The Best Diet for Endometriosis

Endometriosis is a complicated inflammatory, estrogen-related disorder (read more about what exactly endometriosis is). The short story? It’s a condition where endometrial tissue is in the pelvis (outside of the uterus where it should be). It causes quite a bit of pain and affects about 10 percent of those with a uterus. Managing endometriosis is complex, but supplements and lifestyle changes—like adjusting your diet—can help.

How does a change in diet help manage endometriosis?

Your immune system is supposed to catch abnormal cell growth; in endometriosis, it doesn’t. The lesions themselves can increase inflammation and damage and put literal pressure on surrounding structures. And then there are genetic and hormonal components: having too much estrogen can make endometriosis worse, while the lesions themselves are a source of estrogens, allowing the disorder to progress. 

How well specific enzymes in the liver and the gut function plays a role in affecting estrogen levels. Both your diet and gut microbiome (the composition of bacteria in your intestines) affect your immune function and estrogen regulation, which makes diet a significant part in the management of endometriosis. That doesn’t mean that dietary changes will “cure” endometriosis, but they can help slow the progression of the disorder while decreasing pain. 

The main goals of an endometriosis-friendly diet are to:

• Reduce inflammation
• Decrease excess estrogen
• Support your immune function with a healthy gut microbiome

Dietary modifications to help manage endometriosis:

Fiber is your friend

Dietary fiber plays three major roles in endometriosis: It can help bind up excess estrogen, it promotes regular bowel movements and it keeps your microbiome happy. This is important because your gut microbiome influences immune reactions and inflammation.

Ensure adequate dietary fibre while decreasing your intake of simple carbohydrates and processed sugars. High-fibre foods include fruit, vegetables (especially green leafy vegetables), chia seeds, flaxseeds, beans, legumes and nuts. Aim for at least 25 grams of fibre each day.

Foods to include:

• Organic fruits and vegetables: Fruits and vegetables provide fibre and nutrients to support immune function and detoxification. Apples are a great choice since they are a high-fiber fruit (about five to six grams per apple) and contain calcium d-glucarate, a compound that supports healthy estrogen detoxification. Choose organic produce to minimize intake of pesticides that disrupt hormone metabolism.
  
  
• Brassica vegetables: Vegetables in the brassica family contain compounds such as indole-3-carbinol (I3C), 3,3’-diindolymethane (DIM),and calcium d-glucarate which help promote proper estrogen metabolism and detoxification in addition to having anti-cancer and anti-tumor effects. These include arugula, Brussels sprouts, broccoli, cauliflower, bok choy, mustard greens, cabbage, collard greens, turnips and rutabagas.
  
  
• Flaxseeds: Ground flaxseeds are beneficial for endometriosis since they contain omega-3 fatty acids, while their lignan content helps modulate estrogen levels by blocking excess estrogen signalling. These lignans also have antioxidant properties and promote the production of safer (less toxic/carcinogenic) estrogen metabolites.

Keep it anti-inflammatory

There’s a lot of inflammation happening in endometriosis—it allows those endometriomas to grow and infiltrate the body. Those lesions can be sneaky and vicious. They purposely activate the release of pro-inflammatory molecules so that they can grow and obtain their own blood supply. Reducing inflammation can help suppress those endometriomas and decrease the pain of endometriosis

Foods to include:

• Omega-3 fatty acids: Omega-3 fatty acids have been shown to suppress endometrial cells in animal studies. To help decrease inflammation, increase your intake of omega-3 fatty acids and lower your intake of omega-6s (like corn oil). Include fatty fish sources such as salmon, mackerel, herring, anchovies and sardines. Meanwhile, flaxseeds, walnuts, chia and pumpkin seeds contain oils that can be converted to omega-3s in the body.
  
  
• Healthy fats like monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs): Consuming greater amounts of healthy fats from avocados, nuts and seeds, olive oil and fish can promote a more beneficial Omega-3:Omega-6 ratio, to help decrease inflammation.

Foods to avoid in endometriosis

Similar to how there are foods that can improve endometriosis outcomes, there are foods that can make the disorder much worse and increase pain. In one Dutch study, those who reported removing gluten, dairy, and/or soy from their diet had the greatest perceived reduction in pain-related symptoms. A similar study in Australia found that reducing or eliminating gluten, dairy, and/or FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [short-chain carbohydrates]) had 64 percent effectiveness in reducing pelvic pain.

If you have endometriosis, consider avoiding or reducing:

• Trans fats and hydrogenated oils: Hydrogenated and partially hydrogenated oils increase inflammation in the body. These oils and fats are found in margarines, in many brands of peanut butters (opt for natural peanut butters), in pastry shortening, theatre-style popcorn and, in smaller amounts, in meat and dairy products.
  
  
• Gluten: Gluten can cause inflammation and promote autoimmune reactions in some people. Having irritable bowel syndrome (IBS), made worse by high gluten intake, can increase pain and inflammation. In one study, following a gluten-free diet for twelve months led to significant pain reduction in 75 percent of participants.
  
  
• Dairy: The fat in cow dairy contains bovine estrogens (even if it’s organic). Since excess estrogen can make endometriosis worse, you’ll want to avoid dairy. Don’t worry though, there are many alternative milk options for dairy including oat, almond, coconut and hemp. Many of these come fortified with Calcium and other vitamins, so you don’t need to worry about missing out on these dairy-sourced nutrients. You can also find many plant-based dairy substitutes like coconut-milk yogurt).
  
  
• Red meat: As part of the Nurses’ Health Study II, high intake of red meat was associated with an increased risk of endometriosis. Those who ate two servings per day of red meat had a 56 percent increased risk of endometriosis compared to those who ate one or less servings per week.
  
  
• Alcohol: Alcohol increases the activity of an enzyme called aromatase which converts testosterone into estrogen, essentially increasing estrogen levels. Several studies link alcohol intake to chronic inflammation and an increase in endometriosis risk. (Read more about drinking alcohol while trying to conceive.)

Follow a plant-based (or mostly plant-based) diet with some non-processed animal products such as eggs, fish and poultry. Include lots of vegetables (especially greens), fruits, and omega-3-rich foods and avoid trans fats, partially-hydrogenated oils, red meat and alcohol. You can also try a gluten-free, dairy-free diet to help decrease pain.