Endometriosis can be an overwhelming diagnosis and can have a huge impact on quality of life. The good news is that nutrition can be a powerful tool in managing your symptoms.
What is Endometriosis?
Endometriosis is “characterized by the presence of endometrial tissues outside the uterine lining, typically on the external surface of the uterus, the ovaries, fallopian tubes, abdominal wall, or intestines.”1 It can be hard to diagnose given the wide variety of symptoms and symptom severity. It is estimated to affect between 10 and 15% of women of reproductive age. Symptoms include pelvic pain, bleeding between periods, painful periods, fatigue, bloating, constipation, diarrhea, and impacted fertility. Some women are asymptomatic. The only definitive diagnosis comes from surgery, so many women spend years dealing with symptoms without an official diagnosis.
What Should I Eat to Manage Endometriosis Symptoms?
Although there is no known cure for endometriosis, nutrition can help with symptom management. Many endometriosis symptoms stem from inflammation characteristic of the disease. Though nutrition intervention will be highly individualized, here are some general nutrition considerations:
Choosing the Right Fats
Saturated fats should be limited as much as possible. This is because saturated fats have been shown to be pro-inflammatory. Palmitic acid, a type of saturated fat found in meat (especially red meat), dairy, and palm oil, has been shown to increase estrogen production in the body, exacerbating endometriosis where high levels of estrogen are already inflammatory.2 It is recommended to consume less than 6% of your total daily calories from saturated fat4 and the lower the better. As much as possible, replace saturated fats in your diet with unsaturated fats.
Unsaturated fats have anti-inflammatory effects and can be categorized into monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs).2 Foods that contain MUFAs include olive oil, canola and other vegetable oils, nuts, seeds, avocado, and full fat dairy. PUFAs can be further categorized into omega-3 or omega-6 fatty acids. Omega-6s are found in vegetable oils, nuts, and seeds. Omega-3s are found in fish and fish oils, seaweed, flaxseed, chia seeds, soybeans, and walnuts.
The bottom line on fat is to focus on including unsaturated fat sources in your diet for overall health and their anti-inflammatory benefits. Swap saturated fat sources for unsaturated where able. This may look like choosing lean meats (chicken, turkey) over red meat, using olive oil instead of butter, and incorporating nuts and seeds into your snacks and meals. Aim to include 2-3 servings of fatty fish per week as they are an excellent source of omega-3s.
Fiber
Fiber is an indigestible carbohydrate. Known most commonly for its digestion benefits, fiber plays several roles in the management of endometriosis. Fiber increases levels of sex hormone binding globulin in the blood, thereby reducing circulating estrogen. Women with endometriosis typically have excessive estrogen circulating in the blood which contributes to inflammation and thereby pain. A reduction in estrogen can lead to decreased endometriosis symptoms. Fiber also plays a role in blood sugar management, which can decrease inflammation. Adequate fiber intake will also help to reduce constipation. Aim for 30g fiber per day at a minimum. Food sources include fruits, vegetables, legumes, nuts, and seeds.
Antioxidants
Antioxidants are compounds that reduce oxidative stress in the body by binding with free radicals. What does that mean? Free radicals are unpaired electrons that can cause damage to our cells. Antioxidants are compounds that provide electrons that bind with those free radicals, thereby stabilizing them and preventing them from causing damage. Common antioxidants are vitamins C and E, anthocyanins, carotenoids, and more.
This applies to endometriosis because there is increasing evidence of a correlation between oxidative stress and disease severity3. There is some research suggesting antioxidant supplementation, particularly with vitamins C and E, can reduce symptom severity. More research is needed on antioxidant supplementation and a broad recommendation does not exist at this point. Generally, though, aim to incorporate a variety of antioxidant sources in your diet. Main sources are fruits and vegetables but whole grains, nuts, and seeds contain antioxidants as well. Eating the rainbow (ie. getting multiple colors of fruits and vegetables on your plate) can help you get a good variety of antioxidants in your diet.
The Bottom Line
We still have a lot to learn about nutrition’s impact on endometriosis symptom management. We do know that a diet high plants (fruits, vegetables, plant-based protein sources) is beneficial as they provide both fiber and antioxidants. Red meat intake should be limited (I recommend no more than once per week) with a focus on lean meat, fish, and plant-based protein sources. This is a general overview. Working with a dietitian can help you build a diet aimed at your symptoms that takes into account your medical history and lifestyle. Learn more about working with a dietitian for endometriosis here.
Sources:
- Barnard ND, Holtz DN, Schmidt N, Kolipaka S, Hata E, Sutton M, Znayenko-Miller T, Hazen ND, Cobb C, Kahleova H. Nutrition in the prevention and treatment of endometriosis: A review. Front Nutr. 2023 Feb 17;10:1089891. doi: 10.3389/fnut.2023.1089891. PMID: 36875844; PMCID: PMC9983692.
- Marcinkowska A, Górnicka M. The Role of Dietary Fats in the Development and Treatment of Endometriosis. Life (Basel). 2023 Feb 27;13(3):654. doi: 10.3390/life13030654. PMID: 36983810; PMCID: PMC10058497.
- Zheng, SH., Chen, XX., Chen, Y. et al. Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis. Reprod Biol Endocrinol 21, 79 (2023). https://doi.org/10.1186/s12958-023-01126-1
- Saturated fat. www.heart.org. (2025, March 10). https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats