Non-hormonal interventions for endometriosis: Diet & Exercise TipsMost people with endometriosis will be offered a hormonal treatment to soothe symptoms of severe period pains, pelvic pain and pain during sex. Hormonal birth control is the traditional option, but it has received some negative feedback in recent years due to the link between endometriosis and infertility. Endometriosis is found in around 33%of infertile women, making contraceptives that halt ovulation an unappealing option for many. It is also important to note that endo often requires lifelong treatment, even in some cases after surgery has been performed to remove the abnormal growths—also known as lesions—that cause pain, inflammation and in some cases, infertility. While hormonal treatments such as birth control or gonadotropin-releasing hormones (GnRH) can temper symptoms, there is often a high recurrence rate after stopping the treatment. Because of this, it’s a good idea to explore multiple options when looking to treat your endo—and it doesn’t have to be medical treatments. This article will explore how diet and exercise can help with endo management, and how to incorporate these changes in a way that prioritises your mental and emotional wellbeing.
But where are all the non-hormonal treatments?
There is a lot left to be explored in the field of non-hormonal medical treatments for endo. Recent studies have tested the efficiency of non-steroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen and naproxen—and tumor necrosis factor (TNF), as both tackle the factors that trigger the development of lesions. Despite the link between anti-inflammatory medication and hindering lesion development, the safety and efficacy of these drugs have not been studied in large clinical trials, leaving many clinicians hesitant to prescribe them as a long-term treatment option. This leaves a huge gap in the market and an urgent need for research into non-hormonal interventions for endometriosis. Some UK researchers have discovered a link between endo pain and macrophages, white blood cells that undergo changes due to the endo condition. By focussing on macrophages and their role in producing the pain associated in endometriosis, researchers have opened up a new area to explore in non-hormonal pain reducers.
The link between endo and diet
With the field of non-hormonal endo medication still in its infancy, many people turn to lifestyle changes to alleviate symptoms. Certain foods can speed up the progression of endometriosis, and even place you at a greater risk of developing it if you don’t have it. Research has found that things like inflammation, estrogen regulation and menstruation can all impact the severity of endometriosis—and they are all aspects that can be affected by the food we eat. There is no universal diet plan for endometriosis—but through trial and error, you can discover foods to avoid that trigger endo symptoms, and ones to add to your diet that soothe them. But remember: when trying out any new diet, it’s important to consult with a licensed clinician, nutritionist or dietician. This is especially true with a condition like endo, when what you eat can have a significant effect on hormone levels and other factors that can impact your body. If you’re looking for a good place to start on your dietary journey.
Anti-inflammatory foods
Endometriosis is a chronic inflammatory condition, which means that for many people, incorporating anti-inflammatory food into their diet can relieve symptoms. An anti-inflammatory diet includes high-fibre foods like fruits, veggies, legumes and whole grains. Fibrous foods have been proven to decrease estrogen levels, which can have a positive effect on endo symptoms caused by inflammation from high estrogen levels. It also includes iron-rich foods, like leafy greens, broccoli, nuts and seeds, as well as foods rich in fatty acids: fatty fish such as salmon and sardines, or walnuts, chia and flax seeds. Some studies have shown that consuming omega-3 fats can discourage endometrial cells from attaching to the endometrium, thus alleviating pain. Antioxidant-rich foods are another key part of an anti-inflammatory diet, as antioxidants such as vitamin C and E carry inflammation-reducing properties. These can be found in berries, spinach, dark chocolate and beets. On the flipside, certain foods contribute to greater inflammation, thus having the potential to trigger endo symptoms. One study found that people with endo experienced a significant decrease in pain after eliminating gluten from their diet. Gluten, red meat, trans fat (usually found in fried or processed foods), caffeine and alcohol have all been proven to increase inflammation, thus intensifying symptoms.
Understanding FODMAP
Another dietary plan that’s received attention from the endo community is alow FODMAP diet. FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols, scientific terms that refer to carbs that can trigger digestive issues such as bloating, gas and stomach pain. These foods can be broken down into four main types: oligosaccharides(wheat, rye, legumes, garlic, onions), disaccharides(foods with lactose as the main carb like milk or yoghurt), monosaccharides(foods with fructose as the main carb like figs or mangoes), and polyols(like blackberries and lychee). FODMAPs are fermented by gut bacteria, leading to uncomfortable or painful gas production. Low FODMAP foods to incorporate into your diet share certain qualities with an anti-inflammatory diet, but differ in some areas. They include whole grains, nuts and seeds, lactose free dairy products, lower fructose fruits like berries and bananas, and veggies such as courgette, aubergine, carrots and Brussel sprouts.Low FODMAP diets are typically recommended for those with irritable bowel syndrome (IBS), but this condition shares some symptoms with endometriosis. One study found that following a low FODMAP diet can improve Endo symptoms, mainly endo-bloat, constipation and diarrhoea.
What about soya?
Soybean, soya, soy: a seemingly innocent legume, but one that has caused great debate within the endo community. Soy contains phytoestrogen, which is a natural compound that imitates estrogen and when consumed, may affect your body in a similar way. One study found that long-term consumption of phytoestrogen through soy was linked to worsened endometriosis. This has been supported by other research, but focussing specifically on the intake of soy supplements. However, there has also been a wealth of research demonstrating no discernable link between soy and endo, as well as research showcasing its benefits. Some studies have shown that soy consumption can actually reduce the likelihood of developing endometriosis and exacerbating its symptoms, positing that phytoestrogens create an anti-estrogen effect on the body.So much conflicting research makes it difficult to either recommend or discourage soy and soy-based foods such as tofu for an endo-friendly diet. Some dieticians promote it, others don’t. The important thing if you do consume soy products is to monitor how it might be affecting your symptoms, and listen to your body.
Exercise for endo
You might have heard that exercising during your period can soothe cramps. Maybe you’ve even rolled your eyes at this statement, as you grab your hot water bottle and crawl into bed. But there may be some truth to it: the act of exercising helps regulate estrogen levels, thus targeting the very thing that is contributing to that pain, bloat and discomfort. Something as simple as walking for 15 minutes can reduce inflammation—leading to a reduction in pain—as well as release endorphins, which can lessen your body’s sensitivity to pain. Exercise is also proven to ease the mental health symptoms often associated with endometriosis due to the mood-boosting effects of endorphins. Sounds great, but what about when pain leaves you in bed struggling to even stand up? If moving seems impossible, you shouldn’t force yourself to exercise. But there are things you can do at times when your pain isn’t at its peak. The link between the musculoskeletal system and endometriosis pain is gaining more attention from medical communities. Your pelvic floor, abdominal wall and hip flexors all brace themselves for the pain from endo, and there are ways to work these muscles and strengthen them to better prepare them for pain. Pelvic muscle exercises, yoga and pilates can all target these muscle groups. Endometriosis UK has published a pelvic exercise programme that aims to rebalance the muscles that lose some of their function as a result of endo pain.
Rejecting the diet mentality
An endometriosis diagnosis is often accompanied by uncertainty, a feeling that can make you feel powerless, unable to claim control of your own body. For many of us, this need for power over our bodies manifests in a focus on the aspects of our lives we can control—diet and exercise being two of them. While it can absolutely be beneficial to experiment with dietary and exercise-related changes to manage your endometriosis, it’s important to recognise when a healthy intention becomes unhealthy. People with a chronic health condition that is related to nutritional recommendations—like endometriosis—may be at a higher risk of developing an eating disorder. Dietary tips are just that: tips, not rules. Diet and exercise cannot cure endometriosis. So if you find yourself sinking into a toxic diet mentality, know that you do not have to restrict yourself to feel better.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964939/Macrophages-stimulate-growth-of-nerve-cells
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.12594
https://pubmed.ncbi.nlm.nih.gov/15237003/endometriosis-diet-tips
https://pubmed.ncbi.nlm.nih.gov/17474167/exercise-and-endometriosisPelvic Exercise Programme
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