This article was written by Stephanie Smith, a Registered Associate Nutritionist specialising in women’s health. 

More than 1.5 million women in the UK suffer with endometriosis – a chronic and debilitating condition causing extreme pain, painful/heavy/irregular periods, gut issues, pain during sex, fatigue and potential fertility struggles (1). 

Despite its occurrence, it takes on average a disappointing 8 years for a woman to be diagnosed (2).

This means women are often left looking to alternative therapies, diets, and ‘Dr Google’ to help provide some relief for their excruciating symptoms (3). But can you eat to support your endo?

What Is Endometriosis?

Endometriosis is a condition where endometrial tissue grows outside the uterus including the ovaries, fallopian tubes, bowel, rectum and bladder, and (less commonly) in the lungs and liver (4).

This tissue still responds to menstrual cycle hormones and therefore builds up across the month and then bleeds. Unlike a period, this blood has nowhere to go, causing chronic inflammation throughout the whole body, severe pain, potential adhesions, scarring and even pelvic inflammatory disease. 

The most common symptoms include (5):

• Extreme pain
• Painful, heavy and irregular periods
• Fatigue
• Pain during sex
• Subfertility 
• Associated gut issues e.g. constipation, diarrhoea, pain when going to the toilet, bloating
• Depression/mental health issues

The only definitive way to diagnose endo is by laparoscopy. Blood tests and ultrasound scans cannot diagnose endo.

There is no cure for endometriosis, treatment includes medical ablation (laser surgery to remove the tissue), pain relieving medication, hormone treatment such as the Mirena coil, OCP, GNRH analogues and, as a last resort, hysterectomy (5).

What Causes Endometriosis?

The cause of endometriosis is still unknown (6). One theory is that retrograde menstruation causes endometriosis – this is when menstrual blood flows upward through the fallopian tubes and into the pelvis instead of through the vagina (7).

Another theory is that immune dysfunction causes endometriosis – in other words the immune system does not effectively clear away the endometrial tissue found outside the womb (8).

These are very much still theories and the real answer is that science isn’t 100% sure why women get endometriosis or why it is so common. You are however thought to be more at risk of developing endo if are genetically predisposed (9). 

Can You Eat to Support Endometriosis?

Endometriosis cannot be cured, so if you see anything out there saying a food or supplement can cure endometriosis you know it’s yet another questionable claim on the internet. 

However, nutrition can help to manage the pain and inflammation associated with endometriosis as well as supporting fertility and gut health.

Focussing on anti-inflammatory foods or following a Mediterranean-style diet is a good option for those with endometriosis and does not come with the risk of nutritional deficiencies like elimination diets might (10). 

What to eat:

• Fruits and vegetables – a high intake of fruits and vegetables has been associated with a reduced risk of developing endo (11)
  • Aim to include a wide variety of fruit and vegetables to maximise on their nutrients and fibre.
  • Eat lots of colour – the colour of fruit and veg represents its antioxidant properties. 
• Wholegrains and fibre
  • Aim for minimum of 30g fibre per day
  • Try different grains such as quinoa, red rice, spelt, buckwheat, freekeh
  • Opt for wholegrain where possible e.g. pasta, bread, cooking flours
  • Add beans and legumes to cooking to easily increase the fibre content
  • Include nuts and seeds
• Dairy – there are lots of claims that suggest dairy is inflammatory and can contribute to the development or progression of endometriosis however research tends to suggest the opposite and favours the inclusion of dairy in managing endo (if you are not intolerant) (12).
  • Try including 3 portions of dairy per day, ideally full fat. This includes milk, yoghurt, kefir, cheese. 
• Omega 3 – potent anti-inflammatory associated with reduced risk of endo (13) as well as supporting gut health, mental health and reducing pain (14)
  • Sources: oily fish, flaxseeds, chia seeds, nuts, seeds, extra virgin olive oil, nut and seed oils. 
• Extra virgin olive oil in itself is liquid gold – do not think of it as a fat but rather a nutritional powerhouse ingredient. Try drizzling on salads, traybakes, pastas or adding to smoothies.
• Antioxidants to help reduce inflammation and oxidative stress (15). Particularly:
  • Vitamin E – sources: nuts, seeds, olive oil, rapeseed oil, avocados
  • Vitamin C – sources: citrus fruits, kiwi, peppers, red fruits, broccoli, brussel sprouts, strawberries, blackcurrants, tomatoes.
• Probiotic and prebiotic foods to support gut health and reduce gut symptoms associated with endo (16)
  • Kefir, live yoghurt, kimchi, miso, sauerkraut
  • Garlic, leeks, green banana, onions, apples, oats, barley, asparagus, rye, legumes.

Along with including lots of these nutritious food, women with endometriosis should be mindful of their consumption of:

• Alcohol – alcohol is inflammatory therefore it makes sense to reduce alcohol when suffering with an inflammatory condition (17)
• Red and processed meats (18) 
• Trans fats – these are fats found mostly in processed fried foods and some baked goods. Limit foods that have hydrogenated vegetable oil in the ingredients list as it has been linked to inflammation (19)

Endometriosis & Relationship with food

Health information is now readily available which means there is an abundance of advice regarding what to eat, what not to eat, fad diets, extreme eating habits and lifestyle choices to help support endo.

A recent study found that dietary change was reported in 44% of endometriosis sufferers (20) and although this can be beneficial to some degree it may negatively affect a person’s relationship with food, creating food fear or fear of derailing from their strict dietary regime. 

Endometriosis is a complex condition causing a myriad of symptoms which can understandably make a person feel out of control. Diet culture has driven a narrative that we are in total control of how our bodies look and feel and unfortunately this isn’t always the case.

Diet and nutrition can be important tools in looking after your body and supporting endo, but if you feel your relationship with food or exercise is taking a toll then it’s important to reconsider where your advice is coming from or reach out to a health professional for support.  

Consulting with a dietitian or registered nutritionist can provide more tailored help and support and may make your personal experience with endo a slightly more comfortable one.

Remember to always reach out to doctors and health professionals and never to be embarrassed of your symptoms. Endometriosis is not ‘just period pain’ and should always be taken seriously. We need to keep the conversation going surrounding women’s health and share our experiences so that one day we can close the gender health gap. 

References:

1. Simoens S, Dunselman G, Dirksen C, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Human Reproduction 2012;27(5):1292-9. 
2. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. (2019) 220:354.e1–12. 
3. O’Hara, R, Rowe, H, and Fisher, J. Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis. BMC Womens Health. (2019) 19:80. 
4. Saunders, P.T.K.; Horne, A.W. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell 2021, 184, 2807–2824.
5. Recommendations | Endometriosis: diagnosis and management | Guidance | NICE 
6. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.
7. Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927; 14: 442–69.
8. Bunis DG, Wang W, Vallvé-Juanico J, et al. Whole-tissue deconvolution and scRNAseq analysis identify altered endometrial cellular compositions and functionality associated with endometriosis. Front Immunol. 2021; 12:788315.
9. Saha, R. et al. (2015) Heritability of endometriosis, Fertility and Sterility, 104(4), pp.947-952. doi:10.1016/j.fertnstert.2015.06.035.
10. Ott, J, Nouri, K, Hrebacka, D, Gutschelhofer, S, Huber, JC, and Wenzl, R. Endometriosis and nutrition-recommending a med-iterranean diet decreases endometriosis-associated pain: an experimental observational study. J Aging Res Clin Pract. (2012) 1:162–6.
11. Mazza, E, Ferro, Y, Pujia, R, Mare, R, Maurotti, S, Montalcini, T, et al. Mediterranean diet in healthy aging. J Nutr Health Aging. (2021) 25:1076–83. doi: 10.1007/s12603-021-1675-6
12. Qi, X., Zhang, W., Ge, M., Sun, Q., Peng, L., Cheng, W., & Li, X. (2021). Relationship Between Dairy Products Intake and Risk of Endometriosis: A Systematic Review and Dose-Response Meta-Analysis. Frontiers in nutrition, 8, 701860. https://doi.org/10.3389/fnut.2021.701860
13. Moore, JS, Gibson, PR, Perry, RE, and Burgell, RE. 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) 57:201–5. 
14. Khanaki K, Nouri M, Ardekani AM, Ghassemzadeh A, Shahnazi V, Sadeghi MR, Darabi M, Mehdizadeh A, Dolatkhah H, Saremi A, Imani AR, Rahimipour A. Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids. Iran Biomed J. 2012;16(1):38-43. 
15. Zheng, SH., Chen, XX., Chen, Y. et al. Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis. Reprod Biol Endocrinol 21, 79 (2023). 
16. Guo, C. and Zhang, C. (2024) Role of the gut microbiota in the pathogenesis of endometriosis: A review, Frontiers in Microbiology, 15.
17. Nodler, JL, Harris, HR, Chavarro, JE, Frazier, AL, and Missmer, SA. Dairy consumption during adolescence and endometriosis risk. Am J Obstet Gynecol. (2020) 222:–257.e16
18. Missmer, SA, Chavarro, JE, Malspeis, S, Bertone-Johnson, ER, Hornstein, MD, Spiegelman, D, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. (2010) 25:1528–35. 
19. Krabbenborg, I, de Roos, N, van der Grinten, P, and Nap, A. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. Reprod Biomed Online. (2021) 43:952–61. 
20. Armour, M., Sinclair, J., Chalmers, K. J., & Smith, C. A. (2019). Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC complementary and alternative medicine, 19(1), 17.