Endometriosis affects some 190 million women worldwide. Characterized by the presence of uterine lining-like tissue outside the uterus, this disease can lead to a variety of symptoms, including pelvic pain, heavy periods and fertility difficulties. While medical and surgical treatments can help manage symptoms, research is highlighting the role of diet in the management of endometriosis. Indeed, certain foods can influence inflammation, hormones and the immune system. In this article, we’ll explore the link between diet and endometriosis, outlining the nutrients to favor as well as those to avoid to help relieve endometriosis-related symptoms.

What is endometriosis?

Endometriosis is a chronic inflammatory disease affecting around 10% of women of childbearing age. It is characterized by the presence of endometrium (a tissue similar to the uterine lining) outside the uterus, which can lead to chronic or acute pelvic pain, bloating, nausea and fatigue, and sometimes depression, anxiety and infertility. Late diagnosis and limited treatment impact on women’s quality of life and psychological well-being. There is currently no cure for endometriosis, and treatment is generally aimed at relieving symptoms. A healthy lifestyle is essential to alleviate symptoms and improve daily well-being. Several studies have demonstrated a link between endometriosis and diet. Diet can play a role in the symptoms of endometriosis, but cannot cure it.

Endometriosis is a hormone-dependent disease, reacting to hormones secreted by the body, including estrogen. Estrogen secretion triggers periodic changes in the uterus and vagina to prepare the body for fertilization and pregnancy. Under its influence, the inner lining of the uterus (known as the endometrium) thickens during the first part of a woman’s hormonal cycle, right up to the moment of ovulation. If fertilization does not occur, estrogen levels fall, causing the uterine lining to disintegrate and menstruation to begin. However, in the case of endometriosis, the cells that act as endometrial cells elsewhere in the body behave in exactly the same way as if they were there. They will therefore act in exactly the same way, even though there is no provision for them to thicken, or for them to evacuate material once they have disintegrated. This leads to lesions, cysts, adhesions and pain. The stimulating hormone estrogen increases inflammation, the development of endometriosis and the associated pain. Adopting a specific diet to combat endometriosis is essential to reduce excess estrogen levels (70% of women already suffer from estrogen dominance), and reduce inflammation.

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The link between diet and endometriosis symptoms

The correlation between diet and endometriosis has been studied in several articles. Studies have attempted to observe whether the consumption of certain foods is a risk factor for endometriosis, or on the contrary, has a protective effect. Alcohol consumption and a diet rich in trans-fatty acids have been shown to have a negative effect on the onset of endometriosis. A systematic review from 2021 assessed the impact of certain nutrients on endometriosis symptoms, anti-inflammatory nutrients could be effective in suppressing endometriosis-related pain, more research is needed to determine a link (1).

There is as yet no standard diet or nutrition to control endometriosis, but preliminary results suggest that an anti-inflammatory diet, such as the Mediterranean diet (lots of vegetables and legumes, olive oil, little meat) would achieve a great reduction in symptoms. The anti-inflammatory diet aims to reduce inflammation in the body, and is particularly recommended in cases of endometriosis. An anti-inflammatory diet incorporates foods rich in nutrients and antioxidants, omega-3s and dietary fiber, while avoiding foods that can exacerbate inflammation (processed products, saturated fats, sugars, etc.).

The benefits of an anti-inflammatory diet for endometriosis sufferers are manifold:

• Pain reduction: Reducing inflammation can relieve the pelvic pain and menstrual cramps often associated with endometriosis.
• Improved fertility: Following an anti-inflammatory diet can help reduce the formation of adhesions and cysts associated with endometriosis, thus improving the chances of fertility.
• Immune boost: Foods rich in nutrients and antioxidants boost the immune system.
• Improved physical and mental well-being: A balanced diet can help reduce fatigue and improve mood, which can be important for endometriosis sufferers, who often experience persistent fatigue and mood disorders.

Preferred foods

To alleviate symptoms and improve quality of life for endometriosis sufferers, dietary adaptation is essential. Recommended foods include fruits and vegetables, sources of omega-3 fatty acids such as oily fish, flaxseeds and walnuts, as well as fiber-rich foods, whole grains and certain spices.

• Fruits and vegetables

Researchers have found an inverse relationship between fruit and vegetable consumption and the risk of endometriosis. The risk of developing the symptoms of endometriosis appears to be significantly reduced in women who consume high levels of fruit and vegetables, compared with those who consume low levels. In particular, one study found that daily consumption of citrus fruits was associated with a 22% lower risk of endometriosis than those who consumed them only once a week (2). A 13% reduction in the risk of endometriosis was observed in women who ate a portion of cruciferous vegetables every day, compared with those who ate them less than once a week. Crucifers, which include plants such as turnips, rapeseed, horseradish and watercress, are best known for belonging to the cabbage family, such as cauliflower or broccoli.

Fruits and vegetables, especially red fruits such as blueberries and citrus fruits, are rich in carotenoids, vitamins C and E, and anti-inflammatory polyphenols, and contain fibers that help reduce blood levels of estrogen. This hormone is implicated in endometriosis, and its reduction helps to improve the balance of the intestinal microbiota. Colorful fruits and vegetables are also rich in antioxidants, molecules that neutralize the free radicals that can contribute to inflammation. By incorporating these foods into your diet, you can reduce the inflammation and pain associated with endometriosis. It is advisable to choose organic, seasonal or local produce to avoid pesticides, which are endocrine disruptors potentially implicated in endometriosis.

• Omega 3s (oily fish, nuts and seeds)

Omega-3-rich foods are known for their ability to modulate the inflammatory response that is a major component of endometriosis. Omega-3s, in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in seafood and oily fish, have a proven anti-inflammatory effect. Omega-3s help reduce the production of inflammatory substances in the body, and can therefore help relieve the symptoms of endometriosis.

They can be found mainly in oily fish such as salmon, mackerel, sardines and anchovies, as well as in nuts and seeds such as flax and chia seeds. Nuts such as walnuts, hazelnuts and almonds are also good sources of essential omega-3 and omega-9 nutrients. However, these foods are often very high in calories and should be eaten in moderation. For vegans, one tablespoon of rapeseed oil a day, or even better, seaweed oil titrated in EPA DHA (to be found in [My] Skin & Hair Essentials Essentiels Peau & Cheveux) will provide sufficient anti-inflammatory fatty acids.

• Fiber-rich foods

Fiber-rich foods can reduce estrogen levels by helping to metabolize/eliminate it: legumes, wholemeal starchy foods, fruit and vegetables, and oilseeds.

• Spices

Many spices and aromatic herbs contain substances with anti-inflammatory and antioxidant properties. These include turmeric, nutmeg and cloves, as well as aromatic herbs such as parsley, coriander, basil, thyme and rosemary.

Foods to avoid

To alleviate symptoms and improve quality of life for endometriosis sufferers, it’s important to adapt one’s diet. Among the foods to avoid are those that are pro-inflammatory. These include red meats, dairy products, refined sugars and cereals, alcohol and ultra-processed foods.

• Red meats

Women reporting a higher consumption of red meats or deli meats had a greater risk of endometriosis. The risk of endometriosis was significantly higher among women who consumed beef and other red me ats, compared with those who consumed the least. Foods rich in omega-6 fatty acids, such as red meat, are correlated with higher concentrations of steroids with higher levels of inflammation and the development of endometriosis.

• Dairy products

Dairy products of animal origin are generally not recommended for endometriosis. They contain arachidonic acid and palmitic acid, two fatty acids suspected of stimulating inflammatory reactions and impacting the hormonal system. What’s more, these products may contain endocrine disruptors such as dioxin, as well as small amounts of estrogen, which can trigger the symptoms of endometriosis.

Milk is also made up of two proteins, casein and lactose. Casein is often poorly tolerated by the immune system, which can trigger an inflammatory reaction and aggravate the pain associated with endometriosis. In lactose-intolerant people, the presence of lactose in dairy products can lead to additional digestive disorders.

As a result, people with endometriosis are often advised to avoid or limit their consumption of dairy products (3). However, studies show conflicting results on whether or not consumption of animal-based dairy products increases the risk of endometriosis (4).

• Ultra-processed foods

These products should be avoided as part of a diet designed to limit the symptoms of endometriosis. In fact, according to an American study, consumption of products containing dietary fats does not directly affect the risk of endometriosis, but consumption of trans-fatty acids does (5).

• Alcohol consumption

It is strongly recommended thatalcohol consumption be avoided oreliminated altogether in cases of endometriosis. Alcohol has the ability to disrupt hormonal levels, notably by increasing estrogen production. Endometriosis lesions are particularly sensitive to estrogen.

• Food additives

Food additives such as preservatives, colorants, flavor enhancers and artificial sweeteners are also likely to promote inflammation. They are frequently used in processed and industrial foods (notably the famous “E” list).

• Vegetable oils

Certain vegetable oils, especially those containing high levels of omega-6 fatty acids, can promote inflammation. These include sunflower, corn, soy and grapeseed oils. We therefore recommend avoiding these oils in favor of those rich in omega-3 fatty acids, such as linseed oil, walnut oil and rapeseed oil. However, these vegetable oils may not be sufficiently titrated in EPA DHA, in which case you should turn to titrated algae oil (to be found in Essentiels Peau & Cheveux) or oily fish.

Food supplements

While a balanced diet based on a variety of high-quality products can help reduce some endometriosis symptoms, supplements can also reinforce the effect of diet. Dietary supplements frequently recommended are :

• Omega-3 fatty acids: These have anti-inflammatory properties and are found in fish oils and seaweed.
• Vitamin D: Essential for regulating the immune system, it can be produced by the skin when exposed to the sun, or taken as a supplement.
• Probiotics: help maintain a healthy balance of intestinal flora, which can influence inflammation.

It’s important to consult a healthcare professional before taking any dietary supplements, to determine which ones are right for you and to avoid possible drug interactions.

Diet plays a major role in maintaining good health and reducing the symptoms of endometriosis. Adopting a specific diet for endometriosis is essential to reduce excess estrogen and ensure a good intake of essential nutrients. On a daily basis, anti-inflammatory foods help combat the inflammation responsible for endometriosis symptoms. In addition to a healthy diet to combat endometriosis, dietary supplements can reinforce the action of the nutrients present in the diet.

Sources

Cited studies :

1. Helbig M, Vesper AS, Beyer I, Fehm T. Does Nutrition Affect Endometriosis? Geburtshilfe Frauenheilkd. 2021;81(2):191-9.doi:10.1055/a-1207-0557
2. Nurses’ Health Study II
3. Huntington A, Gilmour JA. A life shaped by pain: women and endometriosis. J Clin Nurs. 2005;14(9):1124-32. doi:10.1111/j.1365-2702.2005.01231.x
4. Norman M, Razmpour O, Olsen JM. Women’s Use of Self-Care Interventions for Endometriosis Pain in the United States. Nurs Womens Health. 2021;25(5):346-56. doi: https://doi.org/10.1016/j.nwh.2021.07.008
5. Missmer SA et al: A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod, 2010

Sources :

• https://www.who.int/fr/news-room/fact-sheets/detail/endometriosis
• https://sonar.ch/hesso/documents/321122
• https://sante.journaldesfemmes.fr/fiches-nutrition/2518141-endometriose-nutrition-alimentation-anti-inflammatoire/
• https://www.passeportsante.net/fr/Nutrition/Dietes/Fiche.aspx?doc=endometriose-aliments-anti-inflammatoires-choisir#endometriose-les-aliments-a-limiter