Endometriosis and weight: the biology behind it and how to find balance

Hormonal treatments, the contraceptive pill and increased appetite

Some medicines used to treat endometriosis can affect weight in some people. To relieve symptoms and slow the progression of the condition, hormonal treatments are often used, such as the contraceptive pill, progestogens or medicines that temporarily lower the body's oestrogen levels and put the body into a menopause-like state. The effect of treatment on weight varies between people and between different medicines.

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Hormonal treatment can affect the body in different ways. Some people experience an increased appetite or find that their body retains more fluid during treatment. For some people, treatment can also affect energy expenditure, which, together with increased appetite, can make it more difficult to maintain their weight. The extent of this effect varies between different medicines and from person to person.

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For some people, increased appetite and other changes during treatment can make it more difficult to maintain their weight or lose weight. At the same time, pain and tiredness can make it more difficult to be physically active. This shows that weight in people with endometriosis is influenced by many factors and is not simply a matter of willpower. For some people, support with eating habits, exercise and medication for overweight or obesity may help.

Why it is difficult to lose weight with endometriosis

For many people with endometriosis, it can be more difficult to lose weight. Long-term pain can affect the body in several ways, including by increasing stress levels and making it more difficult to sleep, have enough energy to be physically active and stick to healthy habits. Together, these factors can make weight loss more challenging for some people.
Long-term pain can activate the body's stress system and affect levels of the stress hormone cortisol. This, in turn, can affect appetite, sleep and energy levels, among other things. Together with the pain, this can make it more difficult for some people to maintain their weight or lose weight.

At the same time, pain often causes a significant deterioration in sleep quality. Lack of sleep, in turn, reduces the production of the satiety hormone leptin and increases levels of the hunger hormone ghrelin. This hormonal storm explains why patients, particularly women with endometriosis, experience an uncontrollable craving for refined carbohydrates and other energy-dense foods.

Can endometriosis cause weight loss and an increased risk of being underweight?

Yes, in some cases endometriosis can contribute to weight loss, although this is significantly less common than weight gain. If the condition affects the bowel or other parts of the gastrointestinal tract, it can cause severe pain, nausea or other symptoms associated with meals. For some people, this can mean eating less than usual over a longer period, which in turn can lead to weight loss and, in some cases, being underweight.

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The answer to the question "can endometriosis cause weight loss" is therefore that the condition can sometimes develop in a way that mechanically obstructs normal gastrointestinal function. If every meal is followed by cramps, severe bloating or diarrhoea, the patient often develops avoidant eating behaviour to relieve their symptoms. This form of involuntary calorie restriction results in a rapid loss of both body fat and muscle mass, which in the long term makes the body weaker and more vulnerable.

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However, weight gain is significantly more common than weight loss in people with endometriosis. For anyone who is losing weight, it is also important to do so in a way that helps the body preserve muscle mass.

How to lose weight with endometriosis

To succeed when trying to lose weight with endometriosis, the calorie deficit must be created through a strict anti-inflammatory, high-protein diet combined with gentle, muscle-preserving exercise to avoid triggering new episodes of abdominal pain. Because physical activity is often limited by pain, the diet needs to be adapted to take most of the responsibility for the weight loss journey.

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With endometriosis, it can sometimes be more difficult to maintain weight or lose weight. Pain, tiredness, reduced physical activity and certain treatments can combine to make it more challenging. Healthy eating habits, regular exercise and other habits that work in the long term can make it easier to reach and maintain a healthy weight. For some people, medication for overweight or obesity can also be a valuable form of support.

The role of protein in satiety and muscle mass: for women with endometriosis

A high and consistent protein intake is essential with endometriosis because protein provides the strongest biological satiety signal of all nutrients and effectively prevents muscle breakdown when you are in a calorie deficit. When you eat less, the body can use both fat and muscle as sources of energy. If you lose muscle mass, the body's resting energy expenditure may decrease.

For patients with endometriosis, muscle mass is particularly important to protect because it acts as the body's engine for energy expenditure at rest. By including a lean source of protein, such as chicken, fish, tofu or eggs, with every meal, the release of the body's own GLP-1 hormones in the gut is stimulated. This switches off hunger signals to the brain in a completely natural way. An adequate protein intake also reduces the sharp fluctuations in blood sugar that would otherwise fuel low-grade inflammation in the body.

Gentle strength training to preserve metabolism

Strength training can be a good option for many people with endometriosis. It helps preserve or build muscle mass, which is important both for health and during weight loss. Exercise can also reduce strain on the joints and make it easier to move. For anyone experiencing pain, it can be helpful to adapt exercises according to how you feel on the day to avoid making the pain worse.

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Both strength training and cardiovascular exercise have health benefits, and the best form of exercise is often the one that works for your body and the symptoms you experience. Regular exercise can contribute to better blood sugar regulation, increased strength and improved wellbeing. By starting gently and gradually increasing the intensity, many people can find a level of exercise that works even with endometriosis.

Medical weight management as support for endometriosis

When healthy eating habits and regular exercise are not enough to achieve sustainable weight loss, modern medicines for overweight and obesity, such as GLP-1 medicines, can be a valuable form of support for some people. Obesity is a chronic disease that can develop as a result of many interacting factors, with long-term pain and reduced physical activity being some of them.

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GLP-1 medicines mimic a natural gut hormone that helps regulate hunger and satiety. Many people find that they feel less hungry, feel full sooner and think less about food. This can make it easier to eat less and build habits that last over time.

Weight loss can also reduce the amount of body fat, which in itself can contribute to better health. Because fatty tissue produces oestrogen, a reduction in body fat can affect the body's oestrogen levels. How this affects endometriosis symptoms varies from person to person and is still an area where more research is needed.