Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, often causing pelvic pain, painful periods, fatigue and, in some cases, fertility problems. While it is primarily considered a gynaecological disorder, researchers are increasingly exploring whether its effects extend beyond the reproductive system and influence broader aspects of metabolic health.

One area attracting growing attention is the possible relationship between endometriosis and insulin resistance. Chronic inflammation, hormonal fluctuations and changes in body composition have all been proposed as factors that could influence how the body responds to insulin. However, the evidence is still evolving, and it remains unclear whether endometriosis directly contributes to insulin resistance, whether the association is indirect, or whether other factors such as lifestyle, medications or co-existing conditions play a larger role. Understanding this connection could have important implications for long-term health, particularly for women concerned about blood sugar regulation and metabolic disease.

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To better understand what current research says about the relationship between endometriosis and insulin resistance, we spoke to an expert.

Endometriosis and insulin resistance

Kanikka Malhotra, Consultant Dietician & Diabetes Educator, tells indianexpress.com, “Yes, although this connection is still being actively studied. Endometriosis is fundamentally an inflammatory condition, and chronic inflammation is a well-established driver of insulin resistance. Research suggests women with endometriosis may have higher markers of insulin resistance and a greater prevalence of metabolic syndrome features, including elevated blood sugar, even when body weight is similar.”

She adds that the relationship is not yet as firmly established as the link between polycystic ovary syndrome (PCOS) and insulin resistance, “but the biological overlap is strong enough that researchers are paying increasing attention to it.” Because endometriosis is often diagnosed years after symptoms begin, metabolic changes may already be developing silently by the time the condition is identified.

Why the two may be linked

Chronic inflammation appears to be at the centre of this association. Malhotra states that inflammatory compounds released in endometriosis can interfere with insulin signalling, making it harder for cells to absorb glucose. Hormonal changes, particularly altered oestrogen levels, may also influence fat distribution and insulin sensitivity.

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In addition, she mentions that chronic pelvic pain and the emotional burden of living with endometriosis can raise cortisol levels, while reduced physical activity due to pain further worsens insulin sensitivity. “Some hormonal treatments used to manage endometriosis may also affect metabolic parameters. Together, these factors create a complex interaction between inflammation, hormones, stress, physical activity and treatment that can make blood sugar regulation more challenging.”

Monitoring metabolic health

Quick Quiz

See if you can answer this:

Which lifestyle approach best supports metabolic health in women with endometriosis?

A. Focus only on treating reproductive symptoms and ignore blood sugar unless symptoms appear.

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B. Follow an anti-inflammatory diet, stay physically active, get enough sleep, manage stress and discuss blood sugar monitoring with your doctor if you have metabolic risk factors.

C. Eliminate all carbohydrates from your diet.

D. Exercise only when endometriosis symptoms completely disappear.

Reveal the answer

✅ Correct answer: B

Malhotra says that women with endometriosis, especially those with a family history of diabetes or other metabolic risk factors, may benefit from discussing periodic blood sugar monitoring with their healthcare provider. An anti-inflammatory eating pattern rich in vegetables, whole grains, fatty fish, turmeric and ginger, combined with regular physical activity, adequate sleep and stress management, can support both metabolic and reproductive health. A multidisciplinary approach involving a gynaecologist and a dietitian helps ensure that blood sugar and overall metabolic health are monitored alongside endometriosis management.