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.
Affecting an estimated two million women in the UK, endometriosis has no cure but symptoms can be managed. As well as medical treatments like surgery and hormone treatment, lifestyle and diet changes can also be beneficial, these include:
- Following a balanced diet rich in iron, fibre and essential fatty acids (EFAs).
- Increasing physical activity.
- Drinking plenty of water.
- Quitting smoking.
- Avoiding drinking alcohol and caffeine.
On this page we will explore the condition in more depth. We will look at endometriosis symptoms and how a tailored endometriosis diet can support symptom management.
What is endometriosis?
Endometriosis causes tissue outside of the womb to behave in the same way as the womb lining. Typically this affects areas surrounding the womb, but in rare cases it can occur in other areas of the body like the spine.
While symptoms vary from person to person, painful, heavy periods are often noted alongside fatigue and general lack of energy. Understandably, these symptoms can lead to stress and depression for some.
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 normally, when an egg is not fertilised after ovulation, causes the womb lining to thicken and then break down. It is thought that in endometriosis oestrogen has the same effect on these womb lining-like tissues that are outside of the womb, leading to symptoms.
The symptoms of this condition can vary significantly from person to person. For some women, the symptoms can even go unnoticed. The most common endometriosis symptoms however 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
Some women experience pain all the time. Others may only have it during periods, when they have sex or when they use the toilet. Alongside these common symptoms, sufferers may also experience chronic tiredness and general exhaustion.
If you suspect you have endometriosis it is important to get a formal diagnosis from your doctor. The condition will need to be confirmed by a surgical examination called a laparoscopy. A laparoscopy involves passing a tube with a camera through your body to look for endometrial tissue. Once your doctor has confirmed the condition, you will be able to explore treatments.
If you have endometriosis it is important to consider your diet and lifestyle when tackling the condition. What you eat affects how you feel, and experts believe that following certain dietary principles to support the condition can help to relieve symptoms.
While there is a lack of research into the impact nutrition has on the condition, it is believed that eating a balanced, nutritious diet consisting of anti-inflammatory foods is beneficial. Some foods can help to naturally control hormones, which play a key role in endometriosis symptoms. Certain foods may also have a negative effect, triggering symptoms.
As well as easing symptoms, addressing your diet can boost your immune system and provide a preventative measure for overall health.
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.
How a professional can help
Changing your diet and the way you eat can be a difficult process. Working with a suitably qualified nutrition professional to support and guide you can help make the transition easier. They will look into your medical history and individual circumstances. This will help them create a 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 find a professional who has experience in treating endometriosis. Someone with experience in this area (and someone who has received the necessary training) will have the knowledge and expertise to help.
For a general overview of what foods to include and limit in an endometriosis diet, please see below.
What to include:
Soluble fibre aids digestion and helps the body to naturally expel hormones. It does this by binding to any excess oestrogen and inhibiting reabsorption. Sufferers are therefore encouraged to consume the recommended 24 grams of fibre a day. Key foods that are rich in fibre include:
- whole grain foods
- citrus fruits
- chia seeds
- flax seeds.
Having a healthy liver is important for good hormone balance. This is because the liver detoxifies chemicals and waste products including excess hormones. An adequate supply of vitamins and minerals, particularly B vitamins and antioxidants, are therefore important to include in a diet for endometriosis. Such a diet will support the liver in functioning well as well as supporting aspects for general health such as the immune system. 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.
To ensure you're getting enough iron in your diet, try to include the following foods:
- dark green leafy vegetables like cabbage, kale, spinach, watercress
- meat, fish, eggs
- beans and pulses
- nuts and seeds
- iron-fortified cereals or bread
- brown rice.
Essential fatty acids (EFAs)
EFAs help to control inflammation, contribute to positive prostaglandin production and aid tissue healing. These aspects can all help to relieve endometriosis symptoms. When looking at your diet, look to include foods rich in essential fatty acids, such as:
- chia seeds
- flax seeds
- oily fish
- pumpkin 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/oils (such as flaxseed, walnut and evening primrose).
What to limit
As well as including all of the food types described above, you could benefit from limiting any triggering foods. These are foods that may trigger or aggravate the condition.
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 labeling guidance as well as reading the list of ingredients to see if perhaps there are healthier products you could choose.
Try to avoid or cut down the following:
- packaged/pre-prepared meals and snacks
- soft drinks
- fried foods
- smoked and processed meats
- baked goods
- white flour and refined grains
- sugary foods.
Interestingly many people with the condition report symptoms ease after limiting gluten. The link between the two is unknown, but it is 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 experience an improvement.
Full fat dairy products are relatively high in saturated fats and may therefore contribute to inflammation. Choose 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 want to limit cheese intakes to moderate amounts. Alternately, if you find you do better with less dairy in your diet then you can opt for calcium-fortified alternatives such as almond, coconut and rice milk.
Other foods to avoid
Limiting the following foods is also recommended for those following an endometriosis diet:
- Alcohol – Extremely inflammatory and affects vitamin D levels in the liver.
- Caffeine – Can increase menstrual pain and oestrogen levels.
- Soya – Contains high levels of phyto-oestrogens and toxins that can trigger endometriosis symptoms.
- Red meat – Like dairy, is inflammatory and can be difficult to digest.
- Saturated fats – Found in margarine, butter and lard, these fats trigger the production of negative inflammatory prostaglandins.
It is recommended that you find a professional who has experience in treating endometriosis. Someone with experience in the area of diet and lifestyle changes (and someone who has received the necessary training) will have the knowledge and expertise to help.
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. This is because they tackle the inflammation and swelling as well as the associated pain. Paracetamol can also be used, however it is not thought to be as effective as it does not 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, consider all options and please 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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