The Endometriosis & Nutrition Connection

Your Anti-Inflammatory Nutrition Guide for Endometriosis

Did you know that endometriosis affects approximately 1 in 10 women of reproductive age? It is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus, often leading to pain, bloating, fatigue, and fertility challenges. Over the past few months, I have seen a noticeable rise in clients struggling with endometriosis symptoms, and one thing is clear: the connection between nutrition and endometriosis is real. While the exact cause remains unknown, we do know that hormones, immune function, and genetics all play a role, and nutrition can be a powerful tool in managing symptoms. Keep reading for answers to common questions I hear in practice and practical strategies to help navigate this often overlooked area of women’s health.

Endometriosis in Canada: Fast Nutrition Facts 

• Family history of endometriosis can increase risk

• Vitamin D deficiency is common in women with endometriosis

• Omega-3 fatty acids may help reduce inflammation associated with endometriosis

• Vitamins C, E, and melatonin may ease discomfort

• An unbalanced gut microbiome imbalances can worsen symptoms

Know the Signs and Symptoms

Endometriosis is underdiagnosed, but early awareness is key. Symptoms to watch for:

• Painful periods, including back and abdominal pain

• Heaving bleeding during periods

• Digestive discomfort like bloating, diarrhea and constipation 

• Pain during and/or after sex

• Painful urination and/or bowel movements

• Infertility due to scarring and fallopian tube blockage

• Persistent pelvic pain

If these sound familiar, reach out to your healthcare provider for more support!

Endometriosis & Nutrition: A Dietitian’s Approach

1. Balance Your Plate: Canada's Food Guide 

Eating according to Canada’s Food Guide can reduce inflammation and support hormone and immune function. 

The balanced plate method is a great place to start:

• ¼ plate protein (lean meat, poultry, fish, eggs, tofu, legumes)

• ½ plate vegetables and fruit (aim for variety and colour)

• ¼ plate whole grains (buckwheat, oats, quinoa, whole grain pasta or sourdough bread)

Protein helps regulate hormones and supports tissue repair, while vegetables and fruits are rich in antioxidants. Whole grains (with >4g fibre per serving) contribute fibre to support gut health and estrogen elimination.

2. Vitamin D: The Sunshine Nutrient 

Low vitamin D levels have been linked with increased pain and inflammation in endometriosis.

• Target daily intake: 600 to 2,000 IU per day.

• Sun exposure: 10 minutes of direct sun exposure (without sunscreen) on face, arms, or legs can help your body produce vitamin D, but only during certain months and latitudes.

• Dietary sources: Fatty fish (salmon, sardines), egg yolks, and fortified cow or plant-based milks. However, food alone is not enough to meet needs.

• Supplementation is key; most Canadians require a daily supplement year-round.

3. Omega-3 Fatty Acids: Anti-Inflammatory Allies 

Omega-3s help reduce the production of inflammatory compounds and may lower the risk and severity of endometriosis-related pain.

• Aim for: 1,000 mg of EPA (eicosapentaenoic acid) per day through diet and/or supplements.

• From food:

  • 2-3 servings of fatty fish per week (e.g., salmon, sardines, mackerel, trout, herring)

  • Plant-based options: ground flaxseed, chia seeds, walnuts, hemp hearts, and algal oil

• Supplement guidance: Look for omega-3 supplements with at least 1,000 mg of EPA (and some DHA). Choose third-party tested brands for quality.

4. Antioxidant-Rich Foods: Defend Against Oxidative Stress 

Oxidative stress may worsen inflammation and tissue growth linked to endometriosis. A diet rich in antioxidants supports cellular repair and hormone detoxification.

• Goal: 5 servings of vegetables and 2-3 servings of fruit daily

• Serving size: 1 cup raw or ½ cup cooked

• Key antioxidants:

  • Vitamin C: Bell peppers, kiwi, strawberries, oranges

  • Vitamin E: Sunflower seeds, almonds, avocados

  • Vitamin A: Carrots, sweet potatoes, papaya, tangerines

  • Selenium: Brazil nuts, sunflower seeds, brown rice

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5. Probiotics & Gut Health: Hormone and Immune Balance 

A healthy gut microbiome supports estrogen metabolism and immune regulation, both of which are relevant in managing endometriosis symptoms.

• High probiotic foods (from highest to moderate):

  • Kefir

  • Yogurt with active cultures

  • Miso paste

  • Sauerkraut

  • Kimchi

  • Tempeh

• Supplement guidance: Choose a multi-strain probiotic with 5-10 billion CFUs daily. Look for strains like Lactobacillus rhamnosus, L. reuteri, and Bifidobacterium breve, which may help with inflammation and hormone regulation.

6. Anti-Inflammatory Compounds: Nature’s Pain Fighters 

Certain plant compounds have anti-inflammatory properties that can help reduce pelvic pain.

• Quercetin (onions, apples, capers, leafy greens, broccoli)

  • Supplement guidance: 500-1,000 mg/day; consult your healthcare provider

• Curcumin (active compound in turmeric)

  • Combine with black pepper for absorption

  • Supplement guidance: 500-1,000 mg/day standardized curcumin extract

• Melatonin has been shown to reduce endometriosis-related pain by up to 40% in some studies

  • Dose: 3 mg per night may help reduce pelvic pain and improve sleep

7. Minimize Processed Foods: Choose Ingredients that Heal 

Reducing ultra-processed foods can lower inflammation and support better hormone balance.

• Smart swaps:

  • Choose products with fewer than 5-10 ingredients (and that you recognize!) 

  • Look for foods with <5% Daily Value sodium and <8g of sugar per serving

  • Focus on whole or minimally processed ingredients (e.g., oats vs. instant oatmeal packets)

  • Limit red meat to 1x/week and minimize processed meats (e.g., deli meats, sausages)

8. Low FODMAP Diet (For Some)

Many people with endometriosis also experience IBS-like symptoms (bloating, pain, diarrhea, or constipation). The Low FODMAP diet reduces fermentable short-chain carbohydrates that can exacerbate these symptoms.

NOTE: It is a temporary elimination diet followed by a guided reintroduction phase, best done under dietitian supervision.

Examples of High FODMAP Foods to Limit:

• Fruits: Apples, pears, watermelon, mango, stone fruits

• Vegetables: Onion, garlic, asparagus, cauliflower, mushrooms

• Grains: Wheat, rye, barley (especially in large amounts)

• Legumes: Lentils, chickpeas, kidney beans (especially canned or dried)

• Dairy: Milk, yogurt, soft cheese (lactose-containing)

• Sweeteners: Honey, high-fructose corn syrup, sorbitol, mannitol

Examples of Low FODMAP Substitutes:

• Fruits: Bananas, blueberries, oranges, strawberries, kiwi

• Vegetables: Carrots, spinach, zucchini, bell peppers, cucumbers

• Grains: Gluten-free oats, rice, quinoa, corn tortillas

• Legumes: Firm tofu, canned lentils (in small amounts, rinsed)

• Dairy: Lactose-free milk/yogurt, hard cheeses, plant-based alternatives

9. Gluten-Free Trial

Some individuals with endometriosis report improvement in pelvic pain when removing gluten. 

A 2012 study found that 75% of women experienced symptom relief on a gluten-free diet after 12 months. It's worth trying a 6–8 week trial to assess changes.

Foods to Avoid (contain gluten):

• Wheat (bread, pasta, couscous, bulgur)

• Rye (crackers, bread)

• Barley (malt, beer)

• Baked goods, gravies, sauces unless labeled gluten-free

Safe Gluten-Free Foods:

• Quinoa, brown rice, millet, buckwheat, sweet potato

• Gluten-free oats

• Legumes, fruits, vegetables, nuts, seeds

10. Increase Fibre Intake

Fibre supports healthy estrogen metabolism, bowel regularity, and gut microbiome health—all helpful in managing endometriosis.

Recommended Intake: 25–35 grams per day; Fibre-Rich foods by category:

• Vegetables:

  • 1 cup Brussels sprouts, 7g

  • 1 cup cooked broccoli, 5g

  • 1 medium sweet potato with skin, 4g

• Fruits:

  • 1 cup raspberries, 8g

  • 1 medium pear, 6g

  • 1 medium apple with skin, 4g

• Legumes:

  • 1 cup cooked lentils, 15g

  • 1 cup black beans, 15g

  • 1 cup chickpeas, 12g

• Whole Grains (>4g fibre per serving):

  • 1/2 cup cooked quinoa, 5g

  • 1 slice 100% whole grain bread, 5g

  • 1/2 cup steel-cut oats, 5g

• Seeds:

  • 1 tbsp chia seeds, 5g

  • 1 tbsp ground flaxseed, 3g

11. Reduce Alcohol and Caffeine (If Symptomatic)

Alcohol and caffeine may worsen pain and inflammation in some individuals. Caffeine can also increase estrogen levels in high amounts.

Caffeine Guidelines:

• Aim for <200–300 mg caffeine/day

• 1 cup brewed coffee = ~95 mg

• 1 espresso shot = ~64 mg

• 1 cup black tea = ~50 mg

• 1 can cola = ~35 mg

Tips: Switch to herbal teas or decaf if sensitive. Hydrate with water, sparkling water, or infused herbal teas.

12. Magnesium-Rich Foods

Magnesium supports muscle relaxation, reduces menstrual cramps, and lowers inflammation.

Daily Requirement:

• Women: 310–320 mg/day

Food Sources (per serving):

• 1 oz pumpkin seeds: 150 mg

• 1/2 cup cooked spinach: 80 mg

• 1 oz almonds: 75 mg

• 1 cup black beans: 120 mg

• 1 square (30g) dark chocolate (70–85%): ~65 mg

  
  

Supplementation: Consider magnesium glycinate or citrate (200–400 mg/day) if dietary intake is low, consult a healthcare provider for more guidance.

13. Avoid Endocrine Disruptors in Food Packaging

BPA and phthalates found in plastics and linings of cans can mimic estrogen and potentially worsen endometriosis.

Tips to Reduce Exposure:

• Avoid microwaving food in plastic

• Use glass, stainless steel, or ceramic containers

• Choose BPA-free cans or boxed foods

• Reduce packaged and ultra-processed food intake

• Use silicone or beeswax wraps instead of plastic wrap

14. Safe Soy: Possibly Protective

Contrary to outdated myths, moderate soy intake is not harmful and may have estrogen-modulating effects.

Evidence: Isoflavones in soy may bind to estrogen receptors in a protective way. Population studies show no increase in endometriosis with soy intake.

Examples of Whole Soy Foods:

• 1/2 cup tofu: ~25 mg isoflavones

• 1/2 cup edamame: ~20 mg isoflavones

• 1 cup soy milk: ~20–30 mg isoflavones

• 1/2 cup tempeh: ~35 mg isoflavones

Tips: Focus on minimally processed soy sources. Limit soy protein isolate or ultra-processed soy-based snacks.

15. Iron Repletion

Heavy menstrual bleeding can increase the risk of iron deficiency, which can worsen fatigue, mood, and immune function.

Iron Requirements:

• Women aged 19–50: 18 mg/day (higher if menstruating heavily)

Heme Iron (better absorbed):

• 3 oz beef: 2.5 mg

• 3 oz chicken thigh: 1.3 mg

• 3 oz salmon: 0.7 mg

Non-Heme Iron:

• 1 cup cooked lentils: 6.6 mg

• 1 cup cooked spinach: 6 mg

• 1 tbsp pumpkin seeds: 2.5 mg

Boost Absorption:

• Pair with vitamin C-rich foods (e.g., citrus, strawberries, bell peppers)

• Avoid tea/coffee with meals (they reduce absorption)

Supplementation:

• Consider 18–27 mg elemental iron daily if deficient—consult a provider for dosing and form (ferrous gluconate, sulfate, or bisglycinate are common).

By building an anti-inflammatory eating pattern and focusing on nutrient-dense, gut-supportive foods, like fibre-rich plants, omega-3s, iron, magnesium, and probiotic sources, while reducing symptom-triggering ingredients such as processed meats, excess caffeine, alcohol, and endocrine disruptors, individuals with endometriosis can support hormone balance, digestive health, and overall well-being.

Endometriosis Menu Inspiration: 8 Anti-Inflammatory Recipes

These recipes are thoughtfully designed to support hormone balance, reduce inflammation, and nourish the gut. Following the Plate Method, they feature omega-3-rich proteins, antioxidant-packed vegetables, probiotic foods, and low glycemic index starches—along with key nutrients like iron for energy and magnesium for muscle relaxation and cramp support. Fibre-rich ingredients also help regulate estrogen and support digestive health.

BREAKFAST

1. Chia Flax Berry Parfait 

Benefits: Omega-3s, Probiotics, Antioxidants, Low GI, Fibre, Iron 

Ingredients:

• 3 tbsp chia seeds

• 1 tbsp ground flaxseed

• 1 cup unsweetened kefir

• 1/2 cup Greek yogurt (plain, 2% fat)

• 1/2 cup raspberries

• 1/2 cup blueberries

• 1 tbsp walnuts, chopped

• Dash cinnamon

Instructions:

1. In a jar, combine kefir, yogurt, chia seeds, and ground flaxseed. Mix well.

2. Let sit for 10 minutes (or overnight) until thickened.

3. Top with berries, chopped walnuts, and cinnamon.

2. Savoury Miso Oats with Greens & Egg 

Omega-3s, Probiotics, Antioxidants, High Veg Volume, Fibre, Iron 

Ingredients:

• 1/2 cup steel-cut oats

• 1 1/4 cups water

• 1 tsp miso paste

• 1/2 tsp turmeric + pinch black pepper

• 1 tsp olive oil

• 1/2 cup chopped spinach

• 1/2 cup sautéed mushrooms

• 1 egg (soft-boiled or poached)

• 1 tbsp hemp hearts

Instructions:

1. Cook oats in water until soft (about 15 min).

2. Stir in miso paste, turmeric, and pepper.

3. Add spinach and mushrooms. Cook until wilted.

4. Serve topped with egg and hemp hearts.

LUNCH

3. Wild Salmon Quinoa Bowl with Citrus Dressing 

Omega-3s, Antioxidants, Plate Method Friendly, Magnesium, Fibre, Iron 

Ingredients:

• 1/2 cup cooked quinoa

• 1/4 cup shredded carrots

• 1/4 cup chopped bell peppers

• 1/2 cup steamed broccoli

• 1/2 avocado, sliced

• 3 oz cooked wild salmon (baked or grilled)

• 1 tbsp sunflower and pumpkin seeds each

Citrus Dressing:

• 1 tbsp olive oil

• Juice of 1/2 orange

• 1 tsp Dijon mustard

• 1 tsp honey

• Pinch salt & pepper

Instructions:

1. Arrange quinoa, veggies, avocado, and salmon in a bowl.

2. Whisk together dressing ingredients and drizzle over bowl.

3. Top with sunflower seeds and serve.

4. Lentil & Roasted Veggie Power Bowl 

Plant-Based Protein, Antioxidants, Fibre-Rich, Iron

Ingredients:

• 1/2 cup cooked green lentils

• 1/2 cup roasted sweet potato cubes

• 1/2 cup roasted zucchini

• 1/2 cup roasted red onion

• 1/2 cup baby kale or arugula

• 2 tbsp hummus

• 1 tbsp pumpkin seeds

Instructions:

1. Roast veggies at 400°F for 25 minutes with olive oil.

2. Layer lentils and veggies in a bowl over greens.

3. Top with hummus and pumpkin seeds.

DINNER

5. Grilled Mackerel with Garlic Greens & Brown Rice 

High Omega-3, Balanced Plate, Selenium Source, Fibre

Ingredients:

• 1 mackerel fillet (about 4 oz)

• Juice of 1/2 lemon

• 1 garlic clove, minced

• 1 cup steamed kale or Swiss chard

• 1/2 cup cooked brown rice

• 1 tsp olive oil

• Salt and pepper to taste

Instructions:

1. Grill mackerel seasoned with lemon, salt, and pepper (4 min per side).

2. Sauté greens in olive oil with garlic until soft.

3. Serve fish with rice and greens on the side.

6. Tofu Stir Fry with Kimchi & Buckwheat Noodles 

Probiotic-Rich, Antioxidants, Hormone Friendly, Iron, Fibre

Ingredients:

• 3 oz extra firm tofu, cubed

• 1/2 cup sliced carrots

• 1/2 cup broccoli florets

• 1/4 cup red cabbage

• 1/2 cup cooked buckwheat noodles

• 1 tbsp tamari sauce

• 1 tsp sesame oil

• 2 tbsp kimchi

Instructions:

1. Stir-fry tofu until golden. Remove.

2. Add veggies to the pan and cook for 5–7 min.

3. Toss everything with tamari and sesame oil.

4. Serve with kimchi on the side.

DESSERT

7. Turmeric Spiced Chia Pudding 

Anti-inflammatory, Omega-3, Probiotic Base, Iron 

Ingredients:

• 3 tbsp chia seeds

• 3/4 cup unsweetened almond or oat milk

• 1/4 tsp turmeric

• Pinch black pepper

• 1/4 tsp cinnamon

• 1 tsp maple syrup

• 1/4 cup plain kefir (to top)

• Berries to garnish

Instructions:

1. Mix milk, chia, turmeric, pepper, cinnamon, and maple syrup.

2. Chill overnight.

3. Top with kefir and berries before serving.

8. Dark Chocolate Walnut Bites 

Rich in Antioxidants, Selenium, Omega-3, Magnesium

Ingredients:

• 1/2 cup dark chocolate chips (70%+ cocoa)

• 1/4 cup chopped walnuts

• 2 Brazil nuts, chopped (selenium source)

• 1 tbsp chia seeds

Instructions:

1. Melt chocolate in the microwave (30-sec intervals).

2. Stir in nuts and chia seeds.

3. Drop spoonfuls onto parchment paper. Chill until set.

Final Takeaway: Nourish With Knowledge

Managing endometriosis is not just about symptom control, it’s about empowering yourself with everyday tools that help you feel better from the inside out. Whether it’s building a plate with anti-inflammatory foods, exploring evidence-based supplements, or simply trusting your gut when something feels off, you have the power to take charge of your health.

Small steps, like prioritizing whole foods and creating a personalized plan with your healthcare provider, can make a big impact over time.

And remember:

• You’re not alone

• Food can be a powerful tool

• Your voice matters in your care journey

Fun Bonus! Try a “gut-friendly food challenge” this week: Add one anti-inflammatory and/or fermented food (like berries, leafy greens, salmon, kimchi, kefir, or yogurt) to your plate every day for 7 days, then notice how you feel!

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With you every step,

Alissa