Nutrition for Endometriosis
Endometriosis comes with a host of frustrating symptoms, including its impact on fertility. It is important to recognise that not all women with endometriosis will experience delay or difficulty becoming pregnant, but some do.
What is Endometriosis?
Endometriosis is a condition where extra tissue that is similar to the lining of the uterus grows in unusual places. In some cases, the extra endometrium may be around the ovaries or fallopian tubes, sometimes it may progress as far as the colon or other abdominal organs. Endometriosis often presents as extremely painful period-like cramps, sometimes even a few days before the period, and some women with endometriosis also experience pain during sex. The presence of endometrium outside of the uterus can induce an inflammatory reaction, which has additional detrimental effects on the body.
Why might Endometriosis affect fertility?
There are several different factors that may contribute to subfertility in women with endometriosis. One of these is that the extra endometrial tissue could cause a blockage or disrupt the pathway of the egg - for example in the fallopian tube. Another way by which endometriosis may impact fertility is due to its link to chronic inflammation: some studies have found that inflammatory markers (that are higher in women with endometriosis) may disrupt receptivity and implantation in the uterus.
So what about nutrition?
At present there are no clinical guidelines backed by the National Institute of Care Excellence to combat or manage endometriosis, and what research there has been into dietary change for endometriosis is of relatively poor quality. This could be due to small participation numbers in studies, or variables that are not accounted for. Despite this, surveys found that approximately 50% of women with endometriosis have tried dietary change to combat symptoms.
One factor that could be at play is the prevalence of IBS in women with endometriosis: who are 2-3x more likely to experience Irritable Bowel Syndrome (IBS) than women who do not have endometriosis. Symptoms of IBS such as bloating, constipation and abdominal pain may parallel symptoms of endometriosis, amplifying discomfort.
Practical steps:
For women with Endometriosis without IBS -
It is important to maintain a healthy balanced diet, and it can be helpful to focus on intake of antioxidants and omega 3 fatty acids as these could help manage chronic inflammation and maintain healthy cell function. One of the best ways to do this is to follow the principles of the Mediterranean diet. The Mediterranean Diet encourages basing your daily intake on wholegrains, pulses and seeds, and fruit and vegetables. Add to this with 2 portions of oily fish per week, 1-2 portions of eggs or lean white meat, and sparing intake of red or processed meats. In line with the Mediterranean diet, olive oil can be used instead of animal fats or other oils, and getting plenty of physical activity is also highlighted.
For women with Endometriosis and IBS -
When women experience IBS alongside endometriosis they may benefit from more tailored personal nutritional support. This is because no two cases of IBS are the same, and so it is important to identify with each women what triggers may be present for symptoms and how best to manage them. Some women may benefit from reducing their gluten intake, while others may find the best results from stress management breathing exercises around meal times. Some women may find it necessary to trial a low FODMAP diet and reintroduce foods from a ‘blank slate’, and benefit from referral to a Gastroenterology Specialist Dietitian.
If you would like more information or support with your nutrition and endometriosis, you can contact us via our website or social media. You can find more support and information at https://www.theendometriosisfoundation.org
References
DOI: 10.1016/j.fertnstert.2004.06.016
DOI: 10.1042/BST20160474
DOI: 10.1007/s10815-010-9436-1
DOI: 10.1093/humrep/dei135