Endometriosis is an extremely common condition, with research suggesting that it affects 1 in 10 women of reproductive age. In light of Endometriosis Awareness Month, the month of March, this blog post aims to provide a summary of the role of diet in endometriosis management.

Before we delve into the topic of food, let’s firstly explain the condition itself.

What is endometriosis?

 Endometriosis is a chronic inflammatory disease which is progressive, meaning it tends to worsen over time and requires ongoing management. This condition is characterised by the growth of endometrium-like tissue (which typically grows inside the uterus) in areas outside of the uterus. This tissue can grow in several areas of the body but is most commonly found on pelvic organs including ovaries, fallopian tubes and the bowel. If the ovaries are involved, endometriomas (cysts on ovaries) may also form.

With each menstrual cycle, this endometrium-like tissue thickens, breaks down, and bleeds just like it does inside the uterus. However, as it does not have an exit path, it becomes trapped resulting in a build

-up of tissue and with time, scar tissue and adhesions form. This build-up of tissue leads to inflammation in the body which commonly causes pain.

The causes of this condition are not well understood, although there are certain factors that may increase one’s risk of endometriosis, such as genetics. What we do know is that elevated levels of oestrogen (relative to progesterone) contribute to the growth of endometrium cells.

The progression and symptom severity varies greatly among individuals so treatment and management strategies will also vary. Generally, a holistic approach to managing symptoms and improving overall wellbeing is most beneficial. This may involve one ormore of surgery, medications, changes in diet, exercise and taking care of other lifestyle factors such as sleep and stress.

Common symptoms

While there is considerable variation, symptoms typically include pelvic pain and digestive discomforts. Very often symptoms are reflective of the location of tissue growth, but the severity of symptoms is not necessarily reflective of the severity of theendometriosis itself. Also, symptoms may not always be cyclical. To summarise, common symptoms include:

• Pain (pelvic, back, during intercourse, when using bowels or urinating)
• Abnormal periods (painful, heavy, irregular, prolonged)
• Digestive discomforts (bloating, constipation, diarrhoea, nausea, changes in bowel movements)
• Fatigue

These symptoms can severely impact on one’s day to day functioning and enjoyment of life. Low mood and mental health concerns are also very common.

Let’s quickly discuss digestive issues – why do women with endometriosis often experience uncomfortable gut symptoms such as bloating, constipation and diarrhoea?

When inflammation is present in the pelvic area, it makes sense that a feeling of abdominal tenderness, sensitivity and bloatingensues. If endometrium-like tissue is found on the bowel, this commonly results in pain when using one’s bowelsor other digestive discomforts such as constipation, diarrhoea and bloating.

Inflammatory conditions, such as endometriosis, tend to cause an overactive immune system (or immune dysfunction). As the gut is a major immune organ, containing many immune cells, gastrointestinal symptoms are very common. For this reason, women with endometriosis commonly also have IBS (irritable bowel syndrome). The link between these two conditions is very interesting and quite a topic on its own!

The role of diet in endometriosis management

Firstly, it’s important to note that there is no ‘one size fits all’ approach. For this reason, a tailored plan specific to one’s overall picture of health, symptoms, and lifestyle is key. With this in mind, summarised below are a few dietary approaches which can be extremely beneficial.

An anti-inflammatory way of eating

Eating in a way that reduces inflammation has been shown to not only help reduce pain

but also potentially slow the growth of endometrial tissue. In a nutshell, this involves eating nutrient-rich wholefoods which contain plenty of fibre, antioxidants and omega-3 fatty acids. Fresh fruits and vegetables, beans and lentils, nuts, seeds, wholegrains and some fatty fish such as salmon, trout, sardines and mackerel are all good examples. Drinking enough water is also key.

You may have heard of curcumin too, which is the active ingredient of turmeric. More research is required but curcumin proposes anti-inflammatory properties so including turmeric in cooking is a great idea. Other spices that provide anti-inflammatory benefits include cinnamon and ginger.

In addition to enjoying the foods and spices above, being mindful of certain foods which tend to support a pro-inflammatory environment is also beneficial. Examples include meat (especially fatty and processed meats), refined carbohydrates (such as white breads, commercial cakes and pastries, fast foods), processed foods, and drinks that are high in refined sugars. Too much caffeine and alcohol can also increase inflammation so for many it’s beneficial to limit and enjoy in moderation.

The Mediterranean Diet

The Mediterranean Diet is often praised and referred to as being beneficial for those with endometriosis. Being typically high in fresh vegetables, fruits, legumes, nuts, fish, wholegrains and olive oil, and lower in meats, dairy and processed foods it provides a great example of an anti-inflammatory way of eating.

The Low FODMAP Process

You may have heard of the Low FODMAP Diet. I like to refer to this as a process rather than a diet as it involves 3 stages. FODMAPs is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols all of which are carbohydrates that are either indigestible or poorly absorbed by some. Initially developed by researchers at Monash University in Melbourne as a symptom management approach for those with IBS, the low FODMAP diet (or process) has been shown to help many with endometriosis too. IBS is very common amongst women with endometriosis, however, not all women with endometriosis experience IBS symptoms and so following the process which involves short-term restriction of certain foods is not necessary for all. As temporary food restriction is required, plus the process is quite a process, guidance and support from a Dietitian with experience in the area is highly recommended. As there is a lot to discuss, we will be covering all things low FODMAP in detail in another blog post.

Boosting foods which may help to reduce circulating oestrogen

This is an emerging area of research but what we do know is that consuming certain vegetables may help to reduce circulating oestrogen. Phytochemicals, found in cruciferous vegetables, help the body to metabolise excess estrogen. So, if you do have endometriosis here is one great reason to enjoy cauliflower, broccoli, brussel sprouts, kale and arugula.

What about gluten, red meat, dairy and soy?

For some women with endometriosis, reducing or avoiding gluten, red meat or dairy appears to improve symptoms. However, I will add here that it is not always helpful to limit or avoid. For example, dairy is an important food group providing a great source of calcium as well as other minerals and vitamins. If reducing or avoiding dairy helps to improve symptoms (e.g. bloating) it’s crucial to make sure you replace with other great sources of calcium. Lactose intolerance is very common amongst women with endometriosis so digestive discomforts and pain can often be attributed to lactose rather than dairy (as a food group). If this is the case, lactose free products are worth a try plus are a brilliant source of calcium.

And what about soy? For many years, soy products have been feared due to their phytoestrogen content. However, some research shows that soy may actually be beneficial for women with endometriosis. If interested to read more jump over to the endometriosis blog posts at nurturefromwithin.com.au.

A final note

With regards to endometriosis management, food does make a big difference.

Also, other lifestyle factors play an equally important role. These include exercise (enjoying appropriate types of physical activity – a women’s health physio will be able to help), stress and anxiety management (the input of a psychologist can be extremely helpful) and working to achieve and maintain adequate sleep. Fascinatingly, hypnotherapy has been shown to have great benefits with managing and improving endometriosis symptoms. This is a new area of research but so far is looking very promising, so watch this space.

• by Lara Nowland, Accredited Practising Dietitian & Nutritionist, Nurture From Within

Lara practices in Adelaide and Mount Barker. Her area of experience and interest is women’s health. You can read more about endometriosis and diet at nurturefromwithin.com.au