What is Endometriosis?
Endometriosis is a chronic inflammatory condition affecting the female reproductive system, which causes tissue similar to the lining of the womb to grow in different parts of the body, usually in the pelvis area including the pelvic wall, ovaries, bladder and bowel. Approximately one million Australian girls, women, and those assigned female at birth* live with endometriosis and are typically develop symptoms throughout adolescence. The gold-standard for diagnosis is to have laparoscopy and biopsy (tissue sample) taken. In some cases, a diagnosis may be suggested without having a laparoscopy.
What are the symptoms?
Endometriosis symptoms are different from person to person and can fluctuate over time making it difficult to diagnose and leading to delays in diagnosis. It is also possible to have endometriosis and not have any symptoms.
Common symptoms may include:
- Fatigue
- Pain that stops you on or around your period
- Pain on or around ovulation.
- Pain during or after sex
- Pain with bowel movements
- Pain when you urinate
- Pain in your pelvic region, lower back or legs
- Having trouble holding on when you have a full bladder or having to go frequently
- Heavy bleeding or irregular bleeding
- Infertility (trouble falling pregnant): Up to 50% of infertile women have endometriosis
Some women with endometriosis experience other symptoms such as:
- Bladder and bowel problems (e.g. the need to wee frequently, constipation or diarrhoea)
- Irritable Bowel Syndrome (IBS) symptoms, such as constipation and/or diarrhoea, abdominal discomfort and bloating especially around the time of your period
- Mood conditions (e.g. anxiety and depression)
- Asthma
Endometriosis can present differently at various stages of life – whether you’re a teenager, navigating adulthood, or going through perimenopause. To make matters more complicated, the symptoms of endometriosis often overlap with other conditions such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). This can make it challenging for doctors to diagnose endometriosis with some women waiting on average 6 to 8 years to get a diagnosis.
Is there a role for diet for managing endometriosis symptoms?
If you’re living with endometriosis, you might find yourself asking, “Can I eat my way out of this?” While there’s no magical diet that can cure endometriosis, research shows that diet may play an important role in the treatment, management, and even prevention of endometriosis. Dietary changes positively influence pain in women with endometriosis with many women reporting improvements in their symptoms by adopting self-management strategies, including dietary changes.
Diet can also be a risk factor for developing endometriosis. In a study, researchers discovered something important. Women who ate a lot of pro-inflammatory foods had a higher chance of developing endometriosis.
These foods included a lot of sugar, processed foods with trans fats, and saturated fats. Women on this diet were four times more likely to develop the condition. Additionally, women who ate more than two servings of red meat daily exhibited a 56% increased risk of endometriosis.
Common diets that may help manage endometriosis symptoms
The Mediterranean diet
The Mediterranean diet is an excellent anti-inflammatory approach. It includes healthy fats, lean proteins, and fiber-rich foods that help reduce pain and inflammation (Ashrafi et al., 2020; Nirgianakis et al., 2021).
A Mediterranean diet is a dietary pattern that focuses on wholesome, nutritious foods, including plenty of cold-pressed extra-virgin olive oil, vegetables, fruits, wholegrains, nuts, seeds and legumes. It also includes moderate servings of fish, poultry, and dairy and low amounts of red meats and sweets.
Research suggests that the Mediterranean diet may help assist with reducing endometriosis associated pain and it has also been shown to be beneficial for fertility and supporting mental health too.
Mediterranean Pantry essentials include:
- Extra Virgin Olive Oil: Use it for dressings and as a healthy cooking oil to enhance flavour and provide good fats.
- Whole Grains: Choose quinoa, rolled oats, sourdough or seeded bread, brown rice, buckwheat and wholegrain/wholemeal pasta for nourishing options high in fibre.
- Legumes, Nuts, and Seeds: Include chickpeas, lentils, beans, almonds, and pumpkin seeds for plant-based protein and healthy fats.
- Eat the Rainbow: Aim for at least five servings of colourful vegetables daily
- Fresh Fruit: Keep seasonal fruit handy for snacks or desserts that are both delicious and nutritious.
- Dairy: Include a probiotic-rich, low sugar option like Greek yoghurt
- Fish Twice a Week: Incorporate fatty fish like salmon, tuna, and sardines for omega-3 fatty acids
- Limit Red Meat: Reduce red meat intake and opt for lean poultry or plant-based proteins like tofu, beans, and lentils.
The low FODMAP diet
Up to 1 in 2 women with endometriosis also suffer from symptoms of Irritable Bowel Syndrome (IBS) and If you have endometriosis you are 2-3 times more likely to be diagnosed with IBS. The low FODMAP diet was developed by Monash University and is a short-term elimination diet for people with IBS. It essentially lowers your intake of a group of fermentable carbohydrates or sugars that can contribute to symptoms of bloating, wind, diarrhoea, constipation and abdominal discomfort.
A 2017 study in a group of women with endometriosis and IBS showed that a low FODMAP diet improved symptoms in 72% of the cohort. A low FODMAP diet should always be done short-term and alongside a knowledgeable dietitian.
Examples of high FODMAP foods include:
- Vegetables: Apples, blackberries, stone-fruit , pear and watermelon
- Asparagus, Fruits: peas, mushrooms and cauliflower
- Most legumes including chickpeas, kidney beans and lentils
- Onion and garlic
- Large amounts wheat-based breads, pasta and cereal
- Large amounts of cow’s milk, yoghurt, cottage cheese
- Some artificial sweeteners
- Cashews and pistachios
Gluten-free and dairy-free diets can sometimes improve symptoms for women with endometriosis but one theory as to why is because these foods are generally high in FODMAPs.
Vegetarian & Vegan diets
Vegetarian, vegan or plant-based diets emphasise plant foods with minimal or no animal products including meat, chicken, eggs and cheese. These dietary patterns have a strong focus on fruit, vegetables, legumes, wholegrains, nuts, seeds and tofu and tempeh and are therefore rich in dietary fibre and antioxidants which can assist with lowering inflammation and reducing oestrogen levels in the body which can reduce symptoms.
Additionally, these dietary patterns are generally lower in high GI carbohydrates, added sugars and saturated fat and these are known to have an anti-inflammatory effect in the body. If you are following a plant-based diet it is important to consult with an Accredited Practising Dietitian (APD) to make sure you are getting enough nutrients like protein, calcium, vitamin B12, iron and omega-3 fatty acids through foods or supplementation.
ORS has a dedicated team of Accredited Practising Dietitians (APD) here to support you if you have a diagnosis of endometriosis. If you have endometriosis you may be eligible for some Medicare-subsidised visits to see an APD. Speak to your GP or give us a call to find out more.
Remember, personalised advice is key to finding the best options for you. Click this link or call ORS on 1800 000 677 to connect with an ORS dietitian today!
About this blog
This blog was written in collaboration with ORS’ Dietetics general manager Erene Thong, State manager for dietetics Nicole Saliba, dietetics student advisor Bronte, & dietetics student Jessica.
References:
Ashrafi, M., Jahangiri, N., Sadatmahalleh, S. J., Aliani, F., & Akhoond, M. (2020). Diet and The Risk of Endometriosis in Iranian Women: A Case-Control Study. International Journal of Fertility & Sterility, 14(3), 193–200. https://doi.org/10.22074/ijfs.2020.44378
Celiac Disease Foundation. (2018). Sources of Gluten | Celiac Disease Foundation. Celiac Disease Foundation; Celiac. https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/
Dougan, M. M., Fest, S., Cushing-Haugen, K., Farland, L. V., Chavarro, J., Harris, H. R., & Missmer, S. A. (2024). A prospective study of dietary patterns and the incidence of endometriosis diagnosis. American Journal of Obstetrics and Gynecology, 231(4). https://doi.org/10.1016/j.ajog.2024.04.030
Gastroenterology Consultants of San Antonio. (n.d.). Low FODMAP Diet for Irritable Bowel Syndrome | IBS Treatment. Gastroenterology Consultants of San Antonio. https://www.gastroconsa.com/patient-education/irritable-bowel-syndrome/low-fodmap-diet/
Krabbenborg, I., Roos, N. de, Grinten, P. van der, & Nap, A. (2021). Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. Reproductive BioMedicine Online, 43(5). https://doi.org/10.1016/j.rbmo.2021.07.011
Kumar, K., Appleby‐Gunnill, B., & Maslin, K. (2023). Nutritional practices and dietetic provision in the endometriosis population, with a focus on functional gut symptoms. Journal of Human Nutrition and Dietetics, 36(4). https://doi.org/10.1111/jhn.13158
Nirgianakis, K., Egger, K., Kalaitzopoulos, D. R., Lanz, S., Bally, L., & Mueller, M. D. (2021). Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reproductive Sciences, 29(1). https://doi.org/10.1007/s43032-020-00418-w
