Endometriosis and the Role of Nutrition

Written by Shewar. M | Dietitian 

On the 8th of March the world celebrated International Women’s day. A day dedicated to acknowledge and honour women in various fields. The month of March also brought about the awareness of Endometriosis. A painful chronic condition that affects 1 in every 9 Australian women. This article has been designed to bring awareness to endometriosis and shine light onto how nutrition may play a role in managing endometriosis. 

What is endometriosis?

Endometriosis is an inflammatory condition that causes tissue, similar to the lining of the uterus, to grow in other locations of the body. The condition can be extremely painful, affect fertility and lead to reduced participation in school, work and social activities.

Symptoms of endometriosis vary person to person, however, most commonly individuals experience:

• Severe abdominal pain
• Heavy menstrual bleeding
• Bleeding between periods
• Abdominal bloating
• Fatigue
• Anxiety and depression 
• Infertility

Currently, there is no known cure for endometriosis. There are treatments available to manage symptoms associated with endometriosis and improve quality of life.

Prevalence of Endometriosis in Australia

Nearly 1 million Australians will live with endometriosis at some point in their life. Due to its complexities and symptoms being non-specific, diagnosis is often delayed. This has improved overtime, however we see that it still takes an average of 6.5 years to be diagnosed with endometriosis.

Recent statistics by the Australian Institute of Health and Welfare found that 1 in 7 (14%) of women, girls and those assigned female at birth will be diagnosed with endometriosis by the age of 44 to 49.

Role of Nutrition

So what role does nutrition play in endometriosis?

Nutrition therapy may be helpful in the prevention and treatment of endometriosis and associated pain. Let us look at some foods that may help manage symptoms associated with endometriosis. 

Omega-3 Fatty Acids

Omega 3 has anti-inflammatory properties that may help in reducing endometrial tissue and endometrial inflammation in the body, especially in those diagnosed with stages 3 or 4.

Omega-3 fatty acid rich foods:

• Seafood including, salmon, tuna, pacific oysters, trout, sardines, herring, swordfish, anchovies, mussels and mackerel
• Nori (seaweed)
• Walnuts
• Some seeds (flax seeds, chia seeds, hemp seeds, pumpkin seeds)
• Some fortified foods (eggs and vegan products)

Protein Sources

High meat consumption has been found to be associated with a greater risk of developing endometriosis by impacting oestrogen levels. It is important to get a variety of protein sources (both animal and plant) and a variety of fats to help ensure balance. Opt for these protein source:

Protein Sources:

• Chicken
• Turkey
• Fish
• Shellfish
• Beef
• Beans
• Peas
• Nuts and seeds
• Dairy and eggs
• Soy products (tofu, tempeh, TVP)
• Seitan
• Protein powders

Vitamin D

Research has shown that supplementation of vitamin D may help reduce inflammation and endometrial lesions.

Food sources of Vitamin D include:

• Salmon, tuna, mackerel,
• UV treated mushrooms
• Fortified dairy and non-dairy milks (check the food label)
• Fortified OJ, yoghurts and cereals (check the food label)
• Sunlight
• Egg yolks
• Cheese

Vitamin C & E

Vitamins C and E are well known antioxidants, meaning they protect cells from damage. Research has supported vitamins C and E in reducing inflammation and pelvic pain. These studies used supplemental versions of the vitamins, but both of these micronutrients are abundant in food.

Food sources of vitamins C and E:

• Vitamin C: oranges, grapefruit, mandarins, red and green capsicum, kiwi, tomatoes, broccoli, potatoes, all berries (strawberries, raspberries, blueberries), cantaloupe, passion fruit, guava, goji berries, durian and mango
• Vitamin E: olives, olive oil, avocados, avocado oil, peanuts, seeds, nuts, spinach, broccoli, sunflower oil and safflower oil

Fibre

Increasing dietary fibre has been shown to reduce excess oestrogen from the body, which may lead to reduced progression of the disease. Foods high in fibre include:

• Rolled Oats
• Quinoa
• Brown rice
• Basmati rice
• Whole grain bread
• Wholegrain pasta/noodles
• Fruits and vegetables, but eat the whole food and avoid juice
• Legumes, like beans, lentils and chickpeas

Low FODMAP Diet

Many women experience Irritable Bowel Syndrome- like symptoms causing gastrointestinal discomfort. The low FODMAP diet focuses on identifying possible trigger foods that lead to an increase in gastrointestinal symptoms and endometriosis symptoms. Please seek the advice of a registered Dietitian if you are interested in knowing more information as this diet is individualised to suit your needs. 

Trigger Foods

All bodies are different, however, there are certain foods that are likely to lead to an increase in inflammatory responses. It is important these foods are limited in your everyday diet. These can include:

• Alcohol: Wine, beer and spirits can increase inflammation. At most have 1-2 drink per day
• Caffeine: Limit daily caffeine intake to 400 milligrams or less. One cup of coffee can have over 100 milligrams depending on how it is brewed.
• Fatty meat: Limit fatty meat intake and focus on lean meats mentioned above
• Processed foods: Many packaged foods contain ingredients such as sugar, saturated fat and trans fat which increase inflammation. 
• Sugary drinks: Fruit juice, soft drink and energy drinks are high in sugar which can increase inflammation. Try to limit intake of these drinks an opt for water as fluid choice.

Where to get more help:

If you would like more information regarding Endometriosis please see below:

• Your GP
• Endometriosis Australia: https://endometriosisaustralia.org/
• Registered dietitian. They can help you plan meals that work best with you and endometriosis, as there’s no one-size-fits-all approach.

References

1. Amini, L., Chekini, R., Nateghi, M. R., Haghani, H., Jamialahmadi, T., Sathyapalan, T., & Sahebkar, A. (2021). The Effect of Combined Vitamin C and Vitamin E Supplementation on Oxidative Stress Markers in Women with Endometriosis: A Randomized, Triple-Blind Placebo-Controlled Clinical Trial. Pain Research and Management, 2021, 1–6. https://doi.org/10.1155/2021/5529741
2. Australian Institute of Health and Welfare. (2023). Endometriosis. Retrieved from 
3. https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/summary-1 
4. Barnard, N. D., Holtz, D. N., Schmidt, N., Kolipaka, S., Hata, E., Sutton, M., Znayenko-Miller, T., Hazen, N. D., Cobb, C., & Kahleova, H. (2023). Nutrition in the prevention and treatment of endometriosis: A review. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1089891
5. Better Health Channel. (2012). Endometriosis. Vic.gov.au. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/endometriosis
6. Endometriosis Australia. (2023). Endometriosis Australia. Endometriosis Australia. https://endometriosisaustralia.org/
7. Lilly Zheng, Chen, X., Chen, Y., Wu, Z., Chen, X. M., & Li, X. (2023). Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis. Reproductive Biology and Endocrinology, 21(1). https://doi.org/10.1186/s12958-023-01126-1
8. Yalçın Bahat, P., Ayhan, I., Üreyen Özdemir, E., İnceboz, Ü., & Oral, E. (2022). Dietary supplements for treatment of endometriosis: A review. Acta Bio-Medica : Atenei Parmensis, 93(1), e2022159. https://doi.org/10.23750/abm.v93i1.11237