Written by Christie Lee Austin-Hore, Women’s & Gut Health Dietitian (APD).
Christie Lee Austin-Hore is an Accredited Practising Dietitian specialising in Endometriosis. Based in Perth, her online consulting business makes her unique services available across Australia and around the world. Christie is an #endoadvocate, bridging the communication and education gap between clinicians and clients to help women feel heard, understood and reduce the delay to diagnosis. Christie provides 1:1 tailored coaching sessions using her Signature Endometriosis Framework to slow endometriosis progression, reduce pain, improve bloating, normalise periods and optimise fertility.
You probably would have heard about Irritable Bowel Syndrome (IBS) or know someone who has IBS but never really saw a connection between IBS and hormonal disorders in women. But truth be told, women with endometriosis (Endo) are frequently misdiagnosed with IBS for some time before a correct diagnosis is made.
This is because both conditions have multiple overlapping symptoms such as:
• Visceral hypersensitivity (extreme sensitivity of the inner organs)
• Diarrhoea or constipation
• Pain when passing a stool
• Nausea and
• Reduced quality of life
Gastrointestinal (GI) symptoms are almost as common as gynaecological symptoms in women with Endo, which was highlighted in a study that investigated 355 women undergoing laparoscopy for suspected Endo. GI symptoms were present in 90% of patients with confirmed Endo, of which bloating was the most common.
Polycystic Ovary Syndrome (PCOS) sufferers also experience similar symptoms and may conclude that they have IBS per se. A particular study found that 41.7% of the subjects with PCOS appeared to suffer from gastrointestinal symptom characteristics of IBS, hence the high chance of a misdiagnosis.
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Endo or PCOS should be excluded before making an IBS diagnosis. It is possible to have both, and unfortunately if you have one of them you are at increased risk of having the other.
A study showed women with endometriosis were 3.5 times more likely to have been diagnosed with IBS than women without. Similarly, PCOS is also associated with an increased occurrence of IBS. A study from 2010 revealed 42% of participants with PCOS also had IBS, compared to only 10% in the group who did not have PCOS 🤯
Until we know the root cause of IBS, PCOS and Endo respectively, it is hard to pin point exactly why these women are at a higher risk. However, there a number of commonalities between the conditions and this cross-over gives medical researchers some excellent clues.
Some of the common symptoms include:
• Hormone imbalances (testosterone, estrogen, progesterone balance)
• Gut dysbiosis (when the normal balance of bacteria is disrupted in the body)
• Visceral hypersensitivity (a very sensitive gut)
• Chronic inflammation throughout the body
• Stress, anxiety and depression
Oh, woe to all women who are dealing with Endo, PCOS, or IBS! But fear not, though there may not be a complete cure for all these problems, but there is a diet approach to regain a sense of control.
A 2017 Monash University study looked at the effectiveness of a low FODMAP diet on symptom management among women with IBS alone or in conjunction with endometriosis. The findings showed 72% of women with endometriosis had greater than a 50% improvement in bowel symptoms, with more women experiencing improved symptom management if they had both IBS and endometriosis compared to IBS alone.
The Role of the Low FODMAP Diet
FOD-what? Well, here comes the extremely long and jargony terminology that needed the abbreviation. FODMAP: Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. Essentially, FODMAPs are sugars found in foods and are poorly absorbed by some. They act as a food source for the gut bacteria which hang out in the intestine. However, if they are poorly absorbed, they then start to ferment, leading to various symptoms such as pain and bloating.
This link is a fantastic source for FODMAP information if you would like to know more about it. Now with the low FODMAP diet, it comes in 3 main phases:
Eliminating high FODMAP foods from the diet;
Reintroducing FODMAP groups to identify triggers; then
Personalising the FODMAP diet to suit each individual. This process requires supervision from a dietitian as there is a real science to the process which can quickly get overwhelming on your own. And this is why it is extremely important to see a dual qualified Women’s Health Dietitian who is also certified with Monash FODMAP (aka me!) to access the best care for IBS concerns related to Endo or PCOS.
If you are experiencing Endo or PCOS, I would love to guide and journey with you through the path of improving your quality of life. Apply for a 15 minute Complimentary Strategy Call with Christie to learn more about how her programs can help you find freedom from Endo, PCOS and IBS.
Connect with Christie on Instagram @endometriosis.dietitian.