Eating for Endometriosis While TTC: Anti-Inflammatory Diet Claims vs. the Evidence

Short answer: no diet has been shown to treat endometriosis or to improve fertility specifically in people who have it. The best-known diet study, from the Nurses' Health Study II, found that women who ate the most long-chain omega-3 fats were less likely to be diagnosed with endometriosis, and those who ate the most trans fats were more likely. That's about risk of developing it, not managing it. A 2021 systematic review of dietary interventions found mostly positive but weak studies with moderate to high risk of bias. A Mediterranean-style, minimally processed diet is a reasonable foundation, but it works alongside medical care for endometriosis, not instead of it.

This is the nutrition side of a bigger topic. For the clinical side, including surgery, medication and fertility treatment, see conceiveguide.com's guide to endometriosis and fertility, fertilestart.com's endometriosis TTC guide, and howtohaveababy.com's endometriosis and fertility overview.

Study 1: dietary fat and endometriosis risk

In 2010, Stacey Missmer and colleagues published an analysis of 12 years of data from the Nurses' Health Study II in Human Reproduction. Diet was measured by food-frequency questionnaire three times and averaged over time. Over 586,153 person-years of follow-up, 1,199 cases of laparoscopically confirmed endometriosis were reported.

The authors suggested these may be modifiable risk factors, and said the findings supported efforts to remove trans fats from the food supply.

What it means for you if you already have endometriosis

Less than it might seem. The study looked at who developed or was diagnosed with endometriosis, not at symptoms or fertility in people who already have it. It's observational, so it shows association, not cause. Still, the two directions it points (more omega-3, fewer trans fats) line up with general healthy-eating advice, so acting on them carries little downside.

Study 2: what dietary interventions show

A 2021 systematic review by Nirgianakis and colleagues in Reproductive Sciences looked specifically at diet as a treatment approach. It found:

• 9 human studies and 12 animal studies.
• Of the human studies, only 2 were randomized controlled trials; the rest were 2 controlled studies, 4 uncontrolled before-and-after studies and 1 qualitative study.
• Interventions included supplements, adding specific foods, excluding foods, and changing the whole diet.
• Most studies reported positive effects on endometriosis-related symptoms, but they generally had moderate or high risk of bias.
• The authors called for well-designed randomized trials to establish short- and long-term effectiveness and safety.

In plain terms: there are encouraging signals, but the studies are small and mostly not designed to rule out other explanations, such as placebo effects or symptoms improving on their own.

Popular endometriosis diet claims, checked

A sensible way to eat while TTC with endometriosis

Because the evidence is limited, the goal is a diet that's good for fertility and overall health, might ease symptoms, and doesn't create new problems. A Mediterranean-style pattern fits all three. Our guides to the Mediterranean diet and fertility, the anti-inflammatory fertility diet and building an anti-inflammatory plate cover it in detail.

• Fish, especially oily fish, a couple of times a week, choosing lower-mercury options. If you don't eat fish, discuss an algae or fish oil supplement with your clinician; see our omega-3 and DHA guide.
• Avoid trans fats. Check labels for partially hydrogenated oils, which still turn up in some imported and older products.
• Plenty of vegetables, fruit, legumes and whole grains for fiber.
• Olive oil, nuts and seeds as main fat sources.
• Less processed meat and fewer sugary drinks. Sugary drinks have their own link to slower conception; see our post on soda, juice and energy drinks while TTC.

Elimination diets: proceed carefully

Gluten-free, low-FODMAP and dairy-free diets are popular in endometriosis communities, and some people feel better on them, possibly because endometriosis and gut symptoms often overlap. But cutting out whole food groups while trying to conceive can leave gaps in fiber, iodine, calcium, B vitamins and iron. If you want to try one:

1. Talk to your clinician or a registered dietitian first, and get tested for celiac disease before going gluten-free if that's a question.
2. Change one thing at a time and keep a symptom diary.
3. Set an end date to evaluate whether it's helping.
4. Make sure your prenatal and diet still cover the key nutrients.

Questions to bring to your specialist

• "Is there anything in my diet or supplements that could interfere with the treatment you're recommending?"
• "Would a referral to a dietitian who works with endometriosis make sense for me?"
• "If I try an elimination diet, how will we judge whether it's helping?"
• "Should I be tested for celiac disease or iron deficiency, given my symptoms and periods?"
• "Are there supplements I should stop before surgery or fertility treatment?"
• "How long should we try before moving to treatment, given my diagnosis and age?"

Heavy periods, common with endometriosis, can also lower iron stores over time, which is one more reason to ask about bloodwork rather than guessing. Bringing a short food and symptom diary to the appointment makes these conversations more productive.

Supplements often marketed for endometriosis

You'll see products marketed with "endo" in the name, often combining herbs, antioxidants and omega-3s. We didn't find strong human evidence that these combinations treat endometriosis or improve fertility in people who have it. If you take any, add them to your written list for your specialist, especially before surgery or fertility treatment, since some can affect bleeding or interact with medications. Supplements don't treat infertility or endometriosis.

Sources

• Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25(6):1528–1535. PubMed 20332166
• Nirgianakis K, Egger K, Kalaitzopoulos DR, et al. Effectiveness of dietary interventions in the treatment of endometriosis: a systematic review. Reprod Sci. Published online March 24, 2021. PubMed 33761124
• ASRM Practice Committee. Definition of infertility: a committee opinion (2023). asrm.org (PDF)