Endometriosis is a medical condition where body tissues outside of the womb (mainly in the pelvic area) behave like the lining of the womb. These tissues thicken and break down, leading to pain and potential fertility problems.
According to Endometriosis UK, the condition affects one in 10 women in the UK. While typically a life-long condition, symptoms of endometriosis can be managed. As well as medical treatments, like surgery and hormone treatment, certain lifestyle and diet changes can be beneficial.
On this page, we'll explore endometriosis in more depth, including the symptoms of the condition, the support available and how lifestyle changes and dietary support can help with symptom management.
What is endometriosis?
Endometriosis causes tissue outside of the womb to behave in the same way as the lining of the womb. Typically this affects areas surrounding the womb but, in rare cases, it can occur in other areas of the body like the spine.
The causes of endometriosis are not fully understood and there are several theories as to why it occurs. The most widely accepted theory is that the tissue of the womb lining is not able to leave the body as it should during a period. This causes it to embed on other organs of the pelvis. This does not, however, explain why some experience the condition after a hysterectomy.
Hormones certainly play a part - endometriosis is rare in women who have been through the menopause and so have less oestrogen in their bodies. Oestrogen is a hormone that, when an egg is not fertilised after ovulation, normally causes the womb lining to thicken and then break down. It's thought that, in endometriosis, oestrogen has the same effect on these womb lining-like tissues that are outside of the womb, leading to symptoms.
Symptoms can vary significantly from person to person and for some women, the symptoms can even go unnoticed.
The most common endometriosis symptoms include:
- painful and/or heavy periods
- pain during/after sex
- pain in the pelvis, lower back and/or lower abdomen
- bleeding between periods
- conception difficulties
While symptoms can vary, many of the above are also often noted alongside fatigue and general lack of energy. Understandably, these symptoms can impact on our general health and well-being, leading to stress and depression for some.
If you suspect you have endometriosis, it’s important to get a formal diagnosis from your doctor. Once your doctor has confirmed the condition, you will be able to explore treatments.
If you have endometriosis, it’s important to consider your diet and lifestyle when tackling the condition. While there is limited research into the impact nutrition has on the condition, we know that what we eat has a big impact on how we feel. Not only that, but addressing your diet can boost your immune system and provide a preventative measure for overall health, too.
That being said, experts believe that following certain dietary principles can help to relieve symptoms related to the condition. It’s believed that eating a balanced, nutritious diet consisting of anti-inflammatory foods is beneficial. Some foods can also help to naturally control hormones, which play a key role in endometriosis symptoms.
Of course, it can work in the opposite way, too - it is thought that certain foods may also have a negative effect, triggering symptoms.
How a professional can help
Changing your diet can be a difficult process, but working with a qualified nutrition professional to support and guide you can help make the transition easier. They will look into your medical history and individual circumstances, to help them create your own tailor-made endometriosis diet plan.
The aim of this plan will be to include elements recommended for an endometriosis diet while promoting long-term changes that can be made gradually. Alongside your new diet, you may also be recommended certain lifestyle alterations. This could include quitting smoking, drinking more water and upping your physical activity. Changes like this are thought to help reduce endometriosis symptoms.
It is recommended that you consult a suitably qualified professional for nutritional advice. They will be able to put together a tailored diet to support your needs, including advice on choosing anti-inflammatory foods rich in vitamins and minerals. Taking your personal health history into consideration, your plan will complement any medical treatments you are already receiving.
For a general overview of what foods to include and limit in an endometriosis diet, please see below.
What to limit:
As already mentioned, when altering your diet following a formal endometriosis diagnosis, it is as much about avoiding certain ‘trigger’ foods as it is about trying to include beneficial food groups.
Limiting the following foods is recommended for those following an endometriosis diet:
Some processed foods can contain certain additives and preservatives that may contribute to inflammation in some people. They may also be high in saturated or processed fats that can promote the production of inflammatory prostaglandins, while potentially offering little in terms of nutritional value.
Read labels, taking note of the guideline daily amount or traffic light labelling guidance, as well as reading the list of ingredients, to see if perhaps there are healthier products you could choose.
Try to cut down the following:
- fried foods
- smoked and processed meats
- white flour and refined grains
- sugary foods
Interestingly, many people with the condition report that symptoms ease after limiting gluten. The link between the two is unknown, but it’s thought that a gluten sensitivity may trigger bowel symptoms which may then increase pain levels.
If you suspect a negative response to gluten-containing foods, try limiting your intake and eating naturally gluten-free options such as wild rice, quinoa and sweet potato, to see if you notice an improvement.
Found in margarine, butter and lard, these fats trigger the production of negative inflammatory prostaglandins. This can cause endometrial cramps and the spread of endometriosis.
Alternatively, foods rich in omega-3 and -6 fatty acids are thought to be crucial for healthy hormone functioning. But before upping your intake of these, be sure to consult a qualified nutritional professional; the wrong combination of omega-6 and omega-3 fatty acids can cause further inflammation.
Full-fat dairy products are relatively high in saturated fats and may, therefore, contribute to inflammation. Try choosing low-fat options for products, like yoghurts and milk, so that you can still benefit from these foods as a source of calcium if you wish. You may also want to limit your cheese intake.
Alternately, if you find you do better with less dairy in your diet, you can opt for calcium-fortified alternatives such as almond, coconut and rice milk.
A healthy liver is important for good hormone balance, as the liver detoxifies chemicals and waste products including excess hormones. Alcohol can be extremely inflammatory and affect vitamin D levels in the liver. So, try to limit alcohol consumption where possible to support the liver in functioning well.
Caffeine can increase menstrual pain and oestrogen levels, as well as aggravating the digestive symptoms many women experience. If you find that caffeine impacts your symptoms, try reducing your intake and trying some healthy and natural alternatives.
Check out Happiful’s guide to caffeine-free energy drinks.
Foods high in phytoestrogens
Phytoestrogens are a natural type of plant oestrogen that can contain toxins that can trigger endometriosis symptoms. One example is unfermented soy products, such as edamame beans, soy milk and soy cheese.
However, when soybeans are fermented - in products such as tofu, natto, miso, tempeh and soy sauce - the beneficial phytochemicals can be more easily absorbed into the body. These products are a good source of omega-3 and protein for the endometriosis diet.
Foods high in synthetic oestrogen
These have a much stronger, stimulating effect and are not cleared very quickly from the body. For example, red meat, which can contain man-made oestrogens that have been mixed into the feed that livestock eat. Like dairy, red meat can be inflammatory and also difficult to digest.
Where possible, it can be best practice to buy herbicide-free, organic produce as synthetic estrogens may also be present in commercially-grown produce. Grain-fed meats are also preferable, in order to avoid hormone fed livestock. Where available, look for grass-fed beef, organic free-range poultry or organically fed pork.
Before making any changes to your diet, please consult your doctor and a qualified nutrition professional.
What to include
Now we know what foods are best to avoid in order to limit food-related symptoms, what foods are important to include in your diet?
Fibre is important as it helps to expel unwanted substances from the body - particularly excess hormones (oestrogen) - in the case of endometriosis. Fibre can also help to stabilise your blood sugar levels and can help to reduce inflammation.
The aim is to include the recommended 30g of fibre a day in your diet. This could be in the form of whole grains, beans and lentils, vegetables and fruits. Soluble fibre is particularly useful as this is the form that binds to substances and reduces their absorption. Examples of soluble fibre include legumes and foods such as chia seeds.
Not sure if you're eating enough fibre? Here's an example of how to get more fibre into your diet, from a qualified nutrition professional.
Ensuring to include some iron-rich foods in your diet can replace iron that may be lost through heavy periods - a common symptom of endometriosis. Iron-rich foods include dark green leafy vegetables such as cabbage, kale, spinach and broccoli, red meat or beetroot.
Essential fatty acids (EFAs)
A good balance of healthy fats is essential for most people, but particularly for endometriosis sufferers, as EFAs can aid hormone balance and reduce inflammation, which help to relieve endometriosis symptoms. Look to include foods rich in essential fatty acids such as oily fish (salmon, sardines, mackerel, anchovies), as well as nuts and seeds.
If you don't think you are getting enough EFAs in your diet, speak to a nutritionist. They may be able to recommend supplements or oils (such as walnut and evening primrose).
While there is no known cure for endometriosis, there are treatments to help manage symptoms. When deciding which treatment to try, you are advised to speak to your doctor who will take your individual circumstances into consideration.
Depending on the severity of your condition, the following treatment options may be offered:
To treat pain and inflammation, non-steroidal anti-inflammatories (NSAIDs) like ibuprofen are often recommended. These can help tackle the inflammation and swelling, as well as alleviating the associated pain. Paracetamol can also be used, however this may not be as effective as it doesn't reduce inflammation.
Stronger painkillers like codeine can be used if other painkillers are not suitable; however, as a common side-effect is constipation, it can aggravate endometriosis symptoms.
Hormone treatments aim to limit the body's production of oestrogen. This hormone is responsible for the growth and shedding of endometrial tissue. With less of this hormone, the degree of problem tissues can be reduced.
Hormone treatment cannot treat adhesions (the 'sticky' areas of tissue that can fuse organs together) or improve fertility. The most commonly used hormone treatments are the combined oral contraceptive pill or patch, as these can be used over long periods of time.
In more severe cases, surgery can be used to remove tissue. This can help endometriosis symptoms and improve fertility. Depending on the location of the tissue, you may be offered the following surgeries:
- Laparoscopic surgery - The least invasive form of surgery, this is done through keyhole surgery.
- Laparotomy - For severe cases, a wide cut is made to the abdominal area so the affected tissue can be accessed and removed.
- Hysterectomy - Radical surgery is considered if a woman has not responded to other treatments. Hysterectomy is the removal of the womb and can be done with or without the removal of ovaries, though this does not guarantee reduced endometriosis symptoms. Hysterectomy is not a decision to make lightly, so please consider all options and consult your GP before any treatment.
Content has been reviewed by a dietitian. All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.
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