Endometriosis is a chronic, inflammatory condition affecting around 10% of all women. It is characterised by a range of symptoms including:
● Painful periods, often heavy
● Pain during intercourse
● Pain when passing bowel movements or urine, especially around our periods
● Fatigue and tiredness
● Gut symptoms, especially bloating, known as endo belly. Plus constipation and diarrhoea
● Back pain, pelvic pain, and pain radiating down the legs
● Difficulty getting pregnant - around 30-50% of people with endometriosis experience infertility (1)
Endometriosis is a complicated condition which means we don’t have all the information to prescribe a specific diet. This is where the internet comes in: There’s a huge amount of misinformation. This is understandable; when faced with a condition that takes on average 7.5 years in the UK to be diagnosed (2), it makes sense that people are taking advice about what to eat and what not to eat from strangers on the internet. So, if you are someone who has followed any dietary advice covered here, know this is not a blame game, but a helpful guide for you to know what the science says.
The top 4 endometriosis diet myths
Here I am going to cover the top 4 online information sources I see and hear about endometriosis dietary management.
Myth No 1: Cut out dairy!
The premise of this is based on the really common myth that dairy promotes inflammation - which we have a body of research that suggests is not the case. In fact, dairy products like milk and yoghurt are thought to be anti-inflammatory (3,4). Dairy is a nutrition-packed food that shouldn't be feared.
My advice: If you’re not lactose intolerant (diagnosed by your GP), aim to eat 2-3 servings of dairy products every day. If you try to limit dairy intake for environmental or ethical reasons, opt for 2-3 portions of fortified plant options (5).
Myth No 2: Stop eating gluten, and follow a low fodmap diet!
Gluten is another food that’s on the no-no list for endometriosis. If you have Coeliac disease (diagnosed by your GP) then definitely do avoid gluten. However, if you have cut out gluten because you’ve been told it will solve gut problems like bloating, this isn’t necessarily true. When people cut out gluten or foods in general, we often find gut health symptoms can get even worse (6).
As for the low fodmap diet, for some people this might be beneficial - but not as a long-term thing. The low fodmap diet has been made into a dietary trend when actually it’s a short-term approach that needs to be supervised with a low fodmap specialist. If you have suffered from any sort of poor relationship to food, this can trigger those feelings of food preoccupation etc again. A low fodmap approach is the last line approach to managing IBS-like symptoms, so get in touch if you would like to explore all the ways I can help you manage them without restrictions.
Myth No 3: Never eat processed foods or saturated fats again!
Let’s start with the fact that all food is “processed” to some degree, whether that’s chopping tomatoes or milling wheat into flour.
Now, if you’re talking about the nutrition of blueberries versus spicy Doritos, yes the former is more nutritionally dense, but that doesn’t mean the latter should be completely avoided. In the context of endometriosis, if your diet is made up of only “fun foods”, then you might find your symptoms less easy to handle. But, if that’s what you have access to and all you can make, that’s ok too. It’s all about balance over time, not getting every day perfect.
My advice: Stop looking at what you can remove, and instead, what you can add-in. Alongside your breakfast sandwich made from sausage and egg, could you add some berries, an orange, or some spinach?
Myth No 4: Cut out soya products
Soya products have a bad reputation in endometriosis circles because of the thought that phytoestrogens (plant estrogens) increase inflammation, but actually, there’s evidence that these phytoestrogens are anti-inflammatory (7, 8).
My advice: Don’t cut out soya foods - they’re great sources of protein, vitamins, minerals, and seem to be beneficial for endometriosis, up to 4 portions per day which are considered the safe upper limit. Soya products include tofu, soya milk, tempeh, and soya mince.
My top 4 tips for managing endometriosis symptoms
Like I keep saying, we don’t have heaps of evidence into endometriosis and dietary management, but we do know that it’s an inflammatory condition and a dietary pattern similar to a Meditteranean diet is likely beneficial (8).
Top Tip No 1: Add in fibre
Fibre plays a big role in general health and is especially great for managing the IBS-like symptoms that sufferers of endometriosis often have. Foods high in fibre tend to have great overall nutrient profiles - fruits, vegetables, whole grains, beans, lentils, nuts, and seeds are examples of high fibre foods. Try adding in an extra portion of some of these foods into your normal meals, like adding lentils to pasta dishes.
Top Tip No 2: Try to eat more oily fish
Omega 3 fatty acids are found in oily fish so try to eat at least one portion (120g) per week. If you don’t want to eat fish, adding foods like tofu, chia seeds, flaxseeds, or walnuts every day can also add beneficial omega 3s to your diet.
Top Tip No 3: Opt for extra virgin olive oil and other healthy fats
We have evidence that extra virgin olive oil may help with pain management of endometriosis, such as pelvic pain, pain during periods, and pain during intercourse (9), so try to add in a portion (1 tablespoon) per day on salads, dipped in bread, or drizzled on top of risottos etc. Adding in other healthy fats like nuts, seeds, and avocado will be beneficial for the anti-inflammatory properties too.
Top Tip No 4: Eat more vegetables, especially dark leafy greens, bananas, nuts, and whole grains for magnesium
There is an association with PMS symptoms like fatigue, anxiety, and pain leading up to and during periods in people with low intakes of magnesium plus there is a link with magnesium deficiency and infertility (8). Therefore a recommendation can be made to include magnesium-rich foods in your diet, which are also founds that have anti-inflammatory properties, and tend to be good sources of fibre too. Magnesium-rich foods include leafy greens, pumpkin and sunflower seeds, beans, lentils, dark chocolate, wholemeal bread, wholegrains.
Some other points:
● Nutrition can play a role in helping manage the severity of some symptoms, but food cannot reverse endometriosis.
● Other treatment methods should be taken alongside changes to the diet.
● Endometriosis impacts the immune system, and food can play a role in immune function.
● Cutting out foods or food groups will not be beneficial for long-term health.
If you would like to explore ways to help navigate endometriosis, without restrictions and dieting, reach out to Shannon, a weight-inclusive nutritionist, on her profile to book an appointment.
Bulletti, C., Coccia, M.E., Battistoni, S., Borini, A. (2010) Endometriosis and infertility. J Assist Reprod Genet 27(8): 441-447.
Endometriosis UK: Diagnosis length in the UK. https://www.endometriosis-uk.org/news/it-takes-average-75-years-get-diagnosis-endometriosis-it-shouldnt-37491 [Accessed: 18/03/2021.]
Bordoni, A., Danesi, F., Dardevet, D. (2017) Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr 13(57): 2497-2525.
Ulven, S., Holven, K.B., Gil, A. (2019) Milk and dairy product consumption and inflammatory biomarkers: An updated systematic review of randomized clinical trials. Acv Nutr 1(1): 239-250.
British Dietetics Association - BDA. Dairy benefits, resource library. [Accessed 18/03/2021].
Niland, B., Cash, B. (2018) Health benefits and adverse effects of a gluten-free diet in non-coeliac disease patients. Gasteoenterol Heptaology 14(2): 82-91.
Youseflu, S., Sadatmahalleh, S.J., Mottaghi, A., Kazemnejad, A. (2020) Dietary phytoestrogen intake and the risk of endometriosis in Iranian women: A case-control study. Int J Fertil Steril 13(4): 296-300.
Soave, I., Acchiali, T., W, J.M., Pluchino, N., Caserta, D., Marci. R. (2018) Endometriosis and food habits: Can diet make the difference? JEPPD 10(2); 59-71.
Abokhrais, I.M., et al. (2018) A pilot RCT of the efficacy of purified fatty acids for the treatment of women with endometriosis-associated pain. Pilot Feasibility Stud 4(1): 83.