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Endometriosis Dietary Management & Connection with Gut Health

What is Endometriosis?

Endometriosis or “Endo”, is a progressive and hormone-dependent inflammatory condition that affects the female reproductive system. It occurs when
tissue similar to the endometrial lining implants and grows on the ovaries, bowel, and other tissues lining the peritoneal cavity. As hormone levels change during the menstrual cycle, this misplaced endometrial tissue may then become inflamed, which over time, may lead to infertility, irritable bowel symptoms, heavy periods, and chronic pain, all of which can impact one’s physical and mental health or capacity to work and study. However, early detection and treatment strategies can help manage the condition.

Did you know…

It is estimated that 1 in 10 women have endometriosis

3 in 4 women experience debilitating symptoms

The average time between the onset of symptoms and diagnosis is 4-11 years

Myovant Sciences - Focus Area, Endometriosis


Nutritional Management of Endometriosis

Management of endometriosis should include dietary and lifestyle advice from a qualified health professional. Following certain dietary and lifestyle principles
can help to relieve symptoms related to the condition as well as improve overall health. Recommendations provided should be tailored to each individual, however, evidence-based recommendations for the dietary management of endometriosis include the following strategies.


1. Eating a balanced diet that includes anti-inflammatory foods

This may be considered a Mediterranean style of eating, which is renowned for its abundance of anti-inflammatory compounds. Foods recommended in this nutrition strategy include:

  • A variety of fresh fruits and vegetables
  • Wholegrains
  • Nuts and seeds
  • Extra Virgin Olive Oil (EVOO)
  • Quality proteins – including at least one serve at every meal e.g. White or oily fish, poultry, eggs, legumes, red meats (in small/moderate amounts)

Mediterranean diet 7-day meal plan

2. Include foods that promote a healthy gut microbiome

In recent years, the connection between the gut microbiome and endometriosis has become evident. By maintaining a healthy gut microbiome and consuming a variety of prebiotics, probiotics and dietary fibres, we can help our body to maintain a healthy hormonal balance. This works as beneficial bacteria help to break down excess estrogen in the gut, of which can then bind to dietary fibre, to be removed from the body via stools. Clearing excess estrogen helps with the management of endometriosis.

  • Probiotics foods e.g. Fermented foods – including yoghurt, kimchi, kefir, and miso paste
  • Prebiotic rich foods e.g. Oats, kiwi fruit, broccoli florets, cooked & cooled brown rice – other fibre rich prebiotics include artichokes, asparagus, onions, garlic, bananas and apples, however, they may not be suitable if your symptoms also reflect those of IBS – speak with your dietitian if any of these foods exacerbate your symptoms.
  • Prebiotic supplements e.g. psyllium husk, PHGG (partially hydrolysed guar gum)
  • Dietary fibres e.g. wholegrains, fruit and vegetables with the skin on, leafy greens, legumes, nuts and seeds.

Also include plenty of water into your day, to maintain good hydration & support your gut health.

3. Certain supplements may help to reduce the inflammation associated with endometriosis

Certain compounds in a supplementary form may downplay the hormonal or inflammatory responses in the body, and thus reduce the symptoms of
endometriosis. These can be trialled for their efficacy in the individual, and their use reviewed monthly. Such anti-inflammatory supplements may include:

    • Vitamin D
    • Fish Oil or Algae Oil
    • Resveratrol
    • Turmeric + Piperine
    • Magnesium Malate
    • Vitamin C
    • B Vitamins
    • Copper & Zinc


The Top 7 Vitamin and Supplement Trends of 2021


4. Moderate intake of foods that may trigger the inflammation associated with endometriosis

Some foods may heighten the hormonal or inflammatory responses in the body, and thus trigger symptoms of endometriosis. A moderate intake of these foods can assist with management, with appropriate swaps and personalized recommendations for portions are essential when minimizing the intake of certain foods.

  • Gluten – if coeliac, replace gluten-containing foods with high fibre alternatives like quinoa and brown rice.
  • Lactose – if lactose sensitive, choose lactose-free alternatives, hard cheeses and yoghurt (these are naturally lower in lactose), A2 milk or calcium-fortified plant-based milks, to ensure you don’t miss out on key nutrients.
  • Red meat – as recommended for general wellbeing and for endometriosis management, aim for 2-3 serves of red meat/week
  • Caffeine – limiting to 200mg/day, which is equivalent to 2-3 cups of coffee per/day
  • Ultra-processed foods – excessive consumption of these foods can lead to overproduction of estrogen, which is not supportive of endometriosis management.

5. Lifestyle factors to consider

The inclusion of certain lifestyle practices can help with the continual management of endometriosis. This includes regular sessions of:

  • Physical activity (both planned and incidental activity)
  • Stress-relieving activities e.g. Yoga, meditation, breathing exercises
    Multimodal counseling e.g. OBGYN, GP, Dietitian, Psychologist

594,490 Yoga Stock Photos, Pictures & Royalty-Free Images - iStock

With endometriosis, lifestyle-related factors may also impact the prevalence of symptoms, and therefore should be implemented alongside dietary interventions. Such recommendations include limiting:

  • Tobacco smoke
  • Alcohol
  • Exposure to plastics, pesticides and chemicals which may contain hormone disrupters e.g. Bisphenol A (BPA), which can leach from plastic containers into food and drinks when heated – always look for BPA free plastic or alternatives such as glass or steel containers

6. Endometriosis & other health conditions

Women with endometriosis may also experience gut health issues including Coeliac disease and Irritable Bowel Syndrome (IBS), both of which may also be a factor contributing to the chronic pain that is experienced. If either has been diagnosed in conjunction with endometriosis, the best course of action would be to advise your dietitian of this condition, so they can suggest a nutrition plan that is best suited to your needs. The dietitians here at All Bodies Nutrition specialize in providing nutrition advice that can help manage the symptoms of such conditions, such as a gluten-free diet for coeliac disease or a low FODMAP diet for IBS management.

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