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Seeking out an endometriosis diet that works for your body’s needs can be frustrating if you’re one of the roughly 10% of women affected by this chronic and painful inflammatory condition.
While the most common symptoms include pelvic pain, heavy periods, digestive issues, and impaired fertility or infertility, many affected by endometriosis also feel the loss of overall quality of life.
Unlike other chronic conditions (diabetes, heart disease, Crohn’s disease) where there is a clear connection and benefit of following specific dietary patterns, less is known about a potential endometriosis diet. According to the latest evidence on endometriosis and so-called “anti-inflammatory diets,” below are general recommendations for what to eat and avoid if you have endometriosis.
Can diet impact endometriosis?
Some research has shown that those diagnosed with endometriosis eat fewer vegetables and omega-3 fatty acids (the fats commonly found as fish oil) and consume more red meat, coffee, and trans fats (Helbig, 2021). But that doesn’t mean that these diet choices cause or prevent endometriosis. Most studies on the link between endometriosis and diet are small and not enough for a one-size-fits-all diet recommended for endometriosis.
Endometriosis diet: what to eat
Combating inflammation and reducing pain are often the main goals of a diet to manage endometriosis symptoms. This consists of a well-balanced, whole foods diet rich in fruits and vegetables, a beneficial diet for many health conditions.
Salmon, sardines, herring, chia seeds, flax seeds
These foods are rich in omega-3s. Omega-3s possess anti-inflammatory properties. Studies show that a higher intake of omega-3s can lead to less pain intensity, less use of pain medications, and shorter pain duration (Helbig, 2021).
Fruits and vegetables
Fruits and vegetables are rich in antioxidants, including vitamins A and C and folic acid. Antioxidants curb oxidative stress and inflammation in the body. Eating more fruits and vegetables has also been linked to a lower risk of an endometriosis diagnosis (Helbig, 2021). Dark, leafy greens like spinach and swiss chard are high in magnesium. Higher magnesium intake is associated with a lower risk of endometriosis (Harris, 2013).
The OMAD diet: benefits and risks
Milk, yogurt, egg yolks
These are all foods rich in vitamin D. Vitamin D deficiencies play a role in inflammatory conditions (Helbig, 2021). A study showed that women who had more than three servings of dairy products a day were 18% less likely to be diagnosed with endometriosis than women consuming two daily servings (Harris, 2013).
While dairy and vitamin D-rich foods seem to be protective against endometriosis, many women with endometriosis reduce or eliminate dairy from their diets (Armour, 2021). Symptoms like bloating, constipation, or diarrhea often coincide with endometriosis, and some may eliminate dairy to relieve digestive symptoms (Maroun, 2009). However, some women with endometriosis may be able to tolerate dairy foods.
Either way, maintaining adequate vitamin D is still important for women with endometriosis, as vitamin D status tends to be lower with endometriosis, and more severe endometriosis is linked to lower vitamin D levels (Qiu, 2020).
Black beans, kidney beans, lentils, chickpeas
Iron-rich foods are a good choice when you have endometriosis. These foods are plant-based sources of iron. Iron is a mineral found in blood cells, so higher levels of blood loss during menstruation—a common symptom of endometriosis—can increase the risk for iron deficiency (Kocaoz, 2019).
Legumes and lentils are also complex carbohydrates that are a great source of fiber and can support gut health.
Endometriosis diet: what to avoid
Some foods might exacerbate symptoms or even negatively affect endometriosis risk. These include inflammatory foods like foods high in saturated fats, trans fats, refined sugars, and caffeine and alcohol.
Fatty beef, pork, lamb, butter, lard
One study suggests that women who eat more than two servings of red meat per day have a 56% greater risk of developing endometriosis than women who only eat red meat once a week (Yamamoto, 2018).
Fried foods, processed baked goods, shortening
These foods are high in trans fats and can also lead to inflammation (Mozaffarian, 2004). Research shows higher rates of endometriosis in women who consume a diet higher in trans fats (Missmer, 2010).
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While there’s no clear link between caffeine intake and endometriosis, there’s some evidence linking caffeine to diseases that have to do with the hormone estrogen, like endometriosis (Helbig, 2021).
Alcohol consumption is linked to estrogen-dependent diseases, and one 2013 study showed a link between alcohol consumption and endometriosis (Parazzini, 2013). Alcohol consumption can also negatively impact fertility. Women with endometriosis experience fertility challenges, and excess drinking can add another challenge (Helbig, 2021).
Refined sugars can refer to any food containing many added sugars without fiber, including white bread, cereals, some granolas, and candies. Overconsumption of refined sugars can contribute to inflammation (Della Corte, 2018).
Should gluten be eliminated from an endometriosis diet?
Like dairy, many women with endometriosis choose to eliminate gluten from their diet (Armour, 2021). One study from 2012 does indicate going gluten-free for endometriosis may be beneficial.
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A total of 207 women with painful endometriosis followed a gluten-free diet for a year (Marziali, 2012). 75% of the participants reported significant improvements to their pain, and no one reported worsening endometriosis-related symptoms. While this study may seem to show a good rationale for a gluten-free diet (and is often cited as a reason to eliminate gluten from the diet), there was no control group. So, there’s a chance these results may not hold up if tested against a different diet group for a year.
A gluten-free diet makes sense for those who have gluten sensitivity or Celiac disease. Talk to a healthcare professional about how to determine if gluten may be negatively influencing your endometriosis symptoms.
Lifestyle changes to help endometriosis
In addition to diet, other lifestyle changes can help women with endometriosis and contribute to overall health.
Yoga: A small study of 15 women with endometriosis showed that practicing yoga twice a week for eight weeks helped control pelvic pain (Goncalves, 2016).
Regular exercise: Another study of 20 young women with endometriosis showed that eight weeks of an exercise program significantly reduced pain intensity (Awad, 2017). These women completed low-impact exercises for 30-60 minutes at least three times a week. This study didn’t include a control group, so although they did experience pain relief, there was nothing to compare it to.
Sleep: Symptoms of endometriosis can greatly impact sleep quality (Youseflu, 2020). Limiting caffeine and alcohol can also improve sleep quality. Practicing good sleep hygiene habits like keeping a dark room, avoiding bright light before bed, and lowering the thermostat can improve sleep quality and duration.
5 face yoga exercises and the science behind them
Stress management: Women with endometriosis often experience stress regarding pain or symptom management, and they can have significantly higher levels of the stress hormone cortisol than women without endometriosis (Lima, 2006). Stress management techniques like breathing exercises, sleep, and maintaining healthy relationships can help keep stress and cortisol levels at bay.
The right endometriosis diet for you
If you have endometriosis, dietary and lifestyle changes can help, but it’s always best to consult with a healthcare provider.
More research is needed on the role diet and lifestyle play in endometriosis. Endometriosis care requires a personalized approach for each person. While this article offers general dietary information, a tailored treatment plan is always the best option. Integrated medical care, including a healthcare provider and registered dietitian, can help determine what treatment options and lifestyle choices work best for you.
- Armour, M., Middleton, A., Lim, S., Sinclair, J., Varjabedian, D., & Smith, C. A. (2021). Dietary practices of women with endometriosis: a cross-sectional survey. Journal of Alternative and Complementary Medicine. doi: 10.1089/acm.2021.0068. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34161144/
- Awad, E., Ahmed, H., Yousef, A., & Abbas, R. (2017). Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. Journal of Physical Therapy Science, 29(12), 2112–2115. doi: 10.1589/jpts.29.2112. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29643586/
- Della Corte, K. W., Perrar, I., Penczynski, K. J., Schwingshackl, L., Herder, C., & Buyken, A. E. (2018). Effect of dietary sugar intake on biomarkers of subclinical inflammation: a systematic review and meta-analysis of intervention studies. Nutrients, 10(5), 606. doi: 10.3390/nu10050606. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29757229/
- Gonçalves, A. V., Makuch, M. Y., Setubal, M. S., Barros, N. F., & Bahamondes, L. (2016). A qualitative study on the practice of yoga for women with pain-associated endometriosis. Journal of Alternative and Complementary Medicine, 22(12), 977–982. doi: 10.1089/acm.2016.0021. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27552065/
- Harris, H. R., Chavarro, J. E., Malspeis, S., Willett, W. C., & Missmer, S. A. (2013). Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. American Journal of Epidemiology, 177(5), 420–430. doi: 10.1093/aje/kws247. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23380045/
- Helbig, M., Vesper, A. S., Beyer, I., & Fehm, T. (2021). Does nutrition affect endometriosis?. Geburtshilfe und Frauenheilkunde, 81(2), 191–199. doi: 10.1055/a-1207-0557. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870287/
- Kocaoz, S., Cirpan, R., & Degirmencioglu, A. Z. (2019). The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pakistan Journal of Medical Sciences, 35(2), 365–370. doi: 10.12669/pjms.35.2.644. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31086516/
- Lima, A. P., Moura, M. D., & Rosa e Silva, A. A. (2006). Prolactin and cortisol levels in women with endometriosis. Brazilian Journal of Medical and Biological Research = Revista brasileira de pesquisas medicas e biologicas, 39(8), 1121–1127. doi: 10.1590/s0100-879×2006000800015. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16906287/
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- Marziali, M., Venza, M., Lazzaro, S., Lazzaro, A., Micossi, C., & Stolfi, V. M. (2012). Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?. Minerva Chirurgica, 67(6), 499–504. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23334113/
- Missmer, S. A., Chavarro, J. E., Malspeis, S., Bertone-Johnson, E. R., Hornstein, M. D., Spiegelman, D., et al. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction (Oxford, England), 25(6), 1528–1535. doi: 10.1093/humrep/deq044. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20332166/
- Mozaffarian, D., Pischon, T., Hankinson, S. E., Rifai, N., Joshipura, K., Willett, W. C., et al. (2004). Dietary intake of trans fatty acids and systemic inflammation in women. The American Journal of Clinical Nutrition, 79(4), 606–612. doi: 10.1093/ajcn/79.4.606. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15051604/
- Parazzini, F., Cipriani, S., Bravi, F., Pelucchi, C., Chiaffarino, F., Ricci, E., et al. (2013). A metaanalysis on alcohol consumption and risk of endometriosis. American Journal of Obstetrics and Gynecology, 209(2). doi: 10.1016/j.ajog.2013.05.039. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23707678/
- Qiu, Y., Yuan, S., & Wang, H. (2020). Vitamin D status in endometriosis: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 302(1), 141–152. doi: 10.1007/s00404-020-05576-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32430755/
- Yamamoto, A., Harris, H. R., Vitonis, A. F., Chavarro, J. E., & Missmer, S. A. (2018). A prospective cohort study of meat and fish consumption and endometriosis risk. American Journal of Obstetrics and Gynecology, 219(2), 178.e1–178.e10. doi: 10.1016/j.ajog.2018.05.034. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29870739/
- Youseflu, S., Jahanian Sadatmahalleh, S., Roshanzadeh, G., Mottaghi, A., Kazemnejad, A., & Moini, A. (2020). Effects of endometriosis on sleep quality of women: does life style factor make a difference?. BMC Women’s Health, 20(1). doi: 10.1186/s12905-020-01036-z. Retrieved from https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01036-z
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.