What role can nutrition play for people living with endometriosis?

While endometriosis is the second most common gynaecological diagnosis in the UK, the ‘diagnostic silent period’ remains a significant barrier to care. Recent data indicates that the average time to diagnosis in the UK has risen to eight years and 10 months,[1] while other regional reviews highlight delays of five to eight years.[2] Currently, the gold standard for diagnosis remains laparoscopic surgery, an invasive and costly procedure that often acts as a bottleneck in the patient pathway.

Although non-surgical diagnostic tools are in development, these significant delays remain the norm, during which time a patient's quality of life often undergoes a steep decline, impacting physical, sexual, psychological and social health.[3]

While some individuals remain asymptomatic, endometriosis frequently manifests as debilitating pain and infertility. The clinical presentation is broad and symptoms can be cyclical, encompassing dysmenorrhoea, dyspareunia, dysuria and dyschezia, alongside heavy menstrual bleeding and persistent fatigue. Gastrointestinal symptoms, often referred to as ‘endo-belly’ include bloating, nausea, diarrhoea and constipation, typically peaking during menstrual periods.

In most cases, symptoms begin in adolescence and may improve after menopause, though some continue to experience persistent pain later in life. As a lifelong condition, management focuses on reducing pain, improving quality of life and preserving fertility. Standard care typically involves a combination of analgesics, hormonal therapies and surgery tailored to the individual.[2]

Increasingly, the scientific community is shifting its perspective to view endometriosis not merely as a reproductive disorder, but as a systemic disease. Evidence now demonstrates potential involvement of the gastrointestinal, urinary and even musculoskeletal systems, necessitating a more holistic approach to management.[3]

Research suggests that many patients are unsatisfied with conventional medical treatments.[4] For example, hormonal therapy is frequently associated with unwanted side effects, leading to high discontinuation rates.[5] Furthermore, while laparoscopic excision can decrease overall pain, the recurrence rate remains high, reaching up to 50% within five years.[6] This has led to an increasing interest in self-management strategies, with many individuals turning to complementary approaches, including nutritional supplementation or more restrictive dietary patterns.[7]

Despite the current lack of large-scale clinical trials, lifestyle interventions (including nutrition) appear to have a promising role in symptomatic management. Current research suggests that a Mediterranean eating pattern offers a robust starting point. This is characterised by a high intake of vegetables, fruits, legumes, seeds and nuts, with moderate amounts of dairy and fish and limited red meat. This high intake of dietary anti-inflammatory compounds, paired with a holistic lifestyle framework, can potentially improve the well-being of those navigating the condition.[8]

Similarly, an anti-inflammatory diet (which shares principles with the Mediterranean diet but focuses more strictly on the physiological balance between pro- and anti-inflammatory compounds) shows potential in modulating the chronic inflammatory environment which characterises endometriosis.[9]

Lately, the term ‘endometriosis diet’ has gained traction, following an experience-based protocol developed by patients in the Netherlands. This involves restricting red meat, gluten, cow’s milk, added sugars and caffeine, while prioritising fresh produce, oily fish and plant-based proteins. While the goal is to promote protective nutrients and discourage risk factors, there is currently very limited evidence and no formal guidelines on its use.[10]

Interestingly, it appears that women with newly diagnosed endometriosis often report an unbalanced dietary pattern characterised by high consumption of meat, cured meats and salt, alongside a low intake of vegetables; this creates an unfavourable balance between pro-inflammatory and anti-inflammatory foods.[11] Therefore, when patients are guided toward healthier dietary patterns, paired with reduced alcohol intake and increased physical activity, they can utilise these as a low-risk, high-benefit foundational recommendation.[12]

Beyond these foundational patterns, more targeted and restrictive dietary interventions are often explored where gastrointestinal symptoms are prominent. For instance, the intersection of endometriosis and gut health has gained clinical interest because both conditions frequently involve visceral hypersensitivity. This overlap often leads to ‘endo-belly’, making the low-FODMAP diet a relevant tool for reducing IBS-related symptoms in endometriosis.[13]

While some studies have explored the elimination of gluten, dairy or even low-nickel diets with mixed results, these interventions must be approached with caution. Professional dietetic supervision is essential to mitigate the risk of nutritional deficiencies and to maintain a healthy relationship with food.[14]

Targeted supplementation may offer an additional layer of support. While the evidence for vitamin D remains varied, other antioxidants show more consistent promise. The combination of vitamin E and vitamin C has demonstrated potential in reducing chronic pelvic pain by altering prostaglandin production and mediating inflammatory pathways.[15]

Furthermore, emerging research into melatonin suggests it may assist with pain modulation, sleep quality and mood.[16]

When recommending supplements, dietitians must consider the evidence for dosage, safe upper limits, potential drug-nutrient interactions and cost.

1. Endometriosis UK. “Dismissed, ignored and belittled”: The long road to endometriosis diagnosis in the UK. London, UK: Endometriosis UK; 2024

2. De Corte P, Klinghardt M, von Stockum S, Heinemann K. Time to diagnose endometriosis: Current status, challenges and regional characteristics—A systematic literature review. BJOG. 2025;132:118-130

3. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations. The Lancet. 2021;397(10276):839-852

4. Lukas I, Kohl-Schwartz A, Geraedts K, et al. Satisfaction with medical support in women with endometriosis. PLoS ONE. 2018;13(11):e0208023

5. Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: A systematic review. Fertil Steril. 2017;108(1):125-136

6. Cea Soriano L, Lopez-Garcia E, Schulze-Rath R, Garcia Rodriguez LA. Incidence, treatment and recurrence of endometriosis in a UK-based population analysis. Eur J Contracept Reprod Health Care. 2017;22(5):334-343

7. De Araugo SC, Varney JE, McGuinness AJ, et al. Nutrition interventions in the treatment of endometriosis: a scoping review. J Hum Nutr Diet. 2025;38(1)

8. Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Mueller MD. Mediterranean diet as a holistic approach for women with endometriosis. Nutrients. 2022;14(11):2345

9. Martire FG, Costantini E, d’Abate C, et al. Endometriosis and nutrition: therapeutic perspectives. J Clin Med. 2025;14(11):3987

10. Van Haaps A, Wijbers J, Schreurs A, et al. A better quality of life could be achieved by applying the endometriosis diet: A cross-sectional study in Dutch endometriosis patients. Reprod Biomed Online. 2023;46(4):623-630

11. Ruotolo A, Vannuccini S, Capezzuoli T, et al. Diet characteristics in patients with endometriosis. Journal of Endometriosis and Uterine Disorders. 2025;9:100094

12. Türkoğlu D, Pinar N, Çelik S, Aydin O. Dietary patterns and endometriosis: Is a Mediterranean and anti-inflammatory approach beneficial? J Obstet Gynaecol Res. 2024;50(8):1450-1462

13. Moore JS, Gibson PR, Perry RE, et al. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic profile and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017;57(2):201-205

14. Krabbenborg I, de Roos N, van der Grinten P, et al. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients. Reprod Biomed Online. 2021;43(6):952-961

15. Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013;161(3):189-195

16. Esmaeilzadeh S, Habibolahi F, Moher D, et al. Melatonin and sleep parameters in infertile women with endometriosis. PLoS ONE. 2025;20(4):e0321635