Endometriosis: Nutritional Considerations

Endometriosis is an estrogen-dependent disorder,² and some studies have suggested that oxidative stress may contribute to the disease process.³ These observations may explain the apparent value of diet and exercise interventions, which can improve both hormone levels and antioxidant status. Conversely, alcohol may increase the risk for endometriosis through its documented tendency to increase both estrogen level and oxidative stress. The following factors have been shown in epidemiologic studies to be associated with reduced risk of endometriosis:

A high-fiber, plant-based diet. Although research on the effectiveness of dietary approaches is limited, several lines of evidence support the use of plant-based diets. First, case-control studies have suggested that frequent red meat and ham consumption is associated with endometriosis risk, while fruit and vegetable intake appears to be protective. In an Italian population including 504 cases and an equal number of matched controls, women who ate at least 7 servings of red meat per week had twice the risk of endometriosis compared with those who ate fewer than 3 servings of red meat weekly. Women having 13 or more servings per week of green vegetables had a 70% lower risk of endometriosis compared with those ate fewer than 6 servings per week. And those eating 14 or more servings of fruit per week had a 20% lower risk compared with women having fewer than 6 servings per week.⁴ Second, women with higher fiber intake and lower intake of fatty foods have reduced estrogenic activity,⁵ a change that may be beneficial in this population but has not as yet been tested (See Dysmenorrhea chapter.)

Exercise. Women who exercise have a much lower risk for endometriosis, and those who engage in frequent strenuous exercise have at least 75% lower risk for endometriosis, compared with those who do not engage in high-intensity activity.⁶

Avoiding alcohol. Compared with healthy women and women with other gynecological problems, women who drink alcohol appear to have a greater incidence of endometriosis.⁷ In women with infertility, the risk of endometriosis was 50% higher in individuals who drank alcohol compared with control subjects.⁸

Orders

See Basic Diet Orders chapter.

Exercise prescription.

Alcohol restriction.

What to Tell the Family

Endometriosis is a painful disorder that will frequently respond to available medical therapies. Regular exercise may improve symptoms. Alcohol consumption should be minimized. A low-fat, vegan diet, which is helpful for functional menstrual pain, has not been tested for endometriosis.