Why I rarely talk about weight when it comes to endometriosis
I very rarely talk about weight—your body weight—when we look at reducing your endometriosis symptoms. I didn’t think there was a clear relationship between being overweight or underweight and your endometriosis symptoms.
Until a few months ago.
The gynaecologist visit that changed my thinking
My 20-year-old daughter has had a lot of issues with her period—severe pain and heavy bleeding. We ended up in the emergency department after one particularly bad episode. A GP referred her to a gynaecologist, and she asked me to go along with her for support and to help make sense of the information.
Toward the end of the 20-minute consultation, the gynaecologist told my daughter she should try to put on some weight because body fat holds on to oestrogen—and that might help her premenstrual mood symptoms.
The slim body type conversation
This hit a nerve. In our family, we are genetically very slim. Growing up, people constantly told me to “eat more” or even asked if I was anorexic. My daughter gets the same remarks—even though she eats all the time. We just have a fast metabolism and find it nearly impossible to put on weight.
So being told to “just gain weight” felt dismissive. The gynaecologist didn’t offer any advice on how to do it either. Still, what stuck with me was the idea that body fat holds on to oestrogen.
Am I overlooking something important in my practice?
That comment made me wonder—am I doing my clients a disservice by not looking more closely at body weight when trying to reduce endometriosis symptoms?
So I started researching. But spoiler alert: I’m now more confused than I was before.
Here’s what I found.
Research mostly looks at risk—not symptoms
Most research I found focuses on the risk of developing endometriosis, not on how weight affects existing symptoms.
For example, an Australian study in 2022 found that women aged 18–23 who gained weight had a lower risk of endometriosis than those with a consistently low BMI.
But here’s the catch: Most people I work with had endometriosis symptoms long before age 23. Many started experiencing pain and fatigue as early as their first period—sometimes as young as 11.
So, how helpful is this information if your symptoms began a decade earlier?
Another 2022 study looked at BMI and risk at younger ages
This study found that a higher BMI at age 18 was linked to a lower risk of developing endometriosis. But if you had a higher BMI as a child (ages 10–16), it was associated with a higher risk.
Researchers theorised this might be due to insulin resistance in overweight children, which could prevent ectopic endometrial cells from dying and being cleared out properly.
But again, this raises more questions: What if you were overweight at 12 but slimmed down at 16? Does the risk decrease? Increase? Stay the same? The answers aren’t clear.
Where you carry weight may matter more than how much
One finding that stood out was the impact of abdominal fat—particularly visceral fat around your organs. In women over 30, more abdominal fat correlated with higher oestrogen levels.
And high oestrogen levels can worsen endometriosis symptoms, even though they don’t cause the disease.
That said, researchers couldn’t tell whether abdominal fat causes high oestrogen or simply stores it. Either way, higher visceral fat equals higher oestrogen—which is a problem for endometriosis.
What about weight, inflammation, and fertility?
This is where things started to make more sense.
There's well-established research linking higher body weight with increased inflammation—especially in obesity. A protein called resistin, which increases with more body fat, is directly linked to chronic inflammation.
And we know that inflammation worsens endometriosis symptoms.
Being overweight also increases insulin resistance. That means your body needs to produce more insulin to balance your blood sugar after eating, and that excess insulin leads to more inflammation. Inflammation is what exacerbates symptoms and affects fertility—by making it harder for an embryo to implant.
So… should I focus more on weight loss in my work?
Honestly? No.
What I do with my clients is focus on reducing inflammation through nutrition. That’s the cornerstone of my approach, and here’s why:
- Lower inflammation = fewer endometriosis symptoms.
- Lower inflammation = better chances of successful implantation if you’re trying to conceive.
- Lower inflammation = less favourable environment for endometrial tissue to grow.
That’s the true target—not weight.
Will weight change as a side effect of an anti-inflammatory diet?
Often, yes.
But I want to be clear: I never tell clients to “just lose weight.” It’s not that simple. Weight loss is difficult, deeply personal, and tied to far more than just food choices. Many women who eat extremely well still struggle to lose weight due to hormonal, metabolic, or gut health issues.
However, the anti-inflammatory diets I use:
- Are low in sugar and ultra-processed foods.
- Stabilise blood sugar levels.
- Reduce insulin resistance.
And in doing so, some clients do lose weight. But it’s a side effect—not the goal.
Gut health and weight connection
When we work together, we also focus on improving your gut microbiome. We now know that your gut bacteria play a major role in weight regulation and inflammation. So, addressing gut health can improve both symptoms and your ability to reach a healthy weight—again, as a side effect of supporting your whole system.
A final tip if you’re worried about weight
Ditch the scales.
Honestly, weighing yourself isn’t helpful. Weight fluctuates throughout the day, especially for women. You can weigh more after drinking water or less after eating breakfast—it makes no sense. The number on the scale doesn’t give you any reliable insight into your health or your inflammation.
If you're concerned about your weight, it’s far more useful to look at where you’re carrying it—especially if you notice a tendency toward abdominal weight gain.
But even more than that, let's focus on how your body feels, how your symptoms change, and how we can reduce your inflammation through food.
That’s where the real progress happens.
If you’re ready to start personalising your nutrition for Endometriosis, reach out—I’d love to support you. Book your complimentary Endometriosis Discovery Call to get started: https://theendometriosisnutritionist.online/endometriosis-discovery-call/.