What is endometriosis? 

Endometriosis is the condition where cells similar to the ones in the lining of the womb, are found elsewhere in the body, most commonly within the pelvis (1). These  cells respond  to hormone fluctuations that occur across  the menstrual cycle, which can cause pain and inflammation in the surrounding tissue (2).  Endometriosis is a chronic, life-long condition with varying degrees of disease and symptoms.

Who is affected? 

Women and people assigned female at birth can be affected at any age (1) and it can affect as many as 10% of women (3).  Unfortunately, little is known about what causes endometriosis. There are theories including hormonal and lifestyle factors and there may be a genetic link to the condition (3). On average a diagnosis of endometriosis can often take around 8 years due to symptom overlap with other conditions such as irritable bowel syndrome (IBS)(4). 

Symptoms 

The symptoms and severity of endometriosis can vary from person to person. Some of the symptoms include:

• pain in your lower tummy or back – this is usually worse during your period

• period pain that stops you doing your normal activities

• pain during or after sex

• pain when peeing or pooing during your period

• feeling sick, constipation, diarrhoea, or blood in your pee or poo during your period

• difficulty getting pregnant

Adapted from NHS 2022 (1)

The endometriosis disease process is unfortunately very poorly understood. If you have endometriosis or any of the above symptoms, it is important to get individualised support from your medical provider.

Nutrition 

Currently, there are no clear correlations between particular foods and the risk of developing endometriosis (5) or how effective dietary strategies are in 

in the treatment of endometriosis (6). We need more, better quality research to understand the role of nutrition in endometriosis management. 

Because endometriosis is thought to be an inflammatory condition, many of the theories and studies have looked at including foods with anti-inflammatory properties such as Omega-3, as well as foods containing antioxidants (7). 

The following foods may be beneficial to help reduce symptoms of endometriosis: 

Antioxidants

Polyphenols, vitamin C and vitamin E are commonly found in fruits and vegetables and have been shown to have antioxidant properties that may help to reduce chronic pelvic pain in people with endometriosis (7). Antioxidants are helpful at fighting oxidative free-radicals in the body by making them more stable. One study found that women who had a high intake of fruit and green vegetables were less likely to have endometriosis. (8).

Some examples include:  Green leafy vegetables, avocado, apples, broccoli, citrus fruits, peppers, berries, carrots, and grapes. Aim for 5 portions of fruit and vegetables each day (tinned, frozen and fresh all count!)

Omega-3 fatty acids

Commonly found in oily fish and some nuts and seeds, omega-3 fatty acids have been associated with anti-inflammatory properties which can reduce the likelihood of developing endometriosis (9). Oily fish examples include: Salmon, mackerel and sardines (10) aim for 1-2 portions of oily fish per week, or consider an omega-3 supplement if you don’t eat fish.

Gluten

Endometriosis has a higher prevalence in people with coeliac disease although the reason for this is not known (11). Despite a lack of high-grade evidence for using a gluten-free diet to improve symptoms, one study did find positive results (12). There is no strong evidence to remove gluten from the diet if you have endometriosis.  If you are considering trialling a gluten free diet, it is important to do this under the guidance of a dietitian who will be able to support you, and ensure you are meeting your nutritional needs.

Dairy and Vitamin D

Studies on vitamin D intake and endometriosis are inconclusive (13). One study found that by having an adequate vitamin D status as well as a regular dairy intake (more than 3 portions a day), the risk of developing endometriosis decreased (14). 

Despite the limited evidence, having a good intake of calcium and vitamin D is important to support women’s bone health (15). It is recommended to have a daily supplement of  10μg vitamin D (15) as well as 3 portions of dairy or calcium-fortified dairy alternatives (16).

Reducing or limiting the following types of foods may be beneficial for reducing the risk of developing endometriosis:

• Reducing and limiting red and processed meat consumption (8)

• Removing trans fats from the diet: trans fats are found in some processed and deep-fried foods and they can increase the risk of endometriosis (17)

• Reducing or removing alcohol from the diet (5)

Overall, based on some of the dietary evidence available, consuming a varied and balanced diet similar to the mediterranean diet may be beneficial to help reduce the symptoms of endometriosis. 

Please note the information provided in this article is not a substitute for medical or dietetic advice. If you have any queries regarding your diet or your health, please speak to your GP or a registered healthcare professional. 

For more information visit: 

• Royal College of Obstetricians and Gynaecologists: https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/endometriosis-patient-information-leaflet/

• Endometriosis UK https://www.endometriosis-uk.org/

• NHS https://www.nhs.uk/conditions/endometriosis/