Is the Low FODMAP Diet Helpful for Endometriosis?
An Endometriosis Dietitian Shares Why It’s Not a Long-Term Solution
If you have endometriosis and deal with bloating, constipation, diarrhea, or food intolerances, you might have been told to try the Low FODMAP diet. This diet is often suggested for Irritable Bowel Syndrome (IBS), and many people with endometriosis are first misdiagnosed with IBS before getting the right help.
As a dietitian who works with endometriosis patients, I want to make this clear:
Low FODMAP is not a long-term or primary treatment for endometriosis symptoms.
While it can help with digestive discomfort for a short time, it usually does not help with the pelvic pain or gut problems that come with endometriosis.
What are FODMAPs and Why are They Prescribed?
FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are types of carbohydrates that the small intestine does not absorb well. When they reach the colon, they ferment and cause gas and bloating, which are common in IBS.
They include:
Fructans (wheat, onion, garlic)
Galacto-oligosaccharides (beans, lentils)
Lactose (milk, yogurt)
Excess fructose (apples, honey)
Polyols (stone fruit, sugar alcohols)
These carbohydrates ferment in the gut, which creates gas and changes in fluid that can make bloating, constipation, and diarrhea worse.
The Low FODMAP diet was created by Monash University as a short-term tool to help find food triggers in people with IBS. But endometriosis is not simply a severe form of IBS; it is a whole-body, inflammatory disease that needs a more complex approach.
What Is the Low FODMAP Diet?
The Low FODMAP diet is a short-term elimination plan made to help with IBS symptoms. Some recent studies show it might improve the quality of life for people with endometriosis.
It involves:
Temporary elimination of high-FODMAP foods
Systematic reintroduction
Personalization based on tolerance
Even in IBS care, clinicians caution against long-term restriction due to negative effects on the gut microbiome (Hill et al., 2017).
What Is IBS—and Why Is It So Common in Endometriosis?
IBS (Irritable Bowel Syndrome) is a functional gastrointestinal disorder defined by:
Abdominal pain
Constipation, diarrhea, or alternating bowel patterns
Bloating and gas
People with endometriosis are two to three times more likely to have IBS than those who do not have endometriosis (Varney et al., 2025).
Both conditions have symptoms like diarrhea, constipation, and visceral hypersensitivity, which means the nerves in the pelvis and gut react strongly to pain. Because of this, many people end up in a cycle of restrictive diets that do not treat the real problem.
Root Causes: Why "Endo Belly" Persists on Low FODMAP
Endometriosis can directly disrupt digestion through:
Chronic pelvic inflammation
Visceral hypersensitivity
Altered gut-brain signaling
Physical bowel involvement or adhesions
This means that GI symptoms in endometriosis are often caused by structural and inflammatory issues, not just by what you eat.
If you have tried the Low FODMAP diet and still feel unwell, it is probably because the diet does not address these main causes of gastrointestinal symptoms in the setting of endometriosis:
1. SIBO (Small Intestinal Bacterial Overgrowth)
A 2025 study found a high prevalence of SIBO and IMO (Intestinal Methanogen Overgrowth) in patients with endometriosis (Halfon et al., 2025). If you have an overgrowth of bacteria in your small intestine, even "Low FODMAP" foods can still trigger significant bloating and pain.
2. Impaired Motility and Adhesions
Endometriosis often causes adhesions, which are bands of scar tissue that can stick organs together. If these adhesions affect the bowel, they can twist the intestines or slow things down, causing long-term constipation.
3. Co-occurring Conditions
Many endometriosis patients also navigate:
Mast Cell Activation Syndrome (MCAS): Creating high sensitivity to histamines.
Ehlers-Danlos Syndrome (hEDS): Impacting the structural function of the gut.
Autoimmune Diseases: Requiring a systemic anti-inflammatory focus.
The Risk of Long-Term Restriction
I always tell my patients that the Low FODMAP diet is not a long-term solution. Because it is so restrictive, staying on it for too long can harm your gut health. Without enough fiber, the good bacteria in your gut can decrease, which may make gut problems worse over time.
Also, while it might help your digestion for a short time, it usually does not help with the deep, inflammatory pelvic pain that comes with endometriosis.
My approach is to use the Low FODMAP phase only as a short-term step to calm GI symptoms. The main goal is to move toward a varied, anti-inflammatory Mediterranean-style diet you can follow long-term
Next Steps for Lasting Relief
If you are tired of strict diets for IBS and endometriosis and want to get to the root of your symptoms, try these steps:
Consider Excision Surgery: If you think endometriosis is the main cause of your pain, talk to a specialist about excision surgery, which is the gold standard.
Work with an Endometriosis Dietitian: Find a nutrition plan that fits your body’s needs without extra restrictions.
SIBO Testing: Move beyond guessing and find out whether bacterial overgrowth is driving your "Endo Belly."
GI Mapping: Use comprehensive stool testing to test for dysbiosis and inflammation.
Are you ready to break free from restrictive diets and start your healing journey? Work with me
References
Endometriosis Australia. (2024). Endometriosis and FODMAPs. https://endometriosisaustralia.org/endometriosis-and-fodmaps/
Halfon P, Estrade JP, Penaranda G, Choucroun N, Bouaziz J, Nicolas-Boluda A, Retornaz F, Gurriet B, Plauzolles A. High prevalence of small intestinal bacterial overgrowth and intestinal methanogen overgrowth in endometriosis patients: A case-control study. Int J Gynaecol Obstet. 2025 Jul;170(1):284-291. doi: 10.1002/ijgo.70005. Epub 2025 Feb 17. PMID: 39959963.
Hill P, Muir JG, Gibson PR. Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterol Hepatol (N Y). 2017 Jan;13(1):36-45. PMID: 28420945; PMCID: PMC5390324.
https://www.eds.clinic/articles/gastrointestinal-issues-ehlers-danlos-syndrome-guide
Varney JE, So D, Gibson PR, Rhys-Jones D, Lee YSJ, Fisher J, Moore JS, Ratner R, Morrison M, Burgell RE, Muir JG. Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)-A Randomised, Controlled Crossover Feeding Study. Aliment Pharmacol Ther. 2025 Jun;61(12):1889-1903. doi: 10.1111/apt.70161. Epub 2025 May 4. PMID: 40319391; PMCID: PMC12107219.
