Endometriosis – What is it and can diet help?

Sue Bedford (MSc Nutritional Therapy)

March is Endometriosis Awareness Month, so we’re taking a closer look at what Endometriosis is and how nutrition might help. Throughout the month, keep a lookout for fresh recipe ideas.

What is Endometriosis?

Endometriosis occurs when the lining of the womb is displaced and starts to grow in other sites, such as the ovaries and fallopian tubes (and maybe further). There may be no symptoms or there may be many including pain in the lower tummy or back (pelvic pain), severe period pain, fatigue, changes to your period (heavy bleeding or irregular bleeding), painful bowel movements, and pain during or after sex. Endometrial tissue which is growing outside of the womb goes through the same process each month as that growing inside the womb (it thickens each month and if pregnancy does not occur the lining of the womb breaks down and leaves the body, but if the endometrial tissue is growing elsewhere, it cannot leave the body as blood so instead causes pain, inflammation and scarring).

What causes Endometriosis?

It appears that the actual cause of endometriosis is unknown. It is possible that one of the factors below or a combination of them could be a cause/contribute to the development of endometriosis in some women:

Environmental
Immune Issues
Retrograde menstruation
Genetic
Lymphatic

It is thought that this chronic condition affects around 1 in 10 women and in years gone by has sometimes taken 10 years or more to fully diagnose. It is very important to visit your GP if you have any concerns.

How is Endometriosis diagnosed and treated?

Endometriosis is usually confirmed by ultrasound and laparoscopy but in addition is also made by the description of symptoms such as irregular bleeding or heavy periods, painful bowel movements, pelvic pain, fatigue, bloating of the lower abdomen.

Some of the main treatments for endometriosis include painkillers, hormone medicines and surgery.

How can nutrition help?

Some key objectives regarding nutrition and endometriosis should be to boost gut flora, normalize immune response, remove metabolic wastes and to optimize liver function (the liver is key in the detoxification of toxins and in the metabolism of hormones). Plenty of regular exercise, maintaining a healthy weight and certain key supplements (which would need to be tailored to you individually as part of a personalised nutrition and lifestyle plan) have also been found to help.

Foods to avoid/ decrease:

• Processed meats and red meats – these can lead to further inflammation. Look for grass-fed or organic meat if you do consume a small amount of red meat.

• Trans Fatty acids- these are formed when liquid fats are heated or changed to make something more resembling butter or lard. Trans fats increase the body’s level of many inflammatory markers and these are inflammatory factors that have been shown to be associated with establishment of endometriosis. Check labels and avoid any products that contain hydrogenated or partially hydrogenated fats.

• Reduce omega 6 foods to help rebalance the omega 3:6 ratio. Examples of some omega 6 containing foods are: processed snacks, fast foods, cakes, fatty meats, and cured meats – these lead to an increase in inflammation.

• Limit Caffeine – can increase oestrogen levels and menstrual pain in some.

• Additives and processed foods- affect the liver which is involved in hormone processing.

• Gluten-containing foods – substitute with sweet potato, quinoa or wild rice for a while to see if symptoms ease.

• Alcohol – a healthy liver is important for good hormone balance, as the liver detoxifies chemicals and waste products including excess hormones. Alcohol can be inflammatory and affect vitamin D levels in the liver.

Foods to include in your daily diet:

• Plenty of fruit and vegetables – as these not only provide numerous vitamins and minerals but also contain fibre. This is important as it helps to expel unwanted substances from the body, particularly excess hormones such as oestrogen and also helps to balance gut flora.

• Drink plenty of fresh water each day (lovely with a slice of lemon in!) to flush out toxins.

  Beans, peas, rhubarb, apples, nuts and seeds, carrots, pulses contain natural phytoestrogens which can help to block oestrogen receptors thus help to balance hormones.

• Omega 3- oily fish such as salmon, trout, mackerel along with nuts and seeds to reduce inflammation.

• Recent research has indicated that lycopene may be useful in reducing the abnormal activity of cells and as a result reduce the adhesion effects of endometriosis. Lycopene is a phytochemical and is found in tomatoes (in highest amounts), and other brightly coloured fruit and vegetables such as watermelons, apricots, gogi and papaya (just a few examples).

• Leeks, onions and garlic are prebiotics that help boost gut flora. These also contain compounds and bioflavonoids that help protect against inflammation.

• Consume organic produce whenever possible.

• Foods containing selenium such as brazil nuts, walnuts, eggs, tuna, turkey, chicken and cod – selenium helps to boost white blood cell function and thus immunity. It also helps to produce liver detoxification enzymes.

• A low Glycaemic load (GL) has been shown to reduce painful symptoms in some.

Interesting reading:

Chavarro, J., Rich-Edwards, J., Rosner, B. and Willett, W. (2007) Dietary fatty acid intakes and the risk of ovulatory infertility. American Journal of Clinical Nutrition, Vol. 85, No. 1, pp231-237.

Dbouk, T, Fletcher, N, Jiang Z et al (2008). Lycopene a powerful antioxidant with remarkable anti adhesion effects. Fertil Steril

Helbig M, Vesper AS, Beyer I, Fehm T. Does Nutrition Affect Endometriosis?. Geburtshilfe Frauenheilkd. 2021;81(2):191-199. doi:10.1055/a-1207-0557

Missimer, S. et al.,(2010) Trans fats linked to increased endometriosis risk and omega-3-rich food linked to lower risk. European Society of Human Reproduction and Embryology.

Stacey A. Missmer, Jorge E. Chavarro, Susan Malspeis, Elizabeth R. Bertone-Johnson, Mark D. Hornstein, Donna Spiegelman, Robert L. Barbieri, Walter C. Willett, Susan E. Hankinson, A prospective study of dietary fat consumption and endometriosis risk, Human Reproduction, Volume 25, Issue 6, June 2010, Pages 1528–1535, https://doi.org/10.1093/humrep/deq044

Parazzini F, Cipriani S, Bravi F, et al. A metaanalysis on alcohol consumption and risk of endometriosis. Am J Obstet Gynecol. 2013;209(2):106.e1-10.  [PMID:23707678]

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