The Spoonie Dietitian's Complete Guide to Endometriosis Diet & Nutrition

Endometriosis affects about 10% or 190 million women and girls of reproductive age worldwide. If you're living with endometriosis, you know the daily struggle with chronic pain, inflammation, and gut symptoms. While the cause of endometriosis is still unknown, research suggests that the key players involved are inflammation, oestrogen, and the gut microbiome.

There is no known cure for endometriosis, with the main goal of treatment being symptom control. This is where an endometriosis diet can make a real difference. Early diagnosis and effective treatment are important for endometriosis management, but access is still limited in most settings. It currently takes an average of 7 years to receive a diagnosis. This delay is often due to women being dismissed by medical providers and being misdiagnosed with conditions such as Irritable Bowel Syndrome (IBS).

I myself have endometriosis and know many others with the condition. I personally had symptoms from my first period. I had painful, heavy periods that interfered with my ability to go to school and university. I would be asked if I was unwell, and if I did make it out of the house, by the time I got home I would collapse onto the bed, lounge or floor and be doubled over in pain, and completely exhausted. At 17, I started to develop gut symptoms, and so, like many others, was originally misdiagnosed with IBS. It took until I was 24, over 10 years after my symptoms started, to receive a diagnosis of endometriosis.

What is Endometriosis and How is it Treated?

Endometriosis is a chronic, systemic (whole body), and complex inflammatory condition where endometrial-like tissue (not the endometrium!) grows outside of the uterus.

Common Endometriosis Symptoms Include:

• Pelvic pain and chronic pain

• Painful bowel movements and urination

• Dyspareunia (painful sex)

• Dysmenorrhea (painful periods)

• Lower back pain

• Heavy bleeding

• Bloating and digestive issues

• Chronic fatigue

• Fertility concerns

• And so much more

Standard Endometriosis Treatment Options

Treatment for endometriosis usually involves hormonal medications such as oral contraceptive pills and IUDs, pain relief medications and surgery to remove lesions. Other management options may include pelvic floor physiotherapy, cognitive behavioural therapy, acupuncture, and diet.

How Can Diet and Nutrition Help Manage Endometriosis?

There isn’t one specific endometriosis diet, but studies show that nutrition and diet can affect the key players in endometriosis: chronic inflammation, high levels of oestrogen, and the gut microbiome and its relationship with oestrogen. This means that diet may help with managing symptoms such as pain and gut issues, and improving quality of life.

The main goals of an endometriosis diet are to:

• Reduce inflammation through anti-inflammatory foods

• Reduce excess circulating oestrogen through hormone-balancing nutrition

• Optimise gut health with fibre and diverse plant foods

Various diets have been studied for their potential effects on endometriosis. The following have shown promise in symptom management and disease progression: the Mediterranean diet, Low FODMAP diet, and a high fibre diet.

Best Diets for Endometriosis: What Does the Research Say?

Mediterranean Diet for Endometriosis

The Mediterranean diet has been shown to improve endometriosis pain, dyspareunia, painful bowel movements and dysmenorrhea. These improvements are due to the high level of antioxidants and polyphenols, and the anti-inflammatory properties of the diet.

The Mediterranean diet involves:

• High intake of extra virgin olive oil (EVOO), fruit, vegetables, wholegrains, nuts and legumes/beans

• Moderate intake of fish, poultry and dairy

• Low intake of eggs, red meat and ultra processed foods

Low FODMAP Diet for Endometriosis

Fermentable Oligosaccharides, Dissacharides, Monosaccharides, and Polyols (FODMAPs) are short chain carbohydrates that are easily fermented. These carbohydrates are poorly absorbed by some individuals, leading to IBS symptoms. A low FODMAP diet restricts these and is typically used to manage IBS symptoms.

Those with endometriosis are 2-3 times more likely to have IBS, and so a low FODMAP diet may improve gut symptoms in endometriosis. However, the low FODMAP diet is very restrictive and so is not a long term diet. In order to optimise diet quality it is important to have a reintroduction phase to liberalise your individual diet. This is best done with a Dietitian.

High Fibre Diet for Endometriosis

A high fibre diet may improve endometriosis symptoms as it can help reduce circulating oestrogen and improve gut health, leading to lower inflammation.

How fibre helps endometriosis:

• Fibre is important to regulate our bowels and reduce the amount of oestrogen in our bodies

  • Oestrogen is excreted through our bowel movements.

  • Preventing constipation, prevents oestrogen being reabsorbed into our body

• Fibre also improves our gut health through short chain fatty acid (SCFA) production

• High fibre diets are typically also high in antioxidants and phytonutrients with anti-inflammatory properties

Best Foods for Endometriosis: Nutrition Recommendations

The main nutrients to increase in an endometriosis diet are antioxidants, vitamins C, E and D, omega 3 fatty acids, and fibre. It's also important to reduce saturated fat and highly processed foods. This will help to reduce inflammation and oestrogen, and improve your gut microbiome.

Practical Endometriosis Diet Strategies: Foods to Eat

Increase fruit, vegetables, and fibre (plant diversity and colour for micronutrients)

• Aim for half your plate with a minimum of 3 colours

• Include vitamin C rich foods (citrus fruits, capsicum, tomatoes, kiwi fruit, strawberries) at each meal

• Include brassica vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) to further support oestrogen excretion

• Eat 3-4 serves of legumes (1/2 cup each) per week

• Increase fibre slowly to prevent side effects such as bloating

Increase oily fish and omega 3 for endometriosis

• Include 150g of oily fish (salmon, sardines, mackerel) 2-3 times per week

• Consider algae-based omega 3 supplements if plant-based

Increase healthy fats

• Enjoy nuts, nut butter and seeds daily

• Use extra virgin olive oil (EVOO) as your main cooking oil

• Add avocado to meals regularly

Increase hydration

• Gradually increase water intake to around 3-4L per day (depending on your size and activity level)

• Proper hydration supports hormone elimination and gut health

Choose wholegrains over refined grains

• Swap white bread, rice, and pasta for wholegrain versions

• Try quinoa, brown rice, oats, and wholegrain options

Season liberally with herbs and spices

• Turmeric, ginger, and cinnamon have powerful anti-inflammatory properties

Foods to Limit with Endometriosis

Decrease these foods to reduce inflammation:

• Saturated fats and trans fats

• Ultra processed foods

• Alcohol

• Red meat and processed meats

Remember: You can still have these foods occasionally, but they should make up a smaller part of your diet than wholefoods. An endometriosis diet doesn't have to be perfect or all-or-nothing.

Creating Your Endometriosis Meal Plan: A Gentle Approach

I want you to know that this way of eating isn't all or nothing, and doesn't need to be perfect. An endometriosis diet can still be done with low spoons, and in a gentle way. It will look different for everyone, it's important for your endometriosis nutrition plan to be specific to you, your symptoms, and your lifestyle.

Quick FAQ: Endometriosis Diet Questions

What foods should I avoid with endometriosis? Limit ultra processed foods, excessive red meat, alcohol, and high saturated fat foods. Focus on adding anti-inflammatory foods rather than restriction.

Can diet cure endometriosis? No, there is no cure for endometriosis. However, an anti-inflammatory, hormone-balancing diet can significantly reduce symptoms and improve quality of life.

How long until I see results from an endometriosis diet? Most people notice improvements in gut symptoms within 2-4 weeks, while pain reduction may take 2-3 months of consistent dietary changes.

Want to Go Deeper?

If you're tired of trying to figure this out on your own, I'm here to support you on your journey. Head here to find out more about working with me, a Dietitian who lives with and understands endometriosis.

I also have something specific for Endowarriors coming soon. Join the waitlist here to be the first to know when it launches.

Thanks for reading. You're not alone in this.

🩷Emma