Nutrition and Endometriosis: Current Evidence on Dietary Risk Factors and Clinical Impact – A Narrative Review

Christine Dawczynski,1 Jule Raschke,1 Lea Klein,1 Isabelle Schmidt,1 Svea Eichler,1 Marie Förster,1 Renata Voltolini Velho,2 Barbora Knappe-Drzikova,2 Sylvia Mechsner,2 Deborah Maier,3 Sven-Bastiaan Haange,4 Ulrike E Rolle-Kampczyk,4– 6 Martin Von Bergen,4– 6 Madeleine Held,7,8 Suchithra Varadarajan,7 Melissa Hitzler,7,8 Iris Kolassa7– 91Institute of Nutritional Sciences, Junior Research Group Nutritional Concepts, Friedrich Schiller University Jena, Jena, Germany; 2Charité – Universitätsmedizin Berlin, Department of Gynecology Charité Center for Oncological Surgery, Endometriosis Research Centre Charité, Berlin, Germany; 3Immundiagnostik AG, Bensheim, Germany; 4Department of Molecular Toxicology, Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany; 5Institute of Biochemistry, Leipzig University, Leipzig, Germany; 6German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Leipzig, Germany; 7Clinical and Biological Psychology, Ulm University, Ulm, Germany; 8German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg – Ulm, Ulm, Germany; 9German Center for Child and Adolescent Health (DZKJ), Partner Site Ulm, Ulm, GermanyCorrespondence: Christine Dawczynski, Email [email protected]: Endometriosis (EM) is a severe chronic inflammatory disease characterized by the presence of endometrium-like tissue outside the uterine cavity, causing pain and significantly reducing quality of life. Worldwide, around 10% of women of reproductive age are affected and there is no cure as of now. The limited treatment options focus on hormone therapy, surgery and pain management–—without satisfactory long-term effects. Nutritional strategies might support the prevention and treatment of EM-associated pain as nutrients and phytochemicals exert anti-inflammatory and antioxidant effects, modulate the immune system and hormonal balance. In addition, diet is a key determinant of the composition, health, and function of the gut microbiome. To identify the multitude of potential nutrition-related factors that influence the clinical picture of EM, we conducted a targeted literature search in PubMed, Web of Science, and Google Scholar in 2025. This narrative review examines the association of thirteen areas—including macro- and micronutrients, dietary patterns, contaminants, allergens, and food intolerances—with the risk of EM and therapeutic options. At present, there is only limited scientific evidence regarding the therapeutic benefits of dietary strategies. There are promising indications for the supportive potential of an anti-inflammatory diet, based on elements of the MedD resulting in a regular intake of long-chain n-3 polyunsaturated fatty acids, secondary plant compounds, dietary fibers, vitamins, minerals and trace elements. Certain foods (or food groups) may contribute to a worsening of symptoms in individual patients with EM (eg, cruciferous vegetables, foods containing histamine, gluten, FODMAPs). Since these foods usually provide important nutrients, avoiding them as a preventive measure can lead to nutrient deficiencies. Therefore, individual assessment is required to determine the extent to which these foods are tolerated by women diagnosed with EM. To clarify the supportive role of personalized nutritional concepts to support therapy of EM, there is an urgent need for further high-quality studies.Keywords: endometriosis, dietary fat and fatty acids, dietary protein and essential amino acids, vitamins, minerals, trace elements, secondary plant compounds, probiotics, food additives, Mediterranean diet, elimination diets