Endometriosis is an estrogen-dependent inflammatory disorder that is caused by genetic, environmental, and hormonal factors. When we get sick, our body responds with short-term (acute) inflammation to fight off the infection, which is normal and healthy. However, endometriosis is a complicated disease that can contribute to chronic (long-lasting) inflammation in the body. There isn’t a cure for endometriosis, which has led many to question if dietary modifications can help alleviate endometriosis pain and other symptoms.

Women with endometriosis are also twice as likely to develop irritable bowel syndrome (IBS) as women without endometriosis. IBS causes gastrointestinal distress including diarrhea, constipation, abdominal pain, and bloating. These symptoms tend to overlap with some of the symptoms of endometriosis, making it difficult to diagnose.

Following a healthy, anti-inflammatory diet and managing stress may help improve symptoms of endometriosis and related IBS. Some individuals may benefit from an elimination diet to identify specific foods that may contribute to their pain.

The Mediterranean Diet for Endometriosis

Specific foods and nutrients have proven anti-inflammatory effects on the body, including omega-3 fatty acids (fish oil), curcumin (turmeric) and other spices, antioxidants, whole grains, and more. These nutrients are present in the Mediterranean diet, which is sometimes called an anti-inflammatory diet.

Omega-3 fatty acids — a hallmark of the Mediterranean diet found in chia seeds, salmon, mackerel, other fatty fishes, walnuts, and more — can help combat inflammation. Research suggests that dietary intake of omega-3 fatty acids may reduce pelvic pain in individuals with endometriosis. A review of the literature also found that fatty acids and anti-inflammatory foods were beneficial in relieving endometriosis symptoms.

A Mediterranean diet is also rich in fiber, whole grains, olive oil, legumes, fruits, vegetables, nuts, and seeds. It limits red meat, added sugars, and refined grains.

Iron in Endometriosis

Iron is important to consume to help replace blood lost by heavy menstruation. Iron-rich foods include dark leafy greens and fortified grains, including cereal.

Soy in Endometriosis

Some women with endometriosis are afraid to consume soy products, as they believe it may interfere with hormones, but the research is mixed. One research study of women in Japan found that soy may decrease the risk of endometriosis. Other studies are inconclusive as to whether soy can be helpful or harmful for individuals with endometriosis. In moderation, soy products such as soybeans, edamame, and tofu can be part of a healthy diet.

Discovering Triggers With the Elimination Diet

An elimination diet may be beneficial if you are looking to manage endometriosis symptoms and related symptoms of IBS by helping to identify triggers that make you feel worse.

An elimination diet generally excludes certain foods for three weeks. Then, each food group can be added back into the diet one at a time. For example, for one week, you could reintroduce dairy. The next week, you could reintroduce gluten. Throughout the process, you should keep a food journal to track your symptoms and assess if they seem to correlate with specific foods. Once you discover your food triggers, you can avoid eating them.

If the process of elimination and reintroduction isn’t working out, a low FODMAP diet may help you find relief from IBS. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These fermentable short-chain carbohydrates are prevalent in various foods. It is important not to attempt the FODMAP diet without guidance from a dietitian, as it can be very restrictive and difficult to manage.

What To Eliminate

Always consult with your physician and a registered dietitian before beginning an elimination diet to avoid important nutrient gaps. Foods that can sometimes contribute to inflammation and symptoms include the following:

• Sources of nickel
• Alcohol and caffeine
• Trans fats, saturated fats, and processed meat
• Gluten
• Meat and dairy products
• Added sugars

Sources of Nickel

Research suggests that nickel may contribute to IBS symptoms in individuals with endometriosis. Nickel can also bind estrogen receptors, and has been found in higher concentrations in endometrial tissue. Dietary sources of nickel include black tea, nuts, chocolate and cocoa, soy, and shellfish. Certain grains also contain trace amounts of nickel.

Alcohol and Caffeine

In general, water should be your main beverage of choice. Avoiding alcohol can be important to prevent inflammation and maintain healthy liver function. Caffeine may contribute to cramping and might need to be limited. Some people report that caffeine and alcohol intake increase the risk of endometriosis, but research does not support this idea.

Trans Fats, Saturated Fats, and Processed Meat

Trans and saturated fats (found in butter, fried foods, and baked goods like pastries) and processed meats may worsen cramps and contribute to the spread of endometriosis.

Gluten

Research suggests that following a gluten-free diet for a year can significantly decrease endometriosis symptoms. Sources of gluten include wheat, rye, barley, farro, malt, brewer’s yeast, beer, and sauces and gravies that contain wheat.

Meat and Dairy

Sources of dairy include milk, yogurt, cheese, ice cream, and kefir. Dairy and meat may sometimes have added hormones, which are related to hormone imbalances in people with endometriosis. Dairy products may also contribute to IBS symptoms in some people with endometriosis. However, dairy and meat are excellent sources of calcium, vitamin D, protein, and iron, which are important in a well-balanced diet.

If you need to eliminate dairy, it is important to find nondairy sources of calcium in your diet, such as legumes, kale, quinoa, tofu, or fortified foods such as cereal, almond milk, and orange juice.

If you decide to drink milk and eat beef, choose organic milk, dairy-free milk, or organic grass-fed beef to minimize the risk of consuming added hormones.

Added Sugars

Added sugar is defined as sugars added to foods or beverages when they are processed or prepared. Naturally occurring sugars, such as those in fruit or milk, are not added sugars.

Added sugars may cause inflammation and can be found in condiments like ketchup and tomato sauce, salad dressings, beverages, baked goods, ice cream, and packaged snacks like crackers and pretzels.

General Diet Recommendations for Endometriosis

A healthy diet should typically include the following:

Daily

• Four to five servings of vegetables
• One to two servings of fruit
• Two to four tablespoons of healthy oils
• One to two servings of nuts and seeds
• Three to five servings of whole grains
• Three servings of low-fat dairy or a dairy alternative

Weekly

• Three to five servings of seafood
• Three to five servings of lean meat, poultry, and eggs
• Three to five servings of beans and legumes
• One to two or fewer servings of red meat

Connect With Others Who Understand

Endometriosis can be a painful and debilitating condition to deal with, but you are not alone. MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. Over 116,000 members come together to ask questions, give advice, and share their experiences of living with endometriosis.

Have you found that diet improves your symptoms? What foods work well for you? Leave a comment below or start a discussion on MyEndometriosisTeam.