- What to Eat When You Have Endometriosis
- What Not to Eat With Endometriosis
- What to Eat for Endometriosis
- Focus on Key Nutrients
- Could Going Gluten-Free Help?
- What Foods to Eat—and to Avoid—If You Suffer from Endometriosis
- Why Following an “Endometriosis Diet” Matters
- Foods and Nutrients You Should Eat to Help Endometriosis Symptoms
- Foods and Ingredients You Should Consider Limiting If You Have Endometriosis
- 1. Eat nuts and seeds
- 2. Avoid dairy
- 3. Eat fish and seafood
- 4. Avoid gluten
- 5. Eat fruits — specifically berries and stone fruits
- 6. Avoid sweets
- 7. Eat vegetables
- 8. Limit red meat
- 9. Eat cold-pressed vegetable oils
- 10. Avoid alcohol
- What are the symptoms of endometriosis?
- What are the causes of endometriosis?
- Who is likely to develop endometriosis?
- How is endometriosis diagnosed?
- What is the conventional treatment?
- What therapies does Dr. Weil recommend for endometriosis?
- A healthy diet
- Foods to avoid
- Food as a cause of endometriosis
- How Do Naturopathic Doctors Treat Endometriosis?
- Endometriosis: What is it and what are the symptoms?
- Underlying Causes
- Naturopathic Treatment
- Botanical medicine
- What should you eat if you have endometriosis?
- Foods to avoid with endometriosis
- What else to try to manage endometriosis
- The takeaway about endometriosis diets
What to Eat When You Have Endometriosis
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There’s little agreement among doctors about whether food choices can help control the symptoms of endometriosis, a condition in which tissue similar to, but not the same as, uterine lining grows outside the uterus.
A major review of 11 studies published in April 2013 in the journal Reproductive Biomedicine Online found the link between diet and endometriosis to be unclear. More research about this connection is needed, the authors say.
A study published in 2017 in the journal Ginekologia Polska points to no clear association, either, although the researchers do find evidence that endometriosis is less likely to develop in the first place in women who eat a lot of fruits and vegetables, fish oils, dairy products, and omega-3 fatty acids. Meanwhile, women who eat foods high in fat, trans-unsaturated fatty acids, alcohol, and beef (along with other red meats) seem to be at increased risk for getting endometriosis.
Supporters of a special endometriosis diet can be found, too. Among the most vocal is British nutritionist and author Dian Shepperson Mills, MA, director of the Endometriosis and Fertility Clinic in the United Kingdom and chair of the Endometriosis SHE Trust. Mills has spoken and written about food choices and endometriosis for years, and details her special endometriosis diet in her 2002 book co-authored with Michael Vernon, PhD, and called Endometriosis: A Key to Healing and Fertility through Nutrition.
Thousands of women have tried the diet, she says, which is designed to reduce inflammation and quiet down the immune system’s angry reaction to endometrial tissue that’s not in its normal place inside the uterus. She says the diet also improves the response to pain, and helps in removing extra estrogen (the female sex hormone) responsible for worsening symptoms. Not only pain but fertility improves, she says.
What Not to Eat With Endometriosis
The nonprofit information hub Healthy Women also supports the thinking that diet and endometriosis symptoms are linked. The site cautions women with endometriosis to stay away from high-fat foods, since they may increase the level of circulating estrogen in the body. The more fat in your diet, the more estrogen your body produces. This also happens if you’re overweight, they say.
“Women with endometriosis should avoid fatty foods, such as red meat and dairy foods that may be high in PCBs and dioxins, to reduce their exposure to these estrogenic pesticides,” adds Shepperson Mills. Use organic food whenever you can, or peel fruits and vegetables, she recommends. Some research suggests a link between dioxins in the environment and increased levels of estrogen.
A review published in 2017 in the journal Oxidative Medicine and Cellular Longevity is one of several sources that describes a link between oxidative stress — which includes the formation of cell-damaging substances called free radicals — and endometriosis. Additional research found that a lack of antioxidants may contribute to endometriosis, while absorbing key antioxidant nutrients like selenium and vitamins A, C, and E may help keep it under control.
You may also want to avoid citrus fruits, like grapefruit and oranges, as they can irritate your stomach and upset the way in which estrogen is excreted by the body. When excluding foods from your diet, just make sure to eat alternatives so you avoid any nutrient deficiencies.
What to Eat for Endometriosis
The core of Shepperson Mills’ diet for endometriosis includes these hallmarks of healthy nutrition:
- Freshness. Buy the freshest food you can find and eat it while it’s fresh. Avoid highly processed foods which are full of additives. Cook with fresh foods, but also eat some raw vegetables and fruit every day. To minimize exposure to pesticides, eat organically grown produce whenever possible.
- Variety. Eat a wide range of foods every day. “Make it fun to try new dishes on weekends and expand your horizons,” says Shepperson Mills.
Your daily diet should provide 75 grams of good quality protein from sources like fish, eggs, and low-fat dairy products. Also include a handful of nuts, seeds, and legumes (such as beans), two portions of red or orange vegetables, two green leafy vegetables, and two fruits, including berries, which are high in antioxidants.
Focus on Key Nutrients
Certain foods rich in key nutrients are important components in a diet for endometriosis:
- Vegetables with B vitamins. “A healthy liver with a plentiful supply of B vitamins can degrade estradiol to estriol,” Shepperson Mills says. “Estriol is the form in which estrogen can be bound to fiber and excreted. The diet needs to have sufficient fiber and B vitamins from green vegetables to help the body deal with the constant breakdown of circulating estrogens. Green, leafy vegetables can also help the nervous and immune systems, and magnesium relaxes smooth muscles found in the intestines and uterus.” The best vegetables: those in the cruciferous family, such as cabbage, sprouts, broccoli, cauliflower, kale, turnips, radishes, horseradish, and watercress.
- Iron-rich foods. “With endometriosis you may experience heavy bleeding, so replacing lost iron is important,” she says. Two types of iron are available in the foods we eat, heme iron from protein sources and non-heme iron from plant sources. Non-heme iron is available in green, leafy vegetables, beetroot, dried apricots, and plain chocolate. Heme iron comes from red meat, eggs, and fish.
- Omega fatty acids. Include 1 tablespoon of cold-pressed vegetable oil in your meals daily. Avoid trans fats, and keep saturated fats low. Sources of omega fatty acids include oily fish such as wild Alaskan salmon and Pacific halibut, and tree nuts, seeds, and extra virgin cold-pressed olive oil.
- Fiber. Shepperson Mills suggests getting 30 grams of fiber each day from fruits, vegetables, nuts, seeds, legumes, and whole grains including rye, oats, rice, corn, millet, and buckwheat to keep your intestinal tract healthy and promote the excretion of excess estrogens.
- Water. Drink four to six 8-ounce glasses of water a day. Avoid caffeine, refined sugars, sweeteners, soda (including diet), and alcohol when struggling with endometriosis or trying to get pregnant.
Could Going Gluten-Free Help?
“Eating a wheat-free diet seems to help many women with endometriosis symptoms,” says Shepperson Mills. “Whether this is a result of gluten or another component of wheat is unclear, but it may be worth excluding wheat for one month to see if it makes a difference to your abdominal pains at periods and ovulation. You could also try to exclude dairy foods if you have excess mucus problems.”
Support for going gluten-free with endometriosis can also be found in a study published in 2012 in the journal Minerva Chirurgica. The findings were promising in this research, which looked back at the experience of 207 women with severe, chronic endometriosis symptoms who removed gluten from their diet for 12 months. Painful endometriosis symptoms lessened for a significant number of the women, and while some reported no change in how they felt, at a minimum none indicated their pain got any worse. “If a particular food is upsetting digestion and causing an immune system response, then that food should be avoided,” says Shepperson Mills.
Some doctors aren’t sure that the diet is beneficial in terms of endometriosis relief per se. “Endometriosis is a funny entity in the sense of immunology,” says John C. Petrozza, MD, an obstetrician-gynecologist and chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility Center in Boston. Patients with endometriosis tend to have “problems with asthma and allergies — it’s not uncommon to have irritable bowel syndrome, lactose intolerance, or gluten intolerance,” he says. “So is the diet really helping the endometriosis or the symptoms of irritable bowel syndrome?”
The bottom line: If you have endometriosis, talk to your doctor or a registered dietitian to see if changes to your diet might be worth trying.
Additional reporting by Andrea Peirce
What Foods to Eat—and to Avoid—If You Suffer from Endometriosis
And it’s not just for long-time endo sufferers-some studies suggest if you’re at high risk for the condition (such as if an immediate family member has it) or you got an early diagnosis, changing your diet can also lower your risk.
Ahead, the full scoop on the endometriosis diet, including the foods that can help-and those you should skip or limit if you suffer from the condition.
Why Following an “Endometriosis Diet” Matters
Endometriosis is marked by pain-debilitating cramps but also pain during sex, painful bloating, painful bowel movements, and even back and leg pain.
What contributes to that pain: inflammation and hormone disruption, both of which are heavily influenced by diet, says Columbus-based nutritionist Torey Armul, R.D., spokesperson for the Academy of Nutrition and Dietetics.
Additionally, what you eat plays a huge role in combating oxidative stress, Armul says, since this damage is caused by an imbalance of antioxidants and reactive oxygen species (ROS). And a 2017 meta-analysis in Oxidative Medicine and Cellular Longevity reports oxidative stress may contribute to endometriosis.
In short, a beneficial endometriosis diet should focus on reducing inflammation, reducing oxidative stress, and balancing hormones. (Related: How to Balance Your Hormones Naturally for Lasting Energy)
Foods and Nutrients You Should Eat to Help Endometriosis Symptoms
One of the best ways to combat pain is to eat more of anti-inflammatory omega-3 fatty acids, says Godfrey. Countless studies show omega-3s-specifically EPA and DHA-help prevent and resolve inflammation in the body. Wild salmon, trout, sardines, walnuts, ground flaxseed, chia seeds, olive oil, and leafy greens are all great options, both nutritionists agree. (Related: 15 Anti-Inflammatory Foods You Should Be Eating Regularly)
“Vitamin D has anti-inflammatory effects, and research has found a connection between larger cyst size in women with endometriosis and low vitamin D levels,” says Armul. The vitamin is scarce in most foods, but dairy products like milk and yogurt are often fortified and readily available, she adds. FWIW, there is some conflicting research around the role dairy plays in inflammation, but Armul points out this is a huge food group encompassing everything from Greek yogurt to ice cream and milkshakes. Milk and low-fat dairy products are your best bet for reducing inflammation. (FYI, here’s everything you need to know about dietary supplements.)
If you’re lactose intolerant, vegan, or don’t get daily sun exposure, Armul suggests taking a vitamin D supplement daily instead. “Many people are vitamin D deficient especially during and after the winter months,” she adds. Aim for 600 IU of vitamin D, the recommended daily allowance.
In a 2017 study from Poland, researchers report that more fruits and vegetables, fish oils, dairy products rich in calcium and vitamin D, and omega-3 fatty acids lower your risk for endometriosis. The benefits of colorful produce come from reducing oxidative stress-loading up on antioxidants combats the damage and reduces endo symptoms, says Godfrey. The best foods for that: bright fruits like berries and citrus, vegetables such as dark leafy greens, onions, garlic, and spices like cinnamon.
Foods and Ingredients You Should Consider Limiting If You Have Endometriosis
You want to avoid trans fats entirely, which are known to trigger inflammation in the body, Armul says. That’s fried food, fast food, and other highly processed foods.
Godfrey agrees, adding processed foods and high amounts of sugar often prompt pain in endo sufferers. “A diet high in fat, sugar, and alcohol has been linked with the production of free radicals-the molecules responsible for creating the imbalance that leads to oxidative stress,” she explains. (Related: 6 “Ultra-Processed” Foods You Probably Have In Your House Right Now)
Multiple studies suggest eating red meat often increases your risk for endometriosis. “Red meat has been linked to higher estrogen levels in the blood, and since estrogen plays a key role in endometriosis, it is beneficial to cut down,” Godfrey says. Instead, reach for omega-3-rich fish or eggs for your protein, Armul suggests.
Although gluten doesn’t bother everyone, Godfrey says some endo sufferers will experience less pain if they cut the protein molecule from their diet. In fact, research out of Italy found going gluten free for a year improved pain for 75 percent of endometriosis sufferers involved in the study.
It’s quite common for women to have both endometriosis and irritable bowel syndrome. Among those who do, 72 percent significantly improved their gastro symptoms after four weeks of a low-FODMAP diet in one 2017 Australian study. FYI, FODMAP stands for Fermentable Ogligo-, Di-, Mono-saccharides And Polyols, a long phrase for carbs that are poorly absorbed in the small intestine for some people. Going low-FODMAP includes cutting wheat and gluten, along with lactose, sugar alcohols (xylitol, sorbitol), and certain fruits and vegetables. (For the full rundown, see how one writer fared trying the low-FODMAP diet for herself.)
This can get tricky-you don’t want to skimp on the antioxidants abundant in produce or the vitamin D that often comes from dairy. Your best bet: Focus on cutting the foods experts know increase endo issues and bump up your intake of the foods pros say can help. If you still have pain or other gastro symptoms after that, look into reducing gluten and other FODMAPs while still increasing non-offending produce rich in antioxidants.
- By Rachael Schultz @_RSchultz
One in 10 women in the United States is affected by endometriosis during her reproductive years, according to the American College of Obstetricians and Gynecolosists. And unfortunately it’s a chronic disease that often goes undiagnosed. Endometriosis occurs when misplaced tissues grow in areas like the cervix, bladder, ovaries and fallopian tubes. Basically, the tissue that forms the lining of your uterus is found outside the uterus, causing bleeding, inflammation, scarring and pain. While there is no cure, there are ways to treat and manage the condition, including knowing what to eat if you have endometriosis.
For those who are affected by endometriosis, it is recommended that you focus on an anti-inflammatory, hormone-free diet. Take a look, below, at what you should and shouldn’t consume.
1. Eat nuts and seeds
Foods like almonds, walnuts, hemp seeds, chia seeds, natural nut butters and ground flaxseed are all excellent sources of B vitamins and high in omega-3s, which are anti-inflammatory and good for those with endometriosis. Go for one or two servings a day — perfect for that midday snack.
2. Avoid dairy
Try a low-fat dairy or, if you can, dairy-free diet. Seek out organic dairy products and check labels to avoid foods containing whey, casein, cow’s milk or milk protein — this will reduce the number of added hormones in your food.
According to a September 2014 study published in the European Journal of Clinical Nutrition, dairy containing A1 beta-casein has been shown to cause higher levels of inflammation triggering symptoms of endometriosis than dairy with A2 beta-casein.
3. Eat fish and seafood
Salmon, herring, sardines, black cod — you name it.
Three to five servings of fish a week will have you swimming in omega-3s. Keep an eye out for higher-fat fish and deep-sea fish because they have even greater levels of omega-3s, which are anti-inflammatory.
4. Avoid gluten
A December 2012 study published in Minerva Chirurgica journal found that, among the 207 women studied, 75 percent reported a statistically significant decrease in the painful symptoms of endometriosis after spending 12 months on a gluten-free diet.
Try to focus instead on consuming whole grains like steel-cut oats, quinoa and rice (brown, basmati and wild). The B vitamins and added fiber found in whole grains promote a healthy digestive tract and reduce spikes in blood sugar.
5. Eat fruits — specifically berries and stone fruits
No surprise here. Fruits are good for those with and without endometriosis as they’re a staple in healthy diets, but their antioxidant and anti-inflammatory properties make them particularly good for those with endometriosis. Seek out fruits with a lower glycemic index, such as blueberries, raspberries, peaches, strawberries, pears, grapefruits, oranges, cherries, apples and pomegranates. Aim for one or two servings a day, and choose organic when you can to avoid pesticide residue, which has been — according to a May 2006 study in Reproductive Biology and Endocrinology — associated with hormone imbalances.
6. Avoid sweets
If you have a sweet tooth, this one may be difficult, but sugar is pro-inflammatory, according to an August 2006 study in the Journal of American College of Cardiology. In other words, sugar is bad for endometriosis and should be limited.
Not all hope is lost, though. To satisfy cravings, reach for small servings of dark chocolate, dried fruit, frozen yogurt or sorbet.
7. Eat vegetables
Again, no surprise that vegetables are important to a healthy, balanced diet. Veggies are also found to be chock-full of antioxidant and anti-inflammatory properties. Dark leafy greens, Brussels sprouts, carrots, beets, peas, onions, cauliflower, whatever floats your boat — just be sure to build a colorful, diverse plate of vegetables to get the full range of benefits and wide variety of vitamins A, E and C. Try to get four or five servings per day.
8. Limit red meat
Beef, steak, pork and veal should all be limited to one or two servings per week, at most. Red meat is shown to not only be pro-inflammatory — according to a November 2013 study in the American Journal of Clinical Nutrition — but also cause hormone imbalances, a September 2009 report in Annals of Oncology found. These two combined is bad news for those with endometriosis.
When you do indulge, eat grass-fed and organic meats.
9. Eat cold-pressed vegetable oils
Oils are rich in omega-3s and antioxidants as well as monounsaturated fats, which raise good cholesterol and lower bad cholesterol. Look for expelled cold-pressed oils because they are not chemically treated, according to the Saint Louis University School of Medicine. Whether you drizzle them over a salad, roast or sauté vegetables in them or use them as the final touch on avocado toast, aim for two to four servings a day.
10. Avoid alcohol
Alcohol is believed to impair ovarian function, aggravate PMS symptoms and negatively affect fertility, according to the Saint Louis University School of Medicine Department of Obstetrics, Gynecology, and Women’s Health Center for Endometriosis. Plus, alcoholic beverages tend to have added sugar, which can prevent other vital nutrients from being absorbed.
Image: Valery121283/, Nataly Studio/, mahiart/, grey_and/, Mouse family/, Tanya_mtv/, amenic181/, anat chant/. Design: Ashley Britton/SheKnows.
A version of this article was published in January 2018.
Endometriosis is an estrogen-dependent chronic gynecologic disorder that significantly reduces the quality of life of affected women. Characterized by adhesions of endometrial fragments in extra-uterine sites (predominantly in the peritoneal cavity and ovary but occasionally on the diaphragm, liver, and abdominal wall), the condition occurs in ~10% of the general population and is associated with infertility, pelvic pain, and increased risks for ovarian and other cancers (1,2). Our understanding of its etiology and complex, multi-factorial origins remains inadequate (3-5). Moreover, its asymptomatic nature at the early stages can significantly delay clinical diagnosis. Treatment options are currently limited to hormonal therapy or surgical management; however, these methods are non-curative, may not align with women’s reproductive goals, and frequently lead to recurrence after cessation of treatment (6). Delineating the factors that contribute to lesion development and progression is key to providing opportunities for prevention and more efficacious therapeutic interventions.
Diet is a leading risk factor for many chronic diseases (7,8). The linkage between diet and endometriosis, summarized in a recent review (9), underscores the ability of anti-inflammatory components present in foods to mitigate endometriosis. Nevertheless, there are certain caveats to consider. Notably, most reported studies which support the linkage were conducted using animal models of endometriosis and findings were simply extrapolated to humans. Moreover, in the few studies with affected women, the investigations were predominantly retrospective or case-control, which are prone to selection and/or recall bias and were typically too limited in duration to sufficiently illuminate effects of dietary interventions on lesion development and progression. In the recent paper by Yamamoto et al. (10), the authors report on a prospective cohort study that evaluated the association between intake of red meat, poultry, fish and seafood on the risk of laparoscopically-confirmed endometriosis. In this work, the authors provide important insights on a role for diet in the development and progression of human endometriosis, and highlight important areas for future research. This manuscript is notable for several strengths in study design. First, a large number of pre-menopausal women (total of 81,908 from The Nurses’ Health Study II) with intact uteri and with no prior diagnosis of endometriosis or cancer (except for skin melanoma in a few cases) were followed for a duration of over 20 years (1991 to 2013). Second, diet was assessed using an extensively validated semi-quantitative food frequency questionnaire that incorporated portion size and frequency of intake. Third, endometriosis was laparoscopically-confirmed, obviating uncertainties in diagnosis. The 3,800 cases (women), representing 1,019,294 person-years of follow-up, provided a strong platform to advocate significant dietary influences on endometriosis risk.
From this important data set, we learn that intake of red meat, either as processed or unprocessed, is a major culprit in promoting endometriosis risk (hence, seeing red). Replacement of red meat with fish, shellfish or eggs was associated with lower risk of endometriosis. A quite unexpected result was the rise in endometriosis risk with increasing intake of poultry, albeit this was not as robust as seen for red meat. Yet another surprising finding is that the effect of red meat is independent of animal fat or its most common saturated fatty acid, palmitic acid. The take-home message of the study is consistent with that of a recent report that fish intake relative to red meat, lowers the risk of type 2 diabetes, yet another chronic disease (11). Interestingly, with type 2 diabetes, poultry consumption showed protective effects not noted with endometriosis.
This research sheds light on potential nutrients that may promote red meat’s observed effects on endometriosis risk. The intriguing possibility that heme iron constitutes a major component responsible for the negative effects of red meat consumption is consistent with a previous report suggesting a potential association between heme, which is abundant in red meat, and colon cancer risk (12). In that study, colonic epithelia of rats fed heme-supplemented diet showed higher proliferation rates when compared to those of control counterparts, irrespective of dietary fat content. In a population case-control study of adenocarcinoma of the esophagus and stomach, Ward et al. (13) reported that higher intake of heme iron and total iron from meat sources constitutes a risk for these cancer types. Iron can cause oxidative stress and DNA damage and heme iron catalyzes the endogenous formation of N-nitroso compounds, which are potent carcinogens (13). However, the heme iron hypothesis in colorectal cancer posits local mutagenic effects, which may not be easily extrapolated to ectopic lesion development.
A number of important points are worth considering from Yamamoto et al.’s study. First, the significant increase in endometriosis risk associated with red meat was found from comparing women consuming ≥2 servings per day (equivalent to 14 servings or more per week) with women consuming ≤1 serving per week; the latter effectively being non-red meat eaters. Interestingly, even 2–4 servings per week elicited a modest increase in endometriosis risk, suggesting that limiting red meat consumption to less than once weekly is best. Second, the study indicated that women with the highest red meat consumption (and hence, greater risk for endometriosis) were more likely to be overweight or obese and had greater caloric intake. These observations beg the question of whether the frequency of eating red meat contributes to higher body mass index (BMI) and are seemingly inconsistent with previous studies indicating lower BMI as a risk factor for endometriosis and a predictive factor for severe endometriosis (14,15). In a recent report (16), mice experimentally-induced with endometriosis exhibited lower body weights than sham controls (non-endometriotic mice) with ad libitum feeding. The study’s authors posited that endometriosis may be causal to rather than a consequence of, loss of body weight and body fat due to the accompanying disruption of hepatic metabolic gene expression (16). In a related study using another mouse model of endometriosis (17), high fat-diet promotion of endometriosis occurred in the absence of weight gain, ovarian dysfunction and insulin resistance, but was associated with increased systemic inflammation and oxidative stress. Since metabolic dysfunction rather than BMI is more highly correlated with many chronic diseases (18), the latter commonly characterized by persistent low levels of inflammation, the analyses of pro-inflammatory cytokines and metabolites from Yamamoto et al.’s patient cohort may help address the lingering question on the association between diet, endometriosis and metabolic status. Third, given the estrogen-dependent nature of endometriosis, the authors raise the likelihood that red meat may increase endogenous levels of estrogen in substantial red meat consumers. This is an arguable point since serum levels of estradiol in women with and without endometriosis are comparable (19), although the possibility that local (endometrial tissue) estrogen synthesis is elevated with increased red meat intake cannot be excluded. Harmon et al. (20) compared the levels of estrogens (estrone and estradiol) in sera of premenopausal women with low (considered semi-vegetarians) and high meat (red meat, poultry) intake, and found that serum estrogens were lower in semi-vegetarians than non-vegetarians. However, that study was limited by small sample size, and further data are required to clarify this association. Finally, with the mounting evidence that a woman’s exposure to environmental disrupting chemicals can modulate her reproductive system beginning at early life (21), it is possible that organic pollutants present in farmed animal products may contribute to increased risk of endometriosis. While fish and shellfish are similarly subject to environmental insults, the specific contaminants and the degree of contamination may be different between the animal groups.
Distinct dietary protein sources (e.g., red meat, poultry, fish, eggs), which are known to differ by amino acid composition and fatty acid content were compared in Yamamoto et al.’s report. In recent years, the potential link between dietary protein source and the composition of the gut microbiota has gained considerable ground (22,23). The participation of the gut microbiota in the pathogenesis of endometriosis has been posited as well, based on the role of the gut in regulating signaling molecules that orchestrate inflammatory, immune and proliferative pathways (24). Coming from another viewpoint, Yuan et al. (25) demonstrated significant changes in gut microbiota composition during the development of endometriosis in a mouse model. While the validity of a potential bidirectional relationship between endometriosis and the microbiota has yet to be confirmed in humans, the notion that dietary-induced changes in the intestinal milieu can influence endometriosis and vice-versa, may lead to a more personalized approach and novel biomarkers to reduce the risk for this condition.
The study by Yamamoto et al. lays the foundation to better understand how the multi-faceted nature of endometriosis may be managed by simple dietary changes and provides a compelling case for women of reproductive-age to reevaluate their dietary habits for the prevention of chronic disease.
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Endometriosis is a non-cancerous condition in which tissue that normally lines a woman’s uterus appears elsewhere in the body, particularly on the fallopian tubes, ovaries, rectum, bladder, and other pelvic tissues.
What are the symptoms of endometriosis?
Endometriosis can range from mild to severe, and some women with the condition don’t experience any symptoms. When symptoms do occur, they can include:
- Painful periods
- Lower abdominal pain, either during menstruation or at any time
- Lower back pain
- Pain with bowel movements
- Menstrual irregularities, including spotting and heavy bleeding during periods.
Eventually, this misplaced tissue can cause scarring in the fallopian tubes and ovaries, and a complication of the condition is infertility.
Misplaced endometrial tissue responds to the same hormones produced by the ovaries as does normal endometrial tissue found in the uterus. Consequently, the misplaced tissue may bleed in these remote locations during menstruation and often causes cramps and pain. The actual amount of tissue misplaced doesn’t determine how severe the symptoms are. Some women with a large amount of tissue feel no discomfort, while others with even a small amount of misplaced tissue experience severe pain.
What are the causes of endometriosis?
Endometriosis occurs when uterine tissue (known as endometrium) grows outside the uterus on other pelvic organs. Although the exact cause is still unknown, some researchers believe endometriosis may be triggered by endometrial cells loosened during menstruation “backing up” through the fallopian tubes into the pelvis, a process called retrograde menstruation. Other theories hold that endometriosis involves a faulty immune system, hormones, or genetic factors.
Who is likely to develop endometriosis?
Endometriosis can occur in any menstruating woman but is most common in those who have not had children, have their first child after age 30, and those who have short menstrual cycles (less than 27 days). It occurs less frequently in women who have given birth several times, who use low dose oral birth control, and who exercise regularly.
During pregnancy, endometriosis may go into remission temporarily (and sometimes permanently). Endometriosis tends to resolve itself after menopause because hormone levels decrease.
How is endometriosis diagnosed?
Physicians diagnose endometriosis by asking the patient about her symptoms and performing a pelvic exam. In addition, they may conduct other tests, such as:
- Blood tests, which can detect a certain protein produced by women with endometriosis
- Laparoscopy, a minor surgical procedure in which a doctor inserts a thin viewing tube through the abdomen to view the pelvic organs
- Ultrasound, which uses sound waves to produce images of the pelvis.
What is the conventional treatment?
Conventional treatment of endometriosis depends on the severity of symptoms, a woman’s age, and her desire to have children. Treatments include:
- Pain management. Over-the-counter non-steroidal anti-inflammatories such as ibuprofen may help ease menstrual cramps.
- Oral contraceptives. These drugs help control levels of hormones linked to endometriosis and can make periods shorter and lighter.
- Antigonadotropen drugs. These drugs block the production of ovarian-stimulating hormones, which lowers estrogen levels and shrinks abnormal tissue. However, they can also create an artificial menopause and may cause side effects like hot flashes.
- Surgery. Laparoscopic surgery can remove abnormal tissue without removing a woman’s reproductive organs, but the tissue frequently grows back and may require repeated procedures.
- Hysterectomy. In severe cases, doctors may recommend hysterectomy (surgical removal of the uterus). Sometimes the ovaries are also removed. This is effective but drastic, and only recommended as a last resort for women who do not wish to become pregnant.
What therapies does Dr. Weil recommend for endometriosis?
Dr. Weil recommends the following approaches for treating endometriosis:
- Eat an anti-inflammatory diet.
- Eliminate dairy foods entirely for three weeks. Read labels carefully and avoid all foods containing whey, casein, and cow’s milk or milk protein, because of the estrogenic hormones they may contain, (naturally occurring as well as artificial).
- Eat only hormone-free meat to avoid any additional estrogen exposure.
- Avoid soy foods if you have not been eating them regularly; they are mildly estrogenic.
- Avoid alcohol (it affects how estrogen is metabolized in the body).
- Choose organic foods whenever possible.
- Experiment with traditional Chinese medicine.
- Take omega-3 fatty acid supplements. Start with one gram a day and increase the dose gradually – by one gram a week – to three to four grams daily.
- Try the herb dong quai (Angelica sinensis), three to four grams daily, for its anti-inflammatory and anti-spasmodic effects. (Women with very heavy periods should avoid dong quai since it can make menstrual bleeding worse.)
- Try whole licorice extracts, which can be helpful for inflammatory disorders; experiment with peony (Paeonia officinalis), which can help relieve menstrual cramps.
- Guided imagery or hypnosis can also be of great value.
- Drink a cup or two of red raspberry leaf tea daily to relieve cramps.
- Take 500 mg of supplemental calcium and 250 mg of magnesium daily.
- Try chaste tree herb (Vitex), a general tonic for the female reproductive system. Use 240 mg a day of an encapsulated extract standardized to 0.6 percent aucubine. (Women on birth control pills or taking other hormonal drugs shouldn’t use chaste tree.)
Endometriosis is a disease marked by tissue that should only lines the uterus growing elsewhere in the pelvic cavity, usually around the reproductive organs, and the bowels and bladder. These growths are referred to as lesions or implants.
The uterine tissue reacts to the hormonal changes that occur during the menstrual cycle, and thickens in preparation for pregnancy. If no pregnancy occurs, the tissue breaks down naturally and is expelled as part of the menstrual cycle.
Endometrial lesions undergo the same monthly cycles in response to hormones such as estrogen, but once broken down cannot leave the body. This can lead to pain and inflammation, and can result in organs becoming stuck together.
Endometriosis currently has no cure, although several treatments can help to manage the condition. Lifestyle changes, like adjustments to diet, may also ease pain and improve overall health.
A healthy diet
A healthy diet for endometriosis may consist of foods that are anti-inflammatory and do not alter a person’s hormone levels, such as organic foods.
A diet high in fruit and vegetables accompanied by lean meat, poultry, eggs, or seafood may help reduce the symptoms of endometriosis. Low-dairy or dairy-free alternatives can provide vitamin D, and work to reduce inflammation without causing digestive problems.
Choosing organic foods can also help to manage endometriosis, as these tend to be lower in certain chemicals that can increase estrogen levels in the body. Keepng estrogen levels low helps to reduce the likelihood of a symptoms flare.
Foods to avoid
Eliminating or reducing the intake of some foods may reduce the symptoms of pain, nausea, and cramping women with endometriosis experience. These symptoms can be exacerbated by foods that can stimulate inflammation. Examples include dairy, gluten, high-fat foods, caffeine, and processed foods with added sugar.
Soy products can increase estrogen levels, which may worsen the symptoms of endometriosis as well as triggering the growth of new lesions if consumed in large quantities. Red meat, such as beef, is also associated with increased estrogen levels and the worsening of endometriosis symptoms. It should be consumed sparingly.
As every patient is different, it is possible that some foods may trigger a worsening of symptoms in some people while having no effects in others. Recognizing which foods may aggravate disease symptoms and eliminating them from your diet can help to improve quality of life.
Food as a cause of endometriosis
While the exact cause of endometriosis is not well understood, it is possible that an unhealthy diet can increase the risk of developing it. Studies examining certain dietary factors and endometriosis risk have been mixed in their results. For example, while not proven, the chemical polychlorinated biphenyl is thought to be associated with an increased risk of endometriosis, as it may alter the immune response and mimic the action of estrogen. This chemical can be found in some fatty foods, and in caffeinated drinks such as cola.
Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
How Do Naturopathic Doctors Treat Endometriosis?
Endometriosis is one of the common yet misunderstood medical conditions, affecting 10-15 percent of women of childbearing age. Licensed naturopathic doctors (NDs) utilize effective diagnostic interventions for discovering underlying causes of endometriosis. Trained extensively in clinical nutrition, botanical medicine, pharmaceuticals, and lifestyle counseling, naturopathic doctors provide patients with various options for a comprehensive treatment plan catered to the patient’s personalized needs.
Endometriosis: What is it and what are the symptoms?
Endometriosis is the presence of endometrial tissue outside the uterus. This uterine tissue is not restricted to the uterus and can be found on the ovaries, fallopian tubes, in the abdominal cavity and in other places throughout the pelvic area. This misplaced uterine tissue responds to monthly hormonal cycles and wreaks havoc in many ways. Depending on where the uterine tissue located symptoms can include painful periods, pain during or after intercourse, persistent lower back and pelvic pain, discomfort during bowel movements or urination, menses lasting longer than seven days, bloating, constipation, and diarrhea or nausea during menstruation. Endometriosis is also a common cause of infertility or endometrial cysts.
Endometriosis symptoms may include painful periods, persistent lower back and pelvic pain, bloating, constipation, infertility, and more.
Physicians diagnose endometriosis based on findings during a pelvic exam, presenting symptoms, and a thorough medical history. During the pelvic exam, doctors manually palpate the pelvis for abnormalities such as scars behind the uterus or growths on reproductive organs. Pelvic ultrasound and MRI are often ordered to rule out other causes of the patient’s symptoms. Laparoscopy remains the gold standard for the diagnosis of endometriosis.
While the exact cause of endometriosis is unknown, there are several hypotheses regarding how endometriosis may develop. One possible factor is retrograde menstruation when the endometrial tissue flows backward, out through the fallopian tubes, and into the abdomen to implant and grow on organs in the pelvis.
In addition, endometriosis lesions may arise from Mullerian anomalies that did not correctly differentiate or migrate during fetal development. Other factors such as hormonal imbalance, inflammation, toxic environmental exposures, and immunologic dysfunction may determine why lesions implanted in the pelvic cavity cause symptoms and/or persist. There is also likely a genetic component as endometriosis does run in families.
Understanding multifaceted causes of endometriosis guides treatment for both acute and long-term challenges. Treatment for endometriosis begins by stimulation of the body’s innate ability to heal through restoring healthy inflammatory response, balancing hormones, and aiding the liver’s ability to break down environmental toxins and naturally occurring estrogens. For some, the treatment of endometriosis will also include surgery performed by a gynecologic surgeon.
Some factors that may contribute to endometriosis may include genetics, hormonal imbalance, environmental exposures, and immunologic dysfunction.
Naturopathic treatment also addresses the whole patient. For many women, endometriosis can cause high levels of stress, often due to pain, difficulty in diagnosis, and the trials associated with an often invisible illness. NDs help treat not just the body, but the symptoms of the mind and spirit too.
There are numerous nutritional influences related to endometriosis. Licensed naturopathic doctors often begin with the diet, where patients are able to take an active part in the management and prevention of symptoms. The recommendation of an anti-inflammatory diet is often part of the plan in order to reduce inflammation and help with the balance of estrogen.
In a study of 500 women, there was a significantly decreased risk of developing endometriosis with higher consumption of fruits and green vegetables. Conversely, an increased risk for endometriosis was associated with high intake of red meat. Foods high in dietary fiber are associated with a healthy balance of microorganisms in the gut flora, where they play a significant role in breaking down estrogens and also reducing inflammation. Studies show that the inclusion of soy with its isoflavones can reduce the proliferation of endometrial cells.
Naturopathic treatments including nutrition and dietary changes, botanical medicine, and supplementation have been shown to provide relief for endometriosis symptoms.
Botanical medicine has been shown to provide relief for some endometriosis patients, including:
- Vitex (Chaste Tree) has traditionally been used as a treatment for hormone imbalances in women, causing estrogen to be less available to stimulate endometrial tissue growth.
- Motherwort gently soothes cramps and pain during times of extreme discomfort in the uterus and other lower abdominal regions. As a mild sedative, motherwort helps with needed relaxation during menstrual cramps.
- Rosmarinus officinalis (Rosemary) has been researched as a strong anti-inflammatory herb and can be helpful for those with endometriosis pain.
- Curcumin has also been shown to reduce estradiol which helps to reduce endometriosis symptoms.
- Flax seeds with their anti-inflammatory impact and their capacity to reduce inflammation are also recommended.
- Pycnogenol derived from Pine Bark has been studied and shows the capacity to reduce many of the painful symptoms of endometriosis.
- Green tea has also shown promising results in the treatment of endometriosis.
Another natural treatment for endometriosis may include supplementation such as:
- DIM or diindolylmethane is a natural plant-based chemical is found in the cruciferous vegetables. DIM has been shown to be helpful in reducing excessive bleeding that many endometriosis sufferers have.
- Beta-carotene encourages enhanced immunity and decreases inflammation.
- Essential Fatty Acids decrease inflammatory responses through pathways that produce prostaglandins in the body.
- N-acetyl cysteine (NAC) has been examined for its role in helping those with endometriosis, in particular, it helps to reduce cyst size.
Acupuncture, a modality some licensed naturopathic doctors utilize, when studied, showed a clear benefit to those suffering from symptoms of endometriosis.
Treating endometriosis can be challenging and requires a whole-patient approach encouraged by naturopathic doctors. Natural therapies that address the root cause can lead to appropriate treatments to support the body in restoring optimal function.
A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). The AANP and INM would like to acknowledge Marianne Marchese, ND and Amy Rothenberg, ND for their contributions to the content of this FAQ.
Endometriosis is a complicated gynaecological disorder that causes intense pain to sufferers, but is notoriously hard to diagnose.
It occurs when cells usually found in the womb are also present elsewhere in the body. At a certain point in every monthly cycle these cells are stimulated by hormones, causing them to grow and then bleed, just as they would do in the womb during your period. For sufferers, this causes inflammation, pain, and longer-term internal damage as a result of scar tissue being formed.
Not all sufferers are aware, however, that although endometriosis is a gynaecological disease, changes to diet can actually help to ease the pain and fatigue that are so often resulting symptoms.
For nutritional therapist, Henrietta Norton BSc DipNT, who founded supplement brand Wild Nutrition, it was studying nutrition that brought her own endometriosis to light at the age of 26 – and taught her the power of diet when it comes to improving symptoms.
“From the start of menstruation at the age of 14 I suffered severe period pains and bowel discomfort, and often felt dizzy and faint,” says Henrietta. Painkillers – no matter how strong – never seemed to make an impact, and her intense fatigue wouldn’t shift. But when Henrietta began studying the female endocrine (hormonal) system as part of her training, everything changed as she became aware of the existence of endometriosis.
Henrietta was eventually diagnosed with endometriosis herself, and the more she learnt about it alongside her nutrition studies, the more determined she became to ease the side effects of the condition by making changes to her diet.
“Nowadays my endometriosis is completely manageable, with months going by where my pain is minimal, if present at all,” says Henrietta. Here are some of the adaptations she made to her diet that have made all the difference:
1. Eat colour
“Research shows women who eat green vegetables 13 times or more per week (roughly twice a day) are 70% less likely to have endometriosis,” points out Henrietta, adding that Carotenoid rich foods (such as kale, spinach, peppers, tomatoes, and particularly citrus fruits) have also been scientifically proven to positively affect symptoms of endometriosis. “Use smoothies, juicing or soups to deeply to nourish,” Henrietta suggests.
2. Look after your gut
The gut contains bacteria – good and bad – which can help refine hormonal balance that in turn may help to ease endometriosis. “Beneficial gut bacteria can reduce the production of beta-glucuronidase, an enzyme that remakes oestrogen in the gut,” explains Henrietta. She advises to incorporate “natural, organic yoghurt into your daily diet either on its own or use it to make dressings and sauces”. Fermented foods such as sauerkraut or Kefir also come highly recommended as excellent sources of beneficial bacteria.
3. Fats are essential
The word ‘fat’ might have developed a bad reputation over the years, but don’t forget there are plenty of good fats that, among other things, can benefit endometriosis sufferers. “Essential fats found in nuts, seeds and oily fish can reduce inflammation associated with endometriosis,” explains Henrietta. “Use of essential fatty acids are blocked by processed oils and margarines, as well as white flour, sugar, excessive animal and monounsaturated fats, alcohol, poor nutrition and stress.” She suggests keeping these to a minimum in order to reduce inflammation and its painful repercussions.
4. Try going gluten free
While it’s certainly not advisable for everyone, it could be worth trying a gluten free diet for a short period, to see if it yields any relief in symptoms. Henrietta points to recent research that has categorised endometriosis as an auto-immune condition, noting that its results “documented an improved response in those following a with a gluten-free diet.” 75% of participants found a significant decrease in symptoms when following a gluten free diet over 12 months – so it could be worth a go.
5. Consider taking supplements
A major part of taking control of endometriosis is maintaining optimum levels of nutrients, but because much of the food produced nowadays lacks vital trace minerals and vitamins, Henrietta suggests using supplements to enhance your intake. “Research shows that taking the right nutrients in food supplements can reduce the symptoms of endometriosis significantly. 98% of the women in one study experienced improvements,” says the expert.
The supplements you might be most interested in taking as an endometriosis sufferer include:
● Indole-3-carbinol (I3C) – a compound found in high concentrations in vegetables such as broccoli, cauliflower, Brussel sprouts and cabbage. It supports liver detoxification and the elimination of oestrogen metabolites. BUY HERE
● Methionine – supports the detoxification process of the liver, especially in the breakdown of excess oestrogen. This is especially important for women with MTHFR and endometriosis. BUY HERE
● Vitamin B6 – vital in the breakdown and regulation of oestrogen as well as significantly reducing the intensity and duration of period pains. The B vitamin family is also vital in the conversion of the important fatty acid GLA. GLA supports the production of anti-inflammatory mediators that can reduce the pain-associated inflammation in endometriosis and relax the muscles. BUY HERE
● Magnesium – known as nature’s tranquiliser, acts as a muscle relaxant and has been shown to have a beneficial effect on painful periods and lower back pain. BUY HERE
● Turmeric – the active ingredient in this wonderful spice, Curcuma longa, is showing great promise in treating endometriosis due to its potent ability to reduce inflammation as well as its use as an antioxidant for repairing damage from endometrial adhesions and scar tissue. The recommended dose is 400–600mg of turmeric powder two-three times per day, so use as much as you can in your cooking, and increase your intake with supplements if you wish. BUY HERE
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Catriona Harvey-Jenner Digital Features Editor Cat is Cosmopolitan UK’s features editor covering women’s issues, health and current affairs.
What should you eat if you have endometriosis?
Share on PinterestHealthful fats, such as olive oil, may benefit people with endometriosis.
A person with endometriosis might consider reducing foods that either cause inflammation or raise estrogen levels, both of which may contribute to the disorder or its symptoms. However, more research is needed to establish the link between endometriosis and diet.
A person with endometriosis may benefit from eating plenty of fruits, vegetables, and whole grains. Plant-based proteins, lean meats, and healthful fats may also help.
Healthful fats are available in many foods, including:
- olive oil
- other fatty fish
A person with endometriosis should also reduce their caffeine and alcohol intake, as these can increase estrogen levels.
If a person does not eat fish, it is possible to introduce omega-3 fatty acids into the diet using supplements. These can be purchased at a pharmacy or bought online.
A person can also increase their fiber intake. Fiber is an essential part of a healthful diet and may help to lower estrogen levels. In addition to providing lots of vitamins and minerals, eating fresh sources of fiber can also provide vitamins, minerals, and antioxidants that can reduce inflammation.
There are also some special diets that may help people with endometriosis. These include:
Going gluten-free has become a common diet and lifestyle trend over the last several years. It remains unclear whether this diet is effective for people without celiac disease, which makes a person sensitive to proteins found in wheat.
However, a 2012 study suggests that 75 percent of the 156 women who took part in the study reported a decrease in painful symptoms after following a gluten-free diet for 12 months.
With the FODMAP diet, a person eliminates certain carbohydrates from their diet to reduce their intake of potentially irritating foods. The aim is to allow the gastrointestinal system to heal.
After a person eliminates these foods, they can slowly re-introduce specific foods to see how the body tolerates them. This kind of diet can be difficult for some people, because it involves eliminating a high number of food types from their diet, including:
- processed foods
- added sugars
It is a good idea to track symptoms in a food log to see if they get better after removing certain foods from the diet, or get worse after reintroducing something.
A doctor or dietitian can help a person plan the FODMAP diet elimination program. They can help to track symptoms and identify potentially problematic foods. They can also make sure that this type of a restrictive diet is appropriate for a specific medical or health situation.
Preparation is crucial for success with this type of diet. Planning out each meal, as well as shopping and preparing it ahead of time, can make it much easier to stay on track. A quick Internet search can help a person to quickly and easily find some new meal ideas that work for them.
Whole grains, vegetables, and fruits are a rich source of fiber, minerals, and vitamins. They also provide a high dose of antioxidants that may help combat inflammation. Making these foods part of an endometriosis diet may help both reduce pain and the overall risk of developing the condition.
Try a low-FODMAP diet
This diet may help reduce symptoms associated with endometriosis. The FODMAP diet restricts foods that are fermentable, oligo-, di- and monosaccharides and polyols. The bacteria in the gut ferment FODMAPs, causing gas, which can cause discomfort and pain in people with irritable bowel syndrome (IBS). Following low-FODMAP guidelines as your endometriosis diet may help in reducing symptoms of the condition if you have endometriosis along with IBS.
Try a gluten-free diet
There is evidence that eating a diet free of gluten may benefit people with endometriosis. In clinical studies, it has been found that people who ate a gluten-free diet as part of their endometriosis diet plan had a significant reduction in their pelvic pain.
Include soy in your diet
Though according to some evidence soy may cause a negative influence on endometriosis, certain other studies indicate that it may reduce its risk or severity.
Include curcumin in your diet
Making curcumin, a compound found in turmeric, part of your endometriosis diet may reduce the severity of the condition because it suppresses the growth of the endometrial cells.
Foods to avoid with endometriosis
Avoid the following foods to reduce the symptoms of endometriosis:
Avoid artificial trans fats
Artificial trans fats, present in certain processed foods such as donuts, fries, pastries, and crackers, increase your risk of cardiovascular disease. According to some evidence, eating foods with a high amount of trans fats increases the risk of occurrence of endometriosis, so it’s best to avoid them as part of an endometriosis diet.
Reduce the consumption of red meat
Consuming more than two servings of red meat per day, particularly the processed varieties, has been found to increase the risk of endometriosis in women in certain studies. Eating another source of protein in place of red meat may help improve the inflammation that is one of the characteristics of endometriosis. While making your endometriosis diet plan, make sure to incorporate other sources of protein into your meals.
Limit alcohol and caffeine
Some research studies suggest that alcohol and caffeine may increase your risk of endometriosis. Furthermore, high caffeine intake may also increase your levels of estrogen. While the evidence isn’t conclusive, it’s preferable to reduce the intake of both alcohol and caffeine if you have endometriosis.
Limit your intake of processed foods
Processed foods contain high amounts of unhealthy sugar and fats and are low in fiber and essential nutrients. They may promote the occurrence of inflammation and pain. Omega-6 fats — present in plant oils including corn, peanut, and cottonseed oil — may increase pain, inflammation, and uterine cramping. On the contrary, omega-3 fats present in walnuts, flax, and fish may help in reducing these symptoms. Removing processed food items such as chips, pastries, candy, fried foods, and crackers from your endo diet may help minimize the pain related to endometriosis.
What else to try to manage endometriosis
Apart from an endometriosis treatment diet, the best management approach is to consult your physician and follow a specific treatment plan.
Physical therapy may help reduce pain and improve the quality of life for people with endometriosis. Doing physical exercise regularly has a protective effect against inflammatory diseases because it increases the levels of anti-inflammatory compounds in the body. Eight weeks of exercise can be very effective for reducing postural abnormalities and pain related to endometriosis.
The takeaway about endometriosis diets
Endometriosis has no cure, and medical or surgical treatments are the most beneficial and effective methods to manage the condition. But making certain dietary changes may help manage and reduce the symptoms related to endometriosis for some. A dietitian can help you find the right endometriosis diet plan. A specific plan that is tailored according to your requirements will yield the best results.