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

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.

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

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.

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

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.

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

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

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

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

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.

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.