29 Mar 2017

Low FODMAP diet may help women with endometriosis, IBS

Judy Moore is a PhD student with the Monash
by Anne Crawford

Endometriosis is a chronic gynaecological condition affecting up to 10% of women. It is characterised by symptoms such as pelvic pain and severe dysmenorrhoea (period pain) but also by symptoms typically associated with Irritable Bowel Syndrome (IBS).

A Central Clinical School PhD student investigating the link between the two conditions has found that a low FODMAP diet appears effective in women with concurrent endometriosis and IBS.

Judy Moore first observed the cross-over of symptoms amongst patients when she was working previously at a specialised IBS service in Christchurch, New Zealand. The experienced nurse was assessing patients with IBS who were on the low FODMAP diet.

Judy noticed that women who had endometriosis as well as IBS were more likely to do well on the diet than those with IBS alone.

Together with colleagues from the Department of Gastroenterology School, Monash University and Alfred Hospital, the PhD student tested the observation by conducting a retrospective analysis of data from the collaborating Intus, Digestive and Colorectal Care clinic.

The review, an audit of 160 female patients over a five-year period (January 2009 to December 2013), was published this month in ‘The Australian & New Zealand Journal of Obstetrics & Gynaecology’ (ANZJOG).

The paper noted that endometriosis is common in women with IBS and that it has been reported that the two conditions share a common potential pathogenic mechanism –visceral hypersensitivity, in which the bowel is more sensitive to stretching. The low FODMAP diet reduces stretching of the bowel wall and hence the stimulus that leads to symptoms.

The study concluded that women with both conditions had a threefold increase in the likelihood of responding to the low FODMAP diet compared to those without endometriosis.

The association between IBS and endometriosis is not new; clinicians have often raised concerns about the difficulty in distinguishing between the two conditions. Women with endometriosis are frequently misdiagnosed with IBS. (See link below for more information about symptoms.)

Supervising author Professor Peter Gibson, Head of Gastroenterology and who has led the FODMAP diet research, said the link had been underexplored.

“There have been associations made before but they’re not well talked about or studied very much,” Professor Gibson said.

“We think the link is really important,” he said.

Professor Gibson said the authors published the study in ‘The Australian & New Zealand Journal of Obstetrics & Gynaecology’ because they thought it was pertinent to gynaecologists’ and obstetricians’ clinical practice. Gastroenterologists are experienced with managing IBS with dietary therapies but this is a potential new use for the diet.

“People with endometriosis and IBS should perhaps be given the chance to have some dietary management of their gut symptoms – reducing their FODMAP intake might improve their symptoms considerably,” he said.

Professor Gibson cautioned that the research had limitations and further investigation was needed, but said the study was valuable in highlighting the issue.

See more detail:


Judith S. Moore, Peter R. Gibson, Richard E. Perry, Rebecca E. Burgell. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. The Australian & New Zealand journal of obstetrics & gynaecology. First published: 17 March 2017 DOI: 10.1111/ajo.12594

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