What is the best diet for endometriosis?

Symptoms can vary but often include:

• Pelvic and lower back pain, especially during periods
• Pain during or after sex
• Painful bowel movements
• Pain urinating
• Fatigue
• Digestive problem including diarrhoea, constipation and bloating
• Fertility problems

The exact cause of endometriosis remains unknown but the number of women suffering from endometriosis has increased over the last few decades, and while this is partly due to improved awareness and better diagnosis, some experts speculate that our western diet and lifestyle could be a factor.

How diet affects endometriosis

Inflammation is key in the development of endometriosis and is linked with many of the symptoms. Current advice is to avoid or limit foods which are known to trigger inflammation – and eat more foods which may be anti-inflammatory. This can help manage some of the symptoms associated with endometriosis. There is no one-size-fits-all diet when it comes to endometriosis, and what works for one person will not necessarily help another, so unfortunately, it’s a question of trial and error.

Sophie Medin, RD, director at CityDietitians, recommends keeping a food diary – a record of what you eat, how you feel and what else is going on in your life – which can help you identify foods or other triggers that make symptoms better or worse.

Foods to limit for endometriosis

Red meat

A high intake of red meat is thought to increase risk of inflammation and is associated with a higher risk of developing endometriosis. Limit red meat to no more than twice a week and avoid processed meats such as sausages, ham, bacon and salami as much as possible.

Dairy and gluten

Some women find that cutting out gluten and dairy can help alleviate symptoms, particularly bloating and wind. It doesn’t work for everyone, so if after three to four weeks you see no improvement, slowly introduce them back into your diet. When cutting out any foods it’s important to change one thing at a time, otherwise it’s difficult to pinpoint the food causing the problem. If you cut out dairy for more than a few weeks, make sure you get enough calcium from other foods in your diet.

Alcohol

This can contribute to inflammation, increase oestrogen levels, and have an adverse effect on the gut bacteria which could make symptoms worse or trigger a flare up. This doesn’t mean you need stop drinking alcohol completely, but stick within the safe guidelines and monitor your reaction of alcohol using a food diary.

Ultra processed foods (UPFs)

A diet high in UPFs has been shown to increase the risk of inflammation so choose unprocessed or minimally processed foods as much as possible.

Refined and free sugars

A diet high in free sugars can increase risk of inflammation and have an adverse effect on gut bacteria. Free sugars are sugars that are added to food or drinks, and sugars found naturally in honey, syrups (like date syrup), unsweetened fruit juices, smoothies and purées.

Fermentable carbohydrates

A low FODMAP diet can help alleviate symptoms like bloating, flatulence, constipation and diarrhoea. It is a complicated and restrictive diet, so if you’re going to try this approach it’s best to seek the advice of a dietitian.

Histamine foods

Some women find that avoiding histamine-containing foods be can helpful. Histamine occurs naturally in foods including tomatoes, aubergine, avocados, seafood, smoked meats, red wine, aged cheese and fermented foods such as sauerkraut and kimchi.

Caffeine

Caffeine in tea, coffee and some soft drinks can make symptoms worse for some people, so keep an eye on how much you consume and make a note of it in your food diary.

Diet and lifestyle tips for reducing inflammation

• Maintain a healthy weight. Excess body fat can produce extra oestrogen, which can increase inflammation which may worsen endometriosis symptoms.
• Increase omega-3 fatty acids. Omega-3 fats found in oily fish like salmon, mackerel, and fresh tuna have anti-inflammatory properties. Research found that women who had a high intake of omega-3 were less likely to develop endometriosis. Aim to eat at two portions of oily fish a week. If you don’t eat fish, consider taking a supplement.
• Follow an anti-inflammatory, Mediterranean-style diet. Focus on fruits, vegetables, whole grains, lean proteins, healthy, unsaturated fats and foods rich in polyphenols like berries and green tea.
• Increase fibre intake. High-fibre diets are associated with a reduced risk of endometriosis and modifying fibre can be helpful in managing symptoms associated with endometriosis. There are many different types of fibre – prebiotic fibre (found in onions, leeks, mushrooms, asparagus, cabbage, flax seeds and oats) can worsen symptoms. Sophie says, for women with digestive problems, soluble fibre tends to be better tolerated than insoluble fibre, and for anyone with constipation, eating soaked chia seeds or kiwi can be very helpful.

Can supplements help?

Supplements are never a substitute for a healthy balanced diet but research shows that some supplements may be beneficial for women with endometriosis

• Vitamin D: A 2022 study found low levels of vitamin D to be associated with increased risk of endometriosis. Other studies show taking vitamin D supplements could help reduce pelvic pain.
• Omega-3: the evidence that omega-3 can be helpful for women with endometriosis is very convincing, so if you don’t eat fish, it’s a good idea to take a supplement.
• Antioxidants: research suggests that vitamins C and E may help reduce inflammation and pelvic pain associated with endometriosis.
• Probiotics: emerging studies suggest that the gut microbiome may play an important role in the development and management of endometriosis. Although clinical studies in humans are currently limited, trying a supplement may be worth considering.

So, can diet help with endometriosis symptoms?

While diet isn’t a cure for endometriosis, making some healthy changes can help to manage or ease symptoms, although you should be aware that there’s lots of inaccurate and conflicting advice when it comes to diet and endometriosis. Be careful with what you read and, if possible, take advice from a registered dietitian.

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Fiona Hunter, Bsc (Hons) Nutrition, PG Dip Dietetics, is a highly experienced nutritionist, having worked in the NHS and now as an independent nutrition consultant.

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