Written by Taylor Woosley, Science Writer. This article explores lifestyle and dietary strategies that may help manage symptoms of endometriosis.

Endometriosis occurs when endometrial-like tissue grows on the ovaries, fallopian tubes, pelvic peritoneum, and occasionally beyond the pelvic area¹. These lesions respond to hormonal signals, particularly estrogen, and may undergo cyclical changes that contribute to inflammation, fibrosis, and pain. “Endometriosis” is derived from Greek: “endo” (within), “metra” (uterus), and “osis” (disease)². It’s estimated to affect roughly 1 in 10 women of reproductive age, though many go undiagnosed due to variable symptoms and delays in access to specialized care³.

Symptoms vary and can range from mild to severe. Common concerns include pelvic pain, painful periods (dysmenorrhea), pain during or after sex (dyspareunia), heavy menstrual bleeding, bloating, fatigue, bowel or urinary discomfort, and fertility challenges⁴. These symptoms can disrupt work, exercise, sleep, relationships, and mental health, often impacting quality of life.

The cause of endometriosis is not fully understood. Potential mechanisms include retrograde menstruation (menstrual blood flowing back through the fallopian tubes into the pelvis), immune dysregulation, hormonal influences (particularly estrogen dominance), genetic predisposition, and environmental factors⁵. Risk may be increased by a family history of endometriosis, early onset of menstruation, short cycles, heavy bleeding, and certain autoimmune tendencies. While endometriosis cannot be prevented outright, lifestyle and dietary strategies may help manage symptoms alongside medical care. It’s important to recognize that supplements are complementary to, not a replacement for, professional treatment.

The Role of Nutrition in Managing Endometriosis

Diet can influence inflammation, hormone metabolism, gut health, and immune function—all relevant to endometriosis. An anti-inflammatory eating pattern that emphasizes colorful produce, fiber-rich foods, lean proteins, and healthy fats may help reduce prostaglandin-driven pain and systemic inflammation. Supporting liver detoxification pathways and a healthy gut microbiome can also aid estrogen balance, as estrogen is processed and eliminated via the liver and bowel.

Build meals around whole, nutrient-dense foods: plenty of vegetables and fruits, high-fiber legumes and whole grains, omega-3-rich fish, nuts and seeds, and high-quality proteins such as poultry, eggs, and tofu. Cooking at home more often helps reduce exposure to additives and gives better control over ingredients.

Some foods may exacerbate symptoms, including highly processed snacks, refined sugars, trans fats, and excessive alcohol, which can drive inflammation and disrupt hormone balance. Certain individuals notice flares with red meat, caffeine, or dairy; tolerance varies, so consider a structured elimination and reintroduction approach under guidance. If bowel symptoms are prominent, evaluating FODMAPs or potential gluten sensitivity with a healthcare provider or dietitian may be useful.

Key Supplements for Endometriosis Relief

Supplements are not a cure for endometriosis, but they can complement medical care and nutrition. Targeted vitamins, minerals, and botanicals may help modulate inflammation, support hormone metabolism, ease pain, and improve energy. Always consult your healthcare provider before starting new supplements, especially if you use hormonal therapies, pain medications, or have a bleeding disorder.

Foundational Nutrients:

• Vitamin D: Helps regulate immune function and inflammation; consider testing and supplementing if levels are low. Numerous studies have observed that higher 25(OH)D levels are associated with a decreased risk of endometriosis. One study noted that women in the highest quintile of vitamin D levels had a 24% lower risk of endometriosis compared to women in the lowest quintile⁶. These findings are based on observational data and do not establish a causal relationship.
• B-Complex Vitamins: Support energy and methylation. Folate and vitamin B6 support antioxidant defense and estrogen metabolism pathways that may be relevant to endometriosis-related mechanisms⁷.
• Zinc: This essential trace element supports immune function and antioxidant defenses. Zinc modulates immune responses and reduces oxidative stress, both relevant to inflammatory and oxidative stress pathways implicated in endometriosis. While also regulating matrix metalloproteinases (MMPs), enzymes involved in tissue remodeling, which may influence tissue-remodeling processes (e.g., MMP activity) that have been studied in endometriosis⁸.
• Selenium: Supports thyroid function and antioxidant activity through the glutathione peroxidase (GPX) system. Research shows that GPX, as a selenium-containing enzyme, is widely distributed in human epithelial cells and supports antioxidant defenses through selenium⁹.

Targeted Botanicals and Compounds:

• N-Acetylcysteine (NAC): Supports glutathione production, detoxification, oxidative balance, and liver function. NAC has demonstrated efficacy in preclinical studies through oxidative stress reduction, cytokine production modulation, and angiogenesis impairment, all of which are key mechanisms in endometriosis occurrence¹⁰.
• Resveratrol: Acts as a phytoestrogen and provides polyphenols that may help regulate inflammation and has been studied for its antioxidant and anti-inflammatory properties in the context of endometriosis. Animal model findings report reduced levels of vascular endothelial growth factor (VEGF) in endometrial tissue¹¹; the clinical relevance of these findings in humans remains under investigation.
• Quercetin: Data on this naturally occurring flavonol showcases that quercetin supplementation has been reported to decrease serum prostaglandin E2 (PGE₂) levels and reduce serum CA-125 concentration¹². These biomarkers are commonly evaluated in endometriosis research; however, direct effects of quercetin supplementation on endometriosis lesion size have not been conclusively established in human studies.
• Melatonin: Acting as a neurohormone and a potent antioxidant, emerging evidence suggests melatonin may benefit pain modulation and sleep support. Furthermore, data supports its ability in neuroendocrine signaling and circadian regulation, which may influence hormonal pathways relevant to endometriosis¹³. While effects on ectopic endometriotic lesions have been explored primarily in experimental models, human evidence remains limited and mainly related to symptom-based outcomes.
• Probiotics: Short-chain fatty acids, beneficial metabolites produced in the gut such as butyrate and propionate, have been studied for their role in gut-immune communication, host-microbiome communication, and host-microbiome interactions These pathways are considered relevant to endometriosis, and emerging research suggests that microbiome-derived metabolites may influence mechanisms associated with endometriotic lesion development¹⁴. However, most of the current evidence comes from experimental models, and clinical data in humans remains limited.
• Alpha lipoic acid (ALA): ALA is a bioactive molecule with potent antioxidant capabilities. It may inhibit endometriosis progression through reducing ER-β protein levels and NALP-3 expression and activity¹⁵.

To incorporate supplements effectively: start low and go slow, introduce one product at a time, and monitor changes in energy, pain, bowel habits, and cycle patterns. Take fat-soluble nutrients like vitamin D with meals that include healthy fats. Choose reputable brands tested for purity and potency. Reassess every 8–12 weeks and discontinue anything that causes adverse effects.

Essential Fatty Acids and Their Benefits

Omega-3 fatty acids may aid in reducing the progression of endometriosis through their role in decreasing growth factors and limiting cell survival¹⁶. Furthermore, EPA and DHA, the primary marine omega-3s, have been shown to reduce pro-inflammatory cytokines such as TNF-α, IL-6, and IL-1¹⁷. Regular intake may help support a more balanced inflammatory response.

Dietary sources include fatty fish such as salmon, sardines, mackerel, trout, and anchovies. Supplemental fish oil or algal oil may be considered when dietary intake is insufficient.

Other helpful fats include extra-virgin olive oil (rich in polyphenols), avocado, and nuts like almonds and pistachios. Limiting trans fats and balancing omega-6 intake from processed seed oils with omega-3s can help shift the body toward a less inflammatory state.

Herbs That May Support Endometriosis Symptoms

Herbal remedies are traditionally used to ease menstrual pain, support hormone balance, and calm inflammation. Evidence varies, but several herbs have supportive data and long histories of use. Work with a knowledgeable practitioner to ensure safety, proper dosing, and to avoid interactions.

• Curcumin: Supports inflammatory modulation and antioxidant activity. Curcumin plays a potential role in endometriosis management through its effects on apoptosis-related pathways, primarily demonstrated in experimental models¹⁸.
• Ginger: Offers robust anti-inflammatory and anti-proliferative properties in the context of endometriosis. Research suggests ginger may influence molecular pathways involved in cell proliferation and prostaglandin signaling; reduce areas of pathological endometrial tissue and demonstrates the capacity to stimulate and support fertility in women with endometriosis¹⁹. However, current evidence is primarily derived from preclinical models, and clinical data in women with endometriosis remains limited.
• Garlic: Garlic has been studied for its antioxidant properties and potential effects on pathways related to oxidative balance. Human evidence from systematic reviews indicates that antioxidant vitamin supplementation may help reduce endometriosis-related pelvic pain and dysmenorrhea²⁰. However, these findings cannot be attributed specifically to garlic, as garlic-specific clinical data in women with endometriosis remains limited.
• Silymarin: Supports liver function and estrogen metabolism. Findings from a 12-week randomized controlled trial demonstrated a notable decrease in IL-6 levels, endometrioma size, and pain symptoms¹⁹.

Developing a Personalized Supplement Plan

Endometriosis presents differently for each person, making a personalized plan important. Consulting a healthcare provider helps align supplements and diet with your medical treatment, symptom profile, and lab results.

Assess your needs by tracking pain patterns, cycle length, bleeding volume, digestive symptoms, energy levels, sleep quality, and stress. Request labs when appropriate, particularly vitamin D, ferritin, thyroid function, inflammatory markers, and potentially sex hormones or methylation-related nutrients.

Because responses vary, consider a time-limited trial of one or two new supplements at a time, track changes, and reassess with your provider. This approach improves safety, reduces guesswork, and helps you identify what lifestyle and supplement routine may best support individual needs.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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