Endometriosis is a chronic, systemic condition that affects millions of women worldwide. It is characterized by the growth of endometrial-like tissue outside the uterus, leading to pain, inflammation, fatigue, digestive symptoms, and sometimes infertility. While endometriosis often improves or resolves after menopause, women who use hormone therapy in menopause may experience a recurrence of symptoms due to the continued presence of circulating estrogen.
Because inflammation plays a key role in the progression and pain of endometriosis, diet can have a major influence on how the disease behaves. Recent studies published in the Journal of Aging Research in Clinical Practice and in Reproductive Sciences have demonstrated that dietary choices significantly affect the severity of pain, disease progression, recovery from surgery, and fertility outcomes in women with endometriosis.
Mediterranean Diet
There is no single diet that can cure endometriosis, but certain eating patterns can help reduce inflammation and balance estrogen metabolism, both of which can lessen symptoms and improve overall health. Among all dietary approaches, the Mediterranean diet remains the most consistently beneficial. This diet emphasizes fruits, vegetables, whole grains, legumes, olive oil, nuts, seeds, and omega-3-rich fish such as salmon and sardines. It is rich in antioxidants, polyphenols, anti-inflammatory compounds, and fiber—nutrients that support hormonal balance and reduce chronic inflammation.
If following a Mediterranean diet is difficult due to cost, time, or taste preferences, supplements can be used strategically. Vitamins D, A, C, E, and B3, as well as omega-3 fatty acids, have shown benefits in supporting immune and hormonal regulation. Turmeric and its active compounds (such as curcumin) may reduce inflammatory cytokines associated with endometriosis pain. The supplement DIM (diindolylmethane) can help the body metabolize estrogen into less active forms, potentially lowering hormonal stimulation of endometrial tissue. Essential minerals such as calcium, magnesium, selenium, zinc, and iron also support reproductive and immune function, while probiotic strains—particularly lactobacilli—may help maintain a healthy microbiome and reduce pelvic inflammation.
There is also growing evidence that adopting these dietary principles may lower the risk of developing endometriosis in the first place. For women seeking to optimize fertility, small studies suggest that eliminating gluten for several months can improve conception rates in those with endometriosis.
Gluten Free
This information is just being studied, but both gluten free and low-nickel diets demonstrated signifigant pain reduction in high qualities studies. This way of eating may also combat fatigue. We like to see the SHBG rise, and if not accomplished by using birth control pills, then we try diet and exercise.
Specific dietary recommendations include the following:
• Eat fiber-rich foods such as fruits, vegetables, legumes, whole grains, and flaxseed. Fiber promotes healthy digestion and helps eliminate excess estrogen, reducing hormonal stimulation of endometriotic tissue. Aim for about 30 to 35 grams of fiber daily.
• Include omega-3 fatty acids from sources like salmon, sardines, chia seeds, and walnuts. Omega-3s have natural anti-inflammatory effects that can reduce pelvic pain.
• Choose magnesium-rich foods such as pumpkin seeds, sunflower seeds, spinach, black beans, avocado, and almonds. Magnesium helps relax smooth muscle tissue and can decrease uterine cramping and pain.
• Use anti-inflammatory herbs and foods regularly, such as turmeric, ginger, garlic, and green tea, to modulate inflammatory pathways.
• Decrease butter and caffeine consumption.
Other solutions
Low-FODMAP diet does improve quality of life and GI symptoms for those with stomach issues around menses. Limit foods known to worsen inflammation, including red and processed meats, high-fat dairy, sugary drinks, alcohol, caffeine, and refined carbohydrates.
Some women benefit from more individualized or restrictive diets, such as gluten-free or low-FODMAP eating patterns, or by avoiding high-nickel foods. However, these should be supervised by a healthcare provider or nutritionist to prevent nutritional deficiencies, especially when eliminating entire food groups.
While diet alone may not cure endometriosis, it can significantly reduce pain and improve daily functioning. For many women, adopting an anti-inflammatory, nutrient-dense diet lessens symptoms enough to reduce reliance on medication or surgical management. During pregnancy, these same dietary principles remain safe and beneficial for both maternal and fetal health.
Most literature, and guidelines regarding menopausal client who have had endometriosis, or at risk for endometriosis with HRT have not looked at dietary guidelines.
At Women’s Health Practice, we encourage every patient with endometriosis to approach care holistically—addressing inflammation, nutrition, and hormone balance together. Small, consistent dietary changes can have a powerful impact on symptoms and long-term well-being.
