Endometriosis and Body Awareness

A recent study reveals that individuals affected by endometriosis tend to have a more negative body image than those in good health. What factors contribute to this phenomenon?

Distorted Body Perception – A Common Challenge

It is common for individuals to experience distorted body perception, where they view themselves less favorably than others. You may have encountered this issue yourself. Often, these individuals perceive themselves as shapeless or misshapen, even when objective assessments suggest otherwise. Distorted body perception is frequently associated with eating disorders such as bulimia or anorexia [1]. Notably, the influence of social media plays a significant role, as the beauty ideals portrayed online can exert immense pressure on individuals. Many people strive to conform to these ideals, and some resort to methods that can be perilous, particularly when pursuing weight loss. Those who spend extensive time on social media are at a higher risk of developing distorted body perceptions [2].

Even more concerning is that a substantial number of posts and, especially, photos on social media do not reflect reality at all. In a London-based study, 90% of respondents admitted using filters or image editing software to enhance their photos before sharing them [3].

Consequently, these so-called beauty ideals are unattainable because they are not real. Humans are biological creatures with typical characteristics that cannot be digitally airbrushed away in real life.

Consider facial makeup, for instance. Our skin naturally has pores and minor imperfections that are part of our unique texture. While makeup can somewhat cover these up, the underlying surface remains visible. Regardless of how skillfully applied or which product is used, there is a limit to what makeup can achieve. However, in advertisements and videos, you often see perfectly smooth, flawlessly even skin devoid of any texture. This, too, is merely the result of image retouching. If these images were presented without editing, the skin of the individuals depicted would appear no different from that of any other person.

Body Perception in Endometriosis

Individuals with chronic conditions tend to harbor a more negative body image than their healthy counterparts [4]. This conclusion arises from a comprehensive meta-analysis involving 330 studies on the subject [5]. People dealing with conditions such as scoliosis, obesity, diabetes, and asthma often have a less favorable view of their bodies and lower self-esteem, especially among women*.

As you may be aware, endometriosis is also classified as a chronic condition with its challenges. Medical professionals have long recognized that individuals with endometriosis often express dissatisfaction with their bodies [6]. However, until recently, the extent to which body perception differs between those with endometriosis and healthy individuals remained unexplored. A study conducted in 2022 in Australia sought to address this gap [7]. The research involved two groups: those affected by endometriosis and a healthy control group. Participants completed questionnaires assessing their satisfaction with their bodies and the impact of pain on their well-being. The findings revealed that individuals with endometriosis exhibited significantly more negative body perceptions. Moreover, the severity of pain correlated with satisfaction levels—the greater the pain, the higher the dissatisfaction with one’s body. Additionally, individuals affected by endometriosis are more prone to experiencing depression compared to their healthy counterparts [8]. This tendency is significantly pronounced when additional chronic conditions coexist with endometriosis, which is not uncommon. Endometriosis often brings about comorbidities, either due to the state itself or other factors. Conditions like intestinal disorders and autoimmune thyroid diseases (e.g., Hashimoto’s thyroiditis) are frequently associated with endometriosis [9]. These additional ailments, mainly if they cause discomfort like diarrhea or bloating, can significantly impact the daily lives of those affected. Furthermore, infertility and involuntary childlessness are sources of significant emotional distress and can contribute to feelings of inadequacy or resentment towards one’s body, which may not function as desired.

The Far-reaching Impact of Endometriosis on Body Image

Pain, as previously mentioned, is a central aspect of endometriosis. Numerous studies have revealed that individuals affected by endometriosis often endure significant pelvic pain, which profoundly negatively influences their body perception [11]. Consequently, it becomes imperative to alleviate this pain as effectively as possible. Painkillers, as a first-line treatment, prove to be highly effective. Research has demonstrated that non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, can provide significant relief [12]. Additionally, acupuncture, an approach from traditional Chinese medicine, yields positive results. A meta-analysis of ten studies supports its efficacy [13]. However, endometriosis presents more challenges beyond pain. For many, one of the most distressing symptoms is the “endo-belly,” characterized by abdominal bloating caused by gas accumulation and inflammation in the abdominal cavity. This often becomes more pronounced just before and during menstruation. It causes discomfort and occasional pain and affects body image, making the abdomen appear larger than it is. In recent months, a social media movement has emerged, with many individuals sharing photos of their endo-bellies. Discovering that others face the same issue can be comforting and boost confidence in dealing with it. It is essential to recognize that extremely flat bellies are the exception, and endometriosis often contributes to a distended belly—it is simply part of the condition. Some dietary adjustments can help alleviate this [10]. Since many individuals with endometriosis also have concurrent conditions like irritable bowel syndrome (IBS), experimenting with different diets, such as the FODMAP diet, can be beneficial. This helps identify which foods are well-tolerated and which contribute to bloating and digestive discomfort. During menstruation, the digestive system tends to be more sensitive, making a lighter diet preferable for those affected. The key is to explore what works best for each individual. And if nothing seems to alleviate the endo-belly, remember that you are not alone in this; perfection is an unrealistic standard perpetuated by the media.

Given the close connection between the gut and the brain, with gut health affecting mental well-being and potentially exacerbating depression, maintaining a healthy diet is paramount [14]. Regular physical activity boosts self-esteem and enhances overall physical health. Adequate sleep is equally essential. The optimal approach is to experiment and determine what suits you best and makes you feel your best; ultimately, that is what truly matters.


Numerous factors influence body image, whether the media portrays unattainable beauty standards or the physical pain that can confine you to bed for days. Rising above these influences is not always easy, but it is essential to remind yourself that perfection is a myth and most photos are edited to an unrealistic degree. Everyone experiences bad days, bloating, or the occasional blemish. On those days when your endo-belly feels particularly bothersome, consider browsing posts and photos on the subject. You will likely find solace in knowing that many individuals with endometriosis share your feelings. Beyond that, prioritize self-care and well-being. Whether indulging in a relaxing bath or physical activity, finding what makes you feel positive about yourself is vital. Remember, you are not defined by endometriosis; it is just one part of you. So, hold your head high, take pride in your achievements, and go easy on yourself. You have every reason to appreciate and embrace yourself and your body.


  1. Professional associations for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany: Distorted body perception often accompanies eating disorders. https://www.neurologen-und-psychiater-im-netz.org/neurologie/ratgeber-archiv/artikel/verzerrte-koerperwahrnehmung-begleitet-oft-essstoerungen/ (abgerufen am 26.02.2023)
  2. Alsaidan MS, Altayar NS, Alshmmari SH, Alshammari MM, Alqahtani FT, Mohajer KA. The prevalence and determinants of body dysmorphic disorder among young social media users: A cross-sectional study. Dermatol Reports. 2020 Dec 22;12(3):8774. doi: 10.4081/dr.2020.8774. PMID: 33408841; PMCID: PMC7772767.
  3. Newport Institute: Do you use a filter everytime you post? https://www.newportinstitute.com/resources/co-occurring-disorders/filters-mental-health/ (abgerufen am 26.02.2023)
  4. Pinquart M. Body image of children and adolescents with chronic illness: a meta-analytic comparison with healthy peers. Body Image. 2013 Mar;10(2):141-8. doi: 10.1016/j.bodyim.2012.10.008. Epub 2012 Dec 7. PMID: 23219705.
  5. Pinquart M. Self-esteem of children and adolescents with chronic illness: a meta-analysis. Child Care Health Dev. 2013 Mar;39(2):153-61. doi: 10.1111/j.1365-2214.2012.01397.x. Epub 2012 Jun 19. PMID: 22712715.
  6. Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, Saita E, Vercellini P. Mental health in women with endometriosis: searching for predictors of psychological distress. Hum Reprod. 2017 Sep 1;32(9):1855-1861. doi: 10.1093/humrep/dex249. PMID: 28854724.
  7. Volker C, Mills J. Endometriosis and body image: Comparing people with and without endometriosis and exploring the relationship with pelvic pain. Body Image. 2022 Dec;43:518-522. doi: 10.1016/j.bodyim.2022.10.014. Epub 2022 Nov 11. PMID: 36375365.
  8. Geller S, Levy S, Ashkeloni S, Roeh B, Sbiet E, Avitsur R. Predictors of Psychological Distress in Women with Endometriosis: The Role of Multimorbidity, Body Image, and Self-Criticism. Int J Environ Res Public Health. 2021 Mar 26;18(7):3453. doi: 10.3390/ijerph18073453. PMID: 33810403; PMCID: PMC8037734.
  9. Endometriose-Vereinigung Deutschland e.V.: Endometriosis rarely comes alone – accompanying complaints and diseases https://www.endometriose-vereinigung.de/files/endometriose/infomaterial/Broschuere%20Begleiterkrankungen%202019_web.pdf (retrieved on 26.02.2023)
  10. Moore JS, Gibson PR, Perry RE, Burgell Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205. doi: 10.1111/ajo.12594. Epub 2017 Mar 17. PMID: 28303579.
  11. Facchin F, Barbara G, Saita E, Mosconi P, Roberto A, Fedele L, Vercellini P. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol. 2015;36(4):135-41. doi: 10.3109/0167482X.2015.1074173. Epub 2015 Aug 27. PMID: 26328618.
  12. Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017 Jan 23;1(1):CD004753. doi: 10.1002/14651858.CD004753.pub4. PMID: 28114727; PMCID: PMC6464974.
  13. Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017 Oct 27;12(10):e0186616. doi: 10.1371/journal.pone.0186616. PMID: 29077705; PMCID: PMC5659600.
  14. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015 Apr-Jun;28(2):203-209. PMID: 25830558; PMCID: PMC4367209.

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