What Is the Best Diet for Endometriosis and Fertility?

Endometriosis is a chronic inflammatory disorder in which the tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. The cause of endometriosis is unknown and there is no cure.

Symptoms include:

• Fertility issues
• Chronic pelvic pain
• Severe menstrual bleeding and pain
• Pain during sexual intercourse

Symptoms are treated with medicine and/or surgery. Nutrition can be very impactful in managing endometriosis symptoms and in supporting fertility.

Endometriosis and Fertility

This chronic condition affects an estimated 1 in 10 women of reproductive age and women with endometriosis often face fertility challenges. Research shows that between 30-50% of women with endometriosis are infertile1. As women with endometriosis often face fertility challenges, managing the condition effectively is crucial for those trying to conceive.

How can nutrition help and is there a best diet for endometriosis? As endometriosis affects everyone differently there is no single ‘best endometriosis diet’. However as endometriosis is associated with chronic inflammation we are essentially looking towards an anti-inflammatory diet such as the Mediterranean style diet. Research shows the Mediterranean Diet can reduce inflammation and endometrial pain2.

The Mediterranean Diet is rich in fibre, lean proteins and healthful fats and lower in processed foods, sugar-sweetened beverages, and refined grain products.

Key nutrients to focus on for endometriosis and fertility

Wholegrains

Include brown rice, wholegrain bread and pasta, quinoa, oats, and barley to help maintain healthy oestrogen levels. Oestrogen is the stimulus for this growth of tissue outside the uterus. This tissue can infiltrate quite deeply into the organs making it difficult to treat. Aim to fill ¼ of your plate with high quality wholegrains at each meal.

Fruits and vegetables

Fruits and vegetables are rich in antioxidants and fibre which can help combat oxidative stress found in the pelvis of those with endometriosis and reduce inflammation. Think lots of colour such as berries, cherries and citrus fruits. This will ensure a variety of vitamins and provide a rich source of fibre to support a healthy gut microbiome.

Cruciferous vegetables and leafy greens such as kale, spinach, brussels sprouts and broccoli contain sulforaphane which may help manage inflammation and oestrogen levels. It is advised to increase cruciferous vegetables slowly as those with endometriosis can often have irritable bowel syndrome (IBS).

Wash your fruits and vegetables well as exposure to pesticides and dioxins have been associated with exacerbating endometriosis symptoms. Aim to fill ½ of your plate with delicious fruits and vegetables to fight inflammation and pain.

Animal based proteins

Opting for fish, poultry and eggs and limit red meat to no more than 1-2 times per week. Red meat and ham intake have been shown to increase inflammation in endometriosis therefore adopting a more Mediterranean style approach which is richer in fish and poultry can help with symptoms. Milk, yoghurt and cheese are also great sources of protein and dairy/calcium (see below for more on dairy).

Plant based proteins

Meet your daily protein needs with a balance of animal and plant based proteins such as beans/peas/lentils and other plant based proteins tofu, tempeh. Consuming adequate amounts of high-quality protein is vital for the creation and repair of all body tissues, enzymes and blood cells. Aim to fill ¼ of your plate with high quality protein at each meal. If you do not eat dairy ensure to include fortified plant based alternatives such as soya milk/soya yoghurt.

Omega 3 rich foods and healthful fats

Omega 3 fatty acids are included in dietary factors that may decrease the risk of endometriosis3 and are effective at reducing inflammation. Consuming oily fish such as salmon/mackerel/sardines, nuts and seeds such as flaxseed/chia seeds/walnuts, nut butters, avocados and extra virgin olive oil (also rich in vitamin E) is a great way to increase omega 3 and healthful fats in your diet.

Use of herbs and spices to flavour food

Adding herbs and spices is a great way to increase antioxidants in your diet. Popular herbs and spices for endometriosis associated pain include rosemary, turmeric, peppermint, cinnamon and ginger.

Supporting gut health

Emerging research suggests a link between gut bacteria and endometriosis4. Increased circulating oestrogen and bacterial dysbiosis in the gut and reproductive tract have been associated with inflammatory signals in endometriosis. Following a Mediterranean style diet and increasing fermented foods such as kimchi, sauerkraut and kefir are all beneficial for gut health. If you are considering a probiotic it is recommended to discuss brands with your fertility dietitian as specific strains have been found to be beneficial for endometriosis and fertility.

Foods to reduce/limit

• Red meat – no more than 1-2 times per week
• Moderate alcohol intake3
• Use of herbs and spices to flavour food instead of salt or readymade sauces. Foods high in salt can damage your gut bacteria and promote inflammation
• Limit sources of saturated fat such as cakes, biscuits, fatty meat, sausages, bacon, ice-cream, chocolate. Decreasing saturated fat by 50% will decrease oestrogen by 20%5. Excess oestrogen can promote inflammation and exacerbate endometriosis
• Limit fruit juices and fizzy drinks which contain high levels of added sugar as this can promote inflammation
• Caffeine – limit your total caffeine intake to 200mg per day for fertility. This equals approximately 2 coffees or 3-4 cups of tea per day

The Role of Specific Diets in Managing Endometriosis

Should I go Gluten Free?

If you have coeliac disease you must strictly avoid gluten in your diet. The evidence to avoid gluten is not as strong for those that do not have coeliac disease. However, a study carried out where women with endometriosis were put on a gluten free diet for 12 months which showed 75% of experienced significant reduction in pain6. This study did not study inflammatory markers therefore is unable to conclude with confidence that a gluten free diet reduces the inflammation. However it seems to reduce pain for some women. There is also some debate that fodmap fructans could affect some women with endometriosis. If you are trialling a gluten free or fructan free diet for endometriosis associated pain then it is strongly advised you only do this under the guidance of a dietitian to prevent any nutrient deficiencies.

Do I need to avoid dairy?

There is still a debate on dairy and endometriosis. There is no good evidence that dairy is inflammatory or negatively impacts endometriosis or fertility. Studies have actually shown that a regular dairy intake reduced the risk of developing endometriosis7. Furthermore intake of high fat dairy foods may decrease the risk of anovulatory infertility8. Many endometriosis sufferers also have IBS and are unable to tolerate lactose. Even with lactose intolerance most people can tolerate some amount of yoghurt and hard cheeses as these have a low lactose content therefore it is not necessary to completely avoid dairy in this case. Avoiding dairy also puts you at increased risk of osteoporosis therefore if you are choosing to avoid dairy ensure that you are replacing it with plant milks and yogurts fortified with calcium and vitamins.

Conclusion

Diet and nutrition play a crucial role in managing endometriosis and improving fertility outcomes. To better support their health and fertility women with endometriosis could benefit from focusing on antioxidant rich, fibre rich and anti-inflammatory foods while limiting processed foods and saturated fats. It is important that we look at diet as part of the puzzle. Dietary changes can complement medical treatments. If you are struggling with infertility and endometriosis a registered dietitian can help to tailor a nutrition plan specific to your individual needs.