Diet in Prevention and Treatment of Endometriosis: Current State of Knowledge

Purpose of Review Endometriosis (EM) is a chronic gynecological disease that affects about 10% of women worldwide. It is characterized by the implantation of endometrial cells at ectopic sites. The most common symptom of EM is painful menstruation, which can often lead to chronic pelvic pain that significantly worsens the quality of life. Because some disease-related processes, such as inflammation, hormonal activity, menstrual cycle, or prostaglandin metabolism, can be modified by diet, nutrition may have a significant impact on development and treatment of EM. The purpose of this article was to overview the current knowledge regarding the dietary management of endometriosis. Recent Findings The attention of researchers has so far concentrated mainly on the role of nutrition in the risk of developing EM, while less attention has been paid to examining the use of diet in the treatment of the disease. Current studies focus primarily on various dietary components that have antiproliferative, anti-inflammatory, antioxidant, analgesic, and estrogen-lowering properties. Summary Exploring different ways of coping with endometriosis can make a significant contribution to improving the quality of life of women at risk or diagnosed with EM. Similar content being viewed by others Availability of Data and Materials Not applicable.

Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39:535–49. Kim JH, Han E. Endometriosis and female pelvic pain. Semin Reprod Med. 2018;36:143–51. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, et al. Endometriosis. Endocr Rev. 2019;40:1048–79. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis Nat Rev Dis Primers. 2018;4:9. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382:1244–56. Rogers PAW, Adamson GD, Al-Jefout M, Becker CM, D’Hooghe TM, Dunselman GAJ, et al. Research priorities for endometriosis. Reprod Sci. 2017;24:202–26. Giudice LC, Kao LC. Endometriosis. The Lancet. 2004;364:1789–99. Gupta S, Agarwal A, Krajcir N, Alvarez JG. Role of oxidative stress in endometriosis. Reprod Biomed Online. 2006;13:126–34. Schink M, Konturek PC, Herbert SL, Renner SP, Burghaus S, Blum S, et al. Different nutrient intake and prevalence of gastrointestinal comorbidities in women with endometriosis. J Physiol Pharmacol. 2019;70:255–68. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15:666–82. Santulli P, Marcellin L, Menard S, Thubert T, Khoshnood B, Gayet V, et al. Increased rate of spontaneous miscarriages in endometriosis-affected women. Hum Reprod. 2016;31:1014–23. Dai Y, Li X, Shi J, Leng J. A review of the risk factors, genetics and treatment of endometriosis in Chinese women: a comparative update. Reprod Health. 2018;15:82. Perricos A, Proestling K, Husslein H, Kuessel L, Hudson QJ, Wenzl R, et al. Hsa-mir-135a shows potential as a putative diagnostic biomarker in saliva and plasma for endometriosis. Biomolecules. 2022;12:1144. Żeberkiewicz M, Hyc A, Iwan A, Zwierzchowska A, Ścieżyńska A, Kalaszczyńska I, et al. Expression of fucosyltransferase 4 (FUT4) mRNA is increased in endometrium from women with endometriosis. J Clin Med. 2022;11:5606. Treatment of pelvic pain associated with endometriosis. a committee opinion. Fertil Steril. 2014;101:927–35. Chen L-H, Lo W-C, Huang H-Y, Wu H-M. A lifelong impact on endometriosis: pathophysiology and pharmacological treatment. Int J Mol Sci. 2023;24:7503. Parazzini F, Viganò P, Candiani M, Fedele L. Diet and endometriosis risk: a literature review. Reprod Biomed Online. 2013;26:323–36. Gołąbek A, Kowalska K, Olejnik A. Polyphenols as a diet therapy concept for endometriosis—current opinion and future perspectives. Nutrients. 2021;13:1347. Radzikowska U, Rinaldi AO, Çelebi Sözener Z, Karaguzel D, Wojcik M, Cypryk K, et al. The influence of dietary fatty acids on immune responses. Nutrients. 2019;11:2990. Riccio L da GC, Santulli P, Marcellin L, Abrão MS, Batteux F, Chapron C. Immunology of endometriosis. Best Pract Res Clin Obstet Gynaecol. 2018;50:39–49. Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, et al. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004;79:606–12. Mozaffarian D, Rimm EB, King IB, Lawler RL, McDonald GB, Levy WC. Trans fatty acids and systemic inflammation in heart failure. Am J Clin Nutr. 2004;80:1521–5. Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45:1105–15. Djuricic I, Calder PC. Beneficial outcomes of omega-6 and omega-3 polyunsaturated fatty acids on human health: an update for 2021. Nutrients. 2021;13:2421. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25:1528–35. Youseflu S, Sadatmahalleh S, Mottaghi A, Kazemnejad A. The association of food consumption and nutrient intake with endometriosis risk in Iranian women: a case-control study. International Journal of Reproductive Biomedicine. 2019;17:661. Trabert B, Peters U, Roos AJD, Scholes D, Holt VL. Diet and risk of endometriosis in a population-based case–control study. Br J Nutr. 2011;105:459. Heilier J-F, Donnez J, Nackers F, Rousseau R, Verougstraete V, Rosenkranz K, et al. Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: a matched case–control study. Environ Res. 2007;103:121–9. Savaris AL, do Amaral VF. Nutrient intake, anthropometric data and correlations with the systemic antioxidant capacity of women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol. 2011;158:314–8. Hopeman MM, Riley JK, Frolova AI, Jiang H, Jungheim ES. Serum polyunsaturated fatty acids and endometriosis. Reprod Sci. 2015;22:1083. Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19:1755–9. Yamamoto MA, Harris HR, Vitonis MAF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol. 2018;219:178.e1. Youseflu S, Sadatmahalleh SJ, Roshanzadeh G, Mottaghi A, Kazemnejad A, Moini A. Effects of endometriosis on sleep quality of women: does life style factor make a difference? BMC Women’s Health. 2020;20:168. Davoodi SH, Shahbazi R, Esmaeili S, Sohrabvandi S, Mortazavian A, Jazayeri S, et al. Health-related aspects of milk proteins. Iran J Pharm Res. 2016;15:573–91. Cichosz G, Czeczot H, Bielecka M. The anticarcinogenic potential of milk fat. Ann Agric Environ Med. 2020;27:512–8. Qi X, Zhang W, Ge M, Sun Q, Peng L, Cheng W, et al. Relationship between dairy products intake and risk of endometriosis: a systematic review and dose-response meta-analysis. Front Nutr. 2021;8: 701860. Almeida-de-Souza J, Santos R, Lopes L, Abreu S, Moreira C, Padrão P, et al. Associations between fruit and vegetable variety and low-grade inflammation in Portuguese adolescents from LabMed Physical Activity Study. Eur J Nutr. 2018;57:2055–68. Khayyatzadeh SS, Kazemi-Bajestani SMR, Bagherniya M, Mehramiz M, Tayefi M, Ebrahimi M, et al. Serum high C reactive protein concentrations are related to the intake of dietary macronutrients and fiber: findings from a large representative Persian population sample. Clin Biochem. 2017;50:750–5. Huang M, Liu J, Lin X, Goto A, Song Y, Tinker LF, et al. Relationship between dietary carbohydrates intake and circulating sex hormone-binding globulin levels in postmenopausal women. J Diabetes. 2018;10:467–77. Rose DP, Goldman M, Connolly JM, Strong LE. High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr. 1991;54:520–5. Friberg E, Wallin A, Wolk A. Sucrose, high-sugar foods, and risk of endometrial cancer–a population-based cohort study. Cancer Epidemiol Biomarkers Prev. 2011;20:1831–7. Harris HR, Eke AC, Chavarro JE, Missmer SA. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod. 2018;33:715–27. Ashrafi M, Jahangiri N, Sadatmahalleh SJ, Aliani F, Akhoond M. Diet and the risk of endometriosis in iranian women: a case-control study. Int J Fertil Steril. 2020;14:193–200. Halpern G, Schor E, Kopelman A. Nutritional aspects related to endometriosis. Rev Assoc Med Bras. 1992;2015(61):519–23. Garzia NA, Cushing-Haugen K, Chiu Y-H, Sandoval-Insausti H, Chavarro JE, Missmer SA, et al. Pesticide residue intake from fruit and vegetable consumption and risk of laparoscopically confirmed endometriosis. F S Sci. 2022;3:376–82. Schwartz NRM, Afeiche MC, Terry KL, Farland LV, Chavarro JE, Missmer SA, et al. Glycemic index, glycemic load, fiber, and gluten intake and risk of laparoscopically confirmed endometriosis in premenopausal women. J Nutr. 2022;152:2088–96. Juárez-Chairez MF, Meza-Márquez OG, Márquez-Flores YK, Jiménez-Martínez C. Potential anti-inflammatory effects of legumes: a review. Br J Nutr. 2022;128:2158–69. Saraf-Bank S, Esmaillzadeh A, Faghihimani E, Azadbakht L. Effect of non-soy legume consumption on inflammation and serum adiponectin levels among first-degree relatives of patients with diabetes: a randomized, crossover study. Nutrition. 2015;31:459–65. Youseflu S, Sadatmahalleh SJ, Mottaghi A, Kazemnejad A. Dietary phytoestrogen intake and the risk of endometriosis in Iranian women: a case-control study. Int J Fertil Steril. 2020;13:296–300. Arab A, Karimi E, Vingrys K, Kelishadi MR, Mehrabani S, Askari G. Food groups and nutrients consumption and risk of endometriosis: a systematic review and meta-analysis of observational studies. Nutr J. 2022;21:58. Tsuchiya M, Miura T, Hanaoka T, Iwasaki M, Sasaki H, Tanaka T, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology. 2007;18:402–8. Darling AM, Chavarro JE, Malspeis S, Harris HR, Missmer SA. A prospective cohort study of Vitamins B, C, E, and multivitamin intake and endometriosis. J Endometr. 2013;5:17–26. Mier-Cabrera J, Aburto-Soto T, Burrola-Méndez S, Jiménez-Zamudio L, Tolentino MC, Casanueva E, et al. Women with endometriosis improved their peripheral antioxidant markers after the application of a high antioxidant diet. Reprod Biol Endocrinol. 2009;7:54. Roshanzadeh G, Jahanian Sadatmahalleh S, Moini A, Mottaghi A, Rostami F. The relationship between dietary micronutrients and endometriosis: a case-control study. Int J Reprod Biomed. 2023;21:333–42. Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Hum Reprod Update. 2021;28:92–131. Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: from pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022;12:1069557. Hernandes C, Silveira P, Rodrigues Sereia AF, Christoff AP, Mendes H, Valter de Oliveira LF, et al. Microbiome profile of deep endometriosis patients: comparison of vaginal fluid, endometrium and lesion. Diagnostics (Basel). 2020;10:163. Ata B, Yildiz S, Turkgeldi E, Brocal VP, Dinleyici EC, Moya A, et al. The Endobiota Study: comparison of vaginal, cervical and gut microbiota between women with stage 3/4 endometriosis and healthy controls. Sci Rep. 2019;9:2204. Lee S-R, Lee J-C, Kim S-H, Oh Y-S, Chae H-D, Seo H, et al. Altered composition of microbiota in women with ovarian endometrioma: microbiome analyses of extracellular vesicles in the peritoneal fluid. Int J Mol Sci. 2021;22:4608. Svensson A, Brunkwall L, Roth B, Orho-Melander M, Ohlsson B. Associations between endometriosis and gut microbiota. Reprod Sci. 2021;28:2367–77. Uzuner C, Mak J, El-Assaad F, Condous G. The bidirectional relationship between endometriosis and microbiome. Front Endocrinol (Lausanne). 2023;14:1110824. Ser H-L, Au Yong S-J, Shafiee MN, Mokhtar NM, Ali RAR. Current updates on the role of microbiome in endometriosis: a narrative review. Microorganisms. 2023;11:360. Chiaffarino F, Bravi F, Cipriani S, Parazzini F, Ricci E, Viganò P, et al. Coffee and caffeine intake and risk of endometriosis: a meta-analysis. Eur J Nutr. 2014;53:1573–9. Kechagias KS, Katsikas Triantafyllidis K, Kyriakidou M, Giannos P, Kalliala I, Veroniki AA, et al. The relation between caffeine consumption and endometriosis: an updated systematic review and meta-analysis. Nutrients. 2021;13:3457. Laschke MW, Schwender C, Scheuer C, Vollmar B, Menger MD. Epigallocatechin-3-gallate inhibits estrogen-induced activation of endometrial cells in vitro and causes regression of endometriotic lesions in vivo. Hum Reprod. 2008;23:2308–18. Xu H, Lui WT, Chu CY, Ng PS, Wang CC, Rogers MS. Anti-angiogenic effects of green tea catechin on an experimental endometriosis mouse model. Hum Reprod. 2009;24:608–18. Ricci AG, Olivares CN, Bilotas MA, Bastón JI, Singla JJ, Meresman GF, et al. Natural therapies assessment for the treatment of endometriosis. Hum Reprod. 2013;28:178–88. Wang CC, Xu H, Man GCW, Zhang T, Chu KO, Chu CY, et al. Prodrug of green tea epigallocatechin-3-gallate (Pro-EGCG) as a potent anti-angiogenesis agent for endometriosis in mice. Angiogenesis. 2013;16:59–69. Matsuzaki S, Darcha C. Antifibrotic properties of epigallocatechin-3-gallate in endometriosis. Hum Reprod. 2014;29:1677–87. Xu H, Becker CM, Lui WT, Chu CY, Davis TN, Kung AL, et al. Green tea epigallocatechin-3-gallate inhibits angiogenesis and suppresses vascular endothelial growth factor C/vascular endothelial growth factor receptor 2 expression and signaling in experimental endometriosis in vivo. Fertil Steril. 2011;96:1021–8. Parazzini F, Cipriani S, Bravi F, Pelucchi C, Chiaffarino F, Ricci E, et al. A metaanalysis on alcohol consumption and risk of endometriosis. Am J Obstet Gynecol. 2013;209:106.e1-106.e10. Li Piani L, Chiaffarino F, Cipriani S, Viganò P, Somigliana E, Parazzini F. A systematic review and meta-analysis on alcohol consumption and risk of endometriosis: an update from 2012. Sci Rep. 2022;12:19122. Vennberg Karlsson J, Patel H, Premberg A. Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open. 2020;10: e032321. Nodler JL, DiVasta AD, Vitonis AF, Karevicius S, Malsch M, Sarda V, et al. 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. Am J Clin Nutr. 2020;112:229. Almassinokiani F, Khodaverdi S, Solaymani-dodaran M, Akbari P, Pazouki A. Effects of vitamin D on endometriosis-related pain: a double-blind clinical trial. Med Sci Monit. 2016;22:4960. Mehdizadehkashi A, Rokhgireh S, Tahermanesh K, Eslahi N, Minaeian S, Samimi M. The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis. Gynecol Endocrinol. 2021;37:640–5. Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013;161:189–95. Sukan B, Akdevelioğlu Y, Sukan VN. Effect of antioxidant supplementation on endometriosis-related pain: a systematic review. Curr Nutr Rep. 2022;11:753–64. Zheng S-H, Chen X-X, Chen Y, Wu Z-C, Chen X-Q, Li X-L. Antioxidant vitamins supplementation reduce endometriosis related pelvic pain in humans: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2023;21:79. Sesti F, Pietropolli A, Capozzolo T, Broccoli P, Pierangeli S, Bollea MR, et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial Fertil Steril. 2007;88:1541–7. Signorile PG, Viceconte R, Baldi A. Novel dietary supplement association reduces symptoms in endometriosis patients. J Cell Physiol. 2018;233:5920–5. De Leo V, Cagnacci A, Cappelli V, Biasioli A, Leonardi D, Seracchioli R. Role of a natural integrator based on lipoic acid, palmitoiletanolamide and myrrh in the treatment of chronic pelvic pain and endometriosis. Minerva Ginecol. 2019;71:191–5. Khodarahmian M, Amidi F, Moini A, Kashani L, Salahi E, Danaii-Mehrabad S, et al. A randomized exploratory trial to assess the effects of resveratrol on VEGF and TNF-α 2 expression in endometriosis women. J Reprod Immunol. 2021;143: 103248. Maia H, Haddad C, Pinheiro N, Casoy J. Advantages of the association of resveratrol with oral contraceptives for management of endometriosis-related pain. Int J Womens Health. 2012;4:543–9. Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi V. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012;67:499–504. Krabbenborg I, de Roos N, van der Grinten P, Nap A. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. Reprod Biomed Online. 2021;43:952–61. Aquino NB, Sevigny MB, Sabangan J, Louie MC. The role of cadmium and nickel in estrogen receptor signaling and breast cancer: metalloestrogens or not? J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2012;30:189–224. Silva N, Senanayake H, Waduge V. Elevated levels of whole blood nickel in a group of Sri Lankan women with endometriosis: a case control study. BMC Res Notes. 2013;6:13. Yuk J-S, Shin JS, Shin J-Y, Oh E, Kim H, Park WI. Nickel allergy is a risk factor for endometriosis: an 11-year population-based nested case-control study. PLoS ONE. 2015;10: e0139388. Borghini R, Porpora MG, Casale R, Marino M, Palmieri E, Greco N, et al. Irritable bowel syndrome-like disorders in endometriosis: prevalence of nickel sensitivity and effects of a low-nickel diet. An Open-Label Pilot Study Nutrients. 2020;12:341. Author information Authors and Affiliations Contributions Both authors were involved in conceptualization, literature search, data analysis, original draft preparation, review and editing of the paper and had final approval of the submitted review article. Corresponding author Ethics declarations Compliance with Ethical Standards The manuscript does not contain clinical studies or patient data. Conflict of Interest The authors declare that they have no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Oszajca, K., Adamus, A. Diet in Prevention and Treatment of Endometriosis: Current State of Knowledge. Curr Nutr Rep 13, 49–58 (2024). https://doi.org/10.1007/s13668-024-00518-y Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13668-024-00518-y