Dietary habits and the use of supplements in endometriosis: a literature review
Abstract
Introduction: Endometriosis is a gynecological pathology that affects about 10% of women of reproductive age. The disease can cause pelvic pain, infertility and other symptoms, and is associated with risk factors such as early menstruation and late menopause. Although there is still no cure, nutritional interventions and supplementation are strategies explored for treatment and symptom relief. Objective: To investigate the effects of diet and the use of dietary supplements on the management of endometriosis, through a literature review. Materials and methods: A literature review was carried out using the PubMed, Medline, SciELO, and Lilacs databases, focusing the search on articles published between 2014 and 2024, with free access, available in Portuguese, English, and Spanish, focusing on terms related to endometriosis, diet, and supplements. The search for a theoretical framework took place in the second half of 2024. Results: 16 articles were selected, all in English, including animals and women aged 20 to 50 years, in addition to 2 guidelines on the subject. A dietary pattern composed of unsaturated fatty acids and fiber seems to be beneficial for reducing inflammatory processes and intestinal maintenance, significantly reducing the symptoms of dysmenorrhea, dyspareunia, and chronic pelvic pain. Dietary restrictions on gluten, lactose and FODMAPS, despite having an effect on an individualized basis, do not present evidence that recommends their exclusion for treatment in endometriosis. Studies with food supplements, although they point to possible benefits, are still early. Conclusion: There is still scarce evidence in the literature that diet can effectively reduce endometriosis symptoms.
References
-Afrin, S.; Alashqar, A.; El Sabeh, M.; Nassif, J.; Al-Hendy, A.; Borahay, M. A. Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies. Nutrients. Vol. 13. Num. 6. 2021. p. 1747.
-Allaire, C.; Bedaiwy, M.A.; Yong, P.J. Diagnosis and management of endometriosis. Canadian Medical Association Journal. Vol. 195. Num. 10. 2023. p. E363-E371.
-Amini, L.; Chekini, R.; Nateghi, M.R.; Haghani, H.; Jamshidi, T.; Lamyian, M.; Ghasemi, V.; Taghizadeh, A.; Shahisavandi, M. The effect of combined vitamin C and vitamin E supplementation on oxidative stress markers in women with endometriosis: a randomized, triple-blind placebo-controlled clinical trial. Pain Research and Management. Vol. 2021. Num. 1. 2021. p. 5529741.
-Becker, C.M.; Bokor, A.; Heikinheimo, O.; Horne, A.; Jansen, F.; Kiesel, L.; King, K.; Kvaskoff, M.; Nap, A.; Peters, K.; Vermeesch, E.; White, L.; Watts, N.; Missmer, S.A. ESHRE guideline: endometriosis. Human Reproduction Open. Vol. 2022. Num. 2. 2022. p. hoac004.
-BIREME. Descritores em Ciências da Saúde (DeCS). Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde. 2024.
-Bogusz, A.; Górnicka, M. Low Diet Quality and Nutritional Knowledge in Women with Endometriosis: A Pilot Study. Healthcare. Vol. 12. Num. 6. 2024. p. 673.
-Brasil. Ministério da Saúde. Endometriose: entenda os principais aspectos da doença. Empresa Brasileira de Serviços Hospitalares (EBSERH). 2023.
-Brouns, F.; Van Haaps, A.; Keszthelyi, D.; Schreurs, A.M.F.; Nap, A.W. Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Frontiers in Nutrition. Vol. 10. 2023. p. 1060462.
-Cirillo, M.; Argento, F.R.; Becatti, M.; Fiorillo, C.; Coccia, M.E.; Fatini, C. Mediterranean Diet and oxidative stress: a relationship with pain perception in endometriosis. International Journal of Molecular Sciences. Vol. 24. Num. 19. 2023. p. 14601.
-Clower, L.; Carneiro, T.; Geldenhuys, W.J.; Santanam, N. Targeting oxidative stress involved in endometriosis and its pain. Biomolecules. Vol. 12. Num. 8. 2022. p. 1055.
-De Leo, V.; Cagnacci, A.; Cappelli, V.; Morgante, G.; Luisi, S. Role of a natural integrator based on lipoic acid, palmitoylethanolamide and myrrh in the treatment of chronic pelvic pain and endometriosis. Minerva Ginecologica. Vol. 71. Num. 3. 2019. p. 196-200.
-Figueiredo, F.D.A. Aprova o Protocolo clínico e diretrizes terapêuticas da Endometriose. Portaria Nº 879. Ministério da Saúde. 2016.
-Finotti, M. Endometriose. Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Protocolo n. 78. 2021.
-Haaps, A. Van; Wijbers, J.; Schreurs, A.M. F.; Wijbers, J.H.E.; Schuit Maker, N.W.E.; Nap, A.W. A better quality of life could be achieved by applying the endometriosis diet: a cross-sectional study in Dutch endometriosis patients. Reproductive BioMedicine Online. Vol. 46. Num. 3. 2023. p. 623-630.
-Heard, M.E.; Melnyk, S.B.; Simmen, F.A.; Yang, Y.; Simmen, R.C.M. High-fat diet promotion of endometriosis in an immunocompetent mouse model is associated with altered peripheral and ectopic lesion redox and inflammatory status. Endocrinology. Vol. 157. Num. 7. 2016. p. 2870-2882.
-Heard-Lipsmeyer, M.E.; Alhallak, I.; Simmen, F.A.; Melnyk, S.B.; Simmen, R.C.M. Lesion genotype modifies high-fat diet effects on endometriosis development in mice. Frontiers in Physiology. Vol. 12. 2021. p. 721523.
-Herup-Wheeler, T.; Shi, M.; Harvey, M.E.; Schwenke, S.M.; Woodbury, J.; Taylor, R.N.; Appt, S.E.; Missmer, S.A.; Harris, H.R.; McKinnon, B.; Lebovic, D.I.; Grümmer, R.; Wieser, F.; Greaves, E.; Gargett, C.E.; Santanam, N. High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia. Frontiers in Endocrinology. Vol. 15. 2024. p. 1362677.
-Hujis, E.; Van Stigt, B.J.; De Roos, N.; Van Haaps, A.; Schreurs, A.M.F.; Nap, A.W. The feasibility of an anti-inflammatory diet in endometriosis: barriers and facilitators perceived by endometriosis patients. Reproductive BioMedicine Online. Vol. 48. Num. 2. 2024. p. 103449.
-Hunt, G.; Allaire, C.; Yong, P.J.; Lisonkova, S. Endometriosis: an update on diagnosis and medical management. British Columbia Medical Journal. Vol. 63. Num. 4. 2021. p. 158-163.
-Karlsson, J.V.; Patel, H.; Premberg, A. Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open. Vol. 10. Num. 2. 2020. p. e032321.
-Krabbenborg, I.; Roos, N.; Van Der Grinten, P.; Nap, A.W. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. Reproductive BioMedicine Online. Vol. 43. Num. 5. 2021. p. 952-961.
-Kumar, K.; Narvekar, N.N.; Maslin, K. Self-managed dietary changes and functional gut symptoms in endometriosis: a qualitative interview study. European Journal of Obstetrics & Gynecology and Reproductive Biology. Vol. 19. 2023. p. 100219.
-Kumar, K.D.; Appleby‐Gunnill, B.; Maslin, K. Nutritional practices and dietetic provision in the endometriosis population, with a focus on functional gut symptoms. Journal of Human Nutrition and Dietetics. Vol. 36. Num. 4. 2023. p. 1529-1538.
-Mazza, E.; Troiano, E.; Mazza, S.; Serrone, A.; Maurotti, S.; De Francesco, A.; Pujia, A.; Montalcini, T. The impact of endometriosis on dietary choices and activities of everyday life: a cross-sectional study. Frontiers in Nutrition. Vol. 10. 2023. p. 1251703.
-Molina, N.M.; Jurado-Fasoli, L.; Sola-Leyva, A.; Ruiz-Gómez, M.J.; Labarta, E.; Castillo-Díaz, J.M.; Amaro-Gahete, F.J.; Sáez-Casado, M.J. Endometrial whole metabolome profile at the receptive phase: influence of Mediterranean Diet and infertility. Frontiers in Endocrinology. Vol. 14. 2023. p. 1152737.
-Newton, E. R. Endometriose. Femina. Vol. 50. Num. 8. 2022. p. 462.
-Nodler, J.L.; DiVasta, A.D.; Vitonis, A.F.; Chavarro, J.E.; Missmer, S.A.; Goodman, E.; Williams, P.L. Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trial. The American Journal of Clinical Nutrition. Vol. 112. Num. 1. 2020. p. 229-236.
-Parazzini, F.; Esposito, G.; Tozzi, L.; Noli, S.; Bianchi, S. Epidemiology of endometriosis and its comorbidities. European Journal of Obstetrics & Gynecology and Reproductive Biology. Vol. 209. 2016. p. 3-7.
-Sullivan-Myers, C.; Sherman, C.A.; Beath, A. P.; Cooper, M.J.W.; Mikocka-Walus, A. Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis. Human Reproduction. Vol. 36. Num. 8. 2021. p. 2170-2180.
-Van Haaps, A.P.; Wijbers, J.; Schreurs, A.M. F.; Wijbers, J.H.E.; Schuit Maker, N.W.E.; Nap, A.W. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Human Reproduction. Vol. 38. Num. 12. 2023. p. 2433-2446.
-Van Haaps, A.P.; Brouns, F.; Schreurs, A.M. F.; Keszthelyi, D.; Nap, A.W. A gluten-free diet for endometriosis patients lacks evidence to recommend it. AJOG Global Reports. Vol. 4. Num. 3. 2024. p. 100369.
-Zengul, A.; Demark-Wahnefried, W.; Barnes, S.; Morrow, C.D.; Bertrand, B.; Berryhill, T. F.; Frugé, A.D. Associations between dietary fiber, the fecal microbiota and estrogen metabolism in postmenopausal women with breast cancer. Nutrition and Cancer. Vol. 73. Num. 7. 2021. p. 1108-1117.
-Zondervan, K.T.; Becker, C.M.; Missmer, S.A. Endometriosis. New England Journal of Medicine. Vol. 382. Num. 13. 2020. p. 1244-1256.
Copyright (c) 2025 Daiana Strelow Thurow, Anne y Castro Marques
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish in this journal agree to the following terms:
- Authors retain the copyright and grant the journal the right of first publication, with work simultaneously licensed under the Creative Commons Attribution License BY-NC which allows the sharing of the work with acknowledgment of the authorship of the work and initial publication in this journal.
- Authors are authorized to enter into additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal.
- Authors are allowed and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can bring about productive change as well as increase impact and impact. citation of published work (See The Effect of Free Access).
