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Cycles & Menstruation

What’s the best diet for endometriosis? The science so far

20/05/20245 min read

Written byLaura Harcourt

Reviewed byDr Tania Adib

woman with exquisite smile and beautiful eyes having breakfast with her friend in a cozy cafe.

Endometriosis is a complex condition with lots of different factors affecting it. Learn more about the science behind an endometriosis diet with Holland & Barrett.

Summary

1The effect of diet on endometriosis

Research into this area is extremely new and fairly limited. However, there’s some evidence to suggest that dietary interventions can treat endo...

Jump to details below

2The best foods that may support endometriosis

It’s thought that some foods may help ease the symptoms of endometriosis by balancing levels of these hormones and reducing inflammation. However...

Jump to details below

3Anti-inflammatory foods

Anti-inflammatory foods, like fruit and vegetables, contain plant chemicals (phytochemicals), fibre and antioxidants – all limit inflammatory...

Jump to details below

Jump to section

What we know about endometriosis
The effect of diet on endometriosis
The best foods that may support endometriosis
Anti-inflammatory foods
Foods that support gut health
Foods that support progesterone production
Foods that support your liver
Gut issues and high-FODMAP foods
The final say

Explore related topics

Cycles & Menstruation

When it comes to endometriosis and nutrition, there are many theories about which diet is best. But what evidence supports these claims, and which foods can help you manage your symptoms?

In this article, we aim to answer both these questions and more. We’ve outlined some key foods that may be beneficial to add to your meal plan if you are living with endometriosis, while also highlighting some of the clinically proven benefits.

What we know about endometriosis

Endometriosis is a long-term condition where tissue similar to the lining of the uterus grows outside the uterus, causing symptoms like pelvic pain and period pain.^1,2

Endometriosis is strongly linked to our hormones, especially oestrogen and progesterone. The condition is oestrogen-dependent, which means that this hormone can both contribute to the development of the disease and make symptoms worse.^3,4,5

Plus, endometriosis can create progesterone resistance. This low level of progesterone can put the body into a state of inflammation, which is basically when the immune system kicks into gear to protect us against a perceived threat.⁶

Inflammation is thought to contribute to endometriosis, but it can also work the other way around. In any case, inflammation can make your symptoms worse.^7-10

Lady eating dinner in restaurant. Happy expression

The effect of diet on endometriosis

Research into this area is extremely new and, so far, fairly limited. However, there’s some evidence to suggest that dietary interventions can treat endometriosis-related symptoms.^11,12

It’s important to note that, due to the lack of research in this area, there’s no concrete evidence on the long-term effectiveness of following an endometriosis diet plan.¹¹

However, by looking at the science of how certain foods impact the body, and coupling that with what we already know about the condition, we can get a better idea of what might help.

The best foods that may support endometriosis

It’s thought that some foods may help ease the symptoms of endometriosis by balancing levels of these hormones and reducing inflammation. However, research is currently limited and more trials are needed to confirm that these foods help with endometriosis symptoms.

Anti-inflammatory foods

Inflammation is the body’s process of fighting off disease. However, if you have endometriosis, the inflammatory response is thought to be one of its main triggers, and the effects can be quite painful.^12-14

Although very limited emerging research in this area suggests that anti-inflammatory foods may be helpful for people living with endometriosis.^15,16

Anti-inflammatory foods, like fruit and vegetables, contain plant chemicals (phytochemicals), fibre and antioxidants – all of which limit inflammatory signals caused by the immune system.^11,16-18

One of the best ways to ensure you’re getting a varied amount of fruit and veg in your diet to potentially ease endometriosis-related symptoms is to make your plate as colourful as possible.

Alongside fruits and vegetables that are rich in antioxidants, some other great anti-inflammatory foods can include:^11,18,19

fruits and vegetables: berries, tomatoes, cherries, spinach, and kale
oily fish: are thought to be full of omega-3 fatty acids, a great antioxidant with potential anti-inflammatory properties²⁰
turmeric: this source of curcumin is well known for its anti-inflammatory properties^21,22
ginger: its health-promoting properties have been attributed to its rich phytochemistry²³
nuts and seeds: flaxseed has been found to be rich in antioxidants and walnuts have been shown to trigger an anti-inflammatory response^24,25

Whether these types of anti-inflammatory foods are thought to help with endometriosis or not is an ongoing research space with more evidence-backed data needed to clarify.

Foods that support gut health

Supporting our gut health is also vital for reducing inflammation. Around 70% of our immune cells are housed in our gut, and our immune system is the driving force behind inflammation.²⁶So, it’s important to keep your gut happy!

But gut health doesn’t only play a role in inflammation. It can also help us improve the balance between oestrogen and progesterone.^27,28

This is because we have a special family of bacteria in our gut which work along with the liver to metabolise oestrogen so that we maintain healthy levels in the body. This is especially important for people with endometriosis, who often have too much oestrogen (often referred to as oestrogen dominance) and too little progesterone (also known as progesterone resistance).^27,29,30

So, what can we eat to keep our gut happy? As fibre can help to nourish and balance our gut microbiome, and potentially reduce inflammation, eating a variety of fresh vegetables and fruits is key to help minimise endometriosis-related symptoms.^31-34

Assortment of nuts and seed on rustic table.

Some other high-fibre foods to add to your grocery list include:^34,35

nuts
seeds
brown bread
brown rice
quinoa

Foods that support progesterone production

As previously mentioned, when endometrial tissue grows outside the uterus, progesterone and oestrogen signalling become disrupted, leading to progesterone resistance and oestrogen dominance.³⁶Eating foods that support progesterone production may help to address this imbalance.

To ensure healthy progesterone levels, you need to make sure you’re ovulating every menstrual cycle.³⁷So, to help our body do this, there are certain nutrients you can add to your diet to give a helping hand.

In emerging studies, vitamin D has been found to support healthy ovulation and is thought to positively influence progesterone receptors, making it a possible supplementation option for people with endometriosis.^15,38-40

As we often struggle to get enough sun in the Northern Hemisphere, the NHS recommends that everyone in the UK supplement with at least 400IU of vitamin D between October and March.⁴¹However, it’s always a good idea to speak to your doctor before you start to take a new supplement.

You can also obtain vitamin D from various food sources, including:^41,42

Scrambled eggs and fried mushrooms on bread.

full-fat, organic dairy products
free-range eggs
tinned salmon with bones
beef liver
mushrooms that have been exposed to sunlight (which causes them to generate vitamin D)

Foods that support your liver

Another way to help tackle oestrogen dominance is to support your liver function. This is because oestrogen is mainly broken down by the liver once it’s been used by the body.^43,-45

If your liver isn’t working as it should, researchers have found that it can stop oestrogen from being metabolised and therefore, cause it to build up in your body.^44,46As endometriosis is an oestrogen-dependent condition, the higher your oestrogen levels are, the worse your symptoms are likely to be.^47-49

It’s thought that one of the better ways to support your liver is to limit your alcohol intake. Since alcohol can also contribute to inflammation in the body, it’s generally considered a good idea for people with endometriosis to reduce their alcohol intake anyway.^50,51

Some other foods that can help support liver function include:⁵¹

wholegrains
fruits (such as berries and lemon)
vegetables (like garlic and onion)
coffee
tea
spices

Gut issues and high-FODMAP foods

Many people with endometriosis struggle with associated digestive health issues, including constipation, diarrhoea and bloating. While often confused with irritable bowel syndrome (IBS), it’s not uncommon for people to suffer from both these conditions at the same time.^52,53

FODMAP stands for ‘fermentable oligosaccharides, disaccharides, monosaccharides and polyols’. Sticking to a low-FODMAP diet – which aims to reduce carbs that are harder to digest – might help with digestive endometriosis symptoms according to some small studies, including painful bloating.^15,54This is because high-FODMAP foods can increase gas production, which can contribute to abdominal pain and discomfort.⁵¹

A 2017 study, for example, saw people with both IBS and endometriosis trial a low-FODMAP diet. The vast majority of participants in the study benefited from the change in diet. However, significantly more women with endometriosis reported symptom improvement compared with women with IBS alone (72% vs 49%).⁵¹

So what sort of foods should you be eating as part of a low-FODMAP diet? Here are some great options that might be worth prioritising:⁵¹

proteins: beef, chicken, eggs, fish, lamb, pork, prawns, tempeh, and tofu
grains: oats, oat bran, rice bran, gluten-free pasta, quinoa
fruits: blueberries, raspberries, pineapple, kiwi, grapes, and strawberries
vegetables: bean sprouts, peppers, radishes, carrots, celery, aubergine, kale, tomatoes, spinach, cucumber, pumpkin, and courgette
nuts: almonds (no more than ten per sitting), macadamia nuts, peanuts, pine nuts, and walnuts
seeds: pumpkin, sesame, sunflower seeds, and linseeds
dairy: lactose-free milk, Greek yoghurt, and parmesan
oils: coconut and olive oils

On the flip side, there are certain high-FODMAP foods that may be beneficial to cut down with endometriosis. However, research into the effectiveness of avoiding high-FODMAP foods and its effect on endometriosis needs further research. Eating a well-balanced diet rich in all the nutrients you need is key for your health so do not overly restrict or avoid certain foods unless advised to do so by your doctor.

High-FODMAP foods include:

Whole Wheat Penne pasta with gorgonzola cheese sauce, spinach and walnut.

starches: cereal grains like wheat, whole wheat flour, pasta and wheat-based cereals
sugar: syrups, honey, high-fructose corn syrup and agave
nuts: cashew and pistachio lactose: milk, yoghurt, ice cream

Before starting a low-FODMAP diet, we would always recommend speaking to your doctor or a qualified nutritionist beforehand.

The final say

While a lot more research needs to be done into the impact of nutrition on endometriosis, and the condition in general, the science behind the foods mentioned in this article can offer a great place to start.

For diet recipes to help support endometriosis, why not take a look at some of our own Holland & Barrett recipes.

However, if you’re concerned about your symptoms or are confused about the right nutritional route for you, speak to your doctor or healthcare provider. They’ll be able to advise you on the best approach for your individual circumstances.

Sources

Parasar, P., et al. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports. 2017;6(1):34–41. Available from: https://doi.org/10.1007/s13669-017-0187-1.
NHS. Overview - Endometriosis [Internet]. [Cited 2024 Feb 11]. Available from: https://www.nhs.uk/conditions/endometriosis/.
Osmanlıoğlu, Ş., et al. The relationship between endometriosis and diet. Human Fertility. 2021;1–16. Available from: https://doi.org/10.1080/14647273.2021.1995900.
Tsamantioti ES, Mahdy H. Endometriosis. PubMed. Treasure Island (FL): StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/
Institute for Quality and Efficiency in Health Care. What is an inflammation?. Nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG). 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279298/
Patel, BG., et al. Progesterone resistance in endometriosis: origins, consequences and interventions. Acta Obstetricia et Gynecologica Scandinavica. 2017;96(6):623–32. Available from: https://doi.org/10.1111/aogs.13156.
Giacomini E, Minetto S, Li Piani L, et al. Genetics and Inflammation in Endometriosis: Improving Knowledge for Development of New Pharmacological Strategies. International Journal of Molecular Sciences. 2021;22(16):9033. Available from: https://www.mdpi.com/1422-0067/22/16/9033/htm
Donnez J, Cacciottola L. Endometriosis: An Inflammatory Disease That Requires New Therapeutic Options. International Journal of Molecular Sciences. 2022;28;23(3):1518. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836207/#B8-ijms-23-01518
Endometriosis. www.who.int. [Internet] Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis
Nirgianakis, K., et al. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reproductive Sciences. 2021;29(1). Available from: https://doi.org/10.1007/s43032-020-00418-w.
Barnard ND, Holtz DN, Schmidt N, et al. Nutrition in the prevention and treatment of endometriosis: A review. Frontiers in Nutrition. 2023;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983692/
Pahwa R, Goyal A, Jialal I. Chronic Inflammation. PubMed. Treasure Island (FL): StatPearls Publishing. 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
Machairiotis N, Vasilakaki S, Thomakos N. Inflammatory Mediators and Pain in Endometriosis: A Systematic Review. Biomedicines. 2021;9(1):54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826862/
Nap, A., et al. Endometriosis and the effects of dietary interventions: what are we looking for? Reproduction and Fertility. 2022;3(2):C14–22. Available from: https://doi.org/10.1530/raf-21-0110.
Huijs E, Nap A. The effects of nutrients on symptoms in women with endometriosis: a systematic review. Reproductive BioMedicine Online. 2020;41(2). Available from: https://pubmed.ncbi.nlm.nih.gov/32600946/
Arulselvan, P., et al. Role of Antioxidants and Natural Products in Inflammation. Oxidative Medicine and Cellular Longevity. 2016;1–15. Available from: https://doi.org/10.1155/2016/5276130.
Scheiber A, Mank V. Anti-Inflammatory Diets. PubMed. Treasure Island (FL): StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK597377/
Brouns F, Van Haaps A, et al. Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Frontiers in Nutrition. 2023;10:1166929. Available from: https://pubmed.ncbi.nlm.nih.gov/37731404/
Costabile, G., et al. An Oily Fish Diet Improves Subclinical Inflammation in People at High Cardiovascular Risk: A Randomized Controlled Study. Molecules. 2021;26(11):3369. Available from: https://doi.org/10.3390/molecules26113369.
Hewlings, S., et al. Curcumin: A Review of Its Effects on Human Health. Foods. 2017;6(10):92. Available from: https://doi.org/10.3390/foods6100092.
Peng Y, Ao M, Dong B, et al. Anti-Inflammatory Effects of Curcumin in the Inflammatory Diseases: Status, Limitations and Countermeasures. Drug Design, Development and Therapy. 2021;15:4503–25. Available from: https://www.dovepress.com/anti-inflammatory-effects-of-curcumin-in-the-inflammatory-diseases-sta-peer-reviewed-fulltext-article-DDDT
Mashhadi, NS., et al. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence. International Journal of Preventive Medicine. 2013;4(Suppl 1):S36-42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665023/.
Tan B, et al. Recent Studies on Protective Effects of Walnuts against Neuroinflammation. Nutrients. 2022;14(20):4360. Available from: https://doi.org/10.3390/nu14204360.
Parikh M, Maddaford TG, Austria JA, et al. Dietary Flaxseed as a Strategy for Improving Human Health. Nutrients. 2019;11(5):1171. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567199/
Wiertsema, SP., et al. The Interplay between the Gut Microbiome and the Immune System in the Context of Infectious Diseases throughout Life and the Role of Nutrition in Optimizing Treatment Strategies. Nutrients. 2021;13(3):886. Available from: https://doi.org/10.3390/nu13030886.
Baker, JM., et al. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45–53. Available from: https://doi.org/10.1016/j.maturitas.2017.06.025.
Qin, R., Tian, G., Liu, J., & Cao, L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Frontiers in Cellular and Infection Microbiology. 2022:12, 1069557. https://doi.org/10.3389/fcimb.2022.1069557
Chantalat E, Valera MC, et al. Estrogen Receptors and Endometriosis. International Journal of Molecular Sciences. 2020;21(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215544/
Marquardt RM, Kim TH, Shin JH, Jeong JW. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? International Journal of Molecular Sciences. 2019;20(15):3822. Available from: https://www.mdpi.com/1422-0067/20/15/3822
Cronin, P., et al. Dietary Fibre Modulates the Gut Microbiota. Nutrients. 2021;13(5):1655. Available from: https://doi.org/10.3390/nu13051655.
Shivakoti R, Biggs ML, et al. Intake and Sources of Dietary Fiber, Inflammation, and Cardiovascular Disease in Older US Adults. JAMA Network Open. 2022;5(3):e225012–2. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790576
NHS. How to get more fibre into your diet [Internet]. [Cited 2024 March 24] 2022. Available from: https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/
Pathan S, Siddiqui RA. Nutritional Composition and Bioactive Components in Quinoa (Chenopodium quinoa Willd.) Greens: A Review. Nutrients. 2022 Jan 27;14(3):558. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840215/
Marquardt, RM., et al. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis?. International Journal of Molecular Sciences. 2019;20(15):3822. Available from: https://doi.org/10.3390/ijms20153822.
Cable JK, Grider MH. Physiology, Progesterone. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/
Rafiee, M., Naseri, M., Akbari-Fakhrabadi, M., et al. Vitamin D3 induces the expression of membrane progesterone receptors (mPRs) on naive CD4+ T lymphocyte cells in women of reproductive age. International Immunopharmacology. 2019;72, 55-61. Available from: https://doi.org/10.1016/j.intimp.2019.03.053
Yang M, Shen X, Lu D, Peng J, Zhou S, Xu L, et al. Effects of vitamin D supplementation on ovulation and pregnancy in women with polycystic ovary syndrome: a systematic review and meta-analysis. Frontiers in Endocrinology. 2023;14:1148556. Available from: https://pubmed.ncbi.nlm.nih.gov/37593349/
Várbíró S, Takács I, Tűű L, Nas K, Sziva RE, Hetthéssy JR, et al. Effects of Vitamin D on Fertility, Pregnancy and Polycystic Ovary Syndrome-A Review. Nutrients. 2022 Apr 15;14(8):1649. Available from: https://pubmed.ncbi.nlm.nih.gov/35458211/
NHS. Vitamin D - Vitamins and Minerals [Internet]. [Cited 2024 Feb 11]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/.
National Institutes of Health. Vitamin D [Internet]. Nih.gov. 2023. Available from: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Letters. 2005;227(2):115–24. Available from: https://www.sciencedirect.com/science/article/pii/S030438350400802X
Palmisano BT, Zhu L, Stafford JM. Estrogens in the Regulation of Liver Lipid Metabolism. Advances in experimental medicine and biology. 2017;1043:227–56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763482/
Bryzgalova G, Gao H, et al. Evidence that oestrogen receptor-α plays an important role in the regulation of glucose homeostasis in mice: insulin sensitivity in the liver. Diabetologia. 2006 Feb 4;49(3):588–97. Available from: https://link.springer.com/article/10.1007/s00125-005-0105-3
Ezhilarasan D. Critical role of estrogen in the progression of chronic liver diseases. Hepatobiliary & Pancreatic Diseases International. 2020 Oct;19(5):429–34. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1499387220300722?via%3Dihub
Secosan, C., et al. Endometriosis in Menopause—Renewed Attention on a Controversial Disease. Diagnostics. 2020 Feb 29;10(3):134. Available from: https://doi.org/10.3390/diagnostics10030134.
Chantalat E, Valera MC, Vaysse C, Noirrit E, Rusidze M, Weyl A, et al. Estrogen Receptors and Endometriosis. International Journal of Molecular Sciences. 2020 Apr 17;21(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215544/
Bulun SE, Monsavais D, et al. Role of Estrogen Receptor-β in Endometriosis. Nature medicine. 2012 Jul 6;18(7):1016–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077338/
Parazzini F, Cipriani S, Bravi F, et al. A metaanalysis on alcohol consumption and risk of endometriosis. American Journal of Obstetrics and Gynecology. 2013;209(2):106.e1–10. Available from: https://www.ajog.org/article/S0002-9378(13)00528-0/abstract
Bishehsari, F., et al. ‘Alcohol and Gut-Derived Inflammation.’ Alcohol research: Current Reviews. 2017;38(2):163–71. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513683/
Li, H-Y., et al. Plant-Based Foods and Their Bioactive Compounds on Fatty Liver Disease: Effects, Mechanisms, and Clinical Application. Oxidative Medicine and Cellular Longevity. 2021;2021:1–23. Available from: https://doi.org/10.1155/2021/662164.
Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B. Gastrointestinal symptoms among endometriosis patients—A case-cohort study. BMC Women’s Health. 2015 Aug 13;15(1). Available from: https://dx.doi.org/10.1186%2Fs12905-015-0213-2
Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2021 Aug 10;71(6):gutjnl-2021-325214. Available from: https://gut.bmj.com/content/71/6/1117.long
Nabi, MY., et al. ‘Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses.’ Frontiers in Medicine. 2022;9. Available from: https://doi.org/10.3389/fmed.2022.914356.
Barrett, J., ‘How to institute the low-FODMAP diet.’ Journal of Gastroenterology and Hepatology. 2017;32(S1):8–10. Available from: https://doi.org/10.1111/jgh.13686.