Photo: Getty Images / Alexander Spatari
If you're one of the 200 million women worldwide with endometriosis, you're likely frustratingly familiar with its signature pain and risk of infertility. Hormonal birth control and other medications can do wonders for the symptoms and side effects of the condition. (Related: The Endometriosis Symptoms You Need to Know About) But, often overlooked is the fact that simple changes to your diet can also go a long way.
"With all of the fertility patients that I work with, the most important factor in trying to manage endometriosis symptoms is having a balanced, well-rounded diet—adding in lots of good-quality protein, organic fruits and veggies, lots of fiber and healthy fats," says Dara Godfrey, R.D., a nutritionist and fertility specialist with Progyny. Overall diet quality is more important than eating any one specific food; however, certain nutrients can help reduce inflammation (and therefore pain), while other foods specifically make endo pain worse.
And it's not just for long-time endo sufferers—some studies suggest if you're at high risk for the condition (such as if an immediate family member has it) or you got an early diagnosis, changing your diet can also lower your risk.
Ahead, the full scoop on the endometriosis diet, including the foods that can help—and those you should skip or limit if you suffer from the condition.
Why Following an "Endometriosis Diet" Matters
Endometriosis is marked by pain—debilitating cramps but also pain during sex, painful bloating, painful bowel movements, and even back and leg pain.
What contributes to that pain: inflammation and hormone disruption, both of which are heavily influenced by diet, says Columbus-based nutritionist Torey Armul, R.D., spokesperson for the Academy of Nutrition and Dietetics.
Additionally, what you eat plays a huge role in combating oxidative stress, Armul says, since this damage is caused by an imbalance of antioxidants and reactive oxygen species (ROS). And a 2017 meta-analysis in Oxidative Medicine and Cellular Longevity reports oxidative stress may contribute to endometriosis.
In short, a beneficial endometriosis diet should focus on reducing inflammation, reducing oxidative stress, and balancing hormones. (Related: How to Balance Your Hormones Naturally for Lasting Energy)
Foods and Nutrients You Should Eat to Help Endometriosis Symptoms
One of the best ways to combat pain is to eat more of anti-inflammatory omega-3 fatty acids, says Godfrey. Countless studies show omega-3s—specifically EPA and DHA—help prevent and resolve inflammation in the body. Wild salmon, trout, sardines, walnuts, ground flaxseed, chia seeds, olive oil, and leafy greens are all great options, both nutritionists agree. (Related: 15 Anti-Inflammatory Foods You Should Be Eating Regularly)
"Vitamin D has anti-inflammatory effects, and research has found a connection between larger cyst size in women with endometriosis and low vitamin D levels," says Armul. The vitamin is scarce in most foods, but dairy products like milk and yogurt are often fortified and readily available, she adds. FWIW, there is some conflicting research around the role dairy plays in inflammation, but Armul points out this is a huge food group encompassing everything from Greek yogurt to ice cream and milkshakes. Milk and low-fat dairy products are your best bet for reducing inflammation. (FYI, here's everything you need to know about dietary supplements.)
If you're lactose intolerant, vegan, or don't get daily sun exposure, Armul suggests taking a vitamin D supplement daily instead. "Many people are vitamin D deficient especially during and after the winter months," she adds. Aim for 600 IU of vitamin D, the recommended daily allowance.
In a 2017 study from Poland, researchers report that more fruits and vegetables, fish oils, dairy products rich in calcium and vitamin D, and omega-3 fatty acids lower your risk for endometriosis. The benefits of colorful produce come from reducing oxidative stress—loading up on antioxidants combats the damage and reduces endo symptoms, says Godfrey. The best foods for that: bright fruits like berries and citrus, vegetables such as dark leafy greens, onions, garlic, and spices like cinnamon.
Foods and Ingredients You Should Consider Limiting If You Have Endometriosis
You want to avoid trans fats entirely, which are known to trigger inflammation in the body, Armul says. That's fried food, fast food, and other highly processed foods.
Godfrey agrees, adding processed foods and high amounts of sugar often prompt pain in endo sufferers. "A diet high in fat, sugar, and alcohol has been linked with the production of free radicals—the molecules responsible for creating the imbalance that leads to oxidative stress," she explains. (Related: 6 "Ultra-Processed" Foods You Probably Have In Your House Right Now)
Multiple studies suggest eating red meat often increases your risk for endometriosis. "Red meat has been linked to higher estrogen levels in the blood, and since estrogen plays a key role in endometriosis, it is beneficial to cut down," Godfrey says. Instead, reach for omega-3-rich fish or eggs for your protein, Armul suggests.
Although gluten doesn't bother everyone, Godfrey says some endo sufferers will experience less pain if they cut the protein molecule from their diet. In fact, research out of Italy found going gluten free for a year improved pain for 75 percent of endometriosis sufferers involved in the study.
It's quite common for women to have both endometriosis and irritable bowel syndrome. Among those who do, 72 percent significantly improved their gastro symptoms after four weeks of a low-FODMAP diet in one 2017 Australian study. FYI, FODMAP stands for Fermentable Ogligo-, Di-, Mono-saccharides And Polyols, a long phrase for carbs that are poorly absorbed in the small intestine for some people. Going low-FODMAP includes cutting wheat and gluten, along with lactose, sugar alcohols (xylitol, sorbitol), and certain fruits and vegetables. (For the full rundown, see how one writer fared trying the low-FODMAP diet for herself.)
This can get tricky—you don't want to skimp on the antioxidants abundant in produce or the vitamin D that often comes from dairy. Your best bet: Focus on cutting the foods experts know increase endo issues and bump up your intake of the foods pros say can help. If you still have pain or other gastro symptoms after that, look into reducing gluten and other FODMAPs while still increasing non-offending produce rich in antioxidants.