The role diet plays in endometriosis

If you have endometriosis, the endometrial tissue that normally lines the inside of your uterus becomes displaced and moves outside into your pelvic cavity. When this tissue grows and tries to shed during a menstrual period, the endometrium cells instead bleed into the pelvic cavity, becoming fibrous over time and forming scar tissue. Oestrogen and progesterone are essential hormones to regulate your menstrual cycle. They help prepare the endometrium for implantation of a fertilised egg and control menstruation through receptors in endometrial tissue. Progesterone surges at the end of a menstrual cycle, signaling the start of menstruation.  This endometrial tissue located outside your uterus still responds to hormones that circulate in your bloodstream, causing the pelvic pain and cramps you may experience during your period.  The food you eat can influence hormone production and help these symptoms, allowing you to cope better and improve your lifestyle.


The role of hormones in endometriosis
Oestrogen dominance has been linked to women with endometriosis.[i] It occurs when women have higher levels of oestrogen with reduced amounts of progesterone in their bloodstream. Prostaglandins are a hormone stimulated by oestrogen and, if you have endometriosis, continue to be secreted by the endometrium outside the uterus – having a direct observed relationship to the pelvic pain you may experience during menstruation. [ii] Your body produces three types of prostaglandins to be kept in balance for the inflammatory process and to reduce pain symptoms associated with endometriosis. If you have large amounts of endometrial tissue spread throughout your body as well as oestrogen dominance, higher amounts of prostaglandins will be secreted – causing even more cramps and painful periods.[iii]


Prostaglandins, oestrogen and diet
Taking control of your diet can help to alter the levels of oestrogen, progesterone and prostaglandins secreted in your body.  Controlling oestrogen through nutrition is an empowering way to balance these hormone levels in your bloodstream.  A diet that eliminates foods which stimulate the production of oestrogen and supports oestrogen excretion from the body can help you manage the painful symptoms and inflammation caused by endometriosis. If you focus on eating just one type of food, your body might develop a tolerance to it over time. It’s best to have a variety of foods to include in your diet. Eating food fresh and avoiding processed foods can be beneficial for women with endometriosis.


How diet can help
Knowing food sources that may contribute to oestrogen and prostaglandin production and excretion can help you plan your meals.  You can confidently select food to include and exclude from your diet:

  • Fibre, particularly the soluble kind, binds to excess oestrogen and inhibits reabsorption[iv] – this may include fruit, vegetables, beans, whole grains and nuts


  • The body needs a constant supply of B vitamins to help with liver function and creation of enzymes needed to excrete excess oestrogen[v]


  • Glutinous grains, such as wheat, contain phytic acid that reduces mineral absorption[vi] – gluten free is a great option, and try to vary the type of cereals rather than consuming just wheat (spelt and semolina are best avoided too)


  • Cow’s milk can cause bloating if you’re lactose intolerant – if endometrial tissue is attached to your bowel, this bloating can heighten your pain and discomfort


  • Vitamins and minerals such as magnesium, calcium, iron, zinc and selemium may help pain and immunity – vitamins A, C and E are also helpful antioxidants which may help metabolise oils and fats you consume to prostaglandins


  • Omega-3 fatty acids – the balance of the three types of prostaglandins is converted from essential fatty acids using B vitamins,[vii] so consider a balance of a low intake of animal fats combined with increasing your intake of good quality, unrefined cold-pressed vegetable and fish oils


[i] Bulun, S.E. et al. ‘Estrogen biosynthesis in endometriosis: molecular basis and clinical relevance Journal of Molecular Endocrinology 2000; 25:35-42

[ii] Koike, H. ‘Correlation between dysmenorrheic severity and prostaglandin production in women with endometriosis’ Prostaglandins Leukot Essent Fatty Acids 1992; 46:133-7

[iii] Rakhile, H. et. Al ‘Abnormal expression of prostaglandins E2 and F2a receptors and transporters in patients with endometriosis’ Biomed Research International 2014; Article ID 808146, in press

[iv] Gaskins, A.J. et al. ‘Effect of daily fiber intake on reproductive function: the BioCycle Study’ American Journal of Clinical Nutrition 2009; 90 (4):1061-9

[v] Proctor, M.L. & Murphy, P.A. ‘Herbal and dietary therapies for primary and secondary dysmenorrhoea’ Cochrane Database Systematic Review 2001;(3):CD002124

[vi] Coulibaly, A. et al. ‘Phytic acid in cereal grains: Structure, healthy or harmful ways to reduce phytic acid in cereal grains and their effects on nutritional quality’ American Journal of Plant Nutrition and Fertilization Technology 2011; 1:1-22

[vii] Sohrabi, N. et al. ‘Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “A pilot trial” Complementary Therapies in Medicine 2013; 21(3):141-6