Endometriosis is a chronic condition in which endometrial cells grow outside the uterus and can sometimes affect the ovaries, fallopian tubes, and other tissues and organs in the pelvis. Endometriosis is often painful, and its symptoms usually worsen around the patient’s menstrual cycle. The most characteristic symptoms are: Pain in the pelvis and/or lower back; Increased pain during menstruation and intercourse; Pain during bowel movements and urination; Diarrhea or constipation; Abdominal swelling; Heavy menstruation or bleeding between periods; Fatigue. In addition to impairing quality of life, endometriosis can sometimes affect a woman’s reproductive abilities. Treatment of endometriosis sometimes requires surgery, medication to relieve symptoms, and a change in diet. There is still no unequivocal treatment that guarantees long-term success and complete elimination of the problem, but through proper therapy and the care of the woman, the symptoms can be alleviated and the risk of infertility can be limited. Current research suggests that diet and lifestyle can affect the body’s inflammatory processes, estrogen activity, menstrual cycle and prostaglandin metabolism. Therefore, they can affect the risk of developing endometriosis. Risks of developing and worsening endometriosis Certain lifestyle habits and intake of certain foods can affect the progression of endometriosis and increase the risk of its development. Although there is still not enough research to unequivocally link the consumption of a certain food to the development of endometriosis, there is some evidence that suggests the existence of a correlation between the dietary plan and the disease. An example of this is following a diet high in trans fats. Research has found that endometriosis is more common among women who consume more trans fats. They are mainly found in fried, processed and so-called fast food (quick foods)1. High estrogen levels are a risk factor for developing endometriosis. Research shows a link between diet and the incidence of estrogen-dependent diseases (eg, breast cancer and endometrial cancer). Therefore, we can hypothesize that dietary blood estrogen levels may also play a role in the etiology of endometriosis2. Other studies have shown an increased risk of developing endometriosis with a high intake of red meat2. One of the possible pathogenic factors affecting both endometriosis is prostaglandin levels. Dietary omega-6 fatty acids are precursors to the pro-inflammatory prostaglandins PGE2 and PGF2?, which likely increase uterine spasms and cause painful symptoms. However, dietary PGE3 and PGE3? in the form of Omega-3 fatty acids are associated with lower levels of inflammation and therefore less pain.The risk of endometriosis has been studied in relation to the weekly consumption of red meat products as the main sources of saturated fatty acids. Evidence suggests that consumption of ham, beef and other types of red meat is associated with a significantly higher risk of endometriosis. A study involving 207 women with endometriosis showed that 75% of them had a reduction in pain after eliminating gluten from their diet3. Pelvic pain affects up to 39% of women diagnosed with endometriosis. The etiology of painful endometriosis is not fully understood. No definitive data have been published regarding a gluten-free diet administered to achieve relief of painful symptoms associated with endometriosis. Because of the relationship between endometriosis and estrogen levels, it is possible that consumption of soy or phytoestrogens in general contained in food may be associated with a higher risk of developing endometriosis2. Soybean consumption is common in Japan and southwest Asia. Therefore, a case-control study evaluating this relationship was conducted in Japan in a population of 138 women, among whom 79 were diagnosed with endometriosis. A significant correlation between higher levels of isoflavones [genistein (p = 0.01) and daidzein (p = 0.007)] in urine and the occurrence of endometriosis was demonstrated in the group of women suffering from advanced endometriosis (stage III�IV), but not in the group of women with stage I�II endometriosis2. Food may contain chemical compounds from polluted environments, especially chlorinated hydrocarbons, including polychlorinated biphenyls (PCBs). Such compounds tend to bioaccumulate in the lipids contained especially in meat, liver and dairy products. Similarly, pesticides can be consumed along with contaminated fruits and vegetables. The above compounds can also be classified as risk factors for endometriosis2. Foods that can affect hormone regulation, especially estrogen balance, can negatively impact endometriosis. It is also recommended to limit foods that promote inflammation in the body and can increase pain. Such foods are alcohol, caffeine, gluten, red meat, saturated and trans fats. Foods That May Benefit Endometriosis As with many conditions that involve pain and inflammation, endometriosis recommends a varied and balanced diet rich in nutrients that help balance sex hormones to maintain good intestinal health and to reduce inflammation. Such foods are generally: Foods rich in fiber, such as fruits, vegetables, legumes and whole grains. They improve intestinal peristalsis, maintain the levels of beneficial bacteria in the gut and help relieve symptoms such as constipation and diarrhea; Iron-rich foods such as dark leafy greens, broccoli, beans, lentils, peas, whole grains, nuts and seeds.They help maintain hemoglobin levels and prevent the development of iron-deficiency anemia, which is common in women with endometriosis due to heavy bleeding; Foods rich in essential fatty acids such as salmon, sardines, herring, trout, walnuts, chia and flax seeds. They have an anti-inflammatory effect and help to regulate the hormonal balance; Antioxidant-rich foods found in colorful fruits and vegetables, such as oranges, berries, grapes, pomegranate, dark chocolate, spinach and beets. Since each body is unique and reacts to the condition in a different way, each lady should monitor her individual symptoms when consuming one or another food. Keeping a diary of the foods you eat and how the body reacts to them by making specific symptoms worse or worse is very helpful. In addition to eating a healthy diet, taking nutritional supplements can also help relieve symptoms. There is data showing reduced levels of pain in women taking vitamin E and C in dietary supplement form4. Women with endometriosis taking these supplements reported a reduction in peripheral oxidative stress markers and an improvement in antioxidant markers. Curcumin can also help treat endometriosis according to a study that found that curcumin inhibits endometrial cells by reducing the production of estradiol5. In addition to dietary supplements, curcumin can be taken directly through food by adding turmeric to meals or by consuming turmeric tea. Despite the fact that the etiology and effective treatment of the disease are still not fully understood, in practice and clinical research there is enough data on the positive impact of changes in lifestyle and nutrition, in the general healing of the body and the exclusion of pro-inflammatory substances from the menu and the woman’s lifestyle to relieve symptoms and prevent endometriosis. References: 1. Stacey A. Missmer, Jorge E. Chavarro, Susan Malspeis, Elizabeth R. Bertone-Johnson, Mark D. Hornstein, Donna Spiegelman, Robert L. Barbieri, Walter C. Willett, Susan E. Hankinson, A prospective study of dietary fat consumption and endometriosis risk, Human Reproduction, Volume 25, Issue 6, 1 June 2010, Pages 1528�1535, https://doi.org/10.1093/humrep/deq044 https://academic.oup.com/humrep /article/25/6/1528/2915756 2. Joanna Jurkiewicz-Przondziono1,2, Magdalena Lemm3, Anna Kwiatkowska-Pamu?a4, Ewa Zi??ko4, Mariusz K. W?jtowicz2, Influence of diet on the risk of developing endometriosis, Department of Obstetrics and Gynecology , Medical University of Silesia, Poland, Department and University Ward of Internal Medicine, School of Public Health in Bytom, Medical University of Silesia, Poland https://journals.viamedica.pl/ginekologia_polska/article/view/GP.a2017.0017 /42966 3. Marziali M, Venza M, Lazzaro S, et al. Gluten-free diet:a new strategy for management of painful endometriosis-related symptoms? Minerva Chirurgica. 2012 Dec;67(6):499-504. PMID: 23334113. http://europepmc.org/article/med/23334113 4. Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013 Mar;161(3):189-95. doi: 10.1016/j.trsl.2012.05.001. Epub 2012 May 31. PMID: 22728166; PMCID: PMC3484190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484190/ 5. Zhang Y, Cao H, Yu Z, Peng HY, Zhang CJ. Curcumin inhibits endometriosis endometrial cells by reducing estradiol production. Iran J Reprod Med. 2013 May;11(5):415-22. PMID: 24639774; PMCID: PMC3941414. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941414/