Can Diet Really Help Manage Endometriosis Pain? Here’s What the Latest Research Says
Why is Diet for Endometriosis Under the Microscope?
At The Dietologist, we see many individuals living with endometriosis in our virtual clinic every week, navigating chronic pain, digestive symptoms, and fertility struggles.
One of the most common questions we hear is: Can changing my diet really make a difference to my endometriosis symptoms?
With more people exploring nutrition as a tool to manage symptoms, a new study published in JAMA Network Open takes a closer look. We’ve broken down the findings of this large international survey that you have probably seen hit the news and share our thoughts as dietitians with expertise in endometriosis nutrition over the past decade or so.
What is Endometriosis?
Endometriosis ,or endo for short, is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus, most commonly in the pelvic area. Estrogen seems to fuel these lesions. Endometriosis can negatively impact egg quality, block the fallopian tubes, and interfere with embryo implantation.
- 30–50% of those with endometriosis experience infertility or sub-fertility (delays to conception)
- 30% are diagnosed with endometriosis only after experiencing fertility issues
While there is no known cure for endometriosis, laparoscopic surgery can help remove adhesions, cysts and nodules, especially for those trying to conceive. If you suspect endometriosis, speak to your GP about a referral to advanced trained endometriosis surgeon.
Common Symptoms of Endometriosis:
- Pelvic or abdominal pain, especially around menstruation
- Pain during or after sexual intercourse
- Heavy, irregular, or prolonged bleeding
- Intense bloating or “endo belly”
- Constipation, diarrhoea or painful bowel movements
- Fatigue or low energy, especially near your period
These symptoms don’t just affect fertility, they often disrupt work, relationships and mental health too.
Breaking Down the New Study on Diet & Endometriosis Pain
Aim of the Study
To investigate which dietary changes and supplements are being used by individuals with endometriosis, and how effective they are for pain management. This represents the largest international survey to date examining dietary and supplement interventions for endometriosis pain management.
Participants
- N = 2,388 people with a confirmed diagnosis of endometriosis
- Age: 16–71 years (mean: 35.4)
- 99% female, with most participants from Europe and Oceania
- 84% had tried dietary changes; 59% used supplements
Key Findings About Diet & Endometriosis
- Most popular dietary changes:
- Reduced alcohol – 53.2% reported pain improvement
- Reduced gluten – 45.4% reported pain improvement
- Reduced dairy – 45.2% reported pain improvement
- Reduced caffeine – 43.4% reported pain improvement
- Less popular dietary approaches:
- Low FODMAP (32.1%), Mediterranean, vegan, and keto diets
- For supplements, magnesium was the most popular, with 262 of 812 users (32.3%) reporting pain improvement.
What We Think: Our Take as Endometriosis & Reproductive Health Dietitians
What’s Great About This Study
- It’s the largest international survey to date on this topic – good news to see more time and money being spent on the self-management strategies people living with endometriosis can try to support their symptoms whilst researchers explore potential disease causes and cures!
- Reinforces what we see in clinic: many with endometriosis are turning to food for symptom relief
- Starts a much-needed conversation about nutrition as a complementary approach
What to Keep In Mind
While the study is exciting, some limitations mean we can’t take these findings as gospel:
1. Self-Reported Diets Are Tricky
What does “dairy-free” mean to someone who still eats cheese daily? Gluten might be cut from bread, but not from sauces or processed snacks. Without clinical oversight, we can’t assess true compliance to the labelled diet on the survey.
2. Pain Recalled Retrospectively
Pain ratings were based on memory, not real-time tracking, which introduces recall bias and likely affects the reliability of the data.
3. Not Everyone Improved
Almost half the participants didn’t see a benefit. That’s a huge red flag against making blanket dietary recommendations.
4. Could Exacerbate Self-Initiated Dietary Changes & Associated Risks
Based on the data we have, we know that increasingly people with endometriosis feel the pressures of changing their diet to manage their condition which is leading to higher rates of disordered eating & clinical eating disorders in this patient population. These exclusionary dietary approaches such as gluten-free, dairy-free, sugar-free and low FODMAP diets, whilst may be reported to enhance endo symptom management. Understandably, it may be more harmful to an individual’s relationship with food and their body than the potential benefit in endometriosis symptom improvement (Panariello et al., 2023).
Personalised Nutrition for Endometriosis is Essential
This study reinforces our core belief and knowing from supporting hundreds of people living with endometriosis: there is no one-size-fits-all endometriosis diet.
Instead of cutting out entire food groups and hoping for the best, we recommend working with an experienced dietitian who can:
- Help you track symptoms with a food and symptom diary
- Identify your individual food and lifestyle related triggers for symptoms
- Build a diet that supports both symptom relief and current or future fertility
Learn more about when and why to see a dietitian for endometriosis here.
Dietary Management for Endometriosis: Where to Start
If you’re curious about what changes might help, here are a few evidence-informed strategies we often discuss with our endo clients:
1. Fibre: The Unsung Hero
Fibre helps your body excrete excess oestrogen, key for endo management. Focus on:
- Wholegrains, nuts, seeds
- Psyllium husk (start small and drink water!)
- Fruits & veggies
2. Antioxidants: Free Radical Fighters
People living with endometriosis tend to have higher levels of oxidative stress. Boost your antioxidant intake by focusing on:
- Colourful fruits & veggies
- Nuts and seeds (vitamin E)
- Extra virgin olive oil
- Wholegrains
Research has shown vitamin C and E supplementation may help lower inflammatory markers and pain, but we always recommend a food-first approach.
3. Fats: Quality Over Quantity
Omega-3 fats are anti-inflammatory for endometriosis and also support egg health.
Prioritise:
- Salmon, sardines, mackerel, anchovies and ocean trout
- Chia seeds, flaxseeds, walnuts
Limit:
- Processed Meats like deli meats, bacon, ham, salami, prosciutto
- Trans fats in processed baked goods like industrially produced cakes & bsicuits
- Deep-fried takeaway foods
A simple swap to extra virgin olive oil is a great first step to support healthier dietary fats.
Final Thoughts from The Dietologist
Endometriosis affects 1 in 7 women of child-bearing age and is a major cause of the heartbreaking experience of delayed conception.
While surgery remains the gold-standard management for endometriosis, growing evidence suggests that what’s on your plate matters too.
If you want individualised support managing your endo pain and other symptoms, reach out and start working with one of our experienced fertility dietitians today.