove their fallopian tubes and ovaries as well. This is called a hysterectomy with a bilateral salpingo-oophorectomy. When the uterus and ovaries are removed, symptoms of menopause may begin almost immediately after surgery. This is because the ovaries are no longer producing hormones.

These symptoms of menopause can include hot flashes, sleep problems and vaginal dryness. Menopause is also often associated with weight gain. 

Depression Related to Chronic Pain

Pain is the most common symptom of endometriosis. When your pain makes exercising difficult, it’s possible to gain weight from a lack of activity. 

Chronic pain has also been found to lead to depression over time. People with depression may be more likely to overeat or not exercise. These factors can lead to weight gain. Some antidepressant medications can also cause weight gain.

Sleep Hygiene 

People with endometriosis are more likely to experience poor sleep than those without the condition. Lack of sleep has been linked to a slower metabolism, weight gain, obesity, and type 2 diabetes. Discuss treatment options with your healthcare provider if pain or other endometriosis symptoms keep you up at night. 

Managing Weight With Endometriosis 

If your goal is to lose weight while managing your endometriosis, you can start taking small steps. As always, it’s best to check in with your healthcare provider before implementing a new weight loss plan.

Diet and exercise are two essential parts of any weight loss plan. When meal planning, focus on adding fruits, vegetables, lean proteins, whole grains, and healthy fats to your diet. Because endometriosis causes inflammation and gastrointestinal distress, focus on fiber-rich foods. Foods like beans, berries, and dark leafy green vegetables can help reduce inflammation and prevent constipation. 

We all need fats in our diet, and the type you choose matters. People who consume high levels of trans fats are more likely to be diagnosed with endometriosis. Foods high in trans fats include fried foods, pastries, processed foods, and margarine.

Research shows that people who eat a diet rich in omega-3 fatty acids are less likely to be diagnosed with endometriosis.

Try adding omega-3-rich foods to your diet. Some examples include salmon, mackerel, flaxseed oil, chia seeds, and walnuts.

Next, choose an exercise plan that works for you. Most adults need at least 150 minutes of moderate activity each week. This may include brisk walking, swimming, or cycling. Choose activities that you enjoy. If intense workouts tend to exacerbate your endometriosis pain, be sure to pace yourself.

How to Reduce Endo Belly Flares

Endo belly is believed to be caused by inflammation and bloating. To prevent flares, avoid any foods that lead to inflammation. If you notice you don’t feel well after eating certain foods, it’s best to avoid them.

To help you avoid inflammatory foods, your healthcare provider may recommend a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, restricting certain carbohydrates that are difficult to digest and known to cause abdominal distress. People who follow this eating plan cut out red meat, gluten, dairy, alcohol, and caffeine from their diets. 

The low FODMAP diet was designed for people with irritable bowel syndrome (IBS) and is known to help treat constipation and bloating. A study discovered that women who had both IBS and endometriosis showed more improvement on a FODMAP diet than those with IBS not on the diet.

Talk with your healthcare provider or dietitian if you’re interested in changing your diet to address your endometriosis symptoms.

Summary

Endometriosis is a chronic condition that causes pain and heavy or irregular bleeding. It may also lead to bloating, constipation, or diarrhea. Severe bloating from endometriosis, known as endo belly, can make it feel like you have gained weight. 

People with endometriosis may gain weight from fluid retention. Hormonal fluctuations and medication side effects may also contribute to weight gain. 

Talk with your healthcare provider to manage your weight when you have endometriosis. Finding the right eating plan and exercise program can improve your symptoms while helping you to maintain a healthy weight. 

Frequently Asked Questions

  • How do you lose weight with PCOS and endometriosis?

    To lose weight with polycystic ovary syndrome (PCOS) or endometriosis, make a plan with your healthcare provider. Focus on a healthy diet and avoid inflammatory foods that could worsen bloating. Choose an exercise program that includes moderate activity and does not exacerbate your symptoms.

  • Do people gain or lose weight after endometriosis surgery?

    It depends. Undergoing a hysterectomy to remove your uterus and ovaries can significantly improve your endometriosis symptoms and prevent monthly bloating. However, this surgery causes your body to go into menopause, which may increase the chances of weight gain over time.

  • Is endometriosis weight gain related to staging?

    Endometriosis staging measures the severity of the condition. If your symptoms are severe, you may experience more bloating. Severe bloating can feel and look like weight gain. Talk with your healthcare provider if your current treatment regimen does not control your endometriosis symptoms.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.