5 foods to avoid if you have endometriosis, according to a dietician

endometriosis diet
Endometriosis diet: Foods to eat, and to avoid getty


Endometriosis is a chronic gynaecological condition that impacts 190 million women worldwide, often leaving people with debilitating pelvic pain, heavy periods and fatigue.

As the NHS explains, this non-cancerous condition is caused by ‘tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes,’ and can also lead to pain during sex, bowel problems and difficulty becoming pregnant.

There is currently no cure for endometriosis, leaving people living with the condition with often only pain management and lifestyle changes at their disposal. One such lifestyle change is diet – something experts are increasingly supporting as a successful way to manage the condition.

‘We have a slowly mounting catalogue of scientific evidence that suggests that diet can have a positive (and negative) impact on endometriosis,’ says dietician Cordula Henggeler.

Meet the expert: Cordula Henggeler is a UK-based registered dietician specialising in Women's Health, including endometriosis, PCOS and IBS.

Endometriosis diet: Foods to avoid with endometriosis

Henggeler says she doesn’t like to give people long lists of what they can’t eat and advises against cutting out entire food groups unless you have an allergy or intolerance.

‘Living with endometriosis is hard enough without the added burden of a long list of foods you cannot eat,’ she says.

This advice is echoed by The Endometriosis Foundation, who say that cutting out food groups like grains, dairy and/or meat is unlikely to be beneficial – and will instead increase the likelihood of nutritional deficiencies.

‘That being said, many people with endometriosis suffer from food intolerances and there are certainly some who feel better avoiding or reducing individual foods,’ says Henggeler.

Some of these foods include:

Research suggests that endometriosis diagnoses are more common among women who consume high amounts of trans fats. Trans fats are found in processed foods, red meat and alcohol.

In addition, a Polish study from 2017 found that eating red meat may be associated with a higher risk of developing endometriosis.

Endometriosis and gluten

‘Gluten is always a big topic when it comes to endometriosis,’ says Henggeler.

There is little evidence to support the claim that following a gluten-free diet helps to manage the symptoms of endometriosis. Just one study of 207 women found that following this type of diet led to a reduction in pain symptoms – so more research is needed to support this theory.

Henggeler advises that not everyone with endometriosis needs to avoid gluten, especially because many gluten-free alternatives are heavily processed and less nutrient-dense.

She says the limited research on the link between gluten and endometriosis is not robust. ‘It can be difficult to unpick if gluten (the protein component in wheat), or fructans (a carbohydrate found in wheat and other foods and one of the FODMAP categories) is the culprit,’ she says.

If you are concerned about the impact of eating gluten on your health, you can rule out Coeliac disease first, she says. This is especially important if you have a family history of the disease.

‘You could try reducing wheat, choosing naturally gluten-free grains instead and trying good quality sourdough bread instead. Sourdough still contains gluten but is slightly lower in fructans and often better tolerated,’ she advises.

Endometriosis and FODMAP

Some limited research suggests that participants with Irritable Bowel Syndrome (IBS) and endometriosis found their symptoms improved while following a low-FODMAP diet.

It is thought this is because low FODMAP diets can help to reduce excess gas in the colon, which causes bloating, which in turn makes endometriosis symptoms worse.

Examples of high FODMAP foods include: wheat, garlic, onions, pulses and some fruits.

The Endometriosis Foundation recommends only undertaking a low-FODMAP diet under the guidance of a registered dietician, and this approach may not work for everyone so shouldn’t be viewed as a cure-all for endometriosis symptoms.

Endometriosis diet: Foods to eat with endometriosis

Eating nutrient-dense, whole foods is the best way to fight the inflammation caused by endometriosis, as well as remain in general good health. The Endometriosis Foundation says that despite limited research, eating a well-balanced diet including the following nutrients may lead to a reduction in painful symptoms:

In particular, foods high in antioxidants like berries, dark leafy greens and nuts may be helpful.

‘Most people with endometriosis can benefit from adding more antioxidants to their diet to help with inflammatory levels,’ says Henggeler. ‘A simple [way to do this] is to focus on having two to three different colours as part of main meals,’ she advises.

Research from 2012 found that foods high in omega-3 may help with the inflammation and pelvic pain associated with endometriosis. ‘Oily fish [...] is such a powerful nutrient and I would recommend that vegetarians and vegans supplement with an algae-based omega-3,’ she says.

Eating more fibre has also been linked with a reduced risk of endometriosis. ‘Many people with endometriosis have bowel symptoms, so this can be a bit of a tricky one,’ says Henggeler.

She recommends increasing fibre intake slowly, for example, increasing two servings of vegetables per day to three for a week or two until your gut gets used to the increase of fibre. ‘Increasing fibre intake takes time, especially in those with endometriosis who often have a sensitive gut,’ she explains.

Endometriosis and the Mediterranean diet

Mediterranean-style diets have long been lauded for their focus on whole foods, antioxidants and oily fish. The benefits of following this type of diet have been evidenced as reduced risk of cognitive decline, better heart health and reduced risk of developing chronic diseases.

Studies also suggest that following a Mediterranean-style diet could reduce pain for those with endometriosis.

‘I absolutely love the concept of the Mediterranean diet,’ says Henggeler, ‘although I think it is more of a lifestyle than diet, and let's face it – we don't exactly get the Mediterranean fresh air and sunshine in the UK.

‘[The Mediterranean diet is] essentially just a very healthy eating pattern and the principles can be adapted by people regardless of how they choose to eat for cultural, religious or environmental reasons,’ she explains.

Following this diet also involves limiting red meat, refined sugars and processed foods.

Endometriosis supplements

Henggeler says that supplements may be useful for managing endometriosis, but usage needs to be targeted. She advises caution against ‘endometriosis blends’, saying: ‘The individual nutrients [in these supplements] are often not in high enough doses to mimic what has been used in studies.’

While some may find supplements helpful, conflicting advice from private companies with little nutrition training can be confusing and may prey on those who have debilitating symptoms.

‘I have many clients who come to me with 10 or 15 different supplements that often were heavily advertised on social media and there is the risk of taking excess amounts, taking things that are simply not needed or even things that may interact with someone's prescription medications or other health conditions,’ she warns.

‘GPs have minimal nutrition training, and neither do staff working in health food stores so it can be difficult to know who to ask and trust,’ says Henggeler.

However, there are a few key areas of deficiency in people with endometriosis that could be addressed through supplement usage.

‘Many of my endometriosis clients are deficient in one or a few key nutrients such as iron, B12 or vitamin D,’ says Henggeler.

‘One supplement that everyone should be on is vitamin D in winter. Low vitamin D status has been associated with endometriosis and as vitamin D plays a key role in our immune system and inflammatory status it is particularly important for those with endometriosis,’ she advises.


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The bottom line

Due to limited research, there is likely not one particular diet or supplement that will alleviate the symptoms of endometriosis. In addition, everyone is different, and what works for one person may not work for you.

However, as Henggeler states: ‘Diet is also one of the very few things that those with endometriosis can influence.’

Overall, eating a diet high in whole, nutrient-dense foods and low in processed foods, refined sugars and red meat can be the first step along the way to improving the painful symptoms of endometriosis.

Henggeler concludes: ‘Endometriosis is a terrible, debilitating condition and so much of it can feel completely out of an individual's control. Nutrition is one of the few things that those with the condition can control. I believe this in itself is very powerful.’


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