The role of diet in endometriosis symptom management

Endometriosis is a chronic inflammatory disease that affects millions of women worldwide, yet its exact cause remains unclear. Despite extensive scientific research, no single factor has been identified as the sole trigger of the condition. The disease is characterised by the growth of endometrial-like tissue outside the uterus, leading to chronic pain, inflammation, and potential fertility issues. Diagnosing endometriosis is challenging, as its symptoms often overlap with those of other conditions and can vary significantly from person to person.

Endometriosis: Impact on quality of life and treatment options

Endometriosis often remains undiagnosed for years, with an average of four to 11 years between onset of symptoms and diagnosis. Some of its symptoms—chronic pelvic pain, heavy menstrual bleeding, pain during intercourse, and reproductive issues—can significantly reduce the quality of life.

Treatment options involve a combination of medical and surgical approaches. Laparoscopy is the most reliable method for diagnosing and treating endometriosis, but it does not always provide long-term relief. Hormonal therapy helps manage symptoms by regulating estrogen levels, though it is not suitable for women trying to conceive. Furthermore, hormonal therapy can have side effects and does not address existing lesions. NSAIDs like ibuprofen offer short-term pain relief, while regular physical activity (low impact such as stretching and yoga) can help reduce pain and improve overall well-being. Early diagnosis and a personalised treatment approach are essential for effectively managing the condition.

Now the big question: Can diet support the management of endometriosis?

Diet support and managing endometriosis

Many dietary approaches have been suggested to manage endometriosis symptoms, but scientific evidence for a direct link between specific nutrients and the disease remains limited. Most of the available studies are small in scale and of low quality.

Some of the studies have noted that giving a woman with endometriosis (a condition which may leave women feeling helpless) a sense of control over her condition through dietary changes can have a positive psychological impact. The ability to influence symptoms, even in a small way, may contribute to some of the reported benefits, making it difficult to separate the true physiological effects of diet from the empowerment it provides.

An anti-inflammatory approach

Adopting an anti-inflammatory diet may not be a cure, but it can be a powerful tool in managing symptoms and improving overall well-being. The Mediterranean-style diet, which focuses on whole, nutrient-rich foods includes:

• Plenty of fruits and vegetables – rich in antioxidants and fibre, supporting gut health and hormone metabolism.
• Wholegrains- provide sustained energy and help reduce inflammation.
• Healthy fats from fish, nuts, and seeds – sources of omega-3 fatty acids, which may help lower pain levels.

Limiting ultra-processed foods, red meat, high-fat/high-sugar foods, and alcohol – as they may contribute to inflammation and hormonal imbalances.

Alcohol

Alcohol consumption can harm women with endometriosis, as it affects both hormonal balance and gut health. Alcohol can disrupt the gut microbiota, weakening the immune system and increasing inflammation in the body. Additionally, it raises estrogen levels, which is particularly problematic for estrogen-dependent conditions like endometriosis.

Gut health

Gut health is crucial for women with endometriosis, as it is also crucial for estrogen metabolism. Moreover, changes in gut microbiota composition can influence immune function and inflammatory processes in the body—two key factors linked to the progression of endometriosis.

Fibre

Consuming enough fibre (around 30 grams a day) is essential for maintaining a healthy digestive system, which supports gut microbiota and promotes good digestion. Excellent sources of fibre include fruits, vegetables, whole grains, nuts, and seeds. These also act as prebiotics, feeding beneficial gut bacteria and supporting their growth.

Probiotic foods

Probiotic-rich foods can contribute to a balanced gut microbiota and improve digestion. Some of the best sources include kefir, yoghurt, kimchi, kombucha, and other fermented foods. It is important to note that not all fermented products contain live probiotic cultures, so checking labels when choosing these foods can be beneficial.

Probiotic supplements

There is growing interest in the role of probiotic supplements in managing endometriosis symptoms, particularly in relation to pain relief. Some studies suggest that certain strains, such as Lactobacillus, may help reduce inflammation and assist in pain management for women suffering from the condition.

Nutrition myths for patients with endometriosis

There are many myths surrounding nutrition and endometriosis that are not based on solid scientific evidence. Many women with endometriosis experience gastrointestinal symptoms, and while some may notice symptom improvement after making dietary changes, this does not mean that the same dietary practices will be effective for everyone.

Myth: Dairy products must be avoided in endometriosis

If a woman is intolerant to dairy, reducing or eliminating it from her diet may lead to symptom relief. However, there is no scientific evidence to suggest that most women with endometriosis need to exclude dairy to improve their condition. Dairy is an important food group and shouldn't be excluded from the diet without a reason.

Myth: All women with endometriosis should avoid gluten

A gluten-free diet may be beneficial for women who have gluten intolerance or celiac disease. Similar to dairy, there is not enough evidence to support the idea that avoiding gluten leads to symptom improvement in all women with endometriosis. If no gluten sensitivity is present, there is no reason to eliminate it from the diet. Gluten sensitivity can be assessed with the support of a dietitian. 

Myth: A low-FODMAP diet is necessary for all women with endometriosis

A low-FODMAP diet (which limits certain fermentable carbohydrates that can cause digestive discomfort in sensitive individuals) may be helpful for women who suffer from both endometriosis and irritable bowel syndrome (IBS). However, current studies do not conclude that all women with endometriosis need to follow this diet. Restricting entire food groups without a real necessity may even lead to nutrient deficiencies. The low-FODMAP diet is highly restrictive and should be followed under the guidance of a registered dietitian.

Conclusion

While diet can play a role in managing endometriosis symptoms, there is no universal approach that works for everyone. Many dietary myths exist, but scientific evidence remains limited regarding strict food eliminations. Instead of following generalised restrictions, women with endometriosis need to focus on a balanced, nutrient-rich diet that supports overall health and well-being.

Personalised dietary adjustments, guided by a healthcare professional or dietitian, may help alleviate symptoms without unnecessary restrictions. Ultimately, listening to your body and making informed choices is key to better symptom management and improved quality of life.