Endometriosis: 5 Ways Dietitians Help Reduce Pain and Support Hormones

June 19, 2025Wellness Insights

Did you know that 10% of women and girls of reproductive age live with endometriosis?  According to the World Health Organization, approximately 190 million people worldwide are affected by this often painful and underdiagnosed condition. (WHO, 2023). While there is currently no cure, treatment to manage inflammation can help minimize pain and support hormone balance.  If you or someone you love is living with endometriosis, a registered dietitian can provide guidance on the role of nutrition as a powerful piece of your care plan.

What is Endometriosis?

Endometriosis was first discovered about 300 years ago, when a doctor found tissue resembling the lining of the uterus (endometrium) growing outside of the uterus.  It is a complex chronic condition with many different factors thought to contribute to its development.  The misplaced endometrial tissue is associated with inflammation and scarring.  While some individuals don’t have symptoms, for many, endometriosis is characterized by pain, fatigue, heavy periods, mood changes, and infertility.  Pain can also happen during sex, while using the bathroom, or during certain times of a female’s menstrual cycle.

How is it diagnosed?

Unfortunately, diagnosing endometriosis can be a lengthy process. The gold standard for diagnosis is a laparoscopy, a small surgical procedure where a doctor can view abnormal tissue growth outside the uterus.  However, many individuals are living with endometriosis-like symptoms without an official diagnosis because the process of diagnosis can be burdensome to some.  Often, other tests like pelvic exams or ultrasounds can be used to predict if someone may have endometriosis and get them started on some treatment options (even without an official diagnosis).

Why is Endometriosis often Underdiagnosed?

Symptoms of endometriosis often overlap with other conditions, like irritable bowel syndrome (IBS) or premenstrual syndrome (PMS), and are sometimes normalized or dismissed. The variability in symptoms can also make it difficult to diagnose, since one person may have different endometriosis-like symptoms than another.  As a result, many individuals struggling may feel isolated due to the lack of awareness of endometriosis.

Treatment Options

Treatment depends on the severity of symptoms and individual goals (like fertility or pain management). Options include:

• Pain relief medications, such as NSAIDs
• Hormonal therapies (e.g., birth control pills, progestins, GnRH agonists {a medication that mimics the action of gonadotropin-releasing hormone, a natural hormone that regulates the reproductive system})
• Surgical options like laparoscopy or hysterectomy (for more severe cases)
• Removal of ovarian cysts or scar tissue, if necessary
• Alternative treatments, such as pelvic floor physical therapy, acupuncture, or massage therapy

Alongside these treatments, nutrition and lifestyle changes can play a role in managing symptoms.

5 Dietitian-Backed Nutrition Strategies to Manage Symptoms:

1. Adequate nutrition

Food is one of the main ways to signal safety to the body on a biological level, helping people to escape “fight or flight” mode and reduce stress hormones.  Unfortunately, many people with endometriosis experience pain that disrupts their ability to eat regularly. Flare-ups can disrupt hunger cues, leading to under-eating and inadequate nutrient intake, which puts stress on the body and hormones.

Dietitians help clients recognize hunger and fullness cues and navigate low appetite to ensure the body feels safe and nourished. Eating consistently can be a great place to start regulating hormones since it can decrease cortisol.  Aim to eat at least every 4 hours when possible and focus on snacks or smaller meals if eating full meals becomes difficult.  When it feels hard to get nourishment through food, balanced smoothies with fruit, avocado, yogurt, or nuts/seeds can also be a great way to make nourishing yourself easier.

2. Reduce inflammation through food

Inflammation is a major driver of pain in endometriosis. Certain foods can help reduce inflammation, while others may trigger flare-ups.

Anti-inflammatory foods to prioritize:

• A variety of colorful produce and whole fresh foods, especially leafy greens, berries, turmeric, ginger, olive oil, fatty fish (salmon, sardines), walnuts, and chia seeds

Pro-inflammatory foods to reduce:

• Ultra-processed foods, alcohol, caffeine, gluten, and dairy

Some individuals with endometriosis find relief by shifting toward a mostly plant-based diet that emphasizes legumes, seeds, and vegetables over red meats (like beef or pork) and processed products.

A recently published study surveying individuals with endometriosis indicates the power of dietary changes:

• 45% of participants reported a reduction in pain after removing gluten from their diet
• 45% also experienced improvement after reducing or omitting dairy
• 43% reported pain reduction after decreasing caffeine
• 53% saw improvements in pain after reducing alcohol consumption

The removal of foods from your diet can increase the risk of nutrient gaps.  Working with a dietitian while making dietary changes ensures any modifications are supportive of overall health.

3. Prioritize protein to maintain stable blood sugar (and hormones) levels

Keeping blood sugar stable is important for managing inflammation and supporting hormone health.  At Summerfield, we often recommend building a balanced plate with at least ¼ of your plate protein, ½ of your plate vegetables, and ¼ of your plate starches/carbs.  For snacks, aim to get at least 10 grams of protein.  Examples of high protein snacks include homemade protein bites, RX bars or other high-quality protein bar options, roasted chickpeas or edamame, or Greek yogurt.

Whole food sources of protein include eggs, poultry, fish, tofu, legumes, lean meats, and nuts/seeds.

A stable blood sugar supports lower cortisol levels, steadier energy levels, and better appetite regulation.

4. Focus on fiber for optimal gut health

Emerging research suggests a link between endometriosis and gut health (Qin et all). A disrupted gut microbiome may influence estrogen levels, inflammation, and immune function.

To support gut health:

• Include fiber-rich foods: fruits, vegetables, whole grains, legumes, and seeds
• Aim for 25–35 grams of fiber daily
• Consider fermented foods like yogurt, kefir, sauerkraut, and kimchi as a natural source of beneficial bacteria (probiotics)

Fiber helps with estrogen detoxification and supports bowel regularity—important for those with digestive symptoms, like bloating or constipation.

5. Consider seed cycling for hormone balancing

Seed cycling is a food-based strategy designed to support the natural fluctuations of estrogen and progesterone throughout the menstrual cycle.  The goal is to add 1-2 Tablespoons of seeds into your daily meal routine.

• Follicular Phase (Day 1–14): flax and pumpkin seeds
• Luteal Phase (Day 15–28): sesame and sunflower seeds

These seeds provide zinc, selenium, magnesium, and unsaturated fatty acids, which support hormones. While more research is needed, some people report improvements in cycle regularity and PMS symptoms.  For a fun way to practice seed cycling, try making our Chewy Cinnamon and Seed Snacks.

Pillars of Health

Nutrition is essential for managing inflammation, and it’s just one piece of the puzzle. Here are three other foundational pillars of wellness to support hormones:

1. Gentle Movement: During a flare-up, intense workouts may worsen pain. Instead, try walking, stretching, yoga, or Pilates.
2. Stress Management: Chronic stress increases cortisol, which can disrupt sex hormones. Try breathwork, journaling, therapy, or hobbies to support nervous system regulation.
3. Quality Sleep: Sleep is crucial for hormone repair and immune function. Aim for 7–9 hours per night with a calming evening routine.

Ready to take the next step?

As Registered Dietitians at Summerfield Custom Wellness, we work with clients one-on-one to provide personalized health and nutrition guidance that optimizes well-being, reduces inflammation, and supports hormone balance.  Connect with us to learn more.