Caption: Agnus castus, a traditional herb, can support endometriosis by improving hormone balance.
Living with endometriosis can be extremely debilitating, impacting work life, relationships and mental health. The condition impacts about 10% of women in the UK, with many more undiagnosed or struggling to get a diagnosis. The main cause of endometriosis is still unknown, however it’s thought to have multiple factors and driven by inflammation. Nutritionist Eleanor Faulkner discusses the risk factors and ways to support the condition through diet and lifestyle changes.
What is endometriosis?
Endometriosis is an inflammatory condition which impacts an estimated 1 in 10 women who are of reproductive age in the UK (1). In those with endometriosis, endometrial tissue, which usually only lines the uterus, grows in other areas of the pelvic cavity, including the fallopian tubes and ovaries and in some severe cases, the outside of the bowel and bladder, causing the growth of endometrial lesions and adhesions. Over time it can also lead to the development of cysts.
What are the main symptoms?
Common symptoms include severe pain around the pelvic area, heavy periods, painful period cramps, pain going down the legs, irregular periods, painful sex, fertility problems and fatigue. Gastrointestinal symptoms include chronic constipation, bloating, nausea/vomiting, and diarrhea which are common before the period. Some women experience no pain at all, while others experience intense pain all throughout the cycle. The pain and disruption from endometriosis can often lead to lead to secondary mental health symptoms like depression and anxiety and massively impact day to day life.
What are the main causes and risk factors of endometriosis?
There is still no definite known cause of endometriosis and research into the condition is ongoing, however there are a few medical theories that are based on hormonal and immunological factors.
- One theory involves retrograde menstruation, where menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity rather than leaving the body during a period. The endometrial cells transplant and start to replicate in these areas (2). Lymphatic spread theory suggests that endometrial cells spread through the lymphatic system or blood vessels to different areas of the body. This theory explains how sometimes endometrial cells are found outside the pelvic region (3).
- Immune dysfunction is involved in the development of endometriosis. Normally, the immune system clears misplaced endometrial cells, but in endometriosis this process is impaired due to reduced natural killer cell activity, altered macrophage function, and increased production of certain inflammatory cytokines. This promotes a state of chronic inflammation that promotes lesion growth, pain, and scar tissue formation (4).
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Oestrogen dominance is another factor in the development of lesions. This is where oestrogen is higher than usual in relation to progesterone (5). Oestrogen fuels endometrial lesions by stimulating the growth and survival of endometrial-like cells outside the uterus. It also increases inflammation and encourages the formation of new blood vessels which supply the lesions. Existing lesions produce their own oestrogen and are less responsive to progesterone, creating a cycle that allows them to gradually worsen.
Risk factors
Key factors that can worsen existing symptoms of endometriosis:
- Stress is suggested to be involved in the further development of existing lesions through the action of the stress hormone cortisol. Long term stress can impair cortisol signalling and increase production of pro-inflammatory cytokines which support the growth of lesions (6). Chronic stress may also increase pain sensitivity, worsening endometriosis symptoms. Continued stress can also blunt the anti-inflammatory regulation controlled by the vagus nerve. The sympathetic nervous system (SNS) can be activated by depression, which increases production of inflammatory cytokines involved in the progression of endometriosis.
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Gut health and endometriosis are closely linked. A collection of gut bacteria involved in oestrogen metabolism called the estrobolome produces the enzyme β-glucuronidase which increases the reabsorption of oestrogen into the bloodstream, further increasing oestrogen dominance (7).
How can endometriosis be managed?
Standard medical management
Hormonal treatments are the most common medical management to reduce oestrogen production, including the contraceptive pill and the mirena progesterone coil. In some severe cases, people can go through surgery to remove adhesions, which is often used to create a window for women trying to conceive, however surgery can cause additional adhesion torsion scar fibrous tissue. Painkillers are often prescribed to help manage pain.
Managing endometriosis with diet, lifestyle and supplements
Help with reducing inflammation
An anti-inflammatory diet and lifestyle is beneficial for those with endometriosis, which includes a high intake of berries, fruits, vegetables, and other antioxidant-rich whole foods, and a reduced amount of ultra-processed foods. This may help regulate the inflammatory processes and reduce oxidative stress.
Certain supplements have also demonstrated potential benefits, including turmeric and its active compound curcumin, which may modulate inflammatory pathways involved in endometrial tissue by inhibiting NF-κB, COX-2, and TNF-α signalling. Grapeseed extract and pine bark may have similar anti-inflammatory effects (8). Ginger also has anti-inflammatory properties and may provide additional support.
Supporting gut health through friendly bacteria also known as probiotics, prebiotic, and fermented foods may help regulate immune function, inflammation, and endometriosis-related pain through modulation of the gut microbiome (9).
Supplementation with vitamins C and E together has been shown to reduce oxidative stress and may improve symptoms including dysmenorrhoea, dyspareunia, and pelvic pain (10).
Omega-3 fatty acids may further support inflammatory regulation by reducing inflammatory markers such as TNF-α, IL-6, and IL-1, with the EPA to arachidonic acid (AA) ratio potentially influencing disease severity (11). Omega 3’s have also been shown to reduce pain in women with painful periods (12).
Research has shown that consuming essential fatty acids and magnesium are also important considerations, as deficiencies have been associated with endometriosis. Additionally, vitamin D plays a role in regulating immune response, inflammation, and cellular processes involved in endometriosis (13).
Meanwhile N-acetylcysteine (NAC), is a strong antioxidant which has been shown to have promising benefits in those with endometriosis. NAC is a precursor to glutathione which has been reported in a study to reduce inflammation and cyst number and size (14).
Supporting hormone balance
The liver is responsible for metabolizing and clearing excess oestrogen and when it is congested it struggles to process hormones which can cause them to circulate and worsen endometriosis symptoms. Support the liver by avoiding alcohol, caffeine and processed sugars. Instead, include as many colourful fruits and vegetables as possible in the diet which provide essential antioxidants vitamin C and vitamin E. Adding herbs into the diet such as milk thistle and dandelion can help to further support the liver.
Dietary fibre can support a healthy gut microbiota to promote the production of anti-inflammatory short-chain fatty acids which may reduce oestrogen reabsorption by increasing its excretion out of the body. Increase your fibre intake gradually to reduce the chances of bloating and gas. Try and include a mix of soluble fibre like oats, beans, chia seeds, and insoluble fibre like leafy greens and root vegetables. Fibre helps to support the removal of hormones by binding to hormone metabolites in the digestive tract and excreting them.
Adaptogens such as ashwagandha can help lower stress hormones which interfere with female hormone balance, while phytoestrogen herbs like red clover help to ‘crowd out’ endogenous oestrogen to reduce the fuel of lesion growth. Agnus castus is used in clinical settings for endometriosis and has the ability to regulate menstrual cycles and relieve symptoms from the dysregulation of hormones. Fennel has been traditionally used to reduce uterine contractions and may help pain and cramping during painful menstrual periods.
Incorporate healthy habits to manage and reduce stress to support female hormone balance and maximise progesterone production to help avoid oestrogen dominance. Yoga and light exercise can be beneficial!
Other considerations
- In addition to diet and nutrition, research shows there’s a relationship between endometriosis and pelvic floor health, particularly pelvic floor dysfunction involving muscle tension. If you have endometriosis or concerned you might have it, this could be something worth looking at with your healthcare practitioner (15) (16).
- Hormone disruptors in the environment can disrupt hormones and increase inflammation. Switch to organic produce where possible and choose natural based personal care and feminine hygiene products.
- Support the lymphatic system with plenty of movement, deep diaphragm breathing and hydration. Herbs like cleavers and burdock can also assist smooth lymph flow.
Conclusion
Living with endometriosis and improving quality of life can be managed with lifestyle and diet changes. When looking at women’s health & hormone balance supplements containing a blend of the above nutrients, choose ones that are free from artificial additives and fillers and contain active ingredients. For more information about diet, lifestyle and advice on supplements, visit your local independent health food store. To find your nearest one, visit www.findahealthstore.com.
Author: Eleanor Faulkner, BSc, is a Nutrition Advisor at Viridian Nutrition. She holds a BSc honours degree in Food Technology with Nutrition.
References
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Office for National Statistics (2026) ONS data show the hidden costs of endometriosis. Office for National Statistics. Available at: https://www.ons.gov.uk/aboutus/usingpublicdatatoproducestatistics/examplesofhowdataandstatisticsbenefityou/onsdatashowthehiddencostsofendometriosis (Accessed: 31 July 2026).
2. Liu, D.T.Y. and Hitchcock, A., 1986. Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. BJOG: An International Journal of Obstetrics & Gynaecology, 93(8), pp.859-862.
3. Jerman, L.F. and Hey-Cunningham, A.J., 2015. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biology of reproduction, 92(3), pp.64-1.
4. Ahn, S.H., Monsanto, S.P., Miller, C., Singh, S.S., Thomas, R. and Tayade, C., 2015. Pathophysiology and immune dysfunction in endometriosis. BioMed research international, 2015(1), p.795976.
5. Marquardt, R.M., Kim, T.H., Shin, J.H. and Jeong, J.W., 2019. Progesterone and estrogen signaling in the endometrium: what goes wrong in endometriosis?. International journal of molecular sciences, 20(15), p.3822.
6. Lu, C., Xu, J., Li, K., Wang, J., Dai, Y., Chen, Y., Chai, R., Xu, C. and Kang, Y., 2023. Chronic stress blocks the endometriosis immune response by metabolic reprogramming. International Journal of Molecular Sciences, 25(1), p.29.
7. Nannini, G., Cei, F. and Amedei, A., 2025. Unraveling the contribution of estrobolome alterations to endometriosis pathogenesis. Current Issues in Molecular Biology, 47(7), p.502.
8. Trickey, R (2011) Women, Hormones & the Menstrual Cycle, Victoria, Trickey Enterprises Pty Ltd.
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10. Bayu P, & Wibisono JJ. Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomised controlled trials. PLoS One. 2024; 19 (5) e0301867
11. Miyashita, M., Koga, K., Izumi, G., Sue, F., Makabe, T., Taguchi, A., Nagai, M., Urata, Y., Takamura, M., Harada, M. and Hirata, T., 2016. Effects of 1, 25-dihydroxy vitamin D3 on endometriosis. The Journal of Clinical Endocrinology & Metabolism, 101(6), pp.2371-2379.
12. Snipe, R.M., Brelis, B., Kappas, C., Young, J.K., Eishold, L., Chui, J.M., Vatvani, M.D., Nigro, G.M., Hamilton, D.L., Convit, L. and Carr, A., 2024. Omega‐3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: Systematic literature review and meta‐analysis. Nutrition & Dietetics, 81(1), pp.94-106.
13. Ciebiera, M., Esfandyari, S., Siblini, H., Prince, L., Elkafas, H., Wojtyła, C., Al-Hendy, A. and Ali, M., 2021. Nutrition in gynecological diseases: current perspectives. Nutrients, 13(4), p.1178.
14. Porpora, M.G., Brunelli, R., Costa, G., Imperiale, L., Krasnowska, E.K., Lundeberg, T., Nofroni, I., Piccioni, M.G., Pittaluga, E. and Parasassi, T., 2013. Research Article A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine.
15. da Silva, J.P., de Almeida, B.M., Ferreira, R.S., de Paiva Oliveira Lima, C.R., Barbosa, L.M.Á. and Ferreira, C.W.S., 2023. Sensory and muscular functions of the pelvic floor in women with endometriosis–cross-sectional study. Archives of Gynecology and Obstetrics, 308(1), pp.163-170.
16. Fraga, M.V., Oliveira Brito, L.G., Yela, D.A., de Mira, T.A. and Benetti‐Pinto, C.L., 2021. Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: an underestimated association. International Journal of Clinical Practice, 75(8), p.e14350.
The information contained in this article is not intended to treat, diagnose or replace the advice of a health practitioner. Please consult a qualified health practitioner if you have a pre-existing health condition or are currently taking medication. Food supplements should not be used as a substitute for a varied and balanced diet.
