Diet and endometriosis: what science really knows

With endometriosis, tissue similar to the endometrium (the lining of the uterus) grows outside the uterus. These lesions trigger chronic inflammation, like a fire that constantly smoulders in the belly ^[2]. Some foods fan these embers, others help calm them ^[3].

Endometriosis also feeds on oestrogens, the hormones that stimulate the lesions. And some dietary choices influence how much oestrogen circulates in the body, more on that below.

Finally, the gut matters. Many women with endometriosis have digestive issues, and the gut helps regulate inflammation across the whole body. Caring for your diet also means protecting that balance.

Omega-3s (in oily fish, flaxseeds, walnuts) turn into soothing molecules, while too many omega-6s amplify pain ^[4]. In a cohort of more than 70,000 women, the highest omega-3 consumers had a 22% lower risk of endometriosis ^[5]. Supplementation may also reduce pelvic pain ^[6].

Fibre feeds the good gut bacteria and helps clear used oestrogens instead of recycling them into the blood. The BioCycle study linked a high fibre intake to lower oestradiol levels before menopause ^[7]. An accessible goal: 25 to 30 grams a day.

Antioxidants neutralise free radicals, the unstable molecules that "rust" your cells (oxidative stress), which runs higher with endometriosis ^[8]. Vitamin C and E supplements lowered oxidative stress and pain over eight weeks ^[3], and women who eat the most fruit and vegetables have a lower risk ^[9][10].

Simple habits, no deprivation:

• Oily fish 2 to 3 times a week, canned sardines do the job.
• One tablespoon of ground flaxseeds and a handful of walnuts a day.
• Legumes and whole grains for fibre, increased gradually.
• A colourful plate: berries, citrus, broccoli, beetroot, green tea, turmeric.

The evidence stays modest and variable: these levers complement treatment, they do not replace it ^[4].

Online, some women say they feel better without gluten. The most cited study: out of 207 women, 75% reported less pain after 12 months gluten-free ^[11]. But it had no control group, so the real effect cannot be separated from the placebo effect. A lead, not proof.

For dairy, it is even more nuanced: some studies even suggest a protective effect, thanks to calcium and vitamin D ^[9]. The European guidelines (ESHRE) prescribe no specific diet, for lack of solid evidence ^[12]. No exclusion is mandatory.

As for foods that stoke inflammation, excess red meat is linked to a 56% higher risk ^[5b], trans fats to a 48% increase ^[5], and refined sugars raise inflammatory markers ^[10]. It is frequency that counts, not the one-off meal.

An approach that respects your body:

• Test cutting gluten or dairy for 3 months, tracking your symptoms, then decide.
• If nothing changes, there is no reason to keep depriving yourself.
• For a lasting exclusion, a dietitian prevents deficiencies in calcium, vitamin D and fibre.
• Move the slider rather than banning everything: less red meat, alcohol and ultra-processed food.

Nothing complicated. For breakfast, oat flakes with blueberries and walnuts. For lunch, a lentil and colourful-vegetable salad with rapeseed oil. For dinner, grilled sardines with vegetables and quinoa.

Four habits to keep:

• The colour rule: two or three colours per plate.
• One tablespoon of ground flaxseeds a day ^[5].
• Legumes two or three times a week for fibre ^[7].
• Sardines, walnuts and frozen vegetables always in the cupboard.

Perfection does not exist. What matters is consistency, at your own pace, not the strictness of each meal.