What to Eat When You Have Endometriosis

While there's no official "endometriosis diet," some evidence suggests that following a Mediterranean-style diet may improve symptoms. Additionally, some people notice improvements after removing gluten, dairy, and nickel from their diet.

There is no cure for endometriosis, but effective treatment options, including pain relievers, surgery, and hormone therapy, are available. Making dietary changes and exercising may also help.

This article will discuss the research behind different diets for endometriosis. It will also discuss which foods to eat and which to avoid for better symptom management.

Benefits

Although there isn't one specific eating pattern routinely recommended to treat endometriosis, preliminary studies show that making dietary changes can help.

Because endometriosis (a condition in which cells like those lining the inside of the uterus grow outside the uterus) is a chronic inflammatory condition, adopting an anti-inflammatory diet, such as the Mediterranean diet, may help manage symptoms.

One study on 68 people with endometriosis found that a Mediterranean diet significantly relieved general pain as well as pain from menstruation, intercourse, and bowel movements. General condition improvements were also observed.

Based on promising study results and its well-known benefits, researchers suggest that healthcare providers can routinely recommend the Mediterranean diet as a long-term dietary change to people with endometriosis.

Other small studies have found that some people with endometriosis may benefit from gluten-free, low-nickel, or low FODMAP (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets.

How It Works

The Mediterranean diet is primarily plant based and includes a daily intake of whole fruits and vegetables, whole grains, nuts, beans, seafood, and olive oil.

According to research, eating a Mediterranean diet low in processed foods can reduce your risk of developing certain chronic diseases, including heart disease and type 2 diabetes.

In particular, the Mediterranean is high in omega-3 fatty acids, which can help reduce pain and inflammation. Some studies show that diets high in omega-3 fats can reduce the risk of endometriosis.

The Mediterranean diet is also high in fiber, which may help lower estrogen levels. While people need estrogen, too much may worsen symptoms and support the growth of endometriotic lesions. These are lesions seen when the uterine lining grows in places outside the uterus in endometriosis.

Although no foods are off-limits, the Mediterranean diet encourages limiting red meat and trans fats, both of which have been shown to aggravate symptoms of endometriosis.

While the Mediterranean diet does not exclude alcohol consumption, alcohol intake is associated with the risk of developing endometriosis and other chronic inflammatory diseases. Drink mindfully when consuming alcoholic beverages if you exhibit other risk factors for endometriosis.

Duration

Unless otherwise stated by your healthcare provider, the Mediterranean diet can be maintained to improve health and reduce the risk of chronic disease throughout your life. It offers a lot of flexibility and a wide variety of foods, making it easier to stick with than many diets.

What to Eat

When following the Mediterranean diet, you'll be building your meals around fruits, vegetables, beans, and whole grains. The diet allows low to moderate amounts of meat, emphasizing seafood and fish as the primary source of animal protein. Highly processed foods, added sugar, and saturated fats are limited.

Fruits: Aim to consume at least three servings of fruit per day. All fruits, including berries, apples, bananas, figs, oranges, melons, and peaches, are compliant.

Vegetables: Include four or more servings of vegetables per day. Ideally, at least one serving should be raw vegetables. Eat a variety of colorful vegetables, such as squash, carrots, tomatoes, broccoli, kale, spinach, and sweet potatoes.

Whole grains: Consume four servings of grains per day, mainly choosing whole grains such as oatmeal, quinoa, brown rice, and whole wheat bread.

Plant-based proteins: Beans, legumes, nuts, and seeds are the most common plant-based protein sources in the Mediterranean diet. Aim to consume at least three servings of beans and legumes and three servings of nuts and seeds each week.

Animal proteins: Try to eat fish and seafood at least three times per week. Opt for salmon, tuna, and sardines, which are high in omega-3 fatty acids. Poultry, eggs, cheese, and yogurt should be consumed in low to moderate amounts.

Choose low-fat dairy instead of full-fat. Limit red meat, fatty cuts of meat, and processed meat such as sausage, deli meat, bacon, and hot dogs.

Fats/oils: Aim to consume at least 4 tablespoons per day. Olive oil is the main source of added fat in the Mediterranean diet. Other good options include avocado and nut butter.

Processed foods: Heavily processed foods, such as sugary beverages, potato chips, pastries, cakes, french fries, dressings, and gravies, should be limited.

Alcohol and other beverages: You'll want to primarily drink water and avoid sugary beverages when following this diet. As long as it's OK with your healthcare provider, people assigned female at birth are recommended one serving of alcohol if to choose to consume. (One serving is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits).

Recommended Timing

The Mediterranean diet does not recommend specific times to have your meals. It is important to choose portion sizes and meal timings that work best for you.

As long as you can incorporate plenty of fruits, vegetables, whole grains, nuts and/or seeds into your diet while limiting highly processed foods, added sugars, and saturated and trans fats, you can adopt many flexible eating habits and meal timing patterns based on your lifestyle.

Cooking Tips

There are a few simple food swaps you can make to help you get started on the Mediterranean diet. These include:

• Swap out butter for olive oil or avocado.
• Enjoy fruit for dessert.
• Saute foods in olive oil instead of deep frying.
• Use extra virgin olive oil in salad dressings.
• Season food with herbs and spices instead of salt.
• Choose skinless chicken or turkey, or remove the skin before cooking.

Modifications

Many people fear that the Mediterranean diet is too expensive to follow. Although this diet prioritizes fresh, whole foods, which can be costly, there are ways to make it affordable.

For example, frozen fruits and vegetables are usually cheaper and last longer. Shopping for seasonal fruits and vegetables can be more affordable as well, and don't forget to check out your local farmers market.

You can also purchase a whole chicken and remove the skin before cooking and choose dried beans instead of canned beans.

Low-sodium canned fish is also a good option if your budget doesn't allow for fresh fish. Look for canned fish in water rather than oil and bone-in for additional calcium for bone health.

Batch-cooking meals and freezing them and leftovers is another great way to save money.

Considerations

Making dietary changes can be difficult and intimidating. Knowing ahead of time what challenges you may face can help you plan and prepare.

Here are a few things to consider before changing your eating habits.

General Nutrition

According to the Department of Agriculture (USDA), the Mediterranean diet represents a healthy approach to eating that can meet a person's nutrient needs while improving health and reducing the risk of chronic disease.

Although the nutrient content is similar to the current dietary guidelines, the Mediterranean diet offers more fruits, vegetables, and seafood. It does, however, limit dairy. This means it may provide lower amounts of calcium and vitamin D than what is currently recommended.

Sustainability and Practicality in the Real World

Unlike many diets that restrict certain foods and food groups, the Mediterranean diet has no strict rules or regulations. As a result, it may be easier to adhere to in social situations, at home, and when dining out.

Other Diets

In addition to the Mediterranean diet, a small amount of research supports the use of other diets, including gluten-free, low-nickel, and low-FODMAP diets.

Gluten-Free Diet

One 2012 study on 207 people with endometriosis found that 75% of participants experienced decreased pain after following a gluten-free diet for 12 months. But no further studies have been identified that explore this option.

A gluten-free diet restricts foods that contain gluten, a protein found in wheat, rye, and barley. Because it can be very restrictive, gluten-free diets are generally not recommended unless a person has celiac disease or a gluten sensitivity.

Gluten-free diets can also make it difficult to get the proper vitamins and minerals you need.

Low-Nickel Diet

Nickel is an element found in certain metallic objects. It can also be present in some foods. Individuals with endometriosis are more likely to have a nickel allergy than the general population.

For example, one small study found that 90% of people with endometriosis tested positive for nickel allergic contact mucositis (nickel allergy). After three months of following a low-nickel diet, gastrointestinal (GI) and gynecologic symptoms significantly improved.

Researchers concluded that nickel allergies should be considered as a potential cause or contributing factor to some symptoms in people with endometriosis.

Foods high in nickel include:

• Chocolate
• Cocoa
• Oatmeal
• Nuts
• Almonds
• Legumes
• Soy products

Because this diet restricts nutrient-rich foods, it should only be considered if a nickel allergy is confirmed or suspected by your healthcare provider.

Low FODMAP

Symptoms of endometriosis and irritable bowel syndrome (IBS) sometimes overlap. Some people with endometriosis who experience symptoms similar to IBS report improvements in GI symptoms when following a low FODMAP diet.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are types of sugar or sugar alcohols many people have difficulty digesting.

One 2017 study found that a low-FODMAP diet improved IBS symptoms in people with IBS and endometriosis.

Similar to a gluten-free diet, the low FODMAP diet is restrictive and can be challenging to follow. Research on its effectiveness in those with endometriosis remains limited.

Summary

Endometriosis is a painful gynecologic condition. Current research suggests that red meat and foods high in trans fat may make symptoms worse.

Additionally, some research suggests that a Mediterranean-style diet rich in omega-3s, fiber, and antioxidant-rich fruits and vegetables may reduce endometriosis symptoms.

Even if it doesn't provide symptom relief, eating a balanced, nutrient-rich diet can improve your overall health and make you feel better. As you work to modify your eating habits, it's important to make changes gradually and give yourself grace through the process.