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

Laura Harcourt

Written byLaura Harcourt

Dr Tania Adib

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.
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

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 properties21,22
  • 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 response24,25 
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.26 So, 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

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.36 Eating 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.37 So, 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.41 However, 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
  • 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.44,46 As 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.15,54 This 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:

  • 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, we recommend reading the ’4-week endometriosis diet plan’ by Katie Edmonds or taking 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.

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