6 important research-led dietary and lifestyle changes to help manage your endometriosis

BY OUR HEAD OF NUTRITION, LORNA DRIVER-DAVIES 

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With over 13 years specialising in endometriosis and women’s health, I know first-hand that taking positive changes to your diet can influence your symptoms and help you to strengthen your body for surgery, recovery and managing the condition longer term. Research shows the beneficial link between specific nutrients and dietary focus and combating endometriosis symptoms. Eating well with endometriosis may also support your energy, sleep, mood and your ability to juggle a busy life or stress. 

Endometriosis is, in part, a condition where the immune system is ‘dysregulated’ (doesn’t in part function normally) and inflammation not only creates painful or uncomfortable symptoms but also worsens the condition overall. Therefore dietary support focuses on helping the immune system and reducing inflammation. 

1. The endometriosis diet needs key nutrients

Women with endometriosis are recorded to have low nutrient status. Indeed, a great number of the many women I see in clinics and consultations are lacking key nutrients, evidenced by research showing Vitamin D, Zinc, Vitamin E, Omega 3 fatty acid and Vitamin A are typically low in those with the condition. (*1) One thing these nutrients all have in common is that they support the immune system. Not only that, they work as antioxidants and nutrient antioxidants play a supportive role in endometriosis by helping to reduce pain (*2). Interestingly, any nutrients that support the immune system also support hormone equilibrium - another significant area of health to get control of when tackling endometriosis.

For in depth dietary support, we wholly recommend our founder Henrietta’s book Take Control Of Your Endometriosis which has excellent advice on dietary and lifestyle changes as well as many delicious recipes. 

2. Eat more vegetables and colourful fruit

Research shows a positive relationship between increased green vegetable consumption and a significant reduction in endometriosis (*3). A further study showed that Carotenoid rich foods (such as citrus fruit or other vegetables with orange and yellow colours) also positively affected symptoms of endometriosis (*4). This is because these types of vegetables are rich in antioxidants that support the immune system and management of an inflammatory condition. A great way to increase your vegetable intake is through smoothies and soups. 

3. Eat more fibre 

With endometriosis, it's really important to keep your bowel movements regular so that old hormones such as oestrogen can be safely removed as waste (once the body is done using it), and stop higher levels building up. Increasing fibre intake not only helps to keep your bowel movements regular but research also shows that fibre also helps to feed the gut microbiome required for a healthy immune system. 

A special category of vegetable called cruciferous (broccoli, cauliflower, brussel sprouts and cabbage) is particularly beneficial as they contain a natural compound called Indole-3-carbinol (I3C), a type of glucobrassicin which naturally supports oestrogen metabolism (*5). Glucobrassicins have also been shown to have an anti-inflammatory action in the body (*6). 

4. Omega 3 and the endometriosis diet 

The essential fat, Omega 3, plays a really critical role when it comes to supporting endometriosis. It's very common for endometriosis sufferers in the UK to be low in Omega 3 (*7) because not everyone loves eating oily fish two or three times each week. An essential fat cannot be made in the body; it must come from diet or supplementation if you prefer not eating fish. 

Other research shows Omega 3 helps to reduce the progression of the condition and symptoms (*8) because Omega works as an anti-inflammatory, supporting the immune system.  Fish oil supplemented adolescents with endometriosis were reported to have a 50% drop in VAS scores (*9). VAS scores are a subjective measure for acute and chronic pain. Women with higher circulating levels of Omega 3 EPA are less likely to have endometriosis (*10). 

In addition, Omega 3 also has the power to influence how inflammation starts in the first place, by having a positive impact on a special immune protein called NF Kappa B which is involved in the increase of inflammation (*11). Tackling inflammation in endometriosis also helps to control oestrogen production, which we know significantly affects the condition and its ability to progress. This is because oestrogen as a hormone also has the capacity to raise inflammation in the body and this, in turn, means the body produces even more more oestrogen (*12).

5. Consider gluten and wheat removal

Research has shown 75% of endometriosis patients found a significant decrease in symptoms when following a gluten free diet over 12 months. Further, gluten elimination has been shown to reduce endometriosis symptoms (*13). My clinical experience is that patients benefit from removing gluten or wheat, especially if experiencing gut issues, constipation or bloating as these symptoms can worsen classic endometriosis symptoms. 

Removing wheat, which contains gluten, may also be beneficial. Wheat is classified as a ‘high fodmap food’ whereas a Low Fodmap Diet is one of the most respected diets with research showing it can provide 50% improvement in IBS symptoms for those with endometriosis (*14). Digestive issues are common in endometriosis and can create more pain. The Low Fodmap diet involves excluding certain foods, but whilst it's effective, it's best completed under supervision by a nutrition professional.

6. Befriend your gut microbiome  

There is a relationship between endometriosis disease progression and gut health. An official research-based hypothesis called the ‘bacterial contamination hypothesis’ understands that bad bacteria and imbalances in the gut microbiome play a role in the potential for endometriosis to occur (*15). Therefore I recommend in general taking a closer look at your gut health overall and including foods that ‘feed’ the gut such as fermented foods like sauerkraut, raw dairy and kefir. However, if you suffer from digestive upset or bloating when you eat fermented foods or dairy, we recommend avoiding those foods. Please check in with our team of expert nutritional therapists before starting to use a probiotic.

 

For further reading, be inspired by our founder Henrietta's journey to overcoming endometriosis.

And visit our Managing your Endometriosis page to read our recommended Endometriosis essentials

 

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References:

(1) Dietary supplements for treatment of endometriosis: A review. Hum Repod 2004 Aug;19(8):1755-9. Pinar Yalcin Bahat et al.

(2) Santanam et al (2013): Antioxidant supplementation reduces endometriosis-related pelvic pain in humans (2013).

(3) Selected food intake and risk of endometriosis. Hum Reprod 2004 Aug;19(8):1755-9. F Parrazini et al.

(4) Fruit and vegetable consumption and risk of endometriosis. Hum Reprod 2018 Apr; 33(4). H R Harris et al.

(5) Differences in the hepatic P450-dependent metabolism of estrogen and tamoxifen in response to treatment of rats with 3,3'-diindolylmethane and its parent compound indole-3-carbinol. Navarro (2014). Cruciferous vegetables have variable effects on biomarkers of systemic inflammation in a randomized controlled trial in healthy young adults. J Nutr 2014 Nov;144(11):1850-7.

(6) Glucosinolates From Cruciferous Vegetables and Their Potential Role in Chronic Disease: Investigating the Preclinical and Clinical Evidence. Front Pharmacol 2021; 12: 767975. Emma L Connolly et al.

(7) Dietary supplements for treatment of endometriosis: A review. Hum Repod 2004 Aug;19(8):1755-9. Pinar Yalcin Bahat et al.

(8) Herrington et al (2013): Dietary fish oil supplementation inhibits formation of endometriosis-associated adhesions in a chimeric mouse model. Fertility and Sterility Volume 99, issue 2. February 2013, Pages 543-550.e1

(9) Nodler JL, DiVasta AD, Vitonis AF, et al. Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2020 May 26

(10) Hopeman MM, Riley JK, Frolova AI, et al. Serum Polyunsaturated Fatty Acids and Endometriosis. Reprod Sci. 2015 Sep;22(9):1083–7.

(11) Novak et al (2002): NF-kappa B inhibition by omega -3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription. Am J Physiol Lung Cell Mol Physiol. 2003 Jan;284(1):L84-9. Gonzalez-Ramos et al (2003): Involvement of the nuclear factor-κB pathway in the pathogenesis of endometriosis. Fertil Steril. 2010 Nov;94(6):1985-94.

(12) Estrogen Receptors and Endometriosis. Int J Mol Sci 2020 Apr; 21(8): 2815. Elodie Chantalat et al.

(13) Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir 2012 Dec;67(6):499-504. M Marziali et al.

(14) Moore et al (2017): 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 Apr;57(2):201-205.

(15) Bacterial contamination hypothesis: a new concept in endometriosis. Minerva Chir 2012 Dec;67(6):499-504. M Marziali et al.