Overview of Endometriosis and its Symptoms
Endometriosis affects nearly 176 million women worldwide. That means one in ten women suffers from endometriosis.(1)
It is today one of the most common conditions affecting women all over the world, and it has been well established that many natural and man-made chemicals present in the environment also play a role in the development of endometriosis, aside from the hormonal imbalance in the body.(2)
Endometriosis is a disease that involves the reproductive system, causing the endometrium tissue to start growing outside of the uterus in parts of the body such as the ovaries, fallopian tubes, and even the abdomen and bowel.
Symptoms of endometriosis include painful periods accompanied by heavy bleeding. You will also experience pain during sexual intercourse, infertility, and painful bowel movements. Some of the other symptoms may include:
The symptoms of endometriosis, of course, varies from person to person. Furthermore, keep in mind that the severity of the pain you experience with endometriosis is not necessarily a genuine indicator of what is the real extent of the condition. You might be having severe pain even with mild endometriosis, or you might be at an advanced stage of endometriosis and yet only experience little to no pain.
Left untreated, endometriosis increases the risk of infertility. In fact, it is one of the leading causes of infertility worldwide.
Endometriosis also increases the risk of developing adenocarcinoma or ovarian cancer in people who have a history of the condition. However, there have been reports that the risk associated with cancer is still low over your lifetime, and there is no need to rush into any radical treatment regarding the same.(3)
It is common for endometriosis to be mistaken for other conditions that are also known to cause pelvic pain. These can include ovarian cysts or pelvic inflammatory disease (PID). Sometimes it is also confused with irritable bowel syndrome, especially when you experience pain during your bowel movements.
The cause of endometriosis remains unknown, and there is presently no cure for the disorder.
It has been found that there is a close association between what you eat and the risk of endometriosis. Many women have found that making specific dietary changes actually helped them manage their symptoms better and also reduced the pain associated with endometriosis. Let us take a look at some diet tips that can help you manage your endometriosis better.
What is the Link Between Endometriosis and Diet?
The fact is that there is very little research that actually investigates the association between endometriosis symptoms and diet. Nevertheless, many people have reported that eating certain foods helps relieve their symptoms and, at the same time, some foods trigger a flare-up.
In 2013, a study found that women who consumed more omega-3 fatty acids and vegetables were protected from the many symptoms of endometriosis, while women who had a high intake of trans fat, red meat, and coffee were experiencing the exact opposite effect.(4) But due to the fact that the results of the study were not consistent, further research is still required on this.
In 2015, a literature review was published in Brazil that suggested that women who ate a healthy diet were better capable of preventing endometriosis from developing itself. If they already had the condition, then it prevented the condition from progressing further.(5) The foods included in this diet were:
- Whole grains
- Omega-3 fatty acids
You cannot really prevent endometriosis, but according to the US Office on Women’s Health,(6) it is possible to reduce the risk of developing endometriosis by avoiding chemicals and foods that are known to boost the estrogen levels in the body. These substances can also include alcohol and caffeine.
It is essential to recognize that lifestyle, and dietary changes are not going to cure endometriosis, but only help alleviate your symptoms.
What To Include In An Endometriosis Diet?
A person who has been diagnosed with endometriosis should consider decreasing their intake of foods that are known to either cause inflammation or increase the estrogen levels in the body. Both of these factors are known to contribute to the disorder or worsen its symptoms.
While more research is still needed to firmly establish a link between diet and endometriosis, it is believed that a person suffering from this condition might benefit from eating plenty of fruits and vegetables, whole grains and omega-3 fatty acids. Lean meats, healthy fats, and plant-based proteins may also help.
Increase the Intake of Fruits, Vegetables, and Whole Grains
Vegetables, fruits, and whole grains are rich in vitamins and minerals, and also contain high levels of fiber. When you increase your consumption of these foods, it ensures that you are eating a diet packed with the essential nutrients your body needs rather than consuming empty calories only.
The benefits associated with these foods are especially important for women with endometriosis.
Intake of foods that are high in fiber will help lower your estrogen levels,(7) and whole grains, vegetables, and fruits are known to be some of the best sources of dietary fiber. These foods are also going to provide antioxidants, which is known to help fight against inflammation.
A study carried out by the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes in Mexico in 2009 found that women who have endometriosis and who followed a diet that was rich in antioxidants for a period of four months experienced a sharp increase in antioxidant capacity and a decrease the in the markers of oxidative stress.(8)(9)
Another study done by the Joan C. Edwards School of Medicine in the US found that women who took antioxidant supplements had a drastic decrease in pain caused by endometriosis.(10)
Another study carried out by the Università di Milano in Italy directly researched the association between eating fruits and green vegetables and endometriosis. The researching team discovered that the higher the intake of these foods, the lower was the risk of endometriosis.(11)
However, the issue is that the findings of all these studies have not been consistent. For example, yet another study done in 2010 by the University of Washington found that a higher intake of fruits actually increased the risk of developing endometriosis.(12) A possible explanation of this, though, is that consuming more fruits is linked with an increased consumption of pesticide as well. It is known that certain pesticides have strong estrogen-like effects on the body, thus affecting the risk of endometriosis.
Nevertheless, without more research, it is not really possible to say for sure just how vegetables and fruits affect endometriosis. But, current evidence all seem to suggest that a diet rich in fruits, vegetables, and whole grains, will help you get relief from the symptoms of endometriosis.
Increase the Consumption of Omega-3 Fatty Acids
Omega-3 fatty acids are healthy fats that are commonly found in fatty fish and many other animal and plant sources. These fats are known for their anti-inflammatory properties, which are known to help in endometriosis.
There are many types of fats, including plant oils that are rich in omega-6 fats that are known to increase inflammation in the body and also promote pain. However, omega-3 fatty acids have the exact opposite effect, helping boost the body’s inflammation and pain-relieving molecules.(13)
Provided that endometriosis is a condition associated with inflammation and pain, increasing the ratio of omega-3 fatty acids as compared to omega 6-fats in your diet will prove to be beneficial. Furthermore, a high proportion of omega-3 fats in your diet has been shown to inhibit the growth and survival of endometrial cells in many test-tube studies.(14) In fact, preliminary studies have also shown that a high ratio of omega-3 fatty acids in the body might even help in discouraging the implantation of endometrial cells in other areas in the first place.(15)
An observational study carried out by the Brigham and Women’s Hospital and Harvard Medical School in Boston, US, found that women who were regularly consuming very high levels of omega-3 fats were 22 percent less likely to develop endometriosis as compared to women who were consuming the bare minimum amounts of omega-3s.(16)
Last, but not the least, researchers from the Aarhus University in Denmark found that taking fish oil supplements that contained omega-3 fatty acids also slightly reduces menstrual pain and other symptoms.(17) However, the evidence was inconclusive when considered for endometriosis.
So, regardless of whether you consume fatty fish or you take supplements of omega-3, an overall increase of the healthy fats will surely help you fight against inflammation and endometriosis-associated pain.
Cut down on Trans Fats
Over the years, trans fats have garnered a reputation for being super unhealthy. After all, there is no dearth of studies that have firmly established that trans fats increase the levels of bad cholesterol, or LDL cholesterol, in the body, while simultaneously decreasing the levels of the good HDL cholesterol. This increases the risk of heart disease and even death in some cases.(18)
Trans fats are produced when certain liquid unsaturated fats get blasted with hydrogen until they become solidified. Manufacturers of trans fats usually manufacture trans fats to increase the shelf life of their products and also to give the product a more spreadable texture.
This makes these products ideal for using in a wide variety of processed and fried items such as fries, pastries, donuts, and crackers.
At the beginning of 2018, the US Food and Drug Administration (FDA) banned the use of trans fats in all food products due to the danger these foods pose to our health. Even in countries where trans fats are not banned, it is still advisable that you avoid products that contain trans fats.
It is especially important for women with endometriosis to avoid trans fats. It is has been observed that women who consume a high amount of trans fats are known to have a 48 percent greater risk of endometriosis. However, this was only indicated by only one study, meaning that the evidence is not conclusive. Nevertheless, avoiding trans fats is still a good idea for your overall health. You can determine whether or not a product has trans fats by reading the nutrition label. Any product that claims to have hydrogenated fats is also going to contain trans fats.
Pick a Gluten-free or Low-FODMAP Diet
It is known that there are certain diets that help alleviate the symptoms of endometriosis. A gluten-free or a low-FODMAP diet are some of the common options.
Gluten-free Diet: A gluten-free diet is recommended for endometriosis, but keep in mind that it is not recommended for those who have celiac disease or any type of gluten sensitivity. A gluten-free diet is known to be restrictive as well as low in nutrients and fiber. But, at the same time, it is high in refined starches, and there is some evidence that indicates a gluten-free diet might benefit women who have endometriosis.
For instance, a study carried out by the Tor Vergata University in Italy on 207 women participants who suffered from severe endometriosis pain, found that 75 percent of all the participants experienced a dramatic reduction in pain within 12 months of being on a gluten-free diet.(19) However, since the study did not have a control group, the placebo effect could not be accounted for.
Another study also conducted in Italy by the Santa Maria di Leuca Clinic in Rome, found similar results across 300 women participants. This study included a control group, and while one group took only medication, the other group took medication as well as followed a gluten-free diet.(20) At the end of this study, the researching team concluded that the group who was also on the gluten-free diet along with medication experienced the greatest amount of reduction in pelvic pain.
Low-FODMAP Diet: Low-FODMAP diets have become very popular these days. It is believed that a low-FODMAP diet might benefit women who have endometriosis. FODMAP stands for “Fermentable Oligo, Di-, Mono-saccharides and Polyols.”(21) These are known to be short-chained carbohydrates that are resistant to digestion and instead of getting absorbed into the bloodstream, they reach to the far end of the intestines. This is also where a majority of the gut bacteria are found. These gut bacteria then use these carbohydrates for fuel, manufacturing hydrogen gas, and leading to digestive symptoms in individuals who are sensitive to stomach issues. FODMAPS are also known to draw liquid to your intestines, causing diarrhea.
Due to this, consuming a low-FODMAP has shown to improve the symptoms of endometriosis and IBS (irritable bowel syndrome). A study carried out by Monash University, and Alfred Hospital in Australia in people who either had IBS or IBS and endometriosis found that consuming a low-FODMAP diet helps improve the symptoms of IBS by 72 percent in those participants who had endometriosis and IBS together, as compared to just 49% of people who had IBS alone.(22)
Both the gluten-free diet and low-FODMAP diet are known to be restrictive and also challenging to follow, but the relief they offer for endometriosis symptoms makes it worthwhile to follow these diets.
Cut Out Processed Foods
If you have endometriosis, then you should consider cutting down on your intake of processed foods. This is not just recommended for those with endometriosis, but in general, everyone will benefit from cutting down on processed foods.(23)
Processed foods are known to be rich in unhealthy fats and sugar and low in fiber and essential nutrients. This only helps in promoting pain and inflammation in the body rather than reducing your symptoms.(24)
Omega-6 fats that are found in many plant oils, including peanut, cottonseed, and corn oil, are known to aggravate pain, inflammation, and also uterine cramping. On the other hand, omega-3 fats that are found in many fatty fish, walnuts, and even flax, helps decrease pain, uterine cramping, and inflammation.
As a result of this, restricting your intake of foods such as chips, crackers, candy, fried foods, and pastries are going to help reduce symptoms such as endometriosis-related pain.
For a greater impact, you can try to replace processed foods with options that are going to help you manage endometriosis, such as fresh fruits and vegetables, whole grains, and fatty fish.
It is important to remember that even though there is no cure for endometriosis, there are still many treatment options and alternative methods of managing the condition. While medical and surgical options are also available, it doesn’t hurt to try some complementary approaches to find if you can get some relief from pain and other symptoms. Making dietary changes is one such approach that has been known to help many women manage their endometriosis better.
However, just as the symptoms of the disorder varies from person to person, these treatment approaches also work differently from one woman to another. What might work wonders for one person, might not be the right treatment for another.
So take your time to experiment for the many tips given above, and with time you will be able to find the approach that works best for you.
- Attaman, J.A., Stanic, A.K., Kim, M., Lynch, M.P., Rueda, B.R. and Styer, A.K., 2014. The Anti‐Inflammatory Impact of Omega‐3 Polyunsaturated Fatty Acids During the Establishment of Endometriosis‐Like Lesions. American Journal of Reproductive Immunology, 72(4), pp.392-402.
- Soave, I., Caserta, D., Wenger, J.M., Dessole, S., Perino, A. and Marci, R., 2015. Environment and Endometriosis: a toxic relationship. European review for medical and pharmacological sciences, 19(11), pp.1964-1972.
- Kvaskoff, M., Horne, A.W. and Missmer, S.A., 2017. Informing women with endometriosis about ovarian cancer risk. The Lancet, 390(10111), pp.2433-2434.
- Parazzini, F., Viganò, P., Candiani, M. and Fedele, L., 2013. Diet and endometriosis risk: a literature review. Reproductive Biomedicine Online, 26(4), pp.323-336.
- Maria Antonietta Carrozza. (2019). Edometriosi: malattia cronica e complessa dell’età riproduttiva | Maria Antonietta Carrozza. [online] Available at: https://mariaantoniettacarrozza.it/edometriosi-malattia-cronica-e-complessa-delleta-riproduttiva/ [Accessed 10 Aug. 2019].
- womenshealth.gov. (2019). Endometriosis | Womenshealth.gov. [online] Available at: https://www.womenshealth.gov/a-z-topics/endometriosis#references [Accessed 10 Aug. 2019].
- BioCycle Study Group Gaskins Audrey J Mumford Sunni L Zhang Cuilin Wactawski-Wende Jean Hovey Kathleen M Whitcomb Brian W Howards Penelope P Perkins Neil J Yeung Edwina Schisterman Enrique F [email protected] mail. nih. gov, 2009. Effect of daily fiber intake on reproductive function: the BioCycle Study. The American journal of clinical nutrition, 90(4), pp.1061-1069.
- Mier-Cabrera, J., Aburto-Soto, T., Burrola-Méndez, S., Jiménez-Zamudio, L., Tolentino, M.C., Casanueva, E. and Hernández-Guerrero, C., 2009. Women with endometriosis improved their peripheral antioxidant markers after the application of a high antioxidant diet. Reproductive Biology and Endocrinology, 7(1), p.54.
- Sesti, F., Capozzolo, T., Pietropolli, A., Collalti, M., Bollea, M.R. and Piccione, E., 2011. Dietary therapy: a new strategy for management of chronic pelvic pain. Nutrition research reviews, 24(1), pp.31-38.
- Santanam, N., Kavtaradze, N., Murphy, A., Dominguez, C. and Parthasarathy, S., 2013. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational Research, 161(3), pp.189-195.
- Parazzini, F., Chiaffarino, F., Surace, M., Chatenoud, L., Cipriani, S., Chiantera, V., Benzi, G. and Fedele, L., 2004. Selected food intake and risk of endometriosis. Human Reproduction, 19(8), pp.1755-1759.
- Trabert, B., Peters, U., De Roos, A.J., Scholes, D. and Holt, V.L., 2011. Diet and risk of endometriosis in a population-based case–control study. British journal of nutrition, 105(3), pp.459-467.
- Hansen, S.O. and Knudsen, U.B., 2013. Endometriosis, dysmenorrhoea and diet. European Journal of Obstetrics & Gynecology and Reproductive Biology, 169(2), pp.162-171.
- Gazvani, M.R., Smith, L., Haggarty, P., Fowler, P.A. and Templeton, A., 2001. High ω-3: ω-6 fatty acid ratios in culture medium reduce endometrial-cell survival in combined endometrial gland and stromal cell cultures from women with and without endometriosis. Fertility and sterility, 76(4), pp.717-722.
- Netsu, S., Konno, R., Odagiri, K., Soma, M., Fujiwara, H. and Suzuki, M., 2008. Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis. Fertility and sterility, 90(4), pp.1496-1502.
- Missmer, S.A., Chavarro, J.E., Malspeis, S., Bertone-Johnson, E.R., Hornstein, M.D., Spiegelman, D., Barbieri, R.L., Willett, W.C. and Hankinson, S.E., 2010. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction, 25(6), pp.1528-1535.
- Deutch, B., Jørgensen, E.B. and Hansen, J.C., 2000. Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules). Nutrition Research, 20(5), pp.621-631.
- De Souza, R.J., Mente, A., Maroleanu, A., Cozma, A.I., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J. and Anand, S.S., 2015. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. Bmj, 351, p.h3978.
- Marziali, M., Venza, M., Lazzaro, S., Lazzaro, A., Micossi, C. and Stolfi, V.M., 2012. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?. Minerva chirurgica, 67(6), pp.499-504.
- Marziali, M. and Capozzolo, T., 2015. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltranting Endometriosis. Journal of minimally invasive gynecology, 22(6), pp.S51-S52.
- IBS, U. and Us, C. (2019). What Are FODMAPs?. [online] Aboutibs.org. Available at: https://www.aboutibs.org/low-fodmap-diet/what-are-fodmaps.html [Accessed 10 Aug. 2019].
- Moore, J.S., Gibson, P.R., Perry, R.E. and Burgell, R.E., 2017. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(2), pp.201-205.
- Jurkiewicz-Przondziono, J., Lemm, M., Kwiatkowska-Pamuła, A., Ziółko, E. and Wójtowicz, M.K., 2017. Influence of diet on the risk of developing endometriosis. Ginekologia polska, 88(2), pp.96-102.
- Ilich, J.Z., Kelly, O.J., Kim, Y. and Spicer, M.T., 2014. Low-grade chronic inflammation perpetuated by modern diet as a promoter of obesity and osteoporosis. Archives of Industrial Hygiene and Toxicology, 65(2), pp.139-148.
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