Complementary therapies and changes to lifestyle
Many people have found that complementary therapies and changes to their lifestyle, such as healthy eating and movement can help with endometriosis symptoms.
It's important to remember that each person is different and experiences endometriosis differently - what works for one person may not work for another. It is worth trying complementary therapies, changes to your diet, and introducing healthy movement that works for you and your body.
Complementary therapies
Complementary therapies are provided by therapists from a wide variety of disciplines and are often used alongside usual treatments - such as Traditional Chinese Medicine, acupuncture, physiotherapy, osteopathy, and massage.
While there is little research and evidence about complementary therapies, many people have found them helpful, alongside surgical and hormonal treatment.
With endometriosis, therapies are often used to manage particular symptoms, such as period pain. Treatment may also focus on aspects of the condition, for example, inflammation.
If you are going to use complementary therapies talk to your GP first to check interactions with other medicines or treatments and any safety concerns.
Nutritional changes
The experience of endometriosis symptoms is different for each person, as well as each person being unique in their food preferences, lifestyle, medical history, and treatment, therefore, there is no universal 'endo diet'.
However, there are general principles such as reducing foods that either cause inflammation or raise oestrogen levels, both of which may contribute to endometriosis or its symptoms.
Eating the foods that are right for you can help:
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combat bloating
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relieve IBS symptoms
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reduce flares and pain
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regulate bowels
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fight fatigue
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support your gut health which can optimise immune function
Food, symptom, and pain diary
The best way to determine which dietary changes may help you is to keep a food and symptom diary, recording everything that you eat and drink each day.
A clear pattern may not emerge right away so it’s best to keep a food diary for 4-6 weeks.
You may find from a diary that some of your symptoms may be triggered by certain foods and eliminating these from your daily food intake may help to reduce symptoms.
After eliminating foods for 4-6 weeks it may be possible to slowly re-introduce specific foods to see how your body tolerates them but continue your food diary to monitor your symptoms to determine if your symptoms improve, stay the same, or worsen after reintroducing something.
To fight inflammation and pain caused by endometriosis, consume a nutrient-dense, well-balanced diet that’s primarily plant-based and full of vitamins and minerals.
Omega-3 fats can be beneficial because they are natural anti-inflammatories and high levels can be found in some fish - but if you don't eat fish it's possible to include these healthful fats and fatty acids in your diet through other foods and supplements.
Foods that may positively affect endometriosis
Fibrous foods
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Fruit
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Vegetables
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Legumes
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Whole grains
Iron-rich foods
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Dark leafy greens
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Broccoli
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Beans
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Fortified grains
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Nuts
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Seeds
Healthful fats
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Salmon
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Fatty fish
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Tree nuts
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Avocado
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Olive oil
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Olives
Foods rich in essential fatty acids
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Salmon
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Sardines
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Herring
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Trout
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Walnuts
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Chia seeds
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Flax seeds
Antioxidant-rich foods
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Colourful fruits
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Colourful vegetables
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Dark chocolate
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Spinach
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Beets
Foods that may negatively affect endometriosis
Foods that can influence hormone regulation, particularly oestrogen balance, can negatively affect those with endometriosis. Some foods may also cause inflammation leading to further pain.
Alcohol
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can contribute to bloating and diarrhoea
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excess alcohol may cause inflammation
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is processed by the liver so can reduce the effectiveness of oestrogen being removed
Saturated and trans fat
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can increase inflammation
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may have a negative impact on period pain
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is processed by the liver so can reduce the effectiveness of oestrogen being removed
Excess caffiene
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may cause diarrhoea
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can worsen symptoms of anxiety
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is processed by the liver so can reduce the effectiveness of oestrogen being removed
Processed foods
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may contain inflammatory omega-6
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can cause bloating
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are low in fibre, zinc, magnesium, and healthy fats
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is processed by the liver so can reduce the effectiveness of oestrogen being removed
Going gluten free
Many people have reported some type of non-coeliac gluten sensitivity and experience symptoms such as flatulence, bloating, and disturbed bowel function, similar to some of the endometriosis bowel symptoms.
A 2012 study suggested that 75% of people had improved pain perception in all areas and improved quality of life, with no worsening of pain in the remaining 25% after following a gluten-free diet for 12 months.
Gluten is a protein found in some grains (wheat, barley, rye, and oats), and is also found in beer, bottled condiments, some sausages and is present as a thickening in many shop-bought sauces.
Gluten is not an essential nutrient so if you remove gluten from your diet and you feel better for it and have reduced symptoms then this is a good outcome.
To be gluten-free planning out each meal, as well as shopping and preparing ahead of time, can make it much easier to stay on track.
Omega-3 and Omega-6 balance
Omega-3 and omega-6 are fatty acids that you can only get from what you eat.
These fatty acids are different from most other fats, they are biologically active and have important roles in processes like blood clotting and inflammation.
Omega-3 is anti-inflammatory and omega-6 is pro-inflammatory and research shows that the average 'Western' diet tends to be very high in omega-6 and low in omega-3
Given that endometriosis is often associated with pain caused by inflammation, balancing omega-3 and omega-6 intake is especially beneficial for those with endometriosis.
Find out how you can balance omega-3 and omega-6 in your diet here +
Low FODMAP-diet
Some people with endometriosis symptoms have found that a low FODMAP diet relieves some of their symptoms and allows the gastrointestinal system to heal, by eliminating certain carbohydrates that are potentially irritating. FODMAP stands for 'fermentable oligo-, di-, mono-saccharides and polyols'.
FODMAP is a short-term dietary modification rather than a long-term lifestyle change.
Many foods that contain FODMAPs are considered very healthy, and some FODMAPs function like healthy prebiotic fibres, supporting your friendly gut bacteria. If you can tolerate these types of carbs you should not avoid them.
However, for people with a FODMAP intolerance, foods high in these carbs may cause unpleasant digestive issues as your gut bacteria use these carbs for fuel, producing hydrogen gas which may lead to gas, bloating, stomach cramps, pain, and constipation. FODMAPs also draw liquid into your intestine, which may cause diarrhoea.
By eliminating all high-FODMAP foods for a few weeks to see if FODMAPs are the cause of gastrointestinal symptoms. You may experience relief in your symptoms in as little as a few days.
Find out what high FODMAP foods to avoid +
After a few weeks, you can reintroduce foods, one at a time, to help you determine which foods cause your symptoms. If you find that a certain type of food strongly upsets your digestion you may want to then permanently avoid it.
It can be difficult to get started and follow a low-FODMAP diet on your own, so seek the advice of a doctor, dietician, or nutritionist who is trained in this area. This may also help prevent unnecessary dietary restrictions. They can also help to track symptoms and identify potentially problematic foods. They can also make sure that it is appropriate for specific medical or health situations.
Preparation is crucial for success with FODMAP. Planning out each meal, as well as shopping and preparing it ahead of time, can make it much easier to stay on track.
Endo belly
A bloated abdomen is common for people with endometriosis and is often called an 'endo belly'. Bloating can be due to other underlying medical conditions alongside endometriosis such as coeliac disease, Small Intestine Bacterial Growth (SIBO), and Irritable Bowel Disease (IBD). It can also be a symptom of adenomyosis, fibroids, polyps, and ovarian cancer.
For those with endometriosis causes of endo belly include:
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inflammation from endometriotic lesions and changes within the immune system
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dietary triggers, food intolerances and altered gut microbiota
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poor dietary practices such as large portions, eating too quickly, and mindless eating
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constipation
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stress
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hormone fluctuations linked with your menstrual cycle
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some medications
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abnormal abdominal-diaphragmatic reflexes
Identifying foods that trigger your symptoms and endo belly is really important because it's easy to look back and blame your symptoms on the last thing you ate and this may lead you to a restrictive diet, eliminating things unnecessarily or making many changes all at once. Keep a food and symptom diary to figure out the triggers of your symptoms.
Healthy movement to help endometriosis symptoms
Healthy movement which is moderate intensity, low impact, and includes stretching is good for both endometriosis symptoms and overall physical and mental wellbeing.
It's important to find what works best for you and your endometriosis, particularly if you find some types of exercise cause painful flares of symptoms.
Even on bad days, small amounts of activity is better than no activity. Try ‘snacking' on exercise by breaking up the 30 minutes into three lots of 10 minutes or two lots of 15 minutes.
Find out what the benefits of exercise are +
Moderate-intensity exercises will moderate your hormones while building on fitness and strength, while low-impact exercises will help ensure you do not trigger pain due to adhesions and stretching can help increase your range of movement.
Suitable exercises include:
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walking
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cycling
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swimming
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water aerobics
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dancing
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cleaning the house
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gardening
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Pilates
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Yoga
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Tai Chi
Find out more about the benefits of yoga when you have endometriosis +
Finding the relaxation exercises and strength and core exercises that you enjoy and work best for your body may be a process of trial and error. Don’t give up on finding the best physical activity for you.
Exercises to avoid
There are no hard and fast rules when it comes to this because the severity of the condition and its symptoms vary widely from person to person.
But, in general, try to avoid or limit:
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High-intensity workouts which through an interplay with hormones may further aggravate pain symptoms.
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High-impact exercises may trigger pain through adhesions (scar tissue).
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Abdominal exercises, particularly when already experiencing pain. Working first on relaxing and gently stretching muscles first might be useful.
Overcoming barriers to exercise
Sometimes we put up barriers to exercise, here are some of the common ones and how to overcome them:
“I'm not well”
While endometriosis flare-ups can make it challenging to exercise, remember the benefits such as pain relief and improvements in mood. On bad days, yoga and a light walk (perhaps in nature) might be beneficial. Any physical activity can be useful on these days.
“I don’t have time”
It’s important to prioritise your health, so schedule activity into your daily routine – perhaps by getting up earlier or fitting a walk into your lunch break. Aim for ‘snacking' on exercise - if you can't find half an hour try for three 10 minute sessions, use the stairs instead of the lift, park your car 10 minutes' walk away from your destination. And remember all activities count - it doesn’t have to be a workout at a gym; gardening and other activities around the home are an important part of your activity routine too.
“I'm too tired”
Remember physical activity helps to improve your energy levels and sleep better. Start small and slowly build up as your energy levels increase.
“I can't afford it”
You don’t have to join a gym to exercise! There are lots of free and low-cost options, many of which can be built into daily life – walking, dancing, gardening, and community classes.
Join us in our mission to empower people with endometriosis and improve the lives of thousands in Aotearoa New Zealand
We rely on the support of our community to provide the resources and support that people with endometriosis need. There are many ways to get involved and make a difference, from making a donation to volunteering your time.
