Nutrition Therapy for Endometriosis

Someone asked me the other day if I could help them with their diet in order to alleviate some of their symptoms from endometriosis, and I thought this was an excellent topic to write about since it is a condition that affects so many women around the world!

If you do not know what endometriosis is, it is a condition in which uterine tissue (called the endometrium) grows outside of the uterus, and it affects approximately 1 in 10 women and girls of reproductive age (1). Women living with endometriosis may experience severe abdominal pain and cramping, or they may not experience any symptoms at all (2)! Sadly, this condition can also lead to infertility if not properly treated (1,2). Below are just some of the symptoms that are linked to endometriosis (2):

• Pelvic, abdominal, or low back pain (often worsened during menstrual periods)

• Heavy and painful periods

• Pain during or after sexual intercourse

• Infertility

• Bloating

• Constipation or diarrhea

Let me start off by saying that if you suffer from endometriosis, please consult your primary care provider or gynecologist for the best course of action regarding your treatment. While nutrition can be a part of the treatment process, many women also require surgical or pharmaceutical interventions as well.

Now with that being said, let's talk about nutrition...

Nutrition and Endometriosis:

Lifestyle and dietary choices can affect your chances for developing a variety of health conditions, and endometriosis is no exception. Most of the studies done on nutrition and endometriosis agree that foods that promote inflammation can increase women's risk for developing endometriosis. Thankfully, there are also foods that have been shown to have protective benefits or that may relieve some of the symptoms of endometriosis.

Foods that Increase Risk for Endometriosis:

Trans fats: Trans fats are a type of fat that are typically synthetically produced in order to increase the shelf life of various food products and are directly associated with increased risk of endometriosis (3,4) as well as many other health conditions. The current recommendations are to have as little trans fats in your diet as possible (5). Foods that contain trans fats include products such as margarine, shortening, and processed foods.

Red Meats: There is evidence to suggest that increased consumption of animal fat is associated with increased risk of endometriosis (3). Two studies found that increased consumption of red meat in particular was associated with greater risk for developing endometriosis (6,7). What does this mean in terms of food choices? It may be best to purchase animal proteins that are lower in fat (aka leaner cuts of red meat, poultry without the skin, low fat or fat free dairy, etc) to reduce intake of saturated animal fat.

Gluten: One study found that 75% of women with endometriosis who followed a gluten free diet for 1 year had significantly reduced pelvic pain (8).

Foods that Decrease Risk for Endometriosis:

Fruits and Vegetables: Studies have shown that fruit and vegetable consumption is protective against the development of endometriosis (6,9). Fruits and vegetables contain two types of nutrients that have been associated with reducing the risk for endometriosis – fiber and antioxidants. Fiber is a type of carbohydrate that is resistant to digestion and has been shown to reduce estrogen levels in the body. This is important because growth of uterine tissue is largely dependent on estrogen concentrations (10).

Another study found that citrus fruits were especially protective against the development of endometriosis, and women who consumed at least one serving of citrus fruit a day had a 22% lower risk for endometriosis compared to those who had less than one serving per week (9). The benefits of citrus fruit are believed to be due to beta-cryptoxanthin, an antioxidant found in tropical fruits such as oranges, grapefruit, papaya, and more (9). Another study found that vitamins C and E, two antioxidants found in fruits and vegetables, were associated with reduced pelvic pain in women with endometriosis (11). Other antioxidants such as epigallocatechin gallate, which is found in green tea, have also been associated with protective effects against endometriosis (12).

Omega-3 Fatty Acids: One study showed that consumption of omega-3 fats is associated with reduced risk of endometriosis (3,4). Sources of these healthy fats include fatty fish such as salmon and herring as well as walnuts, chia and flax seeds, and algae just to name a few. Another study found that fish oil was associated with reduced abdominal pain during menstruation (13).

Dairy and Vitamin D: One study showed that intake of low-fat dairy as well as increased levels of plasma 25-hydroxy vitamin D (a marker used to assess vitamin D status) was associated with reduced risk for endometriosis (14). Calcium and vitamin D intake were also associated with reduced risk for endometriosis (14).

Putting it all Together:

So what kind of foods should you be having if you are struggling with endometriosis? The research shows that it is best to have a “plant-focused” diet (aka lots of fruits and vegetables) with moderate intake of low-fat meats. In terms of protein, it is best to stick with options that provide beneficial nutrients like omega-3 fatty acids, calcium, and vitamin D such as fatty fish, nuts and seeds, and low-fat or fat free dairy. Lean, white meats such as poultry are also great options for protein.

I hope this article helps answer some of your questions regarding how to deal with endometriosis. Please remember to also consult your doctor to determine if further medical interventions are warranted if you or a loved one is struggling with endometriosis.

Resources:

1. Endometriosis. Accessed June 22, 2021. https://www.who.int/news-room/fact-sheets/detail/endometriosis

2. Endometriosis - Symptoms and causes. Mayo Clinic. Accessed June 22, 2021. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

3. Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25(6):1528-1535. doi:10.1093/humrep/deq044

4. Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2013;169(2):162-171. doi:10.1016/j.ejogrb.2013.03.028

5. 2015-2020 Dietary Guidelines | health.gov. Accessed June 23, 2021. https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015

6. Parazzini F, Chiaffarino F, Surace M, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755-1759. doi:10.1093/humrep/deh395

7. Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. American Journal of Obstetrics & Gynecology. 2018;219(2):178.e1-178.e10. doi:10.1016/j.ajog.2018.05.034

8. Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012;67(6):499-504.

9. Harris HR, Eke AC, Chavarro JE, Missmer SA. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod. 2018;33(4):715-727. doi:10.1093/humrep/dey014

10. Endometriosis | Nutrition Guide for Clinicians. Accessed June 23, 2021. https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342065/all/Endometriosis?refer=true

11. Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational Research. 2013;161(3):189-195. doi:10.1016/j.trsl.2012.05.001

12. Laschke MW, Schwender C, Scheuer C, Vollmar B, Menger MD. Epigallocatechin-3-gallate inhibits estrogen-induced activation of endometrial cells in vitro and causes regression of endometriotic lesions in vivo. Hum Reprod. 2008;23(10):2308-2318. doi:10.1093/humrep/den245

13. Zafari M, Behmanesh F, Agha Mohammadi A. Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian J Intern Med. 2011;2(3):279-282.

14. Harris HR, Chavarro JE, Malspeis S, Willett WC, Missmer SA. Dairy-Food, Calcium, Magnesium, and Vitamin D Intake and Endometriosis: A Prospective Cohort Study. American Journal of Epidemiology. 2013;177(5):420-430. doi:10.1093/aje/kws247