What’s causing your pelvic pain?
Endometriosis affects around one in ten women in the UK and can cause pain, infertility and misery. There's no guaranteed cure; while in some cases it settles on its own, it's usually treated with medication or surgery. However, some women claim eating or avoiding certain foods can help their symptoms. So what's the truth?
If you suffer from endometriosis, a condition that can cause agonisingly painful periods and difficulty getting pregnant, it's understandable to wonder if changing your lifestyle could help. Current treatments for the condition, which include surgery and hormonal medication, can be invasive and have unpleasant side effects. It's no wonder many women with endometriosis pin their hopes on alternative solutions, from acupuncture to avoiding certain foods.
Georgina, 27, from Surrey, was diagnosed with endometriosis six years ago and has had numerous surgeries to help control the condition. She says: "After my latest surgery, I was told that changing my diet - in particular, giving up dairy, gluten and alcohol - might help my symptoms. But I didn't necessarily want to give up the foods I love if there's no evidence that it would actually help."
There are countless blogs online by women who claim their endometriosis symptoms disappeared after changing their diets. Such information can undoubtedly offer hope to those facing devastating pain and infertility - but are these stories too good to be true?
Komal Kumar, senior dietitian at The Lister Fertility Clinic, part of HCA UK, cautions that so far the evidence for a link between certain foods and endometriosis is inconclusive. And even if there is a connection, it's likely diet is only one piece of the puzzle.
"It's only recently research has started to show a potential link between endometriosis and diet," she explains. "But it's important to note that such research refers to how diet can play a role in the management of endometriosis symptoms, rather than as a treatment for endometriosis altogether."
Women with endometriosis who are perhaps most likely to benefit from a dietary change, Kumar reveals, are those who also suffer from digestive conditions such as IBS - which can cause abdominal pain, bloating and constipation or diarrhoea.
"I believe this is a massive breakthrough for women who suffer with other conditions related to their endometriosis, as through dietary management women have the opportunity to greatly improve their quality of life and reduce the burden of their conditions."
The downsides of diet changes
Saying that, Kumar acknowledges that the low FODMAP diet is very restrictive. She certainly wouldn't advise every woman with endometriosis to start following it.
“It's vital that if someone with endometriosis is looking to make dietary changes, they seek the expert opinion of a qualified dietitian first, who can provide the latest credible evidence-based information. Without this, the patient could be at risk of nutritional deficiencies and other negative side effects such as rapid weight loss or gain."
This is particularly important for women who are trying to conceive, she explains. If you're planning a pregnancy, approach any dietary change cautiously and ensure you're getting the nutrients you need before and after conception.
Some women claim their symptoms improve on a gluten-free diet. But should Georgina follow suit? Kumar says not necessarily.
She confirms that some women have found their symptoms improve when they cut out certain foods, but what works for one woman, won't work for everyone.
There was a study conducted on patients with severe endometriosis in 2012, which found 75% of participants noticed an improvement on a year-long gluten-free diet. But the study itself only followed a small amount of women. More research is needed before we know if giving up wheat is truly beneficial in this scenario.
"There is no specific diet for endometriosis management, and it is impossible to say what women should restrict or should include with their diet as everyone is different," Kumar stresses. "It is so important not to restrict certain food groups or nutrients, such as gluten, unless you have been medically diagnosed as having an intolerance or condition such as coeliac disease, as this can deprive the body of vital nutrients."
How to eat well with endometriosis
For most women with endometriosis, Kumar says the best bet is simply to follow a healthy, balanced diet. She points to Public Health England's Eatwell Guide - a resource which shows how much of what we eat overall should come from each food group. You can find more tips on following this method in our healthy eating leaflet.
"This is based on consuming a balanced diet of carbohydrates, fats and proteins, with women aiming for 2,000 calories per day, unless they are specifically looking to gain or lose weight under the close guidance of a dietician."
And remember, while eating certain foods won't necessarily improve endometriosis, it never hurts to eat healthily. Plus, a nutritious diet is also important for preventing potential future health issues such as obesity, high blood pressure, type 2 diabetes and heart disease.
For women looking to conceive, it's advised to take 400 mg of folic acid per day, Kumar explains. And consuming foods rich in folate - such as spinach, kale and broccoli - is also a good idea.
"Following a good nutrition plan can help to regulate ovulation cycles affected by weight, improve the health of a woman's eggs, improve the success of assisted reproduction therapies such as IVF treatment, and improve chances of bringing a healthy baby to full term," she adds.