Nutrition and Lifestyle Factors

  • Lauren Manaker
  • Ceana H. Nezhat


Although endometriosis is a disease that affects a large percentage of women, studies demonstrating the relationship between certain foods or lifestyle modifications are limited. Data from the Nurses’ Health Study II cohort allowed for retrospective observation of certain dietary measures and risk of developing endometriosis utilizing a large sample size over a span of 4 years. Analysis has found that increasing consumption of certain fruits, omega-3 fatty acids, and dairy foods may reduce the risk of developing endometriosis. Dietary and lifestyle modifications and how they relate to endometriosis risk and/or symptoms associated with endometriosis are discussed in this chapter.


Endometriosis Diet Lifestyle Risk reduction Nutrition 


  1. 1.
    Nezhat C, Nezhat F, Nezhat C. Endometriosis: ancient disease, ancient treatments. Fertil Steril. 2012;98(6s):S1–62.CrossRefGoogle Scholar
  2. 2.
    Scutiero G, Iannone P, Bernardi G, Bonaccorsi G, Spadaro S, et al. Oxidative stress and endometriosis: a systematic review of the literature. Oxid Med Cell Longev [Internet]. 2017 [cited 2018 Nov 12];2017:7265238. Available from:
  3. 3.
    Halpern G, Schor E, Kopelman A. Nutritional aspects related to endometriosis. Rev Assoc Med Bras (1992) [Internet]. 2015 Nov-Dec [cited 2018 Nov 12];61(6):519–23. Available from:
  4. 4.
    Locke A, Schneiderhan J, Zick SM. Diets for health: goals and guidelines. Am Fam Physician [Internet]. 2018 [cited 2018 Nov 12];97(11):721–8. Available from:
  5. 5.
    Abshirini M, Mahaki B, Bagheri F, Siassi F, Koohdani F, et al. Higher intake of phytochemical-rich foods is inversely related to prediabetes: a case-control study. Int J Prev Med [Internet]. 2018 [cited 2018 Nov 12];9:64. Available from:
  6. 6.
    Hosseini B, Berthon BS, Saedisomeolia A, Starkey MR, Collison A, et al. Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Am J Clin Nutr [Internet]. 2018 Jun 21 [cited 2018 Nov 12];108(1):136–55. Available from:
  7. 7.
    Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action. J Nutr [Internet]. 2004 [cited 2018 Nov 12];134:3479S–85S. Available from:
  8. 8.
    Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in state-specific adult fruit and vegetable consumption — United States, 2015. MMWR Morb Mortal Wkly Rep [Internet]. 2017 [cited 2018 Nov 12];66:1241–7. Available at:
  9. 9.
    United States Department of Agriculture [Internet]. What is MyPlate? 2018 Jul 9 [cited 2018 Nov 12];[about 1 screen]. Available from:
  10. 10.
    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 [Internet]. 2013 Jan 1[cited 2018 Nov 12];5(1):17–26. Available from:
  11. 11.
    Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, et al. Selected food intake and risk of endometriosis. Hum Reprod [Internet]. 2004 [cited 2018 Nov 12];19:1755–9. Available from:
  12. 12.
    Nurses’ Health Study [Internet]. History;2016 [cited 2018 Nov 12];[two screens]. Available from:
  13. 13.
    Harris HR, Eke AC, Chavarro JE, Missmer SA. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod [Internet]. 2018 Apr 1 [cited 2018 Nov 12];33(4):715–7. Available from:
  14. 14.
    Burri BJ, La Frano MR, Zhu C. Absorption, metabolism, and functions of β-cryptoxanthin. Nutr Rev [Internet]. 2016 Feb [cited 2018 Nov 12];74(2):69–82. Available from:
  15. 15.
    Jackson LW, Schisterman EF, Dey-Rao R, Browne R, Armstrong D. Oxidative stress and endometriosis. Hum Reprod [Internet]. 2005 Jul [cited 2018 Nov 12];20(7):201420. Available at:
  16. 16.
    Das UN. Nutrients, essential fatty acids and prostaglandins interact to augment immune responses and prevent genetic damage and cancer. Nutrition [Internet]. 1989 Mar-Apr [cited on 2018 Nov 12];5(2):106–10. Available from:
  17. 17.
    Trabert B, Peters U, De Roos AJ, Scholes D, Holt VL. Diet and risk of endometriosis in a population-based case-control study. Br J Nutr [Internet]. 2011 Feb [cited on 2018 Nov 12];105(3):45967. Available from:
  18. 18.
    Jurkiewicz-Przondziono J, Lemm M, Kwiatkowska-Pamuła A, Ziółko E, Wójtowicz MK. Influence of diet on the risk of developing endometriosis. Ginekol Pol [Internet]. 2017 [cited on 2018 Nov 12];88(2):96–102. Available from:
  19. 19.
    Yamagata Y, Takaki E, Shinagawa M, Okada M, Jozaki K, et al. Retinoic acid has the potential to suppress endometriosis development. J Ovarian Res [Internet]. 2015 Jul 31 [cited on 2018 Nov 12];8:49. Accessed from:
  20. 20.
    Jiang Y, Chen L, Taylor RN, Li C, Zhou X. Physiological and pathological implications of retinoid action in the endometrium. J Endocrinol [Internet]. 2018 Mar [cited 2018 Nov 12];236(3):R169–88. Available from:
  21. 21.
    Sokalska A, Anderson M, Villanueva J, Ortega I, Bruner-Tran KL, Osteen KG, et al. Effects of simvastatin on retinoic acid system in primary human endometrial stromal cells and in a chimeric model of human endometriosis. J Clin Endocrinol Metab [Internet]. 2013 [accessed on 2018 Nov 13];98:E463–71.Google Scholar
  22. 22.
    National Cancer Institute [Internet]. NCI dictionary of cancer terms: retinoic acid. [accessed 2018 Nov 13];[about one page].
  23. 23.
    Kolahdouz Mohammadi R, Arablou T. Resveratrol and endometriosis: in vitro and animal studies and underlying mechanisms (Review). Biomed Pharmacother [Internet]. 2017 Jul [cited on 2018 Nov 12];91:220–8. Available from:
  24. 24.
    Mendes da Silva D, Gross LA, Neto EPG, Lessey BA, Savaris RF. The use of resveratrol as an adjuvant treatment of pain in endometriosis: a randomized clinical trial. J Endocr Soc [Internet]. 2017 Mar 15 [cited on 2018 Nov 12];1(4):359–69. Available from:
  25. 25.
    Taguchi A, Koga K, Kawana K, Makabe T, Sue F, Miyashita M, et al. Resveratrol enhances apoptosis in endometriotic stromal cells. Am J Reprod Immunol [Internet]. 2016 Apr [cited on 2018 Nov 12];75(4):486–92. Available from:
  26. 26.
    Academy of Nutrition and Dietetics [Internet]. Antioxidants-protecting healthy cells; 2018 Feb [cited 2018 Nov 12]:[one screen]. Available from:
  27. 27.
    National Cancer Institute [Internet]. NCI dictionary of cancer terms: antioxidants. No date listed on website. [cited 2018 Nov 12]:[one screen]. Available from:
  28. 28.
    Alkadi H. A review on free radicals and antioxidants. Infect Disord Drug Targets [Internet]. 2018 Jun 28. [cited on 2018 Nov 12]. Accessed from:
  29. 29.
    Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res [Internet]. 2013 Mar [cited on 2018 Nov 12];161(3):189–95. Accessed from:
  30. 30.
    Lete I, Mendoza N, de la Viuda E, Carmona F. Effectiveness of an antioxidant preparation with N-acetyl cysteine, alpha lipoic acid and bromelain in the treatment of endometriosis-associated pelvic pain: LEAP study. Eur J Obstet Gynecol Reprod Biol [Internet] 2018 Sep [cited 2018 Nov 12];228:221–4. Accessed from:
  31. 31.
    Laschke MW, Menger MD. The gut microbiota: a puppet master in the pathogenesis of endometriosis? Am J Obstet Gynecol. 2016;215(1):68.e1–4.CrossRefGoogle Scholar
  32. 32.
    Itoh H, Sashilhara T, Hosono A, Kaminogawa S, Uchida M. Lactobacillus gasseri OLL2809 inhibits development of ectopic endometrial cell in peritoneal cavity via activation of NK cells in a murine endometriosis model. Cytotechnology. 2011;63(2):205–10.CrossRefGoogle Scholar
  33. 33.
    Arablou T, Kolahdouz-Mohammadi R. Curcumin and endometriosis: review on potential roles and molecular mechanisms. Biomed Pharmacother [Internet]. 2018 Jan [cited on 2018 Nov 12];97:91–7. Accessed from:
  34. 34.
    Signorile PG, Viceconte R, Baldi A. Novel dietary supplement association reduces symptoms in endometriosis patients. J Cell Physiol [Internet]. 2018 Aug [cited on 2018 Nov 12];233(8):5920–5. Accessed from:
  35. 35.
    Chowdhury I, Banerjee S, Driss A, Xu W, Mehrabi S, Nezhat C, et al. Curcumin attenuates proangiogenic and proinflammatory factors in human eutopic endometrial stromal cells through the NF-κB signaling pathway. J Cell Physiol [Internet]. 2018 Sep 27 [cited 2018 Nov 19]. Accessed from:
  36. 36.
    Academy of Nutrition and Dietetics. Position of the academy of nutrition and dietetics: dietary fatty acids for healthy adults. J Acad Nutr Diet [Internet]. 2014 [cited on 2018 Nov 12];114:136–53. Accessed from:
  37. 37.
    Abokhrais IM, Saunders PTK, Denison FC, Doust A, Williams L, Horne AW. A pilot randomised double blind controlled trial of the efficacy of purified fatty acids for the treatment of women with endometriosis-associated pain (PurFECT): study protocol. Pilot Feasibility Stud [Internet]. 2018 Apr 25 [cited on 2018 Nov 12];4:83. Accessed from:
  38. 38.
    Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod [Internet]. 2010 Jun [cited on 2018 Nov 12]25(6):1528–35. Accessed from:
  39. 39.
    Hopeman MM, Riley JK, Frolova AI, Jiang H, Jungheim ES. Serum polyunsaturated fatty acids and endometriosis. Reprod Sci [Internet]. 2015 Sep [cited on 2018 Nov 12];22(9):1083–7. Accessed from:
  40. 40.
    Alisson-Silva F, Kawanishi K, Varki A. Human risk of diseases associated with red meat intake: analysis of current theories and proposed role for metabolic incorporation of a non-human sialic acid. Mol Aspects Med [Internet]. 2016 Oct [cited 2018 Nov 19];51:16–30.Google Scholar
  41. 41.
    Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol [Internet]. 2018 Aug [cited on 2018 Nov 12];219(2):178.e1–178.e10. Accessed from:
  42. 42.
    Messina M. Soy and health update: evaluation of the clinical and epidemiologic literature. Nutrients [Internet]. 2016 Nov 24 [cited on 2018 Nov 12];8(12). Accessed from:
  43. 43.
    World Health Organization [Internet]. Healthy Diet. 2018 Aug 31 [cited 2018 Nov 12];[about 1 screen]. Available from
  44. 44.
    Basu P, Maier C. Phytoestrogens and breast cancer: in vitro anticancer activities of isoflavones, lignans, coumestans, stilbenes and their analogs and derivatives. Biomed Pharmacother [Internet]. 2018 [cited on 2018 Nov 12];107:1648–66. Accessed from:
  45. 45.
    Setchell KDR. The history and basic science development of soy isoflavones. Menopause [Internet]. 2017 [cited on 2018 Nov 13];24(12):1338–50. Accessed from:
  46. 46.
    Martín Salinas C, López-Sobaler AM. Benefits of soy in women’s health. Nutr Hosp [Internet]. 2017 [cited 2018 Nov 13];34(Suppl 4):36–40. Accessed from:
  47. 47.
    Dzuvor CKO, Taylor JT, Acquah C, Pan S, Agyei D. Bioprocessing of functional ingredients from flaxseed. Molecules [Internet]. 2018 [cited on 2018 Nov 13];23(10). Accessed from:
  48. 48.
    Linus Pauling Institute [Internet]. Lignans. [cited 2018 Nov 13];[about 5 screens]. Available from:
  49. 49.
    Tsuchiya M, Miura T, Hanaoka T, Iwasaki M, Sasaki H, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology [Internet]. 2007 May [cited on 2018 Nov 13];18(3):402–8. Accessed from:
  50. 50.
    Chen Y, Chen C, Shi S, Han J, Wang J, et al. Endometriotic implants regress in rat models treated with puerarin by decreasing estradiol level. Reprod Sci [Internet]. 2011 Sep [cited 2018 Nov 13];18(9):886–91. Accessed from:
  51. 51.
    Takaoka O, Mori T, Ito F, Okimura H, Kataoka H, et al. Daidzein-rich isoflavone aglycones inhibit cell growth and inflammation in endometriosis. J Steroid Biochem Mol Biol [Internet]. 2018 Jul [cited 2018 Nov 13];181:125–32. Accessed from:
  52. 52.
    Harris HR, Chavarro JE, Malspeis S, Willett WC, Missmer SA. Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. Am J Epidemiol [Internet]. 2013 Mar 1 [cited 2018 Nov 13];177(5):420–30. Accessed from:
  53. 53.
    Evans MB, Decherney AH. Fertility and endometriosis. Clin Obstet Gynecol [Internet]. 2017 Sep [cited on 2018 Nov 13];60(3):497–502. Accessed from:
  54. 54.
    Hemmert R, Schliep KC, Willis S, Peterson CM, Louis GB, et al. Modifiable life style factors and risk for incident endometriosis. Paediatr Perinat Epidemiol [Internet]. 2018 Oct 11. (ahead of print) [cited on 2018 Nov 13]. Accessed on:
  55. 55.
    Parazzini F, Cipriani S, Bravi F, Pelucchi C, Chiaffarino F, Ricci E, Viganò P. A metaanalysis on alcohol consumption and risk of endometriosis. Am J Obstet Gynecology [Internet]. 2013 Aug [cited 2018 Nov 19]. 209(2):106.e1–10. Accessed from:
  56. 56.
    Saha R, Kuja-Halkola R, Tornvall P, Marions L. Reproductive and lifestyle factors associated with endometriosis in a large cross-sectional population sample. J Women’s Health (Larchmt) [Internet]. 2017 Feb [cited 2018 Nov 13];26(2):152–8. Accessed from:
  57. 57.
    Holdsworth-Carson SJ, Dior UP, Colgrave EM, Healey M, Montgomery GW, Rogers PAW, Girling JE. The association of body mass index with endometriosis and disease severity in women with pain. J Endo and Pelvic Pain Disorders [Internet]. 2018 May 27 [cited 2019 Jan 7];10:79–87. Accessed from:
  58. 58.
    Bravi F, Parazzini F, Cipriani S, Chiaffarino F, Ricci E, et al. Tobacco smoking and risk of endometriosis: a systematic review and meta-analysis. BMJ Open [Internet]. 2014 Dec 22 [cited 2018 Nov 13];4(12):e006325. Accessed from:
  59. 59.
    Kvaskoff M, Biion A, Clavel-Chapelon F. Childhood and adolescent exposures and the risk of endometriosis. Epidemiology [Internet]. 2013 March [cited 2018 Nov 19];24(2):261–9. Accessed from:
  60. 60.
    Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9. PMID: 20855043.CrossRefGoogle Scholar
  61. 61.
    Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazari A. Patients’ and physicians’ descriptions of occurrence and diagnosis of endometriosis: a qualitative study from Iran. BMC Women’s Health. 2014;14:103.Google Scholar
  62. 62.
    Vitti A. Top 10 food strategies to reverse endometriosis. Flo Living [Internet]. 2015 Nov 28. [cited on 2019 Jan 7]. Accessed from

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Lauren Manaker
    • 1
  • Ceana H. Nezhat
    • 2
  1. 1.Nutrition Now, LLCCharlestonUSA
  2. 2.Nezhat Medical CenterAtlantaUSA

Personalised recommendations