Endometriosis, IBS and the Low-FODMAP Diet: Could Changing What You Eat Help Relieve Your Symptoms?
23 hours ago
6 min read
If you have endometriosis, you may be all too familiar with the digestive symptoms that often accompany it. Painful bloating, constipation, diarrhoea, abdominal cramps and a swollen, uncomfortable tummy can make everyday life incredibly difficult. Sometimes referred to as endo belly, this abdominal distension can be so pronounced that women describe looking several months pregnant by the end of the day.
For many women, it can be difficult to distinguish between symptoms caused by endometriosis and those associated with irritable bowel syndrome (IBS). In fact, the two conditions frequently coexist, and there is growing recognition that the digestive system plays an important role in the overall experience of endometriosis.
New research published in the Journal of Human Nutrition and Dietetics in October 2026 has provided encouraging evidence that a low-FODMAP diet may offer meaningful relief for some women living with endometriosis, particularly those who also experience troublesome IBS-like symptoms.
The researchers conducted a systematic review and meta-analysis examining whether following a low-FODMAP diet could improve symptoms and quality of life in women with endometriosis. The review included three studies involving 90 women, with an average age of 34. The researchers explored several important aspects of wellbeing, including the impact of pain on everyday activities, emotional health, feelings of helplessness, social support and self-image.
Across the studies, women reported improvements in several of these areas following dietary intervention, particularly in pain-related quality of life and emotional wellbeing. Although the evidence is still preliminary, these findings are encouraging. Endometriosis affects considerably more than just the reproductive system. It can influence relationships, work, social activities, emotional health and the simple pleasure of feeling comfortable in your own body.
One of the most interesting studies included in the review was an Australian randomised controlled trial published in 2025. This involved 35 women with endometriosis and troublesome gastrointestinal symptoms who followed a low-FODMAP diet and a comparison diet for 28 days each, with a washout period between them.
The results were particularly interesting: 60% of women experienced a meaningful improvement in their overall gastrointestinal symptoms while following the low-FODMAP diet, compared with just 26% on the control diet. Women also reported improvements in abdominal pain, bloating, stool consistency and quality of life.
For women who experience debilitating digestive symptoms alongside endometriosis, these results offer some genuine hope. However, it is important to recognise that this was a relatively small study, and further research is needed before we can draw firm conclusions about the long-term benefits of this approach.
So why might a low-FODMAP diet help women with endometriosis in the first place?
Endometriosis is a chronic, oestrogen-dependent inflammatory condition in which tissue resembling the lining of the uterus grows outside the uterus. It can cause pelvic pain, painful periods, discomfort during sex and difficulties with fertility, but digestive symptoms are also extremely common.
IBS, meanwhile, is a disorder of gut-brain interaction characterised by abdominal pain associated with changes in bowel habits. Although endometriosis and IBS are distinct conditions, they can share some important underlying features, particularly something known as visceral hypersensitivity.
Visceral hypersensitivity occurs when the nerves responsible for detecting sensations from our internal organs become unusually sensitive. This means that normal amounts of intestinal gas, stretching or bowel movement can produce disproportionately uncomfortable or painful sensations. Women with endometriosis may also experience sensitisation of pain pathways involving the pelvic organs and bowel, helping to explain why relatively ordinary digestive processes can sometimes feel extraordinarily painful.
This is where the low-FODMAP diet becomes particularly interesting. FODMAPs are certain types of carbohydrates that are poorly absorbed in the small intestine. The term stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. They occur naturally in many otherwise nutritious foods, including onions, garlic, wheat, apples, pears, beans, lentils, milk and certain vegetables.
When these carbohydrates reach the intestine, they can draw water into the bowel and become fermented by gut bacteria, producing gas. For someone with a sensitive digestive system, this can contribute to bloating, abdominal distension, pain and altered bowel movements. Reducing the overall FODMAP load can help decrease these symptoms by reducing some of the intestinal distension that triggers discomfort.
Importantly, a low-FODMAP diet does not treat the endometriosis lesions themselves. Rather, it may help reduce the additional digestive discomfort that contributes to the overall burden of pain. This is a distinction I think is particularly important, because women with endometriosis are often given the impression that they should be able to control their condition through food alone, which simply isn't supported by the evidence.
Does this mean that every woman with endometriosis should embark on a low-FODMAP diet? Absolutely not. Although the research is promising, the 2026 review included only three relatively small studies, and the researchers rated the overall certainty of the evidence as low to very low. The findings suggest that a carefully supervised dietary trial may be worthwhile for women experiencing significant digestive symptoms, but they do not justify recommending the diet universally.
In my clinical practice, I believe it is essential to look at the whole picture rather than simply handing someone a list of foods to avoid. Bloating and abdominal pain can be influenced by constipation, bowel sensitivity, dietary patterns, pelvic floor dysfunction, hormonal changes and other gastrointestinal conditions. Understanding what is driving someone's symptoms is fundamental to choosing the right nutritional approach.
If a low-FODMAP diet is appropriate, it is important to understand that it is not intended to be a lifelong elimination diet. The process begins with a relatively short period, usually two to six weeks, during which higher-FODMAP foods are replaced with suitable alternatives. This is followed by a structured reintroduction phase to identify which particular carbohydrates trigger symptoms and in what quantities. The ultimate goal is to return to the widest, most varied and nutritionally balanced diet possible while keeping symptoms manageable.
This final stage is particularly important. Many FODMAP-containing foods provide valuable fibre, vitamins, minerals and compounds that nourish our beneficial gut bacteria. Restricting these foods unnecessarily for prolonged periods can reduce dietary diversity, affect nutritional adequacy and potentially alter the gut microbiome. The objective should never be to make someone's diet smaller and smaller, but rather to help them enjoy a varied diet with greater comfort and confidence.
There are also other nutritional considerations for women with endometriosis. Depending on their symptoms, I may explore constipation management, soluble fibre intake, meal patterns, overall nutritional adequacy and the relationship between food intake and digestive discomfort. A balanced Mediterranean-style dietary pattern, rich in vegetables, fruit, wholegrains, pulses, nuts, seeds, olive oil and oily fish, provides valuable nutrients and supports general health, although evidence that any particular dietary pattern can directly reduce endometriosis activity remains limited.
What I find particularly interesting about this research is the growing recognition that endometriosis and digestive health cannot always be considered separately. For women living with both pelvic pain and debilitating bowel symptoms, even a relatively modest improvement in digestive comfort can make an enormous difference to daily life.
Less bloating might mean being able to wear your usual clothes comfortably. Less bowel pain might make going to work, travelling, exercising or enjoying a meal out considerably easier. Feeling more confident about your digestion can also reduce some of the anxiety and uncertainty that often accompany chronic gastrointestinal symptoms.
As a dietitian who works extensively with IBS and complex digestive conditions, I see how profoundly these symptoms can affect quality of life. The relationship between the gut, nervous system and pelvic organs is fascinating, and I think research exploring these connections has enormous potential to improve the way we support women with endometriosis.
The research certainly does not suggest that food is the cause of endometriosis, or that dietary changes can cure it. But it does suggest that, for some women, targeting gastrointestinal symptoms through personalised nutrition may be a valuable addition to their overall treatment.
And that is a genuinely encouraging development.
If you are struggling with endometriosis alongside bloating, constipation, abdominal pain or IBS symptoms, specialist dietetic support can help you explore whether a low-FODMAP approach is appropriate for you, without compromising your nutritional health or your relationship with food.
Research references
Rabelo, A. A., et al. (2026). Effects of a Low-FODMAP Diet on Symptoms and Quality of Life in Women With Endometriosis: A Systematic Review and Meta-Analysis. Journal of Human Nutrition and Dietetics, 39(5), e70353.
Varney, J. E., et al. (2025). Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)—A Randomised, Controlled Crossover Feeding Study. Alimentary Pharmacology & Therapeutics, 61(12), 1889–1903.
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