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Nausea from endometriosis and endo belly – ROSE Study and more

Nausea that doesn’t go away or maybe cycling with your period could mean you have endometriosis endo belly. What does this mean? Endometriosis, a condition where cells that are similar to those which line the inner part of your uterus, may cause nausea and even vomiting, severe abdominal pains, gas, rectal pain or bleeding and other intestinal symptoms. It is very under-diagnosed and many women suffer for decades before the diagnosis is made.

“Endo belly” sums up these endometriosis caused or related symptoms and can be complex and varies from individual to individual. Lots of images circulate on Instagram or videos on YouTube which show bellies that look like pregnancy is going on, and this impacts self-image.

We have learned a lot about what endo looks like, how it presents, what causes it to get worse, and things like that through research. A big ongoing research study is the Research OutSmarts Endometriosis (ROSE) study which is ongoing and looking at clinical and basic science answers. It is not the only study and strides are being made to raise awareness about endometriosis, including how it often presents with intestinal symptoms including endo belly nausea and pain.  

At the G.O. Institute, research is also underway to look at molecular mechanisms of endo. These include circulating cell-free DNA (cfDNA) and micro-RNA assays (miRNA).  This and many other international research efforts will amplify how fast we get to the goal of prevention and cure. 

While we are learning more from the ROSE study and others like it, we already know that there are certain things you can do to defeat the endo-bloat and get your life back.

Here are some tips to help defeat endo-belly and all of its intestinal symptoms:

TIP #1: Make sure it is endo belly and not something even worse 

There are a number of intestinal disorders including Irritable Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS), which may have a clear reason or not. But the closer you come to an accurate diagnosis, the better the treatment results because the treatments can be precisely focused on the problem.  

A very common disorder that often accompanies endometriosis is Small Intestinal Bacterial Overgrowth.  The small intestine is mostly sterile.  But when bacteria overgrow it, you can end up with all sorts of severe swelling symptoms.  In many women, endo belly is both a direct result of endometriosis irritating the bowel as well as SIBO.  So you get a double whammy.  

Depending on your age, and your family history, intestinal disorders can include things like polyps or even cancers of the intestine or ovaries.  So, a gastroenterologist may be a good consultant for you in this case.  If there is anything found on the ovaries, it may be endometriosis and endometrioma (blood filled ovarian cysts), or it can be an ovarian tumor.  Dr. Steven Vasilev MD, G.O Institute director, recommends close attention to detail in his book Ovarian Cyst Treatment, which overlaps endo and other ovarian conditions. 

Other causes of pain and swelling that can contribute to endo-belly are uterine fibroids and uterine adenomyosis.  Both of these can cause severe cramping and the diagnosis can be helped with ultrasound or MRI. 

TIP #2: Look at and track what you eat and drink 

In some cases, intestinal irritation can come from taking in dairy products that your gut can’t digest well.  This can sneak up on you as your body may have less enzymes that are required for digestion as you get older.  Track what you are eating and see if certain foods or drinks lead to symptoms.  

Sometimes, you can do something called an elimination diet.  This means you eliminate whole food groups one at a time to see if things get better and then re-introduce them one at a time.  Start with foods that you suspect the most, possibly dairy or gluten-rich foods. An anti-inflammatory, anti-oxidant diet is at the core of a good anti-endo belly diet.  So, in general, limit toxins and optimize natural organic foods and go light on processed meats.  For example, these diets usually eliminate alcohol, gluten, dairy, eggs, soy, red meat, preservatives, artificial sugars, and caffeine. 

Your intestinal microbiome or gut bacteria is central to your health.  In addition to eliminating foods that just might not agree with you, look at how you feed the good bacteria by consuming probiotics through fermented foods or supplements. Kombucha tea or drinks, kim-chi, kefir, sauerkaut are all options. 

Last but not least, a gastroenterologist may recommend a so-called FODMAP diet, which is short for “fermentable oligo-, di-, monosaccharides, and polyols”.  These are  simple carbohydrates that can increase the volume of gas and liquid volume in the intestine which can certainly lead to abdominal pain, gas, and bloating.  These are all endo belly symptoms. 

Dr. Steven Vasilev MD, the director of the G.O. Institute for Endometriosis Care in Los Angeles, California, encourages all of the above, in addition to discussion of the benefits of surgery.  Dr. Vasilev says “endo care is not just about surgery. That can be very helpful and kickstart a recovery. But attention to details in diet and lifestyle are key to success.”

TIP #3: Movement and Massage 

It seems counter-intuitive to move around when in pain.  But if possible, it can stimulate your internal endorphins to actually counter the pain.  This is the same idea as the concept of the “runner’s high”.  

Exercise, even if it is limited to walking, can also reduce stress, which reduces cortisol, which can hormonally affect endo pain and swelling.  Gentle massage can also improve circulation and add to calming effects.  This can reduce pain and bloating of endo belly

TIP #4: Have your hormones checked

“Due to the fact that endo is at least partly subject to hormonal imbalance, optimizing sex hormones balance is crucial”, says Dr. Vasilev.  While an endocrinologist and nutritional professional can be helpful, you can play a proactive role as well.  Also, “because there are a lot of wingnuts out there”, notes Dr. Vasilev, “doing some due diligence to avoid getting hurt or ripped off is very important and often overlooked”.  

Research studies like ROSE and the basic science studies like those being performed at the G.O. Institute are looking deeper at clinical and molecular factors that drive endo.  But before you get pumped full of “bio-identicals” to “balance” hormones, stop and take a look at what may be wrong.  If you are overweight, lose it.  This can be causing your overabundance of estrogen dominance.  Piling on progesterone creams can hurt you.  If you are taking in estrogenic xeno-hormones from the toxins around you, stop.  If you want to try a gentle approach, use seaweed supplements, which can lower excess estrogen.  Paying attention to your microbiome with probiotics also improves excess estrogen by tuning up your “estrobolome”, a subsegment of your microbiome.  

Reducing stress, mind-body, acupuncture and acupressure, massage, music therapy, and more can also affect your stress hormones which can, in turn, affect your sex hormones.  

TIP #5: Herbs, Supplements and Essential Oils in Moderation are your friends

Dr. Vasilev recommends key supplements which can help with an anti-oxidant anti-inflammatory state.  This includes omega fatty acids (fish oil), magnesium and vitamin D. In addition a calmative balancing effect to help relieve endo-belly and endometriosis nausea can be found with the adaptogen Ashwaganda, lavender, ginger, peppermint and things like that.  CBD is also a great addition to achieving an anti-inflammatory state.  These are all things that, although “natural” should be used under the supervision of a physician who understands medicine and endometriosis.  Many herbals can interact with each other or with medications you may be taking.  

TIP #6: Chill and Sleep

It’s easy to say that stress reduction is key.  This is a stress-filled world.  But, at the very least, restorative sleep is essential.  This is when your body heals itself and improves hormonal balance.  If you have insomnia, consider Melatonin.  This is a great non-drug way to get some great shut-eye.  Have a wind-down routine that is electronics (e.g. cell phone) free towards bedtime.  

Stress reduction using whatever resonates with you can be very helpful during the day.  Check out mindfulness training, yoga or tai-chi or bio-feedback like HeartMath programs.  

TIP #7: Pelvic floor relaxation and therapy 

Endo causes the pelvic floor to spasm.  A combination of self-routines like deep breathing, some acupressure, Kegel-type muscle training can all be very helpful if done routinely.  An expert pelvic floor therapist can help you not only with sessions but also with training for how to do some of these things.  A trained therapist may also talk to you about muscle relaxants vaginally.  Every person is different and “controversial” treatments are controversial only because they don’t work for everyone.  There is no one-size-fits-all for endo.   

TIP #8: Get an endometriosis team on your side

If you are seeking a diagnosis or already know you have endo, seek out someone who is an expert in endo.  This is usually beyond the general gynecologist, although some are deeply involved in endo care.  The endo expert will usually have a team that can be hand-picked for you to treat the endometriosis, the endo-belly, the infertility etc. 

“Surgical diagnosis and expert endo-excision is still the cornerstone of endometriosis therapy”, says Dr. Vasilev.  Especially if you have endo belly and the nausea from endometriosis is related to bowel involvement, you need an uber expert who can do all that is required surgically, including bowel surgery.  Be wary of pretenders that may not be able to handle what they find during surgery.  Dr. Steven Vasilev, an expert robotic surgeon, ultimately cautions, “You don’t want to have to go through multiple surgeries when a correctly performed one can set you on the path to lasting recovery.”  

Learn more about minimally invasive endo-excision surgery HERE.

Dr Steve Vasilev MD
“I help and guide women to defeat gynecologic cancers and advanced pelvic conditions such as endometriosis, using a unique combination of minimally invasive robotic surgery, precision medicine therapies and complementary holistic natural support towards thriving in survivorship." Dr. Vasilev is the only physician quadruple board certified in Ob-Gyn, Gynecologic Oncology and Integrative & Holistic Medicine in the United States. He is an accomplished advanced robotic surgeon and serves as Medical Director of Integrative Medicine and Integrative Gynecologic Oncology at Providence Saint John's Health Center, Professor at John Wayne Cancer Institute in Santa Monica, California and is Clinical Professor at Loma Linda University School of Medicine. He is former faculty and professor at UC Irvine, UCLA, USC and City of Hope. He is an active member of multiple medical societies and has been nationally listed in "Best Doctors" for 18 years.

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