by P & C Barclay

Endometriosis affects an estimated 190 million women and girls globally, yet its diagnosis is often delayed, misunderstood, or mismanaged. Characterised by the growth of endometrial-like tissue outside the uterus, this chronic, oestrogen-dependent inflammatory condition can cause debilitating pelvic pain, heavy menstrual bleeding, infertility, and gastrointestinal distress.

While conventional treatments—ranging from hormonal therapy to surgery—offer temporary relief, many sufferers are turning to a more holistic and sustainable solution: a whole food plant-based (WFPB) diet.

Despite decades of research, the exact cause of endometriosis remains elusive. However, several theories have gained traction:

• Retrograde Menstruation: This occurs when menstrual blood flows backwards through the fallopian tubes into the pelvic cavity, carrying endometrial cells that implant and grow outside the uterus.
• Cellular Metaplasia: Cells outside the uterus may transform into endometrial-like cells under hormonal influence.
• Immune Dysfunction: A compromised immune system may fail to eliminate misplaced endometrial cells, leading to the formation of lesions and scar tissue.
• Genetic Predisposition: A family history of endometriosis significantly increases one’s risk, suggesting a hereditary component.

According to the Mayo Clinic, risk factors include early menarche, short menstrual cycles, high oestrogen levels, and structural abnormalities that hinder menstrual flow.

Inflammation and oestrogen

Endometriosis is fuelled by chronic inflammation and oestrogen dominance. The misplaced endometrial tissue responds to hormonal fluctuations, thickening and bleeding during each cycle. However, unlike uterine tissue, it has no exit route, leading to inflammation, scarring, and pain.

Dr. Hana Kahleova, Director of Clinical Research at the Physicians Committee for Responsible Medicine (PCRM), explains:

“Eating meat and fatty foods may lead to excess oestrogen in the body, which can cause endometriosis pain to flare, while fibre—found only in fruits, vegetables, grains, and beans—may help reduce pain by flushing excess oestrogen out of the body”.

Why WFPB works

The WFPB food regime emphasises unprocessed fruits, vegetables, whole grains, legumes, nuts, and seeds—foods naturally rich in fibre, antioxidants, and anti-inflammatory compounds.

Emerging research suggests this dietary pattern may offer significant relief for endometriosis sufferers for the following reasons:

1. Lower oestrogen levels
Oestrogen plays a central role in endometriosis progression. Diets high in animal fat and low in fibre are associated with elevated oestrogen levels. In contrast, plant-based diets help regulate oestrogen through:

• Increased fibre intake: Fibre binds to excess oestrogen in the gut and facilitates its excretion.
• Reduced dietary fat: Its lower fat intake reduces oestrogen production and circulation.

A review published in Frontiers in Nutrition found that reducing dietary fat and increasing fibre intake lowered oestrogen concentrations by 10–25%, potentially alleviating endometriosis symptoms.

2. Reducing inflammation
Endometriosis lesions are sites of chronic inflammation, marked by elevated levels of cytokines and prostaglandins. Plant-based diets are naturally anti-inflammatory due to their high content of:

• Antioxidants (e.g., vitamins C and E)
• Phytochemicals (e.g., flavonoids, carotenoids)
• Omega-3 fatty acids (from flaxseeds, walnuts, and leafy greens)

A 2025 review in Medicina concluded:

“Plant-based dietary patterns, which are rich in antioxidants, phytochemicals, dietary fibre, and essential micronutrients, have been shown to reduce systemic inflammation, modulate oestrogen activity, and alleviate pelvic pain”.

3. Gut Health and GI Symptom Reduction
Many women with endometriosis experience bloating, constipation, and diarrhoea. A WFPB diet supports gut health through:

• Prebiotic Fibre: Promotes beneficial gut bacteria.
• Reduced Intake of Irritants: Eliminates dairy and processed foods that may exacerbate symptoms.
• Personalised Nutrition: Identifying sensitivities to gluten, dairy, or FODMAPs can further reduce inflammation and GI distress.

The seaweed connection

Seaweed, particularly bladderwrack, has shown promise in modulating oestrogen levels. A study cited by PCRM found that seaweed consumption lowered oestrogen levels in postmenopausal women, and a case study of premenopausal women showed similar effects.

While more research is needed, seaweed’s potential as a natural oestrogen modulator adds another layer to the WFPB toolkit.

Clinical evidence

The Nurses’ Health Study II revealed that women consuming more than two servings of red meat per day had a 56% greater risk of developing endometriosis compared to those who ate less than one serving per week. Increased poultry intake was also associated with a higher risk.

In contrast, a clinical trial involving women with menstrual pain found that a low-fat vegan diet increased levels of sex-hormone binding globulin, which reduces estrogen activity.

Emotional & social relief

Endometriosis doesn’t just affect the body—it impacts mental health, relationships, and quality of life. A WFPB diet, by reducing pain and improving energy levels, can help restore a sense of control and well-being.

Dr Marijana Matek Sarić and colleagues note in their 2025 review:

“Future research should focus on high-quality clinical trials and integrative care models to evaluate the long-term efficacy, safety, and sustainability of these individualised nutritional interventions in the holistic management of endometriosis”.

Food as medicine

While endometriosis remains a complex and multifaceted condition, the evidence supporting dietary intervention—particularly a whole food plant-based approach—is compelling.

By addressing the root causes of inflammation and hormonal imbalance, a WFPB diet offers a non-invasive, empowering path to symptom relief and long-term wellness.

For women navigating the challenges of endometriosis, embracing the healing power of plants may be more than a dietary choice—it could be a lifeline.

Sources consulted

• Mayo Clinic: Endometriosis – Symptoms and Causes
• Cleveland Clinic: Endometriosis Overview
• MyEndometriosisTeam: Causes and Risk Factors
• Medicina Journal: Role of Plant-Based Diets in Endometriosis Management
• Physicians Committee for Responsible Medicine: Plant-Rich Diet and Endometriosis
• Frontiers in Nutrition: Nutrition in Endometriosis Review