{"paper_id":"df2252b4-fb4d-47ad-9c4a-581c9442a953","body_text":"vv\n017\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nhttps://dx.doi.org/10.17352/jgroDOI: 2581-5288ISSN: \nCLINICAL GROUP\nAbstract\nEndometriosis is an in fl ammatory pathology characterized by the growth of endometrial tissue outside the uterus, resulting in chronic pelvic pain and infertility. As \na result, it has been observed that diet can in fl uence the pathophysiology of this disease by attenuating the in fl ammatory environment. In this context, this study aims \nto summarize the infl uence of diet as a complementary therapy for endometriosis. To this end, a narrative review was carried out using the BVS, Emb ase, and Cochrane \ndatabases, including articles available in full in Portuguese, English, and Spanish published in the last 5 years. According to the literature, a diet can have pro-infl ammatory \nproperties in patients with endometriosis, such as a diet rich in saturated fatty acids, and anti-in fl ammatory properties, involving polyunsaturated fatty acids, in order \nto infl uence the metabolism of prostaglandins. It is concluded that endometriosis is a chronic in fl ammatory disease that can be modulated with the adoption of anti-\ninfl ammatory dietary habits that can impact women’s quality of life in the long term.\nResearch Article\nRepercussions of the Anti-\ninfl ammatory Diet on \nEndometriosis Control\nSandriny Maria de Almeida Oliveira¹, Bianca Braga Gomes¹, \nCainã Araújo Saraiva¹, Luana Azevedo Dourado¹, Jeremias \nAguiar Azevedo¹ and Sávio Benvindo Ferreira²*\n1Medical Student, Academic Unit of Life Sciences (UACV), Teacher Training Center (CFP), Federal \nUniversity of Campina Grande (UFCG), 58900-000, Cajazeiras, Paraíba, Brazil\n2PhD in Pharmacology, Academic Unit of Life Sciences (UACV), Teacher Training Center (CFP), Federal \nUniversity of Campina Grande (UFCG), 58900-000, Cajazeiras, Paraíba, Brazil\nSandriny Maria de Almeida Oliveira:  ORCiD: https://orcid.org/0000-0001-8681-255X \nBianca Braga Gomes:              ORCiD: https://orcid.org/0009-0008-7234-8328 \nCainã Araújo Saraiva:         ORCiD: https://orcid.org/0009-0009-4222-4276 \nLuana Azevedo Dourado:     ORC iD: https://orcid.org/0009-0002-7505-7741 \nJeremias Aguiar Azevedo:        ORCiD: https://orcid.org/0009-0003-9568-6710\n*Sávio Benvindo Ferreira:        ORCiD: https://orcid.org/0000-0001-8838-4755\nReceived: 11 July, 2024\nAccepted: 03 August, 2024\nPublished: 05 August, 2024\n*Corresponding author: Sávio Benvindo Ferreira, \nPhD in Pharmacology, Academic Unit of Life Sciences \n(UACV), Teacher Training Center (CFP), Federal Univer-\nsity of Campina Grande (UFCG), 58900-000, Cajazeiras, \nParaíba, Brazil, \nE-mail: savio.benvindo@professor.ufcg.edu.br\nKeywords: Food; diet; Chronic disease; \nEndometriosis; Infl ammation\nCopyright License: © 2024 De Almeida Oliveira \nSM, et al. This is an open-access article distributed \nunder the terms of the Creative Commons Attribution \nLicense, which permits unrestricted use, distribution, \nand reproduction in any medium, provided the original \nauthor and source are credited.\nhttps://www.clinsurggroup.us\nIntroduction\nEndometriosis is an infl ammatory pathology characterized \nby the growth of functional and hormone-dependent \nendometrial tissue outside the uterus, which can result in \nmenstrual changes, chronic pelvic pain, and infertility [1]. It is \ntherefore believed that this clinical condition affects between \n6% and 10% of menopausal women and between 50 and 60% \nof adolescent and adult women with pelvic pain, as well as \nbeing responsible for around 50% of the causes of infertility.\nAccording to the National Health Surveillance Agency \n(ANVISA), endometriosis affects 1 in 10 women between \nthe ages of 25 and 35, who come down with pelvic pain that \ncoincides with the menstrual period, a fact that is normalized, \nresulting in late diagnosis and treatment in around 7 years [2].\nThe clinical picture of endometriosis varies widely and is \nconfused with other pathologies, such as pelvic in fl ammatory \ndisease and irritable bowel, and is characterized as a \nbenign disease that presents with a lesion in the ovary or \nendometrioma and foci of endometrial growth (Figure 1) that \ncan reach the intestine, peritoneum, bladder and adjacent \norgans, resulting in non-speci fi c symptoms [3]. In women \n\n018\nhttps://www.clinsurggroup.us/journals/journal-of-gynecological-research-and-obstetrics\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nwho are oligosymptomatic, infertile, or in the early stages of \nthe disease, diagnosis can be late, which results in thousands \nof underdiagnosed cases that become chronic and compromise \nquality of life [4].\nThe spectrum of signs and symptoms of this infl ammatory \ndisease, the non-correspondence of symptoms with the \nstage of the disease, and the limitation of the use of imaging \ntests due to cost-effectiveness mean that the diagnosis of \nendometriosis is postponed for years, as well as resulting in \n5 or more consultations until the start of speci fi c treatment or \nthe referral of women to specialized centers [5].\nThus, the choice of drug therapies for endometriosis \ntakes into account the in fl ammatory pathophysiology of the \ndisease and the responsiveness to hormones, in addition to \nthe fact that the physiological conditions of the pregnancy \nand menopause period are associated with the resolution of \nthe resulting chronic pain\n [6]. In other words, the prescription \nof progestogen analogs and Combined Oral Contraceptives \n(COCs), which simulate hormonal conditions similar to those of \npregnancy, and GnRH agonists, which promote the suppression \nof endogenous estrogen and resemble menopause [4].\nOn the other hand, the literature shows that aspects related to \nlifestyle changes, especially in relation to an anti-infl ammatory \ndiet, are important as a complement to pharmacological \ntherapy, with the aim of approaching the disease through \ndifferent therapies. That said, it has been observed that \na selective diet can in fl uence the course of endometriosis \npathophysiology, such as in fl ammation and prostaglandin \nmetabolism [7]. This diet is related to the consumption of oral \nomega-3 polyunsaturated fatty acids, a dietary supplement \napproved by the Food and Drug Administration (FDA) that has \na suppressive action on endometrial cells [8].\nIt is worth mentioning that studies have analyzed the \ncorrelation of nutrition on the pathogenesis of endometriosis \nand on the in fl ammatory state of the disease, such as a diet \nbased on antioxidants, as they minimize free oxygen radicals \nand, consequently, infl ammation [6]. On the other hand, a diet \nrich in carbohydrates is associated with a pro-in fl ammatory \nstate, which can aggravate the main symptom of the disease, \nwhich is chronic pain [9]. With this in mind, considering the \ninfl uence of diet on the progression of endometriosis and as a \npotential complementary therapy to pharmacological therapy, \nthis study aims to summarize the repercussions of an anti-\ninfl ammatory diet on the control of endometriosis.\nMethodology\nCharacterization of the research\nThis is a narrative, qualitative, and descriptive review, in \nwhich bibliographic studies on a particular subject are analyzed \nand synthesized in order to provide a relevant and current \ntheoretical reference, as well as gather new perspectives \non a speci fi c topic [10]. In order to construct the research \nquestion, the PICO strategy (Population, Intervention, Control, \nand Outcomes/Outcome) was used, resulting in the research \nquestion: “What are the repercussions of an anti-infl ammatory \ndiet on the control of endometriosis?”\nConducting the research\nThe review was carried out during the months of November \nand December 2023, in the electronic databases Embase, \nCochrane, and VHL aimed at indexing scienti fi c journals \nand articles. The keywords provided by the Health Sciences \nDescriptors (DeCS) and the Boolean operators used in the search \nwere: endometriosis AND diet OR nutrition AND infl ammation, \nwith the search languages being Portuguese and English, \ninvolving articles from the last 5 years. The papers were then \nselected by title, followed by reading the abstract and then the \nfull text, original articles that dealt with endometriosis in the \ndietary context, as well as the in fl uence of food as an anti-\ninfl ammatory therapy, were selected. The exclusion criteria \nwere duplicate studies, review articles, and articles involving \nanimals which, after full reading, did not answer the research \nquestion.\nSummary of results\nBased on the search criteria, 123 articles were found and, \nat fi rst, reviews and studies involving animals were excluded, \nfollowed by other articles excluded by title and abstract and, \nfi nally, after a thorough reading, 8 articles were selected to \nmake up the state of the art. This was followed by an analysis \nof the theoretical basis of each study, as well as an observation \nof the general characteristics of the articles, highlighting the \nmost relevant points to be synthesized in the current narrative \nreview. \nAs this is a review article, it was not necessary to submit the \nstudy to an ethics and research committee, as the analysis was \nbased on secondary data already published in other articles.\nTheoretical background\nUnderstanding Endometriosis\nEndometriosis is a chronic, in fl ammatory gynecological \ndisease in which endometrial tissue grows outside the uterine \ncavity, resulting in local in fl ammation, compression, and \nFigure 1: Possible foci of endometriosis. Source: Adapted from [13].\n\n019\nhttps://www.clinsurggroup.us/journals/journal-of-gynecological-research-and-obstetrics\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nobstruction of other organs, generating chronic pain and, in \nadvanced cases, infertility [4]. In other words, it corresponds \nto ectopic endometrial tissue outside the uterine cavity and \nmyometrium and can be found in the pelvic and abdominal \ncavities, adhered to the peritoneum, ovary, bladder and/or \nintestines [1].\nIn a study [3] that worked with a sample of 153 women \nwith endometriosis, the most prevalent symptoms were: \ndyspareunia (65.4%), dysmenorrhea (88.2%), and infertility \n(52.9%) and, when endometrial tissue appears in non-\nreproductive organs, the associated complaints are: dyschezia, \nhematochezia and dysuria.\nThe causes that explain endometriosis have not yet been \nfully elucidated and may vary in terms of the manifestations \nand bodily responses to ectopic endometrial implants, whose \nprogression is not restricted to a single pathway and may \nregress, progress, or stabilize [11]. The symptoms associated \nwith endometriosis usually appear in adolescence or early \nadulthood, and they also manifest cyclically with the hormonal \nvariations of the menstrual cycle, as the growth of endometrial \ntissue is estrogen-dependent [12].\nWith regard to treatment, the choice of method should \ntake into account the expression of each symptom and the \nsite affected by the disease, as well as including the desire to \nbecome pregnant or not, the patient’s age, and possible surgical \ncomplications. Treatment with combined contraceptives aims \nto slow down the progression of the disease and is used as \nthe fi rst choice for women who want contraceptive protection \nassociated with mild symptoms of endometriosis, as it reduces \ndysmenorrhea and helps to reduce endometriomas [4].\nThus, the hormonal drugs cited in the literature - such \nas isolated progestogens, combined oral contraceptives, \ngestrinone, danazol, and GnRH - have similar effects in \nrelieving pelvic pain. In addition, there is surgical treatment \nto remove endometrial foci in the case of women who have \nnot responded to drug treatment and suffer from progressive \npelvic pain [1].\nPathophysiology of endometriosis\nIn principle, endometriosis is a common, in fl ammatory, \nand debilitating gynaecological disease that can lead to the \noccurrence of many chronic pathologies, such as pelvic pain, \ndysmenorrhoea, and infertility, characterized by the presence \nof endometrial tissue outside the uterus, affecting the ovaries, \nfallopian tubes, bladder, and more distant tissues [14] (Figure \n2).\nDespite being recognized as an in fl ammatory disease, the \npathogenesis of endometriosis and the origin of chronic pain \nand other symptoms remain poorly understood. However, \nit is known that some hormonal, neurological, and systemic \ninfl ammatory factors may be related to the pathophysiology of \nthis condition [15]. \nIn this sense, it is clear that chronic in fl ammation has \nbeen proposed in several studies as an enhancer of the \npathophysiological mechanism of endometriosis [16]. This \nis because the pro-in fl ammatory condition of endometriosis \ntriggers an increase in cytokine and growth factor \nconcentrations, as well as leading to a decrease in cell apoptosis \nand an increase in angiogenesis [17].\nAs evidence of this, in recent decades, researchers have \nFigure 2: Pathophysiology of endometriosis. Source: Adapted from [21].\n\n020\nhttps://www.clinsurggroup.us/journals/journal-of-gynecological-research-and-obstetrics\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nbeen able to fi nd the presence of in fl ammatory mediators \nsuch as interleukin (IL)-1 beta, IL-6, and Tumor Necrosis \nFactor-alpha (TNF- ) in the endometrial tissue of women \nwith endometriosis, demonstrating that in fl ammation \nplays a crucial role in the pathogenesis of endometriosis, as \nthese cytokines positively regulate the production of human \nendometrial haptoglobin in women with endometriosis [14].\nIn addition, the macrophages that in fi ltrate the ectopic \nlesions through chemokine-induced recruitment express \ntypical markers of alternative activation, promoting \nneoangiogenesis and facilitating the growth of endometriosis \nby increasing the levels of vascular endothelial growth factor in \nthe peritoneal fl uid [18].\nFurthermore, the chronic in fl ammatory state of \nendometriosis activates nociceptors, resulting in central \nand peripheral sensitization [7]. Consequently, the \naltered in fl ammatory microenvironment characteristic of \nendometriotic tissue may be related to hyperalgesia and the \npersistence of chronic pain [19].\nIn addition, women with endometriosis have been reported \nto have signifi cant changes in oxidative stress parameters [20]. \nThis factor induces a cytotoxic effect, increased cell membrane \npermeability, enzyme activation, DNA damage, and cell death, \nso pain in women with endometriosis is related to the response \nto tissue injury, the resulting in fl ammatory process, and \noxidative stress [7].\nFinally, in addition to these factors, high serum estrogen \nlevels can contribute to the production of prostaglandins and \nthe development of cell proliferation, favoring in fl ammation \nand the intensifi cation of endometriosis [7]. As a result, because \nit is a chronic in fl ammatory disease dependent on oestrogen, \nthe greatest risk of endometriosis occurs between the ages of \n25 and 35, given that the density of serum hormone levels, \nespecially oestrogen, normally decreases at the age of 35 [19]. \nThe role of nutrition as a complementary therapy\nPro-infl ammatory diet:  Some factors associated with the \ndiet may have properties considered to be pro-in fl ammatory \nin patients with endometriosis, for example, a diet with high \namounts of saturated fatty acids and carbohydrates, and low \namounts of polyunsaturated fatty acids (especially omega-3 \nfatty acids), fl avonoids, and antioxidants [18]. As a starting \npoint, we can cite the results of the Nurses’ Health Study \nII, which shows that the consumption of red meat possibly \nincreases painful symptoms, as it reduces estrogen transporters \nresulting in greater availability of this hormone in circulation, \nwhich stimulates the progression of endometriotic foci that are \nhormone-dependent [7].\nIn a study of thirty-one women diagnosed with \nendometriosis and suffering from gastrointestinal disorders, \ntwenty-eight of them (90.3%) had nickel (Ni) in their oral \nmucosa and were diagnosed with allergic contact mucositis \ndue to Ni, while three of the thirty-one (9.7%) patients did \nnot have nickel in their oral mucosa. After three months on \na low-nickel diet, all gastrointestinal, extraintestinal, and \ngynecological symptoms decreased signifi cantly [15].\nIn this context, nickel (Ni) in high concentrations can \nbe toxic, inducing in fl ammatory and allergic disorders, for \nhumans the main source of the element is in foods such as \ntomatoes, cocoa, beans, mushrooms, green leafy vegetables, \nwhole wheat fl our, soybeans, corn, onions, garlic, shell fi sh, \nnuts, canned foods [15].\nFurthermore, a study carried out using data from the \nNational Health and Nutrition Examination Survey with \nparticipants from the general US population concluded that \nthose with the highest Dietary Infl ammatory Index (DII) scores \nhad a 57% higher risk of endometriosis than those with the \nlowest DII scores [16]. This is due to the high levels of systemic \ninfl ammation caused by the pro-infl ammatory diet, which can \naffect the markers C-reactive protein, IL-6, IL-8, and TNF- , \ncollaborating for the implantation of endometrial cells, growth, \ninvasion, and angiogenic properties of ectopic lesions [18].\nAnti-infl ammatory diet: The main treatments for \nendometriosis are based on hormonal medication and surgical \nremoval of lesions [7]. However, around 75% of symptoms \nrecur after surgery, and ovarian suppressant drugs have \nseveral side effects similar to those of menopause and/or are \ncontraceptives, which generates the need for alternatives to \npromote patients’ quality of life [8].\nStudies are progressively analyzing the importance of therapy \nstrategies that address all demands, including aspects related \nto quality of life. This trend is demonstrated in the analysis of \nthe impact of changes in dietary patterns on controlling the \nsymptoms of chronic diseases such as endometriosis. Over the \nlast decade, it has been observed that diet can infl uence various \nmechanisms involved in endometriosis, such as infl ammation, \nprostaglandin metabolism, and estrogen regulation [7].\nIn this sense, it is important to consider that an ideal \ntherapy for endometriosis includes reducing painful symptoms, \nreducing the size of the lesion, and limiting side effects. \nThese criteria are met by oral omega-3 polyunsaturated fatty \nacids, a dietary supplement approved by the Food and Drug \nAdministration (FDA), which participate in the regulation of \nprostaglandin metabolism and cytokine physiology, potentially \nproducing anti-infl ammatory lipid mediators [8].\nIn this sense, quantitative and qualitative analysis of dietary \nintake is valid, since infl ammatory processes play a signifi cant \nrole in the pathogenesis and progression of endometriosis [20]. \nIn addition, in vitro studies have shown that oral omega-3 \npolyunsaturated fatty acids have a suppressive effect on \nendometrial cell survival\n [22].\nAmong the dietary habits analyzed, a prospective study \nincluded 35 women with endometriosis to analyze the role \nof the Mediterranean Diet (MD) on the perception of pain in \nendometriosis and on oxidative stress. This dietary pattern is \nbased on a daily intake of fruit, vegetables, whole grains, and \nvegetable fats, and a weekly intake of fi sh, poultry, legumes, \n\n021\nhttps://www.clinsurggroup.us/journals/journal-of-gynecological-research-and-obstetrics\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nand eggs, as well as moderate portions of dairy products and \nlimiting red meat and foods with added sugar. Thus, the results \nof the study showed a trend toward a relationship between \nadherence to DM and minimization of chronic non-menstrual \npelvic pain ( p = 0.06), dyspareunia ( p = 0.04), dysuria ( p = \n0.04) and dyskinesia ( p < 0.001) in the fi rst three months of \nthe diet [7].\nIt is therefore understood that dietary therapies can be \neffective in promoting the quality of life of patients with \nendometriosis, considering, for example, that omega-3 \npolyunsaturated fatty acids have the potential to reduce the \npainful symptoms associated with endometriosis, reduce the \nsize of the lesion, preserve the patient’s ability to conceive and \nhave minimal side effects [22].\nThe Mediterranean Diet mainly recommends fi sh rich in \nomega-3 fatty acids and extra virgin olive oils, which have \nan anti-in fl ammatory effect. In addition, in the study, the \ndaily fi ber intake of women with endometriosis was below the \nrecommended levels. Therefore, an increase in fi ber intake was \npromoted through the consumption of fruits, vegetables, and \nwhole grains, in order to regulate the fecal excretion of excess \nestrogen. This approach was based on the understanding that \nhigh serum estrogen levels related to endometriosis lead to the \nproduction of prostaglandins, favoring in fl ammation and the \nproliferation of the disease. Thus, adopting a Mediterranean \ndietary pattern, rich in fruit, vegetables, legumes, whole \ngrains, and fi sh, is a possible non-pharmacological therapeutic \nintervention for endometriosis [7].\nIn addition, a prospective cohort study showed an inverse \nrelationship between magnesium intake and the risk of \nendometriosis (RR = 0.86, 95% CI: 0.73 - 1.01; p = 0.007), \nwhich indicates the potential therapeutic use of magnesium. In \naddition, vitamin C was highlighted for its antioxidant and anti-\ninfl ammatory effects, benefi ts associated with minimizing the \noxidative stress characteristic of endometriosis. Therefore, the \nintake of vitamins and minerals can play an important role in \nthe therapeutic strategy [20].\nDiscussion\nAlthough its pathogenesis is poorly understood, it is known \nthat endometriosis is a multifactorial chronic disease infl uenced \nby genetic, pro-in fl ammatory, hormonal, immunological, \nsystemic, and environmental factors. Risk factors include \nfamily history, long menstrual cycle, low parity, and low \nphysical activity [15].\nIn addition, studies show that endometriosis is intrinsically \nrelated to an in fl ammatory process, tissue damage, oxidative \nstress, and high estrogen levels [7]. These factors are \nresponsible for causing the symptoms of endometriosis, such \nas chronic non-speci fi c pain, dysmenorrhea, dyspareunia, \ndysuria, and the risk of infertility [16].\nAt this juncture, after analyzing various studies, it was \nobserved that because endometriosis is a multifactorial disease \nwith a concomitant infl ammatory pattern, the dietary intake of \npatients has an infl uence on some of the symptoms presented, \nso a complementary approach to treatment would be conducted \nfocused on minimizing in fl ammatory processes in general, in \norder to reduce uncomfortable symptoms [9].\nIn this way, pro-in fl ammatory foods should be avoided, \nsince changing some dietary patterns can reduce infl ammatory \nmarkers by mitigating the chemical signals of prostaglandins \nthat are responsible for painful stimuli [23].\nFurthermore, it is necessary to continue researching diets \nas part of therapeutic strategies, as dietary patterns have \nshown important benefi ts in reducing the symptoms of chronic \ndiseases, such as endometriosis [7].\nOf particular note at this juncture is the intake of oral \nomega-3 polyunsaturated fatty acids and the consumption of \nfoods rich in fi ber, vitamins, and minerals. This is mainly due \nto the regulation of prostaglandins and antioxidant Properties \n[20]. However, studies are still needed to defi ne the appropriate \nlevels of supplementation for controlling endometriosis \nsymptoms [22].\nConclusion\nIt is clear that the prevalence of endometriosis is high, as \nit is a disease that is still underdiagnosed and thought of as \na diagnosis of exclusion, especially in patients with infertility \nand chronic pelvic pain who often do not respond to the \nrecommended pharmacological therapy. As such, treatment \nshould always be individualized, taking into account studies and \nprotocols that show the effectiveness of different therapeutic \nregimes and patients’ quality of life.\nRegarding the role of diet as a complementary therapy, it \nwas observed that the consumption of antioxidant nutrients, \nadditional fatty acids, and a combination of vitamins and \nminerals, in addition to reducing the consumption of red meat, \nhas in fl uenced the modulation of endometriosis. That is, the \nconsumption of foods with anti-in fl ammatory properties \ninterferes with the pathophysiology of this chronic disease \nin the long term. On the other hand, studies have shown that \na pro-in fl ammatory diet contributes to the production of \ninfl ammatory cytokines and prostaglandins that enhance the \ndisease’s unwanted symptoms, such as chronic pain.\nTherefore, the inclusion of anti-in fl ammatory dietary \nhabits, such as the consumption of omega-3 fatty acids, fruits, \nvegetables, legumes, whole grains, fi sh, and fi ber, as well as the \nexclusion of ultra-processed foods containing saturated fatty \nacids and carbohydrates, is a non-pharmacological therapeutic \nintervention with important repercussions in modulating the \ninfl ammatory state of the disease and promoting the quality of \nlife of patients with endometriosis.\nIn this context, there is a consensus in the literature that \nendometriosis is a multifactorial chronic disease, and its \npathophysiology is still complex and poorly understood, which \nmakes diagnosis and treatment dif fi cult, especially when it \ncomes to the infl uence of diet on the progression or prevention \nof this disease. Furthermore, despite the studies and theories \n\n022\nhttps://www.clinsurggroup.us/journals/journal-of-gynecological-research-and-obstetrics\nCitation: De Almeida Oliveira SM, Gomes BB, Saraiva CA, Dourado LA, Azevedo JA, Ferreira SB. Repercussions of the Anti-inflammatory Diet on Endometriosis \nControl. J Gynecol Res Obstet. 2024;10(2):017-022. DOI: https://dx.doi.org/10.17352/jgro.000126\nlinking biological mechanisms and the effect of dietary profi les \non the improvement or worsening of endometriosis symptoms, \nthese studies still lack robust epidemiological evidence.\nAuthors’ contribution\nSO, BG, CS, LD, JA: Conception, organization, writing of the \nwork, critical review, and approval of the fi nal manuscript.\nSF: Conception, critical review and approval of the fi nal \nmanuscript.\nFinancing source\n This work did not receive any type of fi nancial support or \nsubsidy from any entity in the public or private domain.\nAcknowledgement\nWe would like to thank the Júlio Bandeira Hospital (HUJB) \nand our supervisor for the opportunity to develop the scientifi c \ninitiation project on endometriosis that inspired this article.\nReferences\n1. 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