It can be hard to determine the best probiotics for endometriosis and chronic pelvic pain.

The “best probiotic” can be challenging to choose from among the many options.  It’s even more difficult to determine which probiotics are best for endometriosis and chronic pelvic pain.

As health and wellness professionals who support clients with endometriosis and pelvic pain, we have to educate ourselves about the research on the best probiotics for endometriosis and pelvic pain, and their mechanisms of action to better support our clients and patients.

best probiotics for pelvic pain. visual model of intestine with three spoons filled with probiotics

The Best Probiotic Strains for Endometriosis and Pelvic Pain

When we consider the best probiotics for pelvic pain and endometriosis, it’s important to remember that there is significant interaction between pelvic pain and mood disorders.

In women with pelvic pain, common mental health comorbidities found in one study were depressive episodes (42%), dysthymia (54%), social phobia (36.5%), agoraphobia (8.5%), and panic disorder (7.3%) (Castro, et al., 2009.)

A variety of probiotic strains have been studied for the improvement of visceral pelvic pain.

In animal models with chronic stress, the strains Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 have been found to attenuate the Hypothalamic-Pituitary-Adrenal (HPA) axis stress response (Ait-Belgnaoui, et al., 2018).

This calming of the HPA axis stress response can help with mood disorders in both rats and humans (Messaoudi, et al., 2011.) The same combination of strains, L. helveticus and B. longum, have been found to be effective in animal models to regulate glucocorticoid negative feedback on the HPA axis, and by that mechanism, reducing stress-induced visceral pain (Ait-Belgnaoui, et al., 2018.)


Using a single probiotic strain of the two I just mentioned, was found to be less effective in reducing visceral pain in the stressed mice.

probiotic strain illustration

Other strains have also been found to be useful for attenuating depressive symptoms in humans, and may also be useful for reducing pelvic visceral pain.

These strains: include, L. acidophilus, L. casei, B. bifidum, and B. longum (Wallace & Milev, 2017.)

In many of these studies, combinations of probiotic strains are more effective than individual strains.

 For example, VSL #3* has been found to reduce National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) plus diarrhea-predominant irritable bowel syndrome (D-IBS) (Vicari, et al., 2017.)

*a combination of L. acidophilus, S. thermophilus L. plantarum, B. longum (reclassified as B. lactis), L. paracasei, B. breve, L. delbrueckii subsp. Bulgaricus (reclassified as L. helveticus. 

The combination of probiotic strains in VSL#3 has been shown to have protective effects against the development of visceral hypersensitivity in the neonatal maternal separation animal model of stress-induced pain.

In one study, a gene expression modulation mechanism is proposed because TPH1, tryptophan hydroxylase 1, the gene for the enzyme responsible for synthesizing serotonin, a key neurotransmitter involved in IBS treatment, was found to be markedly up-regulated by the neonatal maternal separation imposed on the animal models. This effect was reversed by the VSL#3 intervention,  Distrutti et al., 2013).

  • Bifidobacterium infantis and B. lactis have both been found to reduce visceral pain and hypersensitivity in animal models, (Agostini, et al., 2012, Johnson, et al., 2011, McKernan, et al., 2010).


  • Lactobacillus species, including L. reuteri, L. acidophilus, and L. paracasei, have also been found to attenuate visceral pain via a variety of mechanisms in animal models, including by inducing opioid and cannabinoid receptors, modulating the stress response and improving intestinal permeability, (Eutamene, et al., 2007, Kamiya, et al., 2006, Rousseaux, et al., 2007).


black woman lying down with her hand on her stomach in pain on gray couch

The Best Probiotics for Endometriosis and Pelvic Pain: Adverse Effects

The great news is that there are rarely any adverse effects with the use of any of these well-tested probiotic strains for people with endometriosis and chronic pelvic pain.

Overall, most of my endometriosis clients see an improvement in their gut health once they’ve begun a probiotic regimen. Occasionally mild digestive complaints occur and are easily reduced or eliminated by reducing the probiotic dose or changing the use to a different strain or combination of strains.

Recommended Probiotics for Endometriosis:

In my practice, I commonly use a few specific probiotic combination products for endometriosis and chronic pelvic pain conditions.

Most of these clients also have comorbid mood and/or gastrointestinal symptoms such as celiac disease, which I consider when choosing which product to recommend.

The Gut Institute BIFIDO|MAXIMUS

Clinically, I find that this supplement can sometimes increase constipation.
Start with ¼ – ½ of the full dose, and then increase slowly.
Also, useful for clients struggling with chronic diarrhea in addition to pelvic pain and/ or fecal incontinence.

General Probiotic: Seeking Health ProBiota 12 

This is a high-quality probiotic that includes many of the strains that are well studied to improve pelvic visceral pain, vulvovaginal dysbiosis, and related GI and mood symptoms via a variety of mechanisms, including:
  • Lactobacillus rhamnosus
  • Bifidobacterium bifidum
  • Lactobacillus acidophilus
  • Lactobacillus casei
  • Lactobacillus plantarum
  • Lactobacillus salivarius
  • Bifidobacterium longum
  • Streptococcus thermophiles
  • Lactobacillus bulgaricus
  • Lactobacillus paracasei
  • Bifidobacterium lactis
  • Bifidobacterium breve

Sensitive System: Seeking Health ProBiota HistaminX

  • I like this product for those with very sensitive stomachs.
  • It is similar to ProBiota 12, but has a few distinct strains that are less irritating to those with sensitive digestive systems, or significant food sensitivities.

Digestive Issues: Seeking Health ProBiota Bifido

  • This is my choice for clients who have excessive Lactobacillus strains on stool or organic acids testing.
  • This can sometimes happen for clients who have been using commercial yogurts or single strain lactobacillus supplements in high doses over time.
  • This formula contains Bifidobacterium bifidum, B. longum, B. lactis, B. breve

For WomenL Seeking Health ProBiota Woman 

  • This is a great option for women with pelvic pain, especially if combined with vulvovaginal issues like chronic yeast, chronic BV, or vulvar pain.
  • This product contains more lactobacillus strains to optimize the vulvovaginal environment.
  • Probiotic strains in this product:
    • Lactobacillus acidophilus
    • Lactobacillus brevis
    • Lactobacillus rhamnosus
    • Lactobacilus gasseri
    • Lactobacillus casei
    • Lactobacillus salivarius
    • Lactobacillus plantarum
    • Bifidobacterium bifidum
    • Bifidobacterium breve
    • Bifidobacterium longum

Immune Suport: Seeking Health ProBiota Immune

  • This is a prebiotic fiber to support the growth and thriving of Lactobacillus and Bifidobacterium species.

person with endometriosis lifting their shirt and showing surgery scars














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