What diets are recommended for women with endometriosis?

Dietary Recommendations for Women with Endometriosis

Women with endometriosis should adopt a diet rich in fruits and vegetables (at least 5 portions daily), emphasize omega-3 fatty acids, dietary fiber, and antioxidants, while maintaining a healthy weight through regular physical activity to reduce circulating estrogen levels. 1

Core Dietary Pattern

The Mediterranean and anti-inflammatory dietary patterns show the most promise for symptom improvement in endometriosis. 2 These patterns share key characteristics that address the hormonal and inflammatory nature of the disease:

• Consume at least 5 portions of fruits and vegetables daily, as this may decrease both the risk and symptoms of endometriosis 1
• Increase intake of omega-3 fatty acids from fish and plant sources, which have anti-inflammatory properties beneficial for endometriosis management 2, 3
• Emphasize dietary fiber from whole grains, legumes, and vegetables to help modulate insulin resistance and reduce systemic inflammation 2
• Choose plant-based proteins from legumes, nuts, and seeds as primary protein sources 2

Specific Foods to Increase

• Fish consumption should be increased (particularly fatty fish rich in omega-3s) as this correlates with reduced endometriosis risk 3, 4
• Vegetables (especially non-cruciferous varieties) should form a substantial portion of daily intake 3
• Legumes and potatoes appear protective and should be consumed regularly 3
• Dairy products may have a protective effect, though some women report symptom improvement with reduction 3, 4
• Foods rich in vitamins A, C, D, and B12 should be prioritized 3
• Sources of monounsaturated and polyunsaturated fatty acids (olive oil, nuts, avocados) should replace saturated fats 3
• Minerals including calcium, potassium, and magnesium should be obtained through dietary sources 3

Foods to Limit or Avoid

• Reduce red meat consumption, as diets high in red meat are associated with increased risk 5, 4
• Limit high saturated fat foods which may worsen inflammatory processes 6, 4
• Reduce dairy intake if symptoms persist, as 18.4% of women with endometriosis report improvement with dairy reduction 4
• Limit soy-containing foods based on patient-reported symptom patterns 4

Weight Management is Critical

Maintaining a healthy body weight is crucial because excess adipose tissue converts androstenedione to estrone, creating higher circulating bioavailable estrogens that fuel endometriosis. 1, 7, 6

• In premenopausal women, obesity causes insulin resistance, elevated ovarian androgens, anovulation, and chronic progesterone deficiency—all of which worsen endometriosis 7, 6
• Regular moderate to vigorous physical activity is recommended to achieve and maintain healthy weight while reducing systemic inflammation 1
• Weight management directly reduces circulating estrogen levels, which is fundamental to controlling endometriosis progression 1

Antioxidant Supplementation

Additional intake of antioxidants, omega-3 fatty acids, and combinations of vitamins and minerals may positively affect endometriosis-associated symptoms, though evidence quality is limited 8

• Antioxidant-rich foods (berries, leafy greens, nuts) should be emphasized in the daily diet 2, 8
• Supplementation with isolated nutrients may be considered, but whole food sources are preferred 8

Important Caveats

A gluten-free diet should NOT be routinely recommended for women with endometriosis unless celiac disease is diagnosed, as scientific evidence for efficacy is lacking and long-term adherence may impair diet quality and nutrient intake 9

• While 15% of women with endometriosis self-report adopting gluten-free diets, data is conflicting and provides no evidence for causality 4, 9
• Placebo and nocebo effects significantly influence reported benefits of restrictive diets 9
• Low-FODMAP diets may help if concurrent irritable bowel syndrome symptoms exist, but are not indicated for endometriosis alone 2

Cardiovascular Risk Monitoring

Women with endometriosis have higher risk of hypertension, high cholesterol, and systemic inflammation, making heart-healthy dietary patterns doubly important 1

• The recommended dietary pattern simultaneously addresses both endometriosis symptoms and cardiovascular risk factors 1
• Regular monitoring of blood pressure and lipid profiles should accompany dietary interventions 1

Evidence Limitations

The current evidence base consists primarily of observational studies and low-quality trials 8. Most positive effects reported in dietary intervention studies are based on self-reported outcomes and may be influenced by confounding factors such as baseline weight status 9. However, the recommended dietary pattern (Mediterranean/anti-inflammatory) carries no harm and provides multiple health benefits beyond endometriosis management 2, 3, making it a reasonable recommendation despite evidence limitations.