Endometriosis

Written by Katherine Nicholls

Katherine Nicholls

Nutritionist Resource Content Team

Last updated February 2023 | Next review due August 2024

Endometriosis is a condition where body tissues outside of the womb behave like tissues inside of the womb. These tissues thicken and break down, but can’t escape the body, causing painful deposits. Here we'll explore how lifestyle and dietary changes can help manage symptoms.

What is endometriosis?

Endometriosis causes cells similar to the ones in the lining of the uterus to develop elsewhere in the body. Typically this affects the pelvic area  but, in rare cases, it can affect other areas of the body. 

These tissues thicken and break down, but can’t leave the body like the tissues in the uterus do through a period. As they remain in the body they can cause pain, inflammation, scar tissue and fertility problems. The causes of endometriosis are not fully understood, but this is the most widely accepted theory. 

Hormones certainly play a part. Endometriosis is rare in those who have been through the menopause and have less oestrogen in their bodies. When an egg isn’t fertilised after ovulation, oestrogen causes the womb lining to thicken and then break down. In endometriosis it's thought that oestrogen has the same effect on the tissues that are outside of the womb.

According to Endometriosis UK, the condition affects one in 10 people in the UK. While typically a life-long condition, symptoms of endometriosis can be managed. As well as medical treatments, certain lifestyle and diet changes can be helpful.

Nutritionists who can help with endometriosis

Endometriosis symptoms

Symptoms can vary from person to person. For some, the symptoms can 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
  • fatigue

Understandably, these symptoms can impact 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.

Treatment options

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 circumstances into consideration.

Depending on how severe your condition is, the following treatments may be offered:

  • nutritional therapy
  • exercise
  • pain medication
  • hormone therapy
  • surgery

In the video below, Endometriosis UK gives an overview of endometriosis.

Endometriosis and diet

If you have endometriosis, it’s important to consider your diet and lifestyle. While there is limited research into the impact nutrition has, we know that what we eat has a big impact on how we feel. Addressing your diet can boost your immune system and support your overall health, too.

That being said, experts believe that certain dietary approaches can help relieve symptoms. Eating a balanced, nutritious diet full of anti-inflammatory foods is thought to be beneficial. Following a Mediterranean-style diet, known for its anti-inflammatory properties, is generally recommended. 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 - certain foods may also have a negative effect, triggering symptoms.

While I still have flare-ups, they are less frequent and the amount of time that I spend in excruciating pain, unable to leave the house, has been reduced significantly. This is all thanks to following a wholesome, plant-based diet with very little processed food.

- Jaxx Houghton manages her endometriosis through nutritional therapy

How can a nutrition professional help?

Changing your diet can be difficult, but working with a qualified nutrition professional can make it easier. They will look into your medical history and personal circumstances to create a tailor-made endometriosis diet plan.

The aim will be to include recommended foods for an endometriosis diet while encouraging healthy, long-term changes. Alongside your new diet, you may also be recommended certain lifestyle changes. This could include quitting smoking, drinking more water and increasing your physical activity. 

When changing your diet it is as much about avoiding certain ‘trigger’ foods as it is about including beneficial foods. 

Endometriosis diet

Limiting the following foods is advised for those following an endometriosis diet:

  • processed foods
  • red meat
  • gluten
  • saturated fats
  • dairy 
  • alcohol
  • caffeine

Some general foods to include: 

  • Fibrous foods, including vegetables, whole grains and legumes. 
  • Salmon, walnuts, chia and flax seeds (rich in essential fatty acids).
  • Iron-rich foods such as dark leafy greens and fortified grains

Nutritional therapist Sonal Shah recommends eating for healthy oestrogen metabolism, as endometriosis is oestrogen-dependent. “Cruciferous vegetables like broccoli, kale, and Swiss chard contain magnesium, along with a compound called indole-3-carbinol that assists the body in healthy oestrogen metabolism. Furthermore, many of these foods (also beans and pulses) are rich in fibre, which can all help to restore hormonal imbalance.”

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.

Exercise 

Gentle stretching, mobility and strengthening exercises are thought to help. They can rebalance some of the muscles that may become dysfunctional in those with endometriosis.

Although more research is needed, the musculoskeletal system can affect endometriosis pain. This means working on muscle balance, joint mobility, fitness and posture may help improve pain. 

Endometriosis-UK recommends some basic exercises designed to improve pelvic health.

Medical treatments for endometriosis

Pain medication 

Painkillers can help reduce pain and treat inflammation. Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen are often recommended. You can use stronger painkillers like codeine, but as a common side-effect is constipation, it can aggravate symptoms.

Hormone treatment

Hormone treatments aim to limit the body's production of oestrogen. With less of this hormone, problem tissues can be reduced. The combined oral contraceptive pill or implant are often suggested, as these can be used over long periods of time.

Surgery

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 
  • laparotomy
  • hysterectomy 

Further reading

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