The chronic condition known as endometriosis involves tissue similar to the lining of the uterus growing outside the uterine cavity, most commonly in the pelvic area. This misplaced tissue responds to hormonal cycles, causing inflammation, pain, and scarring. While endometriosis and acid reflux affect different body systems, evidence suggests a connection where endometriosis can contribute to or exacerbate heartburn symptoms. This link is rarely due to direct contact but is instead a result of the body-wide effects of endometriosis.
Endometriosis and General Gastrointestinal Symptoms
Endometriosis frequently presents with symptoms that extend beyond the reproductive organs, causing significant gastrointestinal distress. Individuals often experience chronic bloating, nicknamed “endo belly,” along with constipation, diarrhea, and painful bowel movements. These digestive issues are frequently mistaken for Irritable Bowel Syndrome (IBS), often leading to diagnostic delays.
Women with endometriosis are significantly more likely to receive an IBS diagnosis. This overlap occurs because pelvic inflammation can irritate and affect the function of nearby organs like the colon and intestines. Even without direct infiltration of the bowel, the inflammation created by lesions disrupts normal gastrointestinal function. This pattern of digestive system involvement sets the stage for upper GI issues like heartburn.
The Systemic Connection Causing Heartburn
The link between endometriosis and heartburn is indirect, stemming from systemic effects rather than a direct physical cause. Two primary mechanisms explain how a pelvic condition affects the esophagus and stomach. The first involves the widespread inflammatory nature of endometriosis.
Endometriotic lesions release inflammatory compounds, such as cytokines, into the bloodstream, creating chronic, low-grade inflammation throughout the body. This systemic inflammation can affect the function of the lower esophageal sphincter (LES). When the LES relaxes inappropriately due to inflammatory signaling, stomach acid can reflux upward, causing heartburn.
The second major mechanism is the influence of reproductive hormones on the digestive tract’s smooth muscle. Endometriosis is an estrogen-driven condition, and fluctuations in estrogen levels directly impact the LES. Estrogen relaxes smooth muscles, and high levels may cause the LES to become looser, allowing acid to escape more easily.
Furthermore, the pressure created by common gastrointestinal symptoms like bloating and constipation can physically exacerbate reflux. Increased abdominal pressure pushes stomach contents upward against a potentially weakened LES. Though rare, lesions on the diaphragm can also increase pressure on the stomach and worsen reflux symptoms.
When to Consult a Specialist and Management Strategies
If you experience persistent or worsening heartburn alongside endometriosis symptoms, a comprehensive approach involving multiple specialists is recommended. Consult both a gynecologist or an endometriosis specialist and a gastroenterologist. The gastroenterologist can rule out standard causes of gastroesophageal reflux disease (GERD) and confirm the integrity of the digestive organs.
Documenting the timing, frequency, and severity of heartburn is helpful, especially noting if it worsens during your menstrual cycle. This cyclical pattern suggests a hormonal or inflammatory link to endometriosis. Management strategies often involve treating the underlying endometriosis to reduce systemic inflammation and hormonal drivers.
Treating endometriosis, often through hormonal therapy or surgical excision of lesions, may improve associated heartburn symptoms. This must be coupled with standard reflux treatments, including dietary modifications like avoiding trigger foods such as spicy items, caffeine, and alcohol. Proton pump inhibitors (PPIs) or antacids provide immediate relief, but they should be used alongside a treatment plan that addresses the root cause of inflammation.