Can certain foods help lessen the pain and other discomforts that women with endometriosis feel? Learn the latest thinking on this topic, and what healthy eating with endometriosis looks like.

There’s little agreement among doctors about whether food choices can help control the symptoms of endometriosis, a condition in which the tissue that normally lines the uterus instead grows outside the uterus.

A major review of 11 studies published in April 2013 in the journal Reproductive Biomedicine Online found the link between diet and endometriosis to be unclear. More research about this connection is needed, the authors say.

A study published in 2017 in the journal Ginekologia Polska points to no clear association, either, although the researchers do find evidence that endometriosis is less likely to develop in the first place in women who eat a lot of fruits and vegetables, fish oils, dairy products, and omega-3 fatty acids. Meanwhile, women who eat foods high in fat, trans-unsaturated fatty acids, alcohol, and beef (along with other red meats) seem to be at increased risk for getting endometriosis.

Supporters of a special endometriosis diet can be found, too. Among the most vocal is British nutritionist and author Dian Shepperson Mills, MA, director of the Endometriosis and Fertility Clinic in the United Kingdom and chair of the Endometriosis SHE Trust. Mills has spoken and written about food choices and endometriosis for years, and details her special endometriosis diet in her 2002 book co-authored with Michael Vernon, PhD, and called Endometriosis: A Key to Healing and Fertility through Nutrition.

Thousands of women have tried the diet, she says, which is designed to reduce inflammation and quiet down the immune system’s angry reaction to endometrial tissue that’s not in its normal place inside the uterus. She says the diet also improves the response to pain, and helps in removing extra estrogen (the female sex hormone) responsible for worsening symptoms. Not only pain but fertility improves, she says.

What Not to Eat With Endometriosis

The nonprofit information hub Healthy Women also supports the thinking that diet and endometriosis symptoms are linked. The site cautions women with endometriosis to stay away from high-fat foods, since they may increase the level of circulating estrogen in the body. The more fat in your diet, the more estrogen your body produces. This also happens if you're overweight, they say.

“Women with endometriosis should avoid fatty foods, such as red meat and [high-fat] dairy foods that may be high in PCBs and dioxins, to reduce their exposure to these estrogenic pesticides,” adds Shepperson Mills. Use organic food whenever you can, or peel fruits and vegetables, she recommends. Some research suggests a link between dioxins in the environment and increased levels of estrogen.

A review published in 2017 in the journal Oxidative Medicine and Cellular Longevity is one of several sources that describes a link between oxidative stress — which includes the formation of cell-damaging substances called free radicals — and endometriosis. Additional research found that a lack of antioxidants may contribute to endometriosis, while absorbing key antioxidant nutrients like selenium and vitamins A, C, and E may help keep it under control.

You may also want to avoid citrus fruits, like grapefruit and oranges, as they can irritate your stomach and upset the way in which estrogen is excreted by the body. When excluding foods from your diet, just make sure to eat alternatives so you avoid any nutrient deficiencies.

What to Eat for Endometriosis

The core of Shepperson Mills’ diet for endometriosis includes these hallmarks of healthy nutrition:

• Freshness. Buy the freshest food you can find and eat it while it’s fresh. Avoid highly processed foods which are full of additives. Cook with fresh foods, but also eat some raw vegetables and fruit every day. To minimize exposure to pesticides, eat organically grown produce whenever possible.
  

• Variety. Eat a wide range of foods every day. “Make it fun to try new dishes on weekends and expand your horizons,” says Shepperson Mills.
  

Your daily diet should provide 75 grams of good quality protein from sources like fish, eggs, and low-fat dairy products. Also include a handful of nuts, seeds, and legumes (such as beans), two portions of red or orange vegetables, two green leafy vegetables, and two fruits, including berries, which are high in antioxidants.

Focus on Key Nutrients

Certain foods rich in key nutrients are important components in a diet for endometriosis:

• Vegetables with B vitamins. “A healthy liver with a plentiful supply of B vitamins can degrade estradiol to estriol,” Shepperson Mills says. “Estriol is the form in which estrogen can be bound to fiber and excreted. The diet needs to have sufficient fiber and B vitamins from green vegetables to help the body deal with the constant breakdown of circulating estrogens. Green, leafy vegetables can also help the nervous and immune systems, and magnesium relaxes smooth muscles found in the intestines and uterus.” The best vegetables: those in the cruciferous family, such as cabbage, sprouts, broccoli, cauliflower, kale, turnips, radishes, horseradish, and watercress.
  

• Iron-rich foods. “With endometriosis you may experience heavy bleeding, so replacing lost iron is important,” she says. Two types of iron are available in the foods we eat, heme iron from protein sources and non-heme iron from plant sources. Non-heme iron is available in green, leafy vegetables, beetroot, dried apricots, and plain chocolate. Heme iron comes from red meat, eggs, and fish.
  

• Omega fatty acids. Include 1 tablespoon of cold-pressed vegetable oil in your meals daily. Avoid trans fats, and keep saturated fats low. Sources of omega fatty acids include oily fish such as wild Alaskan salmon and Pacific halibut, and tree nuts, seeds, and extra virgin cold-pressed olive oil.
  

• Fiber. Shepperson Mills suggests getting 30 grams of fiber each day from fruits, vegetables, nuts, seeds, legumes, and whole grains including rye, oats, rice, corn, millet, and buckwheat to keep your intestinal tract healthy and promote the excretion of excess estrogens.
  

• Water. Drink four to six 8-ounce glasses of water a day. Avoid caffeine, refined sugars, sweeteners, soda (including diet), and alcohol when struggling with endometriosis or trying to get pregnant.
  

Could Going Gluten-Free Help?

“Eating a wheat-free diet seems to help many women with endometriosis symptoms,” says Shepperson Mills. “Whether this is a result of gluten or another component of wheat is unclear, but it may be worth excluding wheat for one month to see if it makes a difference to your abdominal pains at periods and ovulation. You could also try to exclude dairy foods if you have excess mucus problems.”

Support for going gluten-free with endometriosis can also be found in a study published in 2012 in the journal Minerva Chirurgica. The findings were promising in this research, which looked back at the experience of 207 women with severe, chronic endometriosis symptoms who removed gluten from their diet for 12 months. Painful endometriosis symptoms lessened for a significant number of the women, and while some reported no change in how they felt, at a minimum none indicated their pain got any worse. “If a particular food is upsetting digestion and causing an immune system response, then that food should be avoided,” says Shepperson Mills.

Some doctors aren’t sure that the diet is beneficial in terms of endometriosis relief per se. “Endometriosis is a funny entity in the sense of immunology," says John C. Petrozza, MD, an obstetrician-gynecologist and chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility Center in Boston. Patients with endometriosis tend to have "problems with asthma and allergies — it’s not uncommon to have irritable bowel syndrome, lactose intolerance, or gluten intolerance," he says. "So is the diet really helping the endometriosis or the symptoms of irritable bowel syndrome?”

The bottom line: If you have endometriosis, talk to your doctor or a registered dietitian to see if changes to your diet might be worth trying.