Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being

Abstract Background Endometriosis affects approximately 10% of reproductive-age women worldwide, with symptom burden significantly impacting quality of life. While current treatment guidelines focus primarily on hormonal and surgical interventions, the role of lifestyle factors in symptom management remains underexplored. Major clinical guidelines acknowledge insufficient evidence for specific lifestyle recommendations, highlighting the need for exploratory research. Therefore, our aim is to explore potential associations between lifestyle factors (nutrition, physical activity, psychosocial well-being) and symptom burden in women with endometriosis using a mixed-methods approach. Methods A convergent mixed-method design combining cross-sectional online surveys (n = 378) with semi-structured expert interviews (n = 5) was conducted between January and March 2025. Lifestyle factors were assessed using newly developed indices for dietary habits, physical activity, and psychosocial well-being. Symptom burden was evaluated using validated endometriosis-specific instruments and numeric rating scales. Results In exploratory analyses, the Dietary Habits Index was not significantly associated with overall symptom burden in the study cohort. However, subgroup analysis revealed a weak negative correlation in participants without food intolerances (β = -0.144, p = 0.021). Physical activity and psychosocial well-being indices showed weak associations with symptom burden (physical activity: β = 0.133, p = 0.010; psychosocial well-being: β = -0.261, p < 0.001). Expert interviews emphasized the importance of individualized, multimodal approaches and highlighted psychosocial factors as particularly relevant for symptom management. Conclusions This exploratory study suggests modest associations between certain lifestyle factors and endometriosis symptom burden. The findings support the need for individualized lifestyle interventions as adjuncts to conventional medical treatment. Given the limited evidence base and methodological constraints, these hypothesis-generating results require validation through well-designed longitudinal studies and randomized controlled trials.