Updated: Jan 27
Endometriosis is a chronic inflammatory condition in which tissue that is similar to the lining of the uterus grows in other parts of the body such as the ovaries, fallopian tubes, uterus and bowel. This tissue acts like uterine tissue and sheds during menstruation but cannot be excreted by the body. This results in pain, scar tissue and adhesion formation. Heavy, painful periods are a hallmark symptom of endometriosis alongside severe abdominal pain, endometrial cysts, bloating, painful intercourse, and infertility.
Endometrioses is actually a very common condition and is estimated to affect 1 in 10 women. Unfortunately, diagnosis can be tricky and may take years.
It’s not entirely clear what causes endometriosis, but it’s thought to be multifactorial in nature with its roots in many different things such as genetics and environmental exposures. Currently there is no cure for endometriosis. Treatments commonly offered include hormonal contraception, and surgery. Endometriosis is a condition which can respond really well to lifestyle and dietary alterations as an addition to its management.
Include Anti-Inflammatory Foods
Inflammation is a key driving factor in endometriosis. Increasing anti-inflammatory foods and reducing pro-inflammatory foods is therefore key in its management. This involves including healthy fats such as oily fish, nuts, seeds, avocado and olive oil while reducing saturated fats such from highly processed foods. Red meat can be high in saturated fats; however, it is also high in iron. Iron is needed to prevent anaemia caused by heavy periods in women with endometriosis. Choose red meat with a low percentage of fat, such as 5% mince to optimise iron intake and reduce saturated fat intake.
Go Gluten Free?
Sensitivity to gluten has been reported in non-coeliac patients with endometriosis. A study examining the effects of a gluten free diet on pelvic pain in 207 women with endometriosis reported significant improvements in pain in 75% of participants after 12 months, along with improved quality of life. Many gluten free products may still be highly processed and low in nutritional value, so minimising heavily processed gluten free alternatives is also advised.
Fibre is Your Friend
Endometriosis is driven by excess oestrogen. Diets high in fibre increase oestrogen excretion. Aim for high fibre foods such as oats, vegetables, fruit and brown versions of rice, pasta and bread. 15g/100kcal is a good starting point for fibre intake. Remember to increase your intake gradually while drinking plenty of water to minimise any possible digestive discomfort.
Another Reason to Eat Your Greens!
Green cruciferous vegetables such as broccoli, spinach and kale are rich in a compound called DIM. DIM can help breakdown excess oestrogen into more favourable oestrogen metabolites, resulting in a more optimal hormone balance. These veggies are also rich in fibre making their inclusion in the diet a win-win!
A diet high in antioxidants A, C & E in women with endometriosis has shown to reduce markers of oxidative stress, which may contribute to inflammation. Foods rich in these antioxidants include fruits such as berries, vegetables and nuts.
What About Supplements?
Like anything, dietary and lifestyle modifications are paramount in managing in endometriosis. Supplements can also be added in for further support.
N-Acetyl Cysteine (NAC)
NAC is a strong antioxidant and a precursor to glutathione, another powerful antioxidant. Supplementing with NAC has shown promising effects in women with endometriosis. A study used 600mg of NAC 3 times a day for 3 consecutive days in the week and then 4 days without for 3 months. The group supplemented with NAC reported improved pain and to an increased number of cysts that had shrunk or disappeared, as well as a smaller number of newly formed cysts compared to controls.
Omega-3 Fish Oil
Omega-3 fats from oily fish and fish oil supplements have been shown to reduce the production of inflammatory cytokines by the body, helping to manage inflammation and reduce pain. Omega-6 and omega-3 fatty acids compete for enzymes in the body. This means that high intakes of omega-6 fats coupled with low intakes of omega-3 fats can lead to an imbalance within the body, promoting inflammation. This imbalance has also been reported to be associated with increased period pain in women with endometriosis. Choose a pure omega-3 fish oil supplement.
Low levels are thought to play a role in many chronic diseases, including endometriosis. The main source of vitamin D is sunlight, meaning that most of the Irish population could be deficient and should therefore supplement with it in the winter months. Vitamin D can reduce the production of pro-inflammatory cytokines in the endometrium which contribute to inflammation and pain. Supplementation prior to menstruation has also been associated with a reduction in pain and use of painkillers.
Vitamin B Complex
Endometriosis can cause severe abdominal pain which can disrupt sleep, increase stress and contribute to fatigue. Supplementing with a vitamin B complex can help in supporting the nervous system and energy levels.
Heavy and prolonged periods are common in endometriosis, putting women at an increased risk developing iron-deficiency anaemia. Symptoms include tiredness, fatigue, paleness and breathlessness. It is a good idea to get iron levels checked through a blood test with your GP if you have endometriosis or have heavy periods. If low levels are detected, a supplement may be recommended. However, iron can build up in our body so it is not recommended to supplement with it unless you have low levels. Iron can also cause digestive discomfort such as constipation. Choosing iron gluconate may be a better option for those who find iron supplements difficult to stomach.