For Your Patients: Lessening the Risk and Severity of Endometriosis

The exact cause of endometriosis is still not known, so for now at least it cannot be prevented. But if you have risk factors such as a close relative with this inflammatory condition or early-onset menstruation with short intervals between your periods, some measures might lower your chance of developing endometriosis or at least lessening its severity.

Risk factors such as heredity, race/ethnicity, and early menarche or late menopause cannot be modified, but others can.

Get Checked Early

If you suspect you are at risk, do not accept the severe pain and frequent periods as part of normal womanhood. Take action. Early medical care can help ward off more severe disease.

Birth Control

Even if you are not sexually active and concerned about unwanted pregnancy, low-dose contraceptives can decrease your body's levels of estrogen, the reproductive hormone that fuels endometriosis. These agents can reduce the thickness of the lining of the uterus, lessening bleeding and lowering the chance of retrograde menstruation and the seeding of uterine tissue at other sites in the body.

Correcting Physical Obstacles

Anatomical problems that cause obstruction of the normal passage of menstrual blood and tissue can lead to a condition known as hematocolpos, which is when blood is trapped in the uterus. When menstrual blood is unable to flow out normally, there can be retrograde menstruation into the pelvic cavity which can lead to endometriosis. An imperforate or closed hymen in young girls can also be an obstacle. Fortunately, these abnormalities can usually be modified with surgery.

Maintaining a Normal Weight

A body mass index (BMI) that is too low is a risk factor for endometriosis, so it's important to keep your weight-to-height BMI in the normal range of about 20 to 25.

Pregnancy

While many life considerations go into deciding when to have a child, an earlier pregnancy, if feasible, may reduce your chance of severe disease and improve existing symptoms.

Diet

Endometriosis is driven by estrogen and inflammation. So taking charge of your diet and eating or avoiding certain foods may help reduce these two components, slow disease progression, and ease symptoms.

"Eat fresh, cook fresh" is the best rule. Experts recommend following a whole-food Mediterranean-type diet that is low in red meat and high in fresh fruits and vegetables, whole grains, legumes, fish, nuts, seeds, and high-quality fats such as avocado, olive, and canola oils.

The large Nurses' Health Study II, for example, found that women who consumed a lot of fruit, especially citrus fruit, had a lower risk of endometriosis.

Many grains and vegetables are also rich in iron, a mineral that may need replacing owing to heavy and frequent menstrual bleeding in those with endometriosis. In addition, the fiber-rich foods of the Mediterranean diet can lower circulating estrogen levels and slow the uptake of this hormone.

Those at risk for endometriosis would also be well advised to steer clear of inflammatory hydrogenated and trans fats and reduce intake of saturated fats. That means avoiding full-fat dairy products, processed and fatty red meats, and ultra-processed and convenience foods with a high chemical-additive content.

Eliminating inflammatory sugary foods and drinks and even artificially sweetened items may also help. Artificial sweeteners have been linked to harming the good bacteria of the intestines and promoting inflammatory bowel disease.

It is not clear how soy foods and soy supplements, which contain plant estrogens, impact endometriosis. Some experts believe estrogen-imitating compounds in soy may block the impact of potent ovarian estrogen and ease endometriosis. Others think these plant estrogens might raise estrogen levels overall and possibly increase risk or worsen the condition. A reasonable approach would be to step-up your intake of soy-based foods and beverages or try supplements to see if any of these can help.

To reduce pain, some women with endometriosis may find relief from a diet low in fermentable carbohydrates and sugary alcohols, the so-called low-FODMAP diet that eases cramps, diarrhea, and bloating in some patients with irritable bowel syndrome.

Supplements

There's a range of commercial supplements containing compounds that are thought to have anti-inflammatory properties. These include omega-3 fatty acids, fish oil, turmeric, and tart cherry. Some of these may be worth a try.

Caffeine and Alcohol

So far, there is no clear evidence of a connection between caffeine consumption and worsening endometriosis. Alcohol, however, can raise estrogen levels and should not be excessively consumed.

Exercise

Regular physical activity can work to lower circulating estrogen and may also improve the way the body breaks down estrogen into its byproducts in a way that may be favorable for endometriosis patients. Exercise can also elevate mood, reduce depression, and generally improve psychological health and pain tolerance for those with chronic conditions.

Complementary Therapies

Some women may find some relief from techniques such as behavioral therapy, meditation, biofeedback, acupuncture, and yoga.

Avoiding Pollutants

Modern life is awash in chemicals that can raise estrogen levels and promote inflammation in the body. These are found everywhere – in plastics and the linings of cans, shower curtains, fire retardants, pesticides, and cleaning and personal-care products. Be careful about the household containers and beauty products you use. Read labels and buy green products when possible. Always thoroughly wash fresh fruits and vegetables before handling and peeling, and wash your hands afterwards.

The Endocrine Society has a list of possibly harmful products and their common sources.

Read previous installments in this series:

For Your Patients: What Is Endometriosis?

For Your Patients: How Will Your Doctor Diagnose Endometriosis?

For Your Patients: What to Know About Endometriosis Treatment

For Your Patients: Fertility and Pregnancy in Endometriosis

For Your Patients: Managing Endometriomas: What to Know

For Your Patients: Tips for Talking to Your Doctor About Endometriosis

For Your Patients: 10 Key Q&As About the Burden of Endometriosis

For Your Patients: The Links Between Endometriosis and Other Diseases

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.