Diet has a vital role in the development and management of endometriosis. What we eat has profound consequences on our health and fertility, and the most common female fertility conditions are polycystic ovary syndrome and endometriosis, which are both diet-related conditions. A healthy diet is a rich source of:
- Antioxidants that moderate oxidative stress and alter the immune state
- Fibre that alters the microbiome, the gut wall and immune health
- Factors that affect sex hormone production
However, diets also contain substances that cause inflammation, either through personal intolerances to foods or through their innate nature. Contamination with antibiotics, pesticides, plastics and coatings are other serious problems people often unwittingly encounter when they eat food.
Research shows that the chances of developing endometriosis and the severity of the condition vary significantly with some simple dietary factors:
|Increases the risk of endometriosis||Reduces the risk of endometriosis|
|Low vitamin A and C||Fresh fruit esp. citrus|
|Red meat (processed or unprocessed)||A vegetarian diet|
|Trans-fats (fried foods)||Omega-3 fats|
Poultry, fish, shellfish and eggs have no noticeable effect on the risk of endometriosis, but they’re generally less inflammatory than red meat. Remember, the three significant drivers of endometriosis are immune imbalance, inflammation and abnormal sex hormone levels.
Research shows that dietary changes are more effective at managing and reversing endometriosis than medications when women are trying to conceive. i
Nutrients and endometriosis
There are some nutrients that help treat endometriosis, and the table below lists their sources and recommended daily amounts: ii
|Nutrient||Nutrient-rich foods||Recommended amount|
|Palmitoylethanolamide (PEA)||Eggs, peanuts (personal intolerance to both of these causes inflammation for a significant number of people)||No recommendation|
|Omega-3 fatty acids||Linolenic acid: flaxseed, canola, walnut, wheat germ, soybean. Nuts and seeds.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA): human milk, fatty fish
|1% of energy intake|
|Omega-6 fatty acids||Linoleic acid: vegetable oils (corn, sunflower, safflower, soybean, cottonseed), poultry fat, nuts (pine nuts, walnuts), seeds (sesame, sunflower and pumpkin).
Arachidonic acid: meats, poultry, eggs, mayonnaise, margarine
|2% of energy intake|
|Vitamins, minerals and antioxidants|
|Vitamin A / Beta-carotene||Cheese, cream, butter, fortified margarine, butter, eggs, liver, dark leafy greens, deep orange fruits (apricots, cantaloupe), vegetables (sweet potatoes, pumpkin, squash, carrots)||680 µg mg/day|
|Vitamin B6||Meat (chicken breast), fish, poultry, potatoes and other starchy vegetables, legumes, non-citrus fruits (banana, watermelon)||1.5 micrograms/day|
|Vitamin C||(Citrus) fruits, cabbage-type vegetables (Brussels sprouts, cauliflower), dark green vegetables (bell pepper, broccoli), cantaloupe, strawberries, lettuce, tomatoes, potatoes, papayas, mangoes, kiwi||75 µg/day|
|Vitamin D3||Fortified foods such as milk, margarine, and butter. Egg yolks, liver, fatty fish, veal||10 µg/day (AI)|
|Vitamin E||Polyunsaturated plant oils, leafy green vegetables, wheatgerm, wholegrains, liver, egg yolks, nuts, seeds, avocado||11 mg/day|
|Calcium||Milk, cheese, yoghurt, small fish with bones (sardines), tofu, greens (Chinese cabbage, broccoli, kale)||950 mg/day|
|Iron||Red meat, eggs, fish, shellfish, poultry, dried fruits, tomatoes||16 mg/day|
|Magnesium||Nuts (cashews), seeds, avocado, dried fruits, cacao powder, wholegrains||350 mg/day|
|Selenium||Seafood, meat, whole grains, fruits, vegetables||70 µg/day|
|Zinc||Red meat, shellfish, wholegrains||7 mg/day|
|3,3’-diindolylmethane (DIM)*||Cruciferous vegetables such as cabbage, Brussels sprouts, broccoli, kale, cauliflower, Kohl-rabi||100 mg/day|
|Polydatin||Polygonum, grapes, wine, hop cones and pellets, beer, cocoa-containing products and chocolate||160 mg/day|
|Pycnogenol||An anti-inflammatory extract from pine bark iii||60 mg a day|
|Quercitin||Apples, red wine, cherries, onions, garlic, leeks, citrus, peppers, lettuce, chilli||200 mg/day|
|N-Acetylcysteine (NAC)||Lean pork, eggs, cereal germ, beans, dairy products, soy||150 mg/day|
|Lactobacilli||Yoghurt, kefir||50-100 CFU a day|
Cruciferous vegetables have long been known to protect against the risk of estrogen-related illnesses such as prostate cancer. Research has identified * 3,3’-diindolylmethane (DIM) as a biologically active chemical in the vegetables that alters the function of some pathways that control cell division and programmed cell death. DIM is formed from the digestion of Indole-3-carbinol (I3C) in the vegetables, and it has two crucial advantages over Indole-3-carbinol I3c:
- It’s more stable
- Unlike I3C, DIM doesn’t increase 4-hydroxyestrogen levels (which is associated with increased tumour risk)
Multiple studies have shown DIM alters sex hormone levels and promotes the death of many cancer cell types:
- Breast iv
- Ovarian v
- Prostate vi
- Gastric vii
- Colon viii
- Hepatoma ix
Supplementing DIM at 100 mg once a day for a year reduces estradiol (E2) from an average of 159 to 102pmol (a 36% fall). x Because DIM supplementation significantly reduces E2 levels, it’s also used for other estrogen-sensitive conditions, including prostate and some breast cancers.
Other nutritional treatments
Isoflavones are a type of phytoestrogens found in soybeans, and they have estrogen‐like activities. While they are structurally similar to estradiol (E2), they have anti‐estrogenic effects in reproductive‐age women with high estrogen levels. xi
Daidzein‐rich isoflavone aglycones (DRIAs) inhibit the growth of endometriotic stromal cells and may reduce lesions. xi-xii
i Shan J, Cheng W, Zhai DX, Zhang DY, Yao RP, Bai LL, Cai ZL, Liu YH, Yu CQ. Meta-analysis of Chinese traditional medicine Bushen Huoxue prescription for endometriosis treatment. Evid Based Complement Altern Med 2017;2017:5416423.
ii Huijs E, Nap A. The effects of nutrients on symptoms in women with endometriosis: a systematic review. Reprod Biomed Online. 2020 Aug;41(2):317-328. doi: 10.1016/j.rbmo.2020.04.014. Epub 2020 May 15. PMID: 32600946.
iii Kohama T, Herai K, Inoue M. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. J Reprod Med. 2007 Aug;52(8):703-8. PMID: 17879831.
iv Lanza-Jacoby S, Cheng G. 3,3’-Diindolylmethane enhances apoptosis in docetaxel-treated breast cancer cells by generation of reactive oxygen species. Pharm Biol. 2018;56(1):407–14. Epub 2018/10/12. pmid:30301388; PubMed Central PMCID: PMC6179060.
v Kandala PK, Srivastava SK. Regulation of macroautophagy in ovarian cancer cells in vitro and in vivo by controlling glucose regulatory protein 78 and AMPK. Oncotarget. 2012;3(4):435–49. Epub 2012/05/09. pmid:22564965; PubMed Central PMCID: PMC3380578.
vi Tsai JY, Chou CT, Liu SI, Liang WZ, Kuo CC, Liao WC, et al. Effect of diindolylmethane on Ca2+ homeostasis and viability in PC3 human prostate cancer cells. J Recept Signal Transduct Res. 2012;32(5):271–8. Epub 2012/08/01. pmid:22845469.
vii Ye Y, Fang Y, Xu W, Wang Q, Zhou J, Lu R. 3,3’-Diindolylmethane induces anti-human gastric cancer cells by the miR-30e-ATG5 modulating autophagy. Biochem Pharmacol. 2016;115:77–84. Epub 2016/07/04. pmid:27372603.
viii Kim EJ, Park SY, Shin HK, Kwon DY, Surh YJ, Park JH. Activation of caspase-8 contributes to 3,3’-Diindolylmethane-induced apoptosis in colon cancer cells. J Nutr. 2007;137(1):31–6. Epub 2006/12/22. pmid:17182797.
ix Munakarmi S, Shrestha J, Shin HB, Lee GH, Jeong YJ. 3,3’-Diindolylmethane Suppresses the Growth of Hepatocellular Carcinoma by Regulating Its Invasion, Migration, and ER Stress-Mediated Mitochondrial Apoptosis. Cells. 2021;10(5). Epub 2021/06/03. pmid:34066056; PubMed Central PMCID: PMC8151225.
x Rinat Yerushalmi, et al., 3,3-Diindolylmethane (DIM): a nutritional intervention and its impact on breast density in healthy BRCA carriers. A prospective clinical trial, Carcinogenesis, Volume 41, Issue 10, October 2020, Pages 1395–1401,
xi Soares SR, Martinez‐Varea A, Hidalgo‐Mora JJ, Pellicer A. Pharmacologic therapies in endometriosis: a systematic review. Fertil Steril. 2012;98(3):529‐555
xii Takaoka O, Mori T, Ito F, et al. Daidzein‐rich isoflavone aglycones inhibit cell growth and inflammation in endometriosis. J Steroid Biochem Mol Biol. 2018;181:125–132
xiii Yavuz E, Oktem M, Esinler I, Toru SA, Zeyneloglu HB. Genistein causes regression of endometriotic implants in the rat model. Fertil Steril. 2007;88(4 Suppl):1129‐1134