March is Endometriosis Awareness Month and in this month’s blog, our resident dietitian Nicole Saliba investigates whether there is a role for diet when it comes to endometriosis.

What is endometriosis?

Endometriosis is an inflammatory condition, where uterine-lining-like tissue grows outside the uterus, often in the pelvic or abdominal cavities. Endometriosis can be symptom-free, but for many often leads to pain and infertility. It affects around 5-10% of women in their reproductive years and often coexists with other medical conditions such as migraines, Irritable Bowel Syndrome (IBS), mental health disorders and autoimmune conditions such as Inflammatory Bowel Disease (IBD) and rheumatoid arthritis. A recent study showed that endometriosis has a detrimental effect on a person’s quality of life comparable to that of living with chronic pain.

What are the main signs and symptoms?

Some people will experience all or none of the symptoms below, however, the main symptoms of endometriosis are pain and infertility. Some common symptoms that people with endometriosis may experience include:

• • >> Painful periods (dysmenorrhea)

• • >> Pain during or after sex (dyspareunia)

• • >> Pain while urinating (dysuria) or defecating (dyschezia)

• • >> Unusually heavy periods or bleeding between periods

• • >> Infertility

• • >> Punnet of berries

• • >> Fatigue
  • >> Gastrointestinal symptoms such as diarrhoea, constipation and bloating

• • >> Nausea, particularly during menstrual periods

Some people with endometriosis may experience atypical symptoms, like back pain, chest pain, leg pain, rectal bleeding, or reflux.

How is it diagnosed?

Endometriosis must be diagnosed by a doctor and ideally by a specialist in this field. The gold standard for diagnosis is laparoscopy (minimally invasive surgery), although nonsurgical diagnostic tools are currently being investigated.

Can dietary changes help?

Medications and surgical treatment are usually only partially effective for pain and so women often look for alternative strategies to control their symptoms including changing what they eat. Dietary interventions have shown promising results in improving endometriosis-related symptoms including reducing pain and inflammation, alleviating troubling gut symptoms and improving energy levels and fatigue. Dietary factors may play a role in the progression and development of endometriosis by influencing hormone metabolism, the menstrual cycle, inflammation regulation, oxidative stress, and muscle contraction. A recent study revealed that 55.5% of participants reported that food influenced their endometriosis symptoms, and modifying their diet provided symptom relief. Dietary factors may play a role in endometriosis by influencing our hormones, the menstrual cycle, inflammation and muscle contraction.

The Mediterranean diet

An Australian study looked at the effects of the Mediterranean diet on endometriosis-associated pain. Patients adhered to a specific diet that included fruits, fresh vegetables, fatty fish, white meat, soy products, whole grain products, magnesium-rich foods, extra virgin olive oil, herbs and spices. Significant pain relief was observed. The Mediterranean diet may alleviate endometriosis-related pain through its anti-inflammatory effects. For example, extra virgin olive oil and fish have been shown to exert anti-inflammatory effects. It is rich in antioxidants and fibre which may have positive effects on pelvic pain and inflammation.  

The low FODMAP diet

Forty-three (72%) of the patients with endometriosis experienced an improvement of symptoms over 50% after following this diet for 4 weeks. Women living with endometriosis are 2.5 times more likely to be diagnosed with IBS. FODMAPs are fermentable carbohydrates found in certain foods such as dairy, wheat, rye and certain fruits and vegetables such as apples, pears, peaches, watermelon, onion, garlic, mushrooms, etc. When these molecules are removed or reduced in the diet, it offers some improvements for women who have concurrent IBS with endometriosis.

Our top dietary tips

1. Incorporate more anti-inflammatory foods which can help alleviate the pain associated with endometriosis. This includes a variety of coloured fruits and vegetables, whole grains, nuts, seeds, legumes and EVOO
2. Eat less pro-inflammatory foods like fatty cuts of red meat, deli meats, refined cakes and biscuits and deep-fried takeaway foods
3. Go easy on red and processed meat Some studies show that reducing the consumption of red and processed meats <2 servings per week can be beneficial in reducing pain and inflammation
4. Include oily fish such as salmon or trout 2-3x/wk to help boost your intake of omega-3 fatty acids which are anti-inflammatory
5. Get screened by your GP for any nutrient deficiencies which can be common in women with endometriosis and address these. These include things like vitamin D, iron, B12 and folate
6. Work with a specialised dietitian to help manage any troubling gut symptoms such as bloating, diarrhoea and constipation. It’s estimated that up to 50% of people with IBS also have endometriosis. A dietitian can help pinpoint any potential food triggers.
7. Reduce your exposure to endocrine-disrupting chemicals (EDCs) which can disrupt the hormonal balance in the body and potentially worsen endometriosis symptoms. This may look like limiting the use of plastic bottles and containers. Avoid reheating food in plastic containers and drink from a steel water bottle.

If you would like learn more about creating healthy meals to fuel your day book in with one of our dietitians today by calling ORS on 1800 000 677 or our Eastsense by ORS clinic on 02 4311 3623.

Nicole Saliba – Clinic Manager

Dietitian, BHlthSc(Nutr&Diet), APD