Can changing your diet relieve endometriosis symptoms?
This long-term condition can have a significant impact on people’s lives, but could dietary changes ease symptoms? By Laura Wingrove March is Endometriosis Awareness Month, raising awareness of this long-term debilitating gynecological condition that 190 million women worldwide suffer with. I’m one of the many who is impacted by it and my symptoms include overwhelmingly painful, heavy and prolonged periods, as well as spotting between periods and fatigue. For many, it causes pain during sex and can lead to difficulties in becoming pregnant. As the NHS explains, it's caused when 'tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes'. Unfortunately, there’s currently no cure, though treatments are available. “People with endometriosis are offered pain management such as ibuprofen, hormonal treatments that suppress the production of estrogen from the ovaries and keyhole surgery to remove the endometriosis,” says Andrew Horne, a professor of gynaecology and reproductive sciences and director of the centre for reproductive health at the University of Edinburgh. However, these aren’t ideal for everyone. “Available hormone drug treatments often have unacceptable side effects and endometriosis-associated pain recurrence may be as high as 50% in the five years following surgery,” adds Horne. Having studied nutrition at university I often look to my diet to improve my health, so I wondered if it could alleviate my endometriosis symptoms. I spoke to experts to find out… Can you reduce endometriosis symptoms through your diet? There’s mounting evidence that a person’s diet can impact their endometriosis symptoms. One study says improving gut bacteria diversity – via diet – could provide some relief for those with endometriosis. While further research is required to find out exactly what could help, the same study flags probiotics, wholegrains, fruits and vegetables as being beneficial to easing endometriosis symptoms, all of which are regarded as positive for improving gut health. Further research states ‘women with endometriosis seem to consume fewer vegetables, omega-3 polyunsaturated fatty acids and dairy products and more red meat, coffee and trans fats,’ so could this be a significant factor? I spoke to dietitian, Bernadette Schroeder who specialises in endometriosis to see if changing my diet could really help. Her advice was: Keep a diary This could give you an insight into potential triggers so “be as detailed as possible,” Schroeder encourages. “Make note of what you eat, when you ate it and what symptoms you experienced. It's beneficial to make note of other factors too such as large meals, eating too quickly or a stressful day. These factors can influence symptoms.” Try a Mediterranean diet Endometriosis causes a chronic inflammatory reaction in the pelvis (and occasionally elsewhere) in the body. Schroeder explains that by following a Mediterranean style diet you could reduce inflammation, which would ease symptoms. “The Mediterranean diet has anti-inflammatory benefits, particularly in other inflammatory diseases (heart disease, diabetes). The diet includes plant-based foods, oily fish, extra virgin olive oil, dairy products (mainly cheese and yoghurt) and limited amounts of red meat.” There’s also further research that suggests following a Mediterranean diet could reduce pain and could have antioxidant effects for those with endometriosis. In other research, virgin olive oil has been shown to have anti-inflammatory properties similar to those in ibuprofen. Schroeder suggests that endometriosis sufferers should eat oily fish at least once a week – something that’s also part of the Mediterranean diet. She explains: “Oily fish is a great source of omega-3s, in particular two types of fatty acids called EPA and DHA. These have shown some promise in reducing period pain (intensity and duration), lowering painkiller use and decreasing endometriosis pain.” Horne echoes this: “Supplements, such as omega-3 polyunsaturated fatty acids (O-PUFAs), have been investigated as a way of reducing pain in endometriosis. In a recent study, decreased pain scores were observed in women with endometriosis after use of O-PUFAs.” Oily fish is also a great source of Vitamin D, which Schroeder explains “has anti-inflammatory, anti-oxidative properties and it also influences the functionality of the immune system.” Iron rich foods Schroeder explains nutritional deficiencies are not universal among people with endometriosis but to look out for iron deficiency, primarily due to heavy menstrual bleeding. A blood test can determine if someone is iron deficient. Iron is present in both animal and plant products and good sources include: Red meatBeans and legumesDark green leafy vegetablesNutsDried fruitsSoya Red meat Beans and legumes Dark green leafy vegetables Nuts Dried fruits Soya If you consume Vitamin C alongside iron, it will aid absorption. So, veggies such as kale and spinach which contain Vitamin C already, can help. Alcohol After the excesses of the festive period, I made a conscious effort to reduce my alcohol intake. Over the following months, I noticed my pain significantly reduce. Is this something others experience? “Yes absolutely,” says Schroeder. “Alcohol is pro-inflammatory as well as a gut irritant so when people cut this out, they can see a difference in symptoms.” “Again, it depends how much and how often you consume alcohol. If people enjoy alcohol, stick within the government's recommendations (which is no more than 14 units a week- spread out). If you can remove it, that’s a good option.” Personalised approach Schroeder’s message is clear – everyone’s experiences are unique and treatments should have a personalised approach. There’s not one diet that fits all, or a magical supplement that eliminates symptoms. It’s not necessary to buy expensive powders or ingredients. “The impact of nutrition can vary from person to person and shouldn’t replace medical interventions, but it can 100% be integrated into your management plan. Don’t face it on your own, get support from a registered dietitian or registered nutritionist. ” The relationship between gut disorders and endometriosis Horne explained to me that some endometriosis symptoms mimic those of gut disorders including irritable bowel syndrome (IBS) and irritable bowel disease (IBD). This in turn he says, can lead to delays with diagnosis and treatment – on average it takes almost nine years to receive a diagnosis in the UK. But could endometriosis and these gut disorders be related? "There has been a recent international study that demonstrates endometriosis shares genetic risk factors with several common GI disorders," explains Horne. "Women with endometriosis were twice as likely to suffer from IBS than those not recorded as having endometriosis. And women with IBS were twice more likely to have a diagnosis of endometriosis.” So, if you have both IBS symptoms alongside an endometriosis diagnosis it could be worth investigating if you actually have both. If so, speak to a healthcare professional about whether a diet such as low-FODMAP could help, as research suggests it could. As for me, I'm heartened by the fact that both experts I spoke to were confident that in the future there will be more treatments available, including further knowledge on the impact of diet on the condition. Disclaimer: Always speak to a medical professional - such as your GP - before making any changes to your diet. Originally published March 2024