Endo Belly: What It Is and How To Get Rid of It

Endo belly is a severely bloated abdomen common in people with endometriosis. Some people say their swelling gets so bad, they look like they’re pregnant.

“People with endometriosis often have symptoms for years before receiving an accurate diagnosis,” says women’s health specialist Megan Billow, DO. “We’re seeing a greater awareness of endo belly these days. Patients even bring in photos to document their symptoms.”

What is endo belly?

Endo belly is a buildup of inflammation and gas inside the abdomen. It typically occurs before or during your period (menstruation).

The main endo belly symptom is a painful, swollen abdomen. Gastrointestinal symptoms, such as constipation, diarrhea and nausea, are also common.

Are there other diseases that look like endo belly?

Endo belly can mimic other gastrointestinal (GI) conditions, such as:

• Celiac disease.
• Crohn’s disease.
• Irritable bowel syndrome (IBS).
• Ulcerative colitis.

From a diagnostic standpoint, “either/or” isn’t a super helpful way to think about endo belly. When it comes to GI problems, you may be facing a “both/and” situation.

“You can have endometriosis plus another gastrointestinal condition, such as irritable bowel syndrome,” states Dr. Billow, adding, “It’s important for your provider to ask you about your medical history and when the symptoms occur. That information really helps us tease out the diagnosis.”

What causes endo belly?

Endometriosis causes endo belly. In endometriosis, cells similar to the lining of your uterus grow in other areas of your pelvis, abdomen or chest. During your menstrual cycle, these cells and the nearby organs and tissues become inflamed.

“Inflammation can cause the swelling we see in endo belly,” explains Dr. Billow. “Endometriosis can also irritate or block the intestines, causing constipation, gas and bloating. In endo belly, both processes are probably causing the abdomen to bulge out.”

In addition to endo belly, symptoms of endometriosis include period pain, painful sex and trouble getting pregnant.

You can also develop endometriosis pain in your back, side, chest or neck.

How do I get rid of endo belly?

Most people can find relief from endo belly. Dietary changes are a good place to start, but if you still experience symptoms after adjusting the way you eat, talk to your healthcare provider.

“Medication and surgery are often the best options since they help treat the underlying cause of endo belly — endometriosis,” Dr. Billow notes.

Treatment options for endo belly include:

Dietary changes

There’s a close relationship between inflammation, estrogen and endometriosis: Inflammation and high estrogen levels stimulate endometriosis.

An anti-inflammatory endometriosis diet emphasizes foods that reduce inflammation and estrogen. For example:

• Fiber removes excess estrogen from your body and helps prevent constipation that can worsen endo belly. High-fiber foods include fruits and vegetables, legumes and whole grains.
• Healthy fats, such as omega-3 and monounsaturated fats, fight inflammation. Salmon, nuts, seeds, avocados and plant oils are all good sources of healthy fats.
• Minerals, such as magnesium and zinc, help relax muscles and regulate your menstrual cycle. To boost magnesium, try leafy greens, dark chocolate, legumes, nuts and seeds. Zinc-rich foods include poultry, red meat (in moderation) and shellfish.

Foods to avoid if you have endometriosis include:

• Alcohol.
• Caffeine.
• Fatty meats.
• Ultra–processed foods.
• Sugary drinks.

Another strategy to improve endo belly is the FODMAP diet. FODMAPs are foods known to cause digestive problems. Initially, you cut out all possible FODMAPs. Then, you slowly add foods back to your diet.

Dr. Billow recommends working with a dietitian to help you identify foods that worsen your endo belly symptoms. She also recommends a daily stool softener to help prevent constipation.

Medications

Medications help manage endometriosis and endo belly by suppressing estrogen. Healthcare providers use two main types of medications:

• Birth control pills and intrauterine devices (IUDs) regulate your menstrual cycle or stop menstrual bleeding entirely.
• Gonadotropin-releasing hormone (GnRH) antagonists block the hormones involved in estrogen production. Elagolix is an approved GnRH antagonist for treating endometriosis.

Your provider may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Surgery

If dietary changes and medication aren’t working, surgery is the next step. “We typically use a minimally invasive laparoscopic approach,” says Dr. Billow.

During laparoscopy:

1. Your provider inserts a thin tube with a camera through a small incision in your abdomen.
2. Guided by video images on a computer screen, your provider removes the endometrial lesions (damaged areas) using small instruments.

Surgery may include removing your uterus (hysterectomy), ovaries (oophorectomy) or part of your bladder or bowel. The extent of surgery depends on your pain and whether you want to have children.

“Preserving fertility for people who want children is an essential part of endometriosis treatment,” says Dr. Billow.

Complementary therapies

Other treatments may relieve pain and help you cope with your symptoms. Some popular therapies include:

• Acupuncture.
• Counseling.
• Physical therapy.
• Yoga.

How long does it take for endo belly to go away?

Endo belly may last for a few days or weeks. It depends on how much endometriosis there is and whether it’s affecting your intestines directly.

Your provider can help you find the right balance of dietary, medical and complementary treatments to help. By working together, you can find lasting relief.