If you have endometriosis, you’ve probably come across advice to cut out dairy. It circulates widely in online communities and wellness spaces, and it can make an already overwhelming condition feel even more difficult to manage.

This guide is here to help. As a dietitian specialising in endometriosis, I regularly see clients navigating this question, and the milks that come up most often are soy, oat, and almond. I have put together a clear, evidence-based overview of these: what each one offers, what to watch out for, and how to choose one that genuinely supports your health.

Do you need to avoid dairy with endometriosis?

The short answer is not necessarily, and here is why.

Recent research has actually found a mild protective association between dairy intake and endometriosis risk. Several studies have found that people who consume more dairy have a lower risk of endometriosis, not a higher one (1, 2). This challenges the commonly repeated idea that dairy is automatically harmful for endometriosis.

That said, some people with endometriosis do experience genuine symptom improvement when they reduce or eliminate dairy, particularly around digestive symptoms such as bloating and cramping (3). This is often related to lactose intolerance or sensitivity to dairy protein rather than endometriosis itself. It is also worth noting that IBS co-exists with endometriosis in a significant number of people, and dairy can be a trigger for IBS symptoms.

The key point: dairy elimination is not a universal requirement for endometriosis. 

If dairy worsens your symptoms, reducing it is a reasonable step. It is also worth trying lactose-free cow’s milk first, as this can resolve digestive symptoms for many people without needing to switch to a plant-based alternative entirely. If dairy does not cause you problems, there is no strong evidence that you need to remove it.

If you are switching to plant milk for any reason, here is how to choose well.

Soy milk: the most nutritionally complete plant milk alternative

Soy milk is the plant milk that most closely mirrors the nutritional profile of cow’s milk. It is a complete protein, meaning it contains all nine essential amino acids, and it provides a good source of vitamins B1, B2, B6, iron, magnesium, and potassium (4). For anyone reducing or eliminating dairy, it is the most nutritionally solid like-for-like swap.

Is soy milk safe for endometriosis?

This is the question that comes up most often. Soy contains compounds called phytoestrogens, which can interact with oestrogen receptors in the body. Since endometriosis is an oestrogen-dependent condition, soy has developed a reputation for making it worse.

Endometriosis is closely linked to oestrogen. Oestrogen can cause endometrial tissue to grow, remain active, and increase the production of inflammatory chemicals called prostaglandins. These chemicals may then encourage the tissue to produce more oestrogen, creating an ongoing cycle of inflammation that can contribute to pain and bloating.

Soy milk and soy foods contain polyphenols called phytoestrogens, which are a type of antioxidant. The reason soy attracts so much debate is that phytoestrogens share a similar structure to the female sex hormone oestrogen, leading to concerns that they might behave in the same way in the body. However, phytoestrogens do not bind to oestrogen receptors in the same way as the oestrogen your body naturally produces.

What makes phytoestrogens particularly interesting is that their effect appears to depend on the oestrogen environment they find themselves in. When circulating oestrogen levels are low, phytoestrogens can have a mild oestrogen-like effect. When oestrogen levels are high, they appear to have the opposite effect, occupying receptors and limiting the influence of stronger oestrogen (5).

Because endometriosis progression is oestrogen-dependent, meaning oestrogen must be present for the condition to advance, concerns arose that dietary phytoestrogens might worsen the condition. Research has since pointed in the other direction. In countries with the highest soy consumption, such as Japan, women who ate more soy were found to have a lower risk of endometriosis progression, likely because of this anti-oestrogenic effect (6). A comprehensive review of the evidence has concluded that soy and its isoflavones are safe at typical dietary intake levels (7).

Overall, soy milk is safe to drink in endometriosis and are a good source of protein, iron, zinc, and calcium. There is no need to avoid them.

What to look for

• Unsweetened versions only.
• Fortified with calcium and vitamin D (aim for at least 120mg calcium per 100ml).

For a more in-depth look at soy and endometriosis, including other soy foods beyond milk, read my previous blog post: Can I Eat Soy Foods with Endometriosis?

Oat milk: a popular and reasonable choice, with some important label-reading required

Oat milk has become the most widely used plant milk, and it does offer some genuine benefits. It contains beta-glucan, a soluble fibre that has been shown to reduce inflammatory markers (8). These are the same inflammatory pathways that are active in endometriosis, making beta-glucan a relevant nutrient for this condition.

Oat milk is also generally well-tolerated digestively, which is useful for people managing gastrointestinal symptoms alongside endo.

What to watch for

Many commercial oat milks contain added sugars and vegetable oils, typically rapeseed or sunflower oil. These oils are high in omega-6 fatty acids, and an excess of omega-6 relative to omega-3 can promote a pro-inflammatory environment (9). This can undermine the anti-inflammatory benefit of the beta-glucan, so choosing the right brand matters.

Oat milk is also higher in carbohydrates and lower in protein than soy milk. If blood sugar balance is a focus for you, this is worth bearing in mind.

What to look for

• Unsweetened versions only.
• Short, simple ingredient list.
• No added rapeseed or sunflower oil where possible.
• Avoid versions containing chicory root fibre, a prebiotic fibre that can irritate sensitive digestive systems.

Almond milk: a light option with antioxidant benefits, though nutritionally limited

Almonds are a good source of vitamin E, a fat-soluble antioxidant. People with endometriosis consistently show higher levels of oxidative stress (10), and an antioxidant-rich diet is a recognised part of nutritional support for the condition.

However, commercial almond milk typically contains only around 2% almonds. The remainder is water, thickeners, and fortifying agents, meaning the nutritional content is quite limited. A small handful of whole almonds would provide considerably more benefit than a glass of almond milk.

Almond milk is also low in both calories and protein. For anyone already experiencing fatigue, which is a common and often significant symptom of endometriosis, a milk that contributes very little energy is worth factoring in.

What to look for

• Fortified with calcium and vitamin D.
• Unsweetened.
• Higher almond content – some brands specify the percentage of almonds used; a higher percentage means better nutritional quality, so it is worth checking the label.

Quick comparison: plant milks for endometriosis

Approximate values per 200ml, unsweetened, based on typical commercial products. Fortified versions will vary.

The bottom line

Choosing the right plant milk is a relatively small part of managing endometriosis through diet, but it is a sensible place to start if you are making changes.

For overall nutritional quality, unsweetened, fortified soy milk is the most evidence-supported choice for endometriosis. That said, the best option is ultimately the one that fits your eating pattern, suits your digestion, and does not trigger symptoms for you.

As with any dietary change, it is important to listen to your body and work with a Registered Dietitian. If you are looking for personalised support to manage your endometriosis, feel free to get in touch to book your free 20-minute Discovery Call, or you can email me at laura@theendometriosisdietitian.com

References

1. Rizzello F, et al. Diet and Endometriosis: An Umbrella Review. Foods. 2025;14:2087. https://doi.org/10.3390/foods14122087
2. Qi X, et al. Relationship Between Dairy Products Intake and Risk of Endometriosis: A Systematic Review and Dose-Response Meta-Analysis. Frontiers in Nutrition. 2021;8:701860. https://doi.org/10.3389/fnut.2021.701860
3. Matek Sarić M, et al. The Role of Plant-Based Diets and Personalized Nutrition in Endometriosis Management. Medicina. 2025;61(7):1264. https://doi.org/10.3390/medicina61071264
4. Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients. 2016;8(12):754. https://doi.org/10.3390/nu8120754
5. Makene VW. Phytoestrogens and Hormonal Balance: Endocrine Modulation, Benefits, and Disruptive Effects. Journal of Technology and Innovation. 2025;5(2):74–81. https://doi.org/10.26480/jtin.02.2025.74.81
6. Tsuchiya M, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology. 2007;18(3):402-408. https://doi.org/10.1097/01.ede.0000257571.01358.f9
7. Messina M, et al. Neither soyfoods nor isoflavones warrant classification as endocrine disruptors. Critical Reviews in Food Science and Nutrition. 2022;62(21):5824-5885. https://doi.org/10.1080/10408398.2021.1895054
8. Zyla E, et al. Anti-Inflammatory Activity of Oat Beta-Glucans in a Crohn’s Disease Model. International Journal of Molecular Sciences. 2021;22(9):4485. https://doi.org/10.3390/ijms22094485
9. Missmer SA, et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction. 2010;25(6):1528-1535. https://doi.org/10.1093/humrep/deq044
10. Scutiero G, et al. Oxidative Stress and Endometriosis: A Systematic Review of the Literature. Oxidative Medicine and Cellular Longevity. 2017;2017:7265238. https://doi.org/10.1155/2017/7265238

This article is intended for general educational purposes and does not constitute personalised medical or dietetic advice. If you would like tailored nutrition support for endometriosis, book a consultation with Laura

The post Best milk for endometriosis: a dietitian’s guide to plant-based alternatives appeared first on The Endometriosis Dietitian.

Winter is a time when our immune systems often face extra challenges. The cold weather, shorter days, and reduced sulight can lower vitamin D levels, potentially weakening immunity. Seasonal illnesses like colds and the flu are more common during the winter months, making it even more important to prioritise immune health, especially for those managing endometriosis.

The link between endometriosis and immune health

For those with endometriosis, this season can intensify symptoms due to the immune system’s role in inflammation and hormonal balance. While there isn’t direct evidence that women with endometriosis are more susceptible specifically to cold germs, research suggests that endometriosis may affect the immune system in ways that could potentially increase susceptibility to infections in general:

• Immune system dysfunction: Studies have observed multiple immune system changes in people with endometriosis, including elevated inflammation levels and altered immune cell function (1).
• Altered microbiome: Research has shown that women with endometriosis have reduced gut microbial diversity with depleted beneficial gut bacteria which can lower immunity (2, 3).

Strengthening your immune system is essential to staying well and reducing symptom flares. By focusing on foods that support immune function, you can help your body combat inflammation, fight off seasonal viruses and better manage symptoms. Here’s how to nourish your immune system this winter with endo-friendly foods.

Immune-supporting foods for endometriosis

Antioxidant-rich fruits & vegetables

Antioxidants help neutralise free radicals to reduce inflammation and support immunity (4, 5). During winter, prioritise seasonal and nutrient-dense options such as:

• Berries: Blueberries, blackberries, and cranberries, rich in vitamin C.
• Leafy greens: spinach, kale, and Swiss chard provide vitamins A and C.
• Cruciferous vegetables: broccoli, Brussels sprouts, cauliflower, bok choi and cabbage, contain the antioxidant sulforaphane, which has been shown to help fight inflammation. They are also proven to help support the reduction of oestrogen levels and thereby reduce inflammation.

Healthy fats

Omega-3 fatty acids and other healthy fats play a crucial role in reducing inflammation (6).

Good sources include:

• Oily fish: salmon, mackerel, trout and sardines for omega-3s.
• Plant-based omega-3s: chia seeds, flaxseeds, and walnuts.
• Extra virgin olive oil: rich in monounsaturated fats and polyphenols.

Fermented foods for gut health

A healthy gut is essential for immune function, especially during winter.

Try to eat a variety of:

• Probiotic-rich foods: yoghurt, kefir, kimchi, and sauerkraut cansupport digestive health and the gut microbiome.
• Prebiotic foods: garlic, onions, leeks, and asparagus, which nourish beneficial gut bacteria.

Vitamin C-rich foods

Vitamin C is a key nutrient for boosting immunity and fighting off winter illnesses.

Good sources include:

• Citrus Fruits: oranges, grapefruits, and lemons.
• Winter Favorites: kiwis, bell peppers, and pomegranates.

Zinc-rich foods

Zinc supports immune cell repair and function.

Try to incorporate some of these foods into your diet:

• Seeds and Pulses: pumpkin seeds, chickpeas, and lentils.
• Lean Proteins: turkey, chicken, and eggs.

Herbs and spices with immune benefits

Winter is the perfect season to warm up with immune-supportive spices. Flavonoids and phenolic acids are the two main compounds that give herbs and spices their antioxidant activity and immune supporting properties (7).

• Turmeric: contains curcumin, a powerful anti-inflammatory compound. Combine this with black pepper to enhance its absorption.
• Ginger: a natural anti-inflammatory and antimicrobial.
• Garlic: offers immune-boosting and antiviral properties.

Key takeways

Winter’s challenges make immune health more important than ever, especially for managing endometriosis. By incorporating nutrient-dense, anti-inflammatory foods, you can strengthen your immune system, reduce the impact of seasonal illnesses, and better manage your endometriosis symptoms.

Need help with tailoring your winter nutrition to manage your endometriosis?

Feel free to book your free 20-minute Discovery Call with me here, or you can also email me: laura@theendometriosisdietitian.com

References

1. The involvement of multifunctional TGF-β and related cytokines in pathogenesis of endometriosis
2. Intricate Connections between the Microbiota and Endometriosis
3. Endometriosis and the microbiome
4. Nutrition in the prevention and treatment of endometriosis
5. Antioxidant supplementation reduces endometriosis
6. Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis
7. Antioxidant Activity of Spices and Their Impact on Human Health

The post Foods to support your immune system in endometriosis appeared first on The Endometriosis Dietitian.

It can be common to be diagnosed with both conditions. In fact, women with endometriosis are twice as likely to have an IBS diagnosis compared to women without endo (1).

Gastrointestinal (GI) symptoms are nearly as prevalent as gynaecological symptoms in women with endometriosis, as shown in a study involving 355 women. Among those with confirmed endometriosis, 90% experienced GI symptoms, with bloating being the most common (2).

IBS and Endo have many overlapping symptoms such as abdominal pain, diarrhoea, constipation, visceral hypersensitivity, nausea and bloating. For more information about the link between endometriosis and IBS, read my previous blog post.

If you’ve been diagnosed with both conditions, this symptom overlap can often make it difficult to determine whether bloating is linked to endometriosis (and often referred to as endo belly) or IBS.

So, how can you tell the difference? This blog post will be exploring the key characteristics, causes and tips for managing endo belly and IBS bloating so that you can feel better equipped when managing both conditions.

What is endo belly?

Endo belly is a term used to describe bloating specific to endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. This can cause inflammation, scarring, and adhesions that contribute to bloating and abdominal distension.

Causes of endo belly:

• Inflammation: Endometriosis can cause chronic inflammation in the pelvic area, leading to swelling and abdominal distension.
• Hormonal Fluctuations: Hormone changes during the menstrual cycle can trigger water retention and bloating in people with endometriosis.
• Scar Tissue and Adhesions: Endometriosis can create scar tissue, or adhesions, that pull on organs and cause digestive symptoms similar to bloating.

Characteristics of endo belly:

• Endo belly bloating tends to follow your menstrual cycle, peaking around the time of your period and can last for several days afterwards.
• It is typically localised to the pelvic region but it can also cause abdominal distension.
• It often comes with other endometriosis symptoms like pelvic pain and pressure, fatigue, and nausea.

What is IBS bloating?

IBS is a functional gastrointestinal disorder that affects the large intestine. Bloating is a hallmark symptom of IBS and is typically linked to abnormal gut motility, hypersensitivity, and changes in gut bacteria.

Causes of IBS bloating:

• Gas Production: Foods that are harder to digest, such as those high in FODMAPs (fermentable carbohydrates), can lead to excess gas production in people with IBS.
• Gut Hypersensitivity: People with IBS often experience heightened sensitivity in the digestive tract, which can make even minor gas build up feel intensely uncomfortable.
• Bacterial Imbalance: Imbalances in gut bacteria, or dysbiosis, may increase gas production, leading to IBS bloating.
• Stress: Anxiety, depression, and stress can disrupt the balance of gut bacteria and the gut-brain axis, which controls digestion and gut sensitivity. Stress hormones like cortisol alter gut motility, often speeding up or slowing down digestion, which can lead to symptoms such as diarrhoea or constipation.

Characteristics of IBS bloating:

• It involves the entire abdomen, occurs randomly, and fluctuates throughout the day, often worsening after meals.
• It often resolves within a few hours and may feel better after passing gas or a bowel movement.
• It’s typically accompanied with other IBS symptoms like digestive discomfort, and changes in bowel habits such as diarrhoea, and/or constipation.

Could the low FODMAP diet help to manage my IBS bloat and endo belly?

A 2017 Monash University study looked at the effectiveness of a low FODMAP diet on symptom management among women with IBS alone or in conjunction with endometriosis. The findings showed that 72% of women with endometriosis and IBS had more than 50% improvements in bowel symptoms after four weeks on the low FODMAP diet (3).

What is the low FODMAP Diet?

Some types of carbohydrates, which are poorly absorbed in the small intestine, can contribute to IBS-type symptoms. These carbohydrates are called FODMAPs, which are Fermentable, Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols. A low FODMAP diet involves eliminating certain carbohydrates for several weeks.

It is important to remember it is not suitable for everyone and there are other options to improve endometriosis and IBS symptoms (as discussed below). However, if you’ve have been diagnosed with endometriosis and IBS, and you’re struggling with bowel symptoms, it’s important to work with a FODMAP trained dietitian so that you can get the right support and guidance to make the most appropriate changes for you.

Other ways to manage endo belly

• Eat lots of anti-inflammatory foods: Ongoing studies strongly suggest that a Mediterranean style, anti-inflammatory diet can help reduce inflammation. This means eating lots of fruits, vegetables, whole grains, healthy fats, and lean proteins. You can find more about this way of eating by downloading my free Endo Ebook here.

• Stay hydrated: Drinking plenty of water can help reduce bloating and inflammation associated with endometriosis. Aim to stay hydrated throughout the day, and limit your intake of caffeine and alcohol, which can exacerbate symptoms.

• Heat Therapy: Heat packs on the abdomen can provide relief from discomfort caused by endo belly. Heat can help soothe muscle tension and reduce pain.

• Rest and Self-Care: Endo belly can be exhausting. Listening to your body and resting when needed can help you cope with the fatigue that often accompanies endo belly.

Other ways to manage IBS bloating

• Eat Slowly: Eating too quickly can lead to swallowing air, which contributes to bloating. Take time to chew food thoroughly.

• Stay hydrated: keeping hydrated helps your digestion run smoothly and can alleviate symptoms, especially if constipation is an issue.

• Try to be active every day: whether it’s a brisk walk, an exercise class or yoga, find an activity you enjoy.
• Stress less: stress can be a big IBS trigger. Techniques like mindfulness, meditation, and even simple deep-breathing exercises can be effective in managing symptoms.

• Track your symptoms: a food and symptom diary is a useful tool to identify any trigger foods which might be making your IBS symptoms worse.

When to see a healthcare provider

If you haven’t been diagnosed with IBS, and you’ve been experiencing symptoms, it’s important that you discuss these with your GP or healthcare provider. He/she can investigate and diagnose IBS, and rule out any other conditions such as Crohn’s disease, coeliac disease, which could indicate underlying digestive issues.

Key takeaways

While bloating and endo belly may seem similar at first, they have distinct causes and characteristics. By learning about and understanding these differences you can make targeted nutrition and lifestyle changes to manage your symptoms and find relief.

Are you looking for some support with a low FODMAP diet? Or maybe you’d like to explore how diet can help you manage your endometriosis and IBS symptoms? If you’d to discuss these further, feel free to book your free 20-minute Discovery Call with me here, or you can also email me: laura@theendometriosisdietitian.com

References

1. Mather, R., et al., Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive Diseases and Sciences. 2010. Apr;55(4):1085-9.
2. Maroun P., et al., Relevance of gastrointestinal symptoms in endometriosis. Australia and New Zealnd Journal of Obstetrics and Gynaecology. 2009. Aug;49(4):411-4.
3. Moore JS., et al., Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Australia and New Zealand Journal of Obstetrics and Gynaecology. 2017 Apr;57(2):201-5.

The post Endo belly or IBS bloat – which one is it? appeared first on The Endometriosis Dietitian.

Soy is a type of legume native to East Asia that has been cultivated for thousands of years. It is a nutritious and versatile food, and it’s one of the most widely consumed plant-based foods in the world, especially in vegetarian and vegan diets.

However, there is much debate on whether soy foods (also called soya foods) are good for certain health conditions, like endometriosis. If you have endometriosis, you might have come across the soy debate and find yourself asking: Will it make my symptoms worse? Will it make them better? Should I be avoiding soy foods with endometriosis altogether?

So, what does the  research actually say? In this blog post, I’ll cover what soy foods are, the nutritional and health benefits of soy, the potential controversy between soy and endometriosis, and explore what the research says about soy and endometriosis.

What are soy foods?

Soy foods are made from the soybean, which is a cream coloured, oval bean, which is the size of a garden pea. Edamame are young soybeans harvested before they ripen or harden. Soy foods include products such as soy milk, tofu, tempeh, soy yoghurt, miso and soy sauce (1).

Soybeans are rich in protein, (containing eight essential amino acids), fibre, essential minerals, and polyunsaturated fats, making them a valuable source of nutrition. Most soy drinks are fortified to ensure they provide similar or higher levels of micronutrients typically found in dairy milk.

Health benefits of soy foods

Soy is praised for its numerous health benefits, including:

• Heart Health: Soy foods have been shown to lower LDL cholesterol (the “bad” cholesterol) and may help reduce the risk of heart disease (2,3).
• Hormonal Balance: The isoflavones in soy may help reduce symptoms of menopause, such as hot flushes, and may play a role in balancing hormone levels (4).

Soy and phytoestrogens

Soy and soy foods also contain polyphenols, which are antioxidants, that have anti-inflammatory benefits. Soybeans and soy foods contain a specific type of polyphenol, known as phytoestrogens, called isoflavones. You can find them in smaller amounts in other legumes and nuts. The most common isoflavones are genistein, daidzein, and glycitein.

Phytoestrogens and endometriosis

Endometriosis is an oestrogen dependent condition, and women with endometriosis often have higher levels of oestrogen. High oestrogen levels have been linked to the production of prostaglandins which are pro-inflammatory and can worsen endometriosis pain and bloating.

The controversy lies in the fact that the phytoestrogens (isoflavones) found in soy foods can have a similar structure to the female sex hormone oestrogen and can therefore mimic the effects of oestrogen in the body. Since phytoestrogens can bind to oestrogen receptors, the assumption is that they could signal the body to elevate oestrogen levels even further, thereby worsening endometriosis symptoms.

However, isoflavones have been found to have an anti-oestrogen effect when oestrogen levels are high in the body. It causes a protective effect where the isoflavones bind to the receptors that oestrogen would usually bind to, thereby blocking oestrogen’s effects. In other words, isoflavones can have a ‘normalising’ effect on oestrogen where they boost levels when they’re low and counteract levels when they’re too high. Therefore, phytoestrogens may help alleviate endometriosis symptoms (5).

One study, conducted in Japan, where soy is a common part of the diet, found that higher intakes of the phytoestrogens genistein and daidzein was associated with a decreased risk of advanced stage endometriosis amongst infertile women. The study also found an association between high intakes of soy phytoestrogens and a decreased severity in endometriosis symptoms. This was because the phytoestrogens had an anti-oestrogenic effect that blocked the body’s own oestrogen from binding to receptors (6).

How can I include soy in my diet?

In addition to their protective benefits for various health conditions, soy and soy foods are highly nutrient-dense and are valuable additions to anyone’s diet, particularly for those following a vegan, plant-based, or lactose-free lifestyle.

If you want to include soy in your diet while managing endometriosis, choose whole soy foods. Opt for minimally processed options like tofu, tempeh and edamame instead of processed soy products.

Phytoestrogens are abundant in many foods other than soy like nuts and seeds, pulses and grains. These foods are also a feature of the Mediterranean diet with many studies showing that women with endometriosis (who adopted this diet) had a significant improvement in pain symptoms. You can read more about this in my free Eating for Endo Ebook here.

Key takeaways

While some concerns remain about the oestrogenic effects of soy, current research suggests that these effects are not likely to exacerbate endometriosis and may, in fact, provide symptom relief for some women. Unprocessed soy foods may offer benefits for women with endometriosis by helping to balance hormones and reduce inflammation.

As with any dietary change, it’s important to listen to your body and work with a Registered Dietitian. If you’re looking for some personalised support to manage your endometriosis, feel free to contact me to book your free 20-minute Discovery Call, or you can also email me here: laura@theendometriosisdietitian.com

References

1. British Dietetic Association (2022). Food Fact Sheet: Soya foods and your health. Accessed: https://www.bda.uk.com/resource/soya-foods.html
2. Ramdath DD, Padhi EM, Sarfaraz S, Renwick S, Duncan AM. Beyond the cholesterol-lowering effect of soy protein: a review of the effects of dietary soy and its constituents on risk factors for cardiovascular disease. Nutrients. 2017 Dec;9(4):324.
3. Taku, K, Umegaki, K, Sato, Y (2007) Soy isoflavones lower serum total and LDL cholesterol in humans: a meta-analysis of 11 randomized controlled trials. American Journal of Clinical Nutrition, 85: 1148–1156.
4. Taku K. Extracted or synthesized soybean isoflavones and menopause hot flushes. Menopause. 2012;19(6):776-790.
5. Bartiromo L, Pinna G, Bini V, Fava V, De Tora L, Lamberti F, et al. Endometriosis and phytoestrogens: friends or foes? A systematic review. Nutrients. 2021 Aug;13(8):2532
6. Zhang Y, Liu Y, Zhou Y, Zhao M, Wu C, Liu J, et al. Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology. 2007 May;18(3):402-8.

The post I have endometriosis, can I eat soy foods? appeared first on The Endometriosis Dietitian.

Understanding endometriosis bloating

Endometriosis is a chronic condition where tissue similar to the lining inside the uterus, known as the endometrium, grows outside of it. This can lead to a range of symptoms, one of the most troubling and often overlooked being bloating, commonly referred to as ‘endo belly’. This type of bloating is not just your typical post-meal fullness; it can be painful, and can significantly impact your daily life.

What causes endometriosis bloating?

Endometriosis bloating is caused by several factors:

• Inflammation: Misplaced endometrial tissue can cause chronic inflammation in the abdominal cavity, leading to swelling and bloating.

• Increased visceral sensitivity: Visceral hypersensitivity means that the nerve endings in your abdomen area are more sensitive to changes in the volume of food, fluid and gas in your bowel. These changes can stimulate the nerve endings, causing expansion, stretching of the bowel and painful bloating.

• Hormonal fluctuations: Hormonal changes throughout your menstrual cycle can exacerbate bloating. Oestrogen, in particular, can increase water retention and bloating.

• Digestive issues: Many women with endometriosis also experience gastrointestinal symptoms like irritable bowel syndrome (IBS) which can contribute to bloating. (If you suspect you have IBS, it’s important that you speak to a healthcare provider about your symptoms to ensure any underlying issue isn’t left untreated).

Symptoms of endometriosis bloating

Endometriosis bloating can be unpredictable, and it can vary in intensity and duration, but common symptoms include:

• A swollen or distended abdomen
• Abdominal pain and cramping
• A feeling of fullness or pressure in the abdomen
• Fluctuations in the severity of bloating, often worsening around the menstrual cycle

Managing endometriosis bloating

There are lots of ways you can reduce your endometriosis belly bloating. Here are my top tips to ease your endometriosis bloating:

Increase your fibre intake

High fibre foods such as fruits, vegetables, wholegrains, pulses, nuts and seeds can help to regulate levels of oestrogen. High oestrogen levels have been linked to the production of prostaglandins which are pro-inflammatory and can worsen endometriosis pain and bloating. Fibre improves the process of excretion of oestrogen. It does this by preventing the absorption of oestrogen, moving it out of our body through our bowels, thereby lowering levels of inflammation and bloating. Having more fibre in your diet can also help with constipation and optimise your gut health too.

Keep hydrated

Fibre draws water into your bowel so you may become dehydrated if you don’t drink enough. Aim to drink 2 litres of water per day to allow the extra fibre to do its job properly. This should increase if you’re physically active or in warmer weather. Water is the best option, but other good choices are herbal teas, particularly peppermint tea which has been shown to help relieve bloating and aid with digestion.

Try not to overeat

Large meals can sometimes stimulate visceral sensitivity, so reduce the size of your portions at mealtimes, or try eating smaller meals more often instead of three large ones each day.

Slow down

Take the time to relax while eating your meals and chew your food well. Take the time to pause and put your fork or spoon down in between each mouthful.

Gentle exercise

Movement can help improve digestion and reduce bloating by helping food move through your body. Listen to your body and choose an enjoyable activity that feels comfortable for you.

Stress management

Techniques such as yoga, meditation, and deep breathing can help manage stress, which can exacerbate bloating .

Adequate rest

Ensuring you get enough sleep can help your body manage inflammation and reduce bloating.

If your bloating is severe, persistent, or accompanied by other concerning symptoms like unexplained weight loss, blood in the stool, or severe abdominal pain, it’s essential to seek medical advice. A healthcare provider can help rule out other conditions and develop a tailored treatment plan.

Key Takeaways

Endometriosis has a variety of symptoms including bloating, which can be unpredicatable and can happen for a variety of reasons. It can be frustrating not knowing when you’ll experience these symptoms such as bloating. However, by making small changes to your way of eating and changes to your lifestyle you can manage your endometriosis bloating which can make you feel more energised and more in control of your symptoms.

If you’re looking for more personalised support, you can contact me to book your free 20-minute Discovery Call, or you can also email me here: laura@theendometriosisdietitian.com

References

1. Mather, R., et al., Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive Diseases and Sciences. 2010. Apr;55(4):1085-9.
2. Issa, A. M., Nakamura, T., & Rapkin, A. J. (2012). Visceral hypersensitivity in endometriosis: a new target for treatment? BioMed Research International, 2012, 981206. doi:10.1155/2012/981206.
3. Hansen, K.E., et al., Visceral syndrome in endometriosis patients. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014. 179: p. 198-203.
4. Leonardi, M., et al., Endometriosis and the microbiome: a systematic review. British Journal of Obstetrics and Gynaecology, 2020; 127: 239-249.
5. Sacco, K., Portelli, M., Pollacco, J., Schembri-Wismayer, P., Calleja-Agius, J., & Attard-Montalto, S. (2012). The role of prostaglandin E2 in endometriosis. Gynecological Endocrinology, 28(2), 134-138. doi:10.3109/09513590.2011.588747.
6. British Dietetic Association (2021) Food Fact Sheet: Fibre.
7. Goldin, B. R., Adlercreutz, H., Gorbach, S. L., Warram, J. H., Dwyer, J. T., Swenson, L., & Woods, M. N. (1982). Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. New England Journal of Medicine, 307(25), 1542-1547. doi:10.1056/NEJM198212163072502
8. Samimi, M., & Tabibi, A. (2015). Evaluation of mint efficacy regarding dysmenorrhea in comparison with mefenamic acid: A double-blinded randomized crossover study. Iranian Journal of Nursing and Midwifery Research, 20(3), 307-311.

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Endometriosis is a chronic, inflammatory gynaecological condition, and it occurs when tissue, that normally lines the uterus, is found in other parts of the body. Organs affected by this ‘stray’ tissue can include the reproductive organs, including the ovaries, fallopian tubes and cervix. However, it can also affect other abdominal organs such as the bowel and bladder.

The presence of this ‘stray’ tissue can cause irritation and inflammation and can also cause scarring. As a result, it can lead to symptoms including pelvic pain, pain during periods and intercourse, heavy periods, fatigue, pain with bowel movements and intense abdominal pain.

Gastrointestinal symptoms in endometriosis

Gastrointestinal symptoms (bloating/diarrhoea/constipation) are common in endometriosis. These symptoms overlap with those of irritable bowel syndrome (IBS), making it difficult to distinguish between the conditions, and causing the possibility of misdiagnosis and/or delayed diagnosis.

However, it is not uncommon for women to be diagnosed with both IBS and endometriosis. For instance, one study showed that 36% of women with IBS had a concurrent diagnosis of endometriosis (1). Another study showed that women with endometriosis were 2.5 times more likely to have been diagnosed with IBS than women without endometriosis (2).

If you suspect you have either condition, it’s important that you speak to a doctor about your symptoms to ensure any underlying issue isn’t left untreated.⁠⠀

What’s the link between endometriosis and IBS?

The exact reasons why women with endometriosis are more likely to have IBS are not fully understood, but several theories and mechanisms have been proposed to explain how the two conditions co-exist:

Inflammatory processes

Endometriosis involves chronic inflammation due to the presence of endometrial-like tissue outside the uterus, which triggers an immune response. This chronic inflammation can affect nearby organs, including the bowel, potentially leading to IBS symptoms. IBS is also associated with low-grade inflammation, suggesting that a shared inflammatory process may link the two conditions(3).

Visceral hypersensitivity

Women with endometriosis often experience heightened sensitivity to pain in the pelvic area, a condition known as visceral hypersensitivity. This increased pain sensitivity can extend to the gastrointestinal tract, contributing to the development of IBS symptoms such as abdominal pain and discomfort(4)

Hormonal influences

Hormonal fluctuations, particularly related to the menstrual cycle, can exacerbate symptoms of both endometriosis and IBS. Oestrogen and progesterone can influence gut motility (changes in the movement of the gut and contents within the gut) and sensitivity, leading to gastrointestinal symptoms that mimic or worsen IBS in women with endometriosis

Microbiome alterations

Emerging research suggests that alterations in the gut microbiome may play a role in both endometriosis and IBS. An imbalance in the gut microbiota, can contribute to inflammation and gastrointestinal symptoms. Women with endometriosis may have distinct microbiome profiles that predispose them to IBS(5)

How can diet help manage symptoms of endometriosis and IBS?

Endometriosis and IBS affects every woman differently, so no treatment plan is guaranteed to work for everyone. However, certain lifestyle changes, home remedies, treatment strategies, and prescription medications can make your symptoms more manageable. I’ve discussed some of these strategies in my previous blog articles here and here.

There has also been further emerging evidence to support the low FODMAP diet approach in managing endometriosis and IBS. A study showed that 72% of women with both conditions experienced a >50% improvement in bowel symptoms on a low FODMAP diet at 4 weeks than those with IBS alone(6).

What’s the low FODMAP diet?

A low FODMAP diet is a 3-step diet that can reduce symptoms of medically diagnosed IBS. FODMAPs are a group of short-chain carbohydrates and sugar alcohols that are poorly absorbed in the small intestine. The term “FODMAP” stands for; fermentable oligosaccharides, disaccharides, monosaccharides & polyols.

For the first 4-6 weeks, high FODMAP foods are eliminated from the diet to reduce symptoms. Foods are then systematically reintroduced one at a time to identify which types of FODMAPs cause symptoms. The final stage of the diet is tailored to include only the FODMAPs that are well-tolerated, ensuring a balanced and enjoyable diet. However, the low FODMAP diet isn’t isn’t suitable for everyone, and should only be applied after a diagnosis of IBS.

If you have been diagnosed with IBS it’s important to work with a FODMAP trained dietitian so that you can get the right support and guidance to make the most appropriate changes for you.

Are you looking for some support with a low FODMAP diet? Or maybe you’d like to explore how diet can help you manage your endometriosis and IBS symptoms? If you’d to discuss these further, feel free to book your free 20-minute Discovery Call with me here, or you can also email me: laura@theendometriosisdietitian.com

References

1. Mather, R., et al., Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive Diseases and Sciences. 2010. Apr;55(4):1085-9.
2. Seaman, H.E., et al., Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study–Part 2. British Journal of Obstetrics and Gynaecology, 2008. 115(11): p. 1392-6.
3. Habib, N., et al., Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. International Journal of Women’s Health. 2020 ; 12 : 35-47.
4. Hansen, K.E., et al., Visceral syndrome in endometriosis patients. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014. 179: p. 198-203.
5. Leonardi, M., et al., Endometriosis and the microbiome: a systematic review. British Journal of Obstetrics and Gynaecology, 2020; 127: 239-249.
6. Moore, J.S., et al., Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol, 2017. 57(2): p. 201-205.

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What is a flare up?

An endometriosis flare up refers to a period of intensified symptoms of endometriosis. Increased pelvic pain is the most common symptom. Other symptoms include heavy menstrual bleeding, fatigue and changes in gastrointestinal symptoms including increased bloating, constipation and diarrhoea.

Flare ups can happen more or less frequently for different people and they can be triggered for different reasons. They can sometimes be linked to hormonal changes, or a change in your routine or can result after something you might have eaten. Other times they can be unpredictable and come without warning.

From debilitating pain to fatigue and emotional distress, navigating through these episodes requires patience, self-care, and support. If you have endometriosis and you’re experiencing a flare up, here are some tips to help you find relief and manage your symptoms.

Tips to manage endometriosis flare ups

Listen to your body: Pay close attention to what your body is telling you. If you feel a flare up coming on, take the time to rest and prioritise self-care. Pushing yourself too hard can exacerbate symptoms and prolong recovery.

Eat lots of anti-inflammatory foods: Ongoing studies strongly suggest that a Mediterranean style, anti-inflammatory diet can help reduce inflammation, regulate oestrogen levels and help improve symptoms and reduce flare ups (1). This means eating lots of fruits, vegetables, whole grains, healthy fats, and lean proteins. You can find more about this way of eating by downloading my free Endo Ebook here.

Limit inflammatory foods: Some foods can trigger inflammation and worsen endometriosis symptoms. Being mindful of your intake of processed foods, saturated and trans fats, red meat, caffeine and alcohol may help to reduce your flare ups (2).

Try some gentle exercise: While rigorous exercise may not be feasible during a flare-up, gentle movement such as walking, yoga, or stretching can help alleviate pain and improve your mood by releasing endorphins. Listen to your body and choose activities that feel comfortable for you.

Stay hydrated: Drinking plenty of water can help reduce bloating and inflammation associated with endometriosis. Aim to stay hydrated throughout the day, and limit your intake of caffeine and alcohol, which can exacerbate symptoms.

Try heat therapy: Applying heat to the lower abdomen, back or thighs can provide significant relief from pain and menstrual cramps. Use a heating pad or a hot water bottle for soothing comfort.

Find some pain relief: Over-the-counter pain relievers such as ibuprofen can help alleviate discomfort during a flare up. If these don’t provide adequate relief, talk to your healthcare provider about prescription pain medications or other options such as a TENS machine (3).

Find ways to relax: Stress can exacerbate pain and discomfort associated with endometriosis. Incorporate relaxation techniques such as deep breathing, meditation, or mindfulness to help manage stress levels and promote emotional well-being.

Enjoy some herbal teas: Herbal teas can be a supportive complementary approach for managing symptoms of endometriosis due to their potential anti-inflammatory, antispasmodic, and analgesic properties. Some herbal teas that may help alleviate symptoms include chamomile, peppermint, ginger and turmeric teas (4).

Ask about your medication options: Hormone treatment aims to limit oestrogen production in your body, as oestrogen encourages endometriosis tissue to grow and shed. If you’re on hormonal medications or birth control to manage endometriosis symptoms, ensure you’re taking them as prescribed. Discuss any concerns or changes in symptoms with your healthcare provider (5).

If you’re looking for more personalised support, you can contact me to book your free 20-minute Discovery Call, or you can also email me here: laura@theendometriosisdietitian.com

References

1. Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis
2. Nutritional aspects related to endometriosis
3. Managing your endometriosis – pain relief
4. Herbs for Endometriosis
5. Endometriosis – Hormone treatment

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