The role of nutrition in endometriosis

Endometriosis is a chronic, hormone-related, and inflammatory disease that affects approximately 10 per cent of the female population [1]. Growing research indicates that nutrition may be involved in both the development and severity of endometriosis. Medical treatment practices for endometriosis are limited, and understanding the role that nutrition plays may provide additional therapeutic strategies.

Learn more about this topic in the HealthCert Professional Diploma program in Medical Nutrition Management – online nutrition training for GPs.

Endometriosis is characterised by endometrial-like tissue which grows outside of the uterus, typically on the external surface of the uterus, the ovaries, fallopian tubes, or abdominal wall.

Endometriosis can significantly affect quality of life and cause a range of symptoms, such as painful periods, fatigue, and bowel or bladder problems.

Omega-3 fatty acids

Dietary fats appear to be a modulating factor for endometriosis. There is some evidence to suggest that high intake of omega-3s can help to reduce pain [2], and that supplementation with omega-3 may help to decrease inflammatory factors and reduce the growth of endometrial implants [3].

One study following 70 709 premenopausal women also found that women consuming more omega-3 fatty acids were less likely to be diagnosed with endometriosis, but more research is needed [4]. Omega-3s can be found in fatty fish, extra virgin olive oil, avocado, nuts, and seeds.

High fibre intake

Since oestrogen is involved in the pathogenesis of endometriosis, nutrition that modulates oestrogen activity may also be important. Research has shown that reducing dietary fats and increasing dietary fibre has been found to reduce circulating oestrogen by 10-25 per cent [5,6]. Including plenty of whole grains, vegetables, fruits, nuts, and seeds to achieve a high fibre intake (>25g/day) may help reduce the reabsorption of oestrogen and reduce circulating oestrogen levels.

Limiting red meat

The Nurses’ Health Study II demonstrated that there was a 56 per cent increased risk of developing endometriosis among women who consumed more than two servings of red meat per day, compared to those who had one serving per week [7]. Red meat may promote inflammatory markers and contribute to endometriosis pathogenesis [8].

Vitamin D supplementation

One clinical trial found that patients with endometriosis and dysmenorrhea experienced reduced pain when treated with vitamin D supplementation [9].

A 2020 review found that low levels of vitamin D were associated with increased symptom severity and increased risk of diagnosis [10]. While more research is needed, vitamin D supplementation may be helpful in reducing symptom severity.

N-acetylcysteine supplementation

There is research to support the use of N-acetylcysteine supplementation to reduce inflammation and alleviate endometriosis [11]. Foods rich in N-acetylcysteine include onions, garlic, and wheat germ, and interestingly, these foods have been found to control oxidative stress in endometriotic cells [12].

Plant-based diets

Vegetables and fruits are rich in bioactive plant compounds, including polyphenols, which have numerous positive health effects [13]. Emerging research has found that low fat plant-based diets may help to reduce inflammation and reduce both severity and duration of pain while modulating premenstrual symptoms [13,14].

Dietary patterns which emphasis anti-inflammatory foods and are rich in fibre, omega-3s, and limit red meat, such as the Mediterranean Diet, may be helpful in both the prevention and management of endometriosis.

Knowledge of nutritional management for endometriosis can equip General Practitioners with strategies beyond hormone therapies and medications to help empower patients with inexpensive and readily available strategies that may reduce the severity and duration of symptoms associated with endometriosis and help improve quality of life.

Learn more with the online HealthCert Professional Diploma program in Medical Nutrition Management.

– Sarah Marko, Accredited Practising Dietitian

Read another blog: Medical nutrition therapy for menopause

References

[1] Piecuch M, Garbicz J, Waliczek M, Malinowska-Borowska J, Rozentryt P. I Am the 1 in 10-What Should I Eat? A Research Review of Nutrition in Endometriosis. Nutrients. 2022 Dec 11;14(24):5283. doi: 10.3390/nu14245283. PMID: 36558442; PMCID: PMC9783589.

[2] Helbig M, Vesper AS, Beyer I, Fehm T. Does Nutrition Affect Endometriosis? Geburtshilfe Frauenheilkd. 2021 Feb;81(2):191-199. doi: 10.1055/a-1207-0557. Epub 2021 Feb 8. PMID: 33574623; PMCID: PMC7870287.

[3] Khanaki K, Nouri M, Ardekani AM, Ghassemzadeh A, Shahnazi V, Sadeghi MR, Darabi M, Mehdizadeh A, Dolatkhah H, Saremi A, Imani AR, Rahimipour A. Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids. Iran Biomed J. 2012;16(1):38-43. doi: 10.6091/ibj.1025.2012. PMID: 22562031; PMCID: PMC3614254.

[4] Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010 Jun;25(6):1528-35. doi: 10.1093/humrep/deq044. Epub 2010 Mar 23. PMID: 20332166; PMCID: PMC2873173.

[5] Rose DP, Goldman M, Connolly JM, Strong LE. High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr. 1991 Sep;54(3):520-5. doi: 10.1093/ajcn/54.3.520. PMID: 1652197.

[6] Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P. Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2017 Jul-Aug;24(5):747-756. doi: 10.1016/j.jmig.2017.04.008. Epub 2017 Apr 26. PMID: 28456617.

[7] Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol. 2018 Aug;219(2):178.e1-178.e10. doi: 10.1016/j.ajog.2018.05.034. Epub 2018 Jun 2. PMID: 29870739; PMCID: PMC6066416.

[8] Osmanlıoğlu Ş, Sanlier N. The relationship between endometriosis and diet. Hum Fertil (Camb). 2021 Oct 27:1-16. doi: 10.1080/14647273.2021.1995900. Epub ahead of print. PMID: 34706611.

[9] Lasco A, Catalano A, Benvenga S. Improvement of primary dysmenorrhea caused by a single oral dose of vitamin D: results of a randomized, double-blind, placebo-controlled study. Arch Intern Med. 2012 Feb 27;172(4):366-7. doi: 10.1001/archinternmed.2011.715. PMID: 22371927.

[10] Qiu Y, Yuan S, Wang H. Vitamin D status in endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2020 Jul;302(1):141-152. doi: 10.1007/s00404-020-05576-5. Epub 2020 May 19. PMID: 32430755.

[11] Porpora MG, Brunelli R, Costa G, Imperiale L, Krasnowska EK, Lundeberg T, Nofroni I, Piccioni MG, Pittaluga E, Ticino A, Parasassi T. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evid Based Complement Alternat Med. 2013;2013:240702. doi: 10.1155/2013/240702. Epub 2013 May 7. PMID: 23737821; PMCID: PMC3662115.

[12] Ngô C, Chéreau C, Nicco C, Weill B, Chapron C, Batteux F. Reactive oxygen species controls endometriosis progression. Am J Pathol. 2009 Jul;175(1):225-34. doi: 10.2353/ajpath.2009.080804. Epub 2009 Jun 4. PMID: 19498006; PMCID: PMC2708809.

[13] Barnard ND, Holtz DN, Schmidt N, Kolipaka S, Hata E, Sutton M, Znayenko-Miller T, Hazen ND, Cobb C, Kahleova H. Nutrition in the prevention and treatment of endometriosis: A review. Front Nutr. 2023 Feb 17;10:1089891. doi: 10.3389/fnut.2023.1089891. PMID: 36875844; PMCID: PMC9983692.

[14] Ciebiera M, Esfandyari S, Siblini H, Prince L, Elkafas H, Wojtyła C, Al-Hendy A, Ali M. Nutrition in Gynecological Diseases: Current Perspectives. Nutrients. 2021 Apr 2;13(4):1178. doi: 10.3390/nu13041178. PMID: 33918317; PMCID: PMC8065992.