Food groups and nutrients consumption and risk of endometriosis: a systematic review and meta-analysis of observational studies

Eating for Optimization: Unraveling the Dietary Patterns and Nutritional Strategies in Endometriosis Management

Endometriosis is a chronic gynecological disorder affecting millions of women worldwide, causing chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility, and severely impacting their quality of life. Treatment primarily involves hormonal therapies and surgical excision, but high recurrence rates and the economic burden are substantial. With these challenges, significant discussion surrounds the potential role of dietary patterns in managing endometriosis, making it necessary to bridge this critical gap. This review investigates the current scientific evidence on the dietary patterns (eg, Mediterranean, vegetarian, anti-inflammatory, low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [low-FODMAP], and Western-style diets) associated with endometriosis and provides a concise, yet thorough, overview on the subject. In addition, antioxidants, microbiota, and artificial intelligence (AI) and their potential roles were also evaluated as future directions. An electronic-based search was performed in MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, Scopus, and Web of Science. The current data on the topic indicate that a diet based on the Mediterranean and anti-inflammatory diet pattern, rich in dietary fiber, omega-3 fatty acids, plant-based protein, and vitamins and minerals, has a positive influence on endometriosis, yielding a promising improvement in patient symptoms. Preclinical investigations and clinical trials indicate that dietary antioxidants and gut microbiota modulation present potential new approaches in managing endometriosis. Also, AI may offer a promising avenue to explore how dietary components interact with endometriosis. Ultimately, considering genetic and lifestyle factors, a healthy, balanced, personalized approach to diet may offer valuable insights on the role of diet as a means of symptom improvement, facilitating the utilization of nutrition for the management of endometriosis.

Effect of omega-3 polyunsaturated fatty acid on endometriosis

OBJECTIVE

This study aimed to evaluate the effect of Omega-3 Fatty Acids (ω-3 PUFAs) on endometriosis.

DESIGN

The authors conducted a comprehensive search of the PubMed, Embase, Cochrane Library and Web of Science databases, focusing exclusively on Randomised Controlled Trials (RCTs) to study the impact of ω-3 PUFAs on endometriosis. The included studies were assessed for methodological quality using the Cochrane bias risk assessment tool and analyzed using data analysis software.

RESULTS

The search yielded five RCTs conducted between the database's inception and July 2023, with a total sample size of 424 patients with endometriosis. The meta-analysis results showed no statistically significant effects of ω-3 Polyunsaturated Fatty Acids (PUFAs) on pain (Mean Difference [MD = -0.387], 95 % Confidence Interval [95 % CI -1.742-0.967], I2 = 93.3 %, z = 0.56, p = 0.575), sexual activity (MD = 0.143, 95 % CI -0.210-0.497, I2 = 0 %, z = 0.79, p = 0.427), pain intervention (MD = -0.216, 95 % CI -0.717-0.285, I2 = 0.0 %, z = 0.84, p = 0.399), catastrophic thinking (MD = 0.158, 95 % CI -0.315-0.632, I2 = 0.0 %, z = 0.66, p = 0.512) and the 12-item short form health survey (MD = 0.001, 95 % CI -0.053-0.503, I2 = 0.0 %, z = 0.00, p = 1.000), which were all statistically insignificant. However, ω-3 PUFAs appeared to reduce the inflammatory response in patients with endometriosis (MD = -5.20, 95 % CI -6.21--4.20, I2 = 0 %, z = 10.13, p < 0.001).

CONCLUSION

Based on the available evidence, ω-3 PUFAs may reduce the inflammatory response in patients with endometriosis, specifically by decreasing levels of pro-inflammatory cytokines, such as TNF-alpha, IL-6 and IL-1, indicating potential anti-inflammatory properties that warrant further investigation.

TRIAL REGISTRATION

PROSPERO: CRD42023441699.

Prevalence of endometriosis in Mayer-Rokitansky-Küster-Hauser syndrome variants: a systematic review and meta-analysis

STUDY QUESTION

In patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS; population), is the presence of functional endometrium (FE) in uterine remnants (URs) (exposure), compared with the absence of FE in UR/absence of UR (comparison), associated with a higher prevalence of endometriosis (outcome)?

SUMMARY ANSWER

The aggregate prevalence of endometriosis was considerably higher in MRKHS patients with FE (MRKHSFE+) than in those without FE (MRKHSFE-).

WHAT IS KNOWN ALREADY

The pathogenesis of endometriosis is not fully understood. The finding of pelvic endometriosis in patients with MRKHS is one of the main objections to the retrograde menstruation (RM) hypothesis. The recent advent of high-resolution ultrasonography and magnetic resonance imaging (MRI) allowed the reliable preoperative identification of FE concealed within UR, and histopathological examination after UR removal is no longer the only means of verifying the presence of a mucosal component. A similar prevalence of endometriosis in MRKHSFE+ and MRKHSFE- patients, as assessed by preoperative ultrasound (US) and/or MRI, would essentially rule out the RM/implantation theory, whereas a substantially higher prevalence of endometriosis in MRKHSFE+ than in MRKHSFE- patients would challenge the embryonic remnants/coelomic metaplasia hypothesis.

STUDY DESIGN, SIZE, DURATION

This systematic review was restricted to full-length, English-language articles published in peer-reviewed journals between 1 January 1980 and 1 June 2024. The electronic PubMed and Embase databases were searched in June 2024. The keyword 'endometriosis' was used in combination with 'Mayer-Rokitansky-Küster-Hauser syndrome', 'Müllerian agenesis', 'uterine agenesis', 'vaginal agenesis', 'Müllerian anomalies', and 'female genital malformations'. References from relevant publications were screened, and PubMed's 'similar articles' and 'cited by' functions were used.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Studies were selected if they reported the presence or absence of FE within UR investigated by preoperative US or MRI or histology after surgical removal, and the presence or absence of surgically confirmed endometriosis. Case series and case reports were deemed eligible for inclusion. Studies not specifically stating the intent to search for the presence of endometrium within UR, or not reporting the results of ultrasonography or MRI, or histological examinations were excluded. Two reviewers independently abstracted data. The risk of bias was assessed using a tool specifically devised to ascertain the methodological quality of case series and case reports.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 102 studies (29 case series and 73 case reports), comprising 666 MRKHS patients in whom the presence or absence of FE was verified were included. Endometriosis was detected in 71 participants (10.7%; 95% CI, 8.5-13.2%), and its prevalence was 8.6% (51/593; 95% CI, 6.6-11.2%) in case series and 27.4% (20/73; 95% CI, 18.4-38.6%) in case reports (P<0.0001). When considering only the 19 case series with ≥10 participants, the proportion of MRKHS patients with endometriosis was 3.4% (41/1219; 95% CI, 2.5-4.5%). Among the 71 MRKHS patients with endometriosis, 64 had coexisting FE, and only seven had no evidence of FE within UR or did not have UR. The proportion of patients with endometriosis was 32.0% in the subgroup with FE (64/200; 95% CI, 25.9-38.8%) and 1.5% (7/466; 95% CI, 0.7-3.1%) in the subgroup without FE within UR/without UR. At meta-analysis considering case series, the overall prevalence estimates of endometriosis in patients with and without FE were, respectively, 16.8% (95% CI, 1.8-38.5%) and 0% (95% CI, 0-0%). In order to evaluate the association between FE and endometriosis we also conducted a meta-analysis that included case series reporting both FE+ and FE- patients. A significantly increased risk of endometriosis was observed in MRKHSFE+ patients compared with MRKHSFE- patients (overall odds ratio estimate was 12.0; 95% CI, 5.1-28.3%). The quality of the evidence score was higher in the case series subgroup (median score, 4 points; interquartile range, 3-5 points) than in the case reports subgroup (median score, 3 points; interquartile range, 2-4 points).

LIMITATIONS, REASON FOR CAUTION

Due to the uncontrolled and non-experimental study design, case series and case reports are associated with an increased risk of selection, performance, detection, attrition, and reporting bias. In the seven cases of endometriosis in patients purportedly without detected FE, a preoperative MRI was not systematically performed or erroneous findings were reported, the anatomical description at surgery was incomplete or inconsistent, the histopathological diagnosis of endometriosis was missing or questionable, and precise microscopic features were not always described. Whether FE (exposure) was truly absent in all these cases and/or whether all lesions diagnosed as endometriosis (outcome) were indeed true disease, seems uncertain.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings should raise awareness of the importance of accurately assessing and reporting the presence or absence of FE within UR, and of systematically performing biopsies of visually diagnosed endometriosis in MRKHS patients. Considering the high risk of bias, the detection of endometriosis in MRKHS patients allegedly without FE in the few relevant case reports published in the last four decades should no longer be interpreted tout court as proof for the coelomic metaplasia/embryonic remnants theory.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynaecological practice. E.S. is Editor-in-Chief of Human Reproduction Open; discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures; and maintains both a public and private gynaecological practice. P.Vi. is Co-Editor-in-Chief of Journal of Endometriosis and Uterine Disorders. All other authors declare they have no conflict of interest.

REGISTRATION NUMBER

The study protocol was registered on PROSPERO (registration number, CRD42024512351).

Analysis of the Biopsychosocial Impacts Associated with Endometriosis to Improve Patient Care

Endometriosis is a non-malignant, inflammatory condition that impacts individuals across various hormonal stages, including before their first menstruation, throughout their reproductive years, and after menopause. This condition arises when tissue resembling the uterine lining grows outside the uterus, resulting in inflammation and a range of symptoms, such as dysmenorrhea, pain during intercourse, chronic discomfort, and challenges with fertility. This review provides a comprehensive analysis of the medical strategies implemented to address the pathology of endometriosis, highlighting its significant impact on the quality of life of the individuals affected by this condition. Endometriosis can influence various aspects of life, including physical health, emotional well-being, social interactions, and professional performance. Usually, to assess the quality of life in women with endometriosis, validated instruments, such as different questionnaire types, are used to measure the physical, psychological, social, and reproductive health impacts. To improve the quality of life of the women experiencing endometriosis, several supportive strategies are proposed. The findings underscore the necessity of managing endometriosis through a multidisciplinary approach that encompasses both medical and surgical interventions, lifestyle modifications, and psychological support.

Effect of dietary patterns and nutritional supplementation in the management of endometriosis: a review

Endometriosis is an estrogen-dependent chronic inflammatory disease which causes dysmenorrhea, chronic pelvic pain, and infertility in women of childbearing age, significantly impacting their quality of life and physical and mental health. The etiology of endometriosis remains unclear, with oxidative stress and inflammation currently thought to play pivotal roles in its pathophysiology. Epidemiological studies and clinical trials indicate that varying dietary patterns and specific nutrient supplementation can influence oxidative stress markers and levels of inflammatory factors and related pathways, potentially impacting the progression of endometriosis. In this review, we summarize the roles of oxidative stress and inflammation in endometriosis and thoroughly examine the current understanding of the effect of dietary patterns and nutrient supplementation in treating endometriosis. This study suggests that nutrients may prevent the occurrence of endometriosis by modulating levels of inflammatory factors, regulating angiogenesis, and influencing the metabolism of estrogen pathways. The findings might provide new insights into the treatment of endometriosis patients and the potential benefits of dietary patterns and nutrient supplementation in patients with endometriosis.

Exploring the Association Between Dietary Fruit Intake and Endometriosis: A Systematic Review and Meta-Analysis

Background/Objectives: Endometriosis is a chronic gynecological disorder affecting up to 10% of women of reproductive age. The etiology of endometriosis remains unclear; however, there is growing interest in identifying modifiable risk factors, particularly dietary influences. The present study aims to systematically evaluate the association between fruit consumption and the incidence of endometriosis. Methods: A comprehensive systematic search was conducted across PubMed, Embase, Web of Science, and Google Scholar for studies published from 1 January 1990 to 30 September 2024. Relevant data were extracted and categorized, and the methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklists. Additionally, meta-analyses were performed using STATA 18.0 to compare daily and weekly fruit consumption among women with and without endometriosis. Results: The analysis included six studies comprising 3689 women with endometriosis and 1463 controls. The meta-analysis revealed no significant association between daily fruit consumption and the risk of endometriosis (odds ratio (OR): 0.95; 95% confidence interval (CI): 0.90-1.01). Similarly, weekly fruit consumption did not demonstrate a significant link to endometriosis risk (OR 1.03, 95% CI: 0.78-1.35). The assessment of publication bias using Begg's and Egger's tests, along with contour-enhanced funnel plots, indicated the absence of publication bias in the data across both analysis groups. Conclusions: This study indicates that fruit consumption does not significantly influence the risk of developing endometriosis. Additional research is necessary to examine preferred dietary interventions for populations affected by this condition.

Causal analysis of dietary preferences and the risk of endometriosis using large-scale population data

Dietary factors have recently been recognized as potentially influential in the pathogenesis of endometriosis (EM), yet studies on the causal relationship between dietary preferences and EM are limited. The present study aimed to explore the causal relationships between 187 dietary preferences and EM using Mendelian randomization (MR) methods. This study utilised genome-wide association study data from over 500,000 European participants for dietary preferences and 64,658 EM patients from Finland. Dietary preferences with potential causal relationships to EM were identified using two-sample MR methods. P-values from the inverse variance weighted (IVW) analysis were corrected using the false discovery rate (FDR) method to ensure accuracy. Additionally, heterogeneity analysis, pleiotropy assessment, leave-one-out analysis, and reverse MR analysis were conducted to further validate and solidify the findings of the study. After FDR correction, IVW analysis revealed that asparagus preference was significantly protective against EM, including in American Society for Reproductive Medicine (ASRM) stages 1-2 and 3-4. Conversely, preferences for different types of coffee and orange juice were associated with an increased likelihood of EM across these stages. Subgroup analysis indicated that asparagus preference had a protective effect against deep EM, ovarian EM, pelvic peritoneal EM, and rectovaginal septum and vaginal EM. In contrast, coffee preference increased the risk of pelvic peritoneal EM, fallopian tube EM, and unspecified EM, whereas orange juice preference increased the risk of deep EM, rectovaginal septum and vaginal EM, pelvic peritoneal EM, and unspecified EM. Reverse MR analysis did not identify causal relationships between EM and the specific dietary preferences that were analysed in this study. These findings suggest that asparagus preference significantly reduces the risk of developing EM, whereas preferences for orange juice and different types of coffee may increase the risk, offering new insights into EM management through dietary modifications.

Management of Endometriosis-Related Pain: Comparing the Effectiveness of Hormonal Therapy, Surgical Interventions, and Complementary Therapies

Endometriosis is a chronic, inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus, affecting women of reproductive age. It is linked with debilitating pain, infertility, and a notable impact on the patient's quality of life. This review aims to highlight the effectiveness of hormonal therapy, surgical procedures, and complementary therapies in managing endometriosis-related pain, providing a comprehensive overview of current treatment options and their implications for clinical practice. The literature reveals that hormonal therapies, including combined oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists, are frequently used to manage endometriosis-related pain by suppressing ovarian function and reducing menstrual flow. Surgical interventions, such as laparoscopy and hysterectomy, offer pain relief by removing endometrial lesions but carry risks of recurrence and complications. Complementary therapies, including acupuncture, dietary modifications, and physical therapy, are increasingly recognized for their potential to minimize pain and improve patients' quality of life, though evidence of their effectiveness varies. The review highlights the need for personalized treatment plans that consider patient preferences, symptom severity, and reproductive goals. Future research should concentrate on the long-term outcomes of different therapies, the advancement of non-invasive diagnostic methods, and the identification of biomarkers for tailored treatment approaches. Clinicians are encouraged to adopt an interdisciplinary approach to endometriosis management, integrating medical, surgical, and complementary therapies to optimize patient outcomes.

Role of macronutrients, dairy products, fruits and vegetables in occurrence and progression of endometriosis: A summary of current evidence in a systematic review

Background

Current evidence on the role of macro- and micronutrients in the aetiopathogenesis of endometriosis is controversial.

Objectives

In this systematic review, we aimed to investigate the effect of macronutrients, dairy products, fruits, and vegetables on the occurrence and progression of endometriosis.

Materials and Methods

A systematic literature review of eligible articles retrieved from medical databases, including PubMed, Cochrane, and Academic Search, was performed from inception to May 2023.

Main outcome measures

The role of nutritional diet effects in endometriosis.

Results

Our search yielded 12 studies, including five prospective cohort trials and seven case-control studies. The analysis of this literature supports the idea that processed and unprocessed red meat increases the risk of endometriosis, while no conclusive evidence exists about the effects of other protein sources on the disease. Studies on total fat consumption, including monounsaturated, polyunsaturated, saturated, and trans-unsaturated fats, do not suggest a definitive association with endometriosis. Green leafy vegetables and fresh fruit consumption may reduce the risk of endometriosis. Furthermore, the evidence regarding fibre consumption is not conclusive. Dairy products were found to have a risk-reducing effect on the disease. However, there was no consensus about the role of vitamin D in endometriosis.

Conclusions

The certainty of the relationship between endometriosis and outcomes of nutritional factors was "very low" to "low," which limits current literature from being applied for conclusive interpretations. Further large-scale randomised trials and consequent meta-analyses are recommended for high-level evidence.

What is new?

This article presents an overview of evidence-based studies on the relationship between endometriosis and macronutrients. In addition, the possible influence of other nutritional variables on the development of endometriosis and the limitations of nutritional studies.

Associations of nutritional status and dietary habits with the development of female infertility. A case-control study

Introduction

Female infertility is a multifactorial condition influenced by lifestyle and dietary factors. Understanding the relationship between nutritional status, dietary habits, and infertility could provide insights for targeted interventions.

Methods

A case-control study was conducted in health centers and hospitals in Alicante, Spain. The study included 60 infertile and 30 fertile women aged 18-40, selected through consecutive sampling. Data on body composition and dietary intake were collected and analyzed.

Results

Infertile women exhibited significantly lower muscle mass (p = 0.005) and larger hip circumference (p = 0.034) compared to fertile women. Additionally, a significant association was found between high red meat consumption and an increased risk of female infertility (p = 0.011).

Discussion

These results suggest that body composition and dietary habits, particularly muscle mass and red meat intake, play a key role in female fertility. Interventions aimed at improving muscle mass, reducing localized body fat, and limiting red meat consumption may enhance fertility outcomes. Further longitudinal research is needed to confirm these findings across diverse populations.

Association between dietary vitamin B6 intake and endometriosis risk: evidence from the national health and nutrition examination survey

Background

Endometriosis is a multifaceted disorder with genetic, immune, inflammatory, and multifactorial origins. Vitamin B6 serves as a pivotal coenzyme in various metabolic pathways involving lipids, hemes, nucleic acids, proteins, and carbohydrates. Dysregulation or deficiency of vitamin B6 can perturb human physiology. However, the relationship between dietary vitamin B6 and endometriosis remains elusive. This study aims to explore how dietary intake of vitamin B6 is associated with the risk of endometriosis.

Methods

Using cross-sectional data from the National Health and Nutrition Examination Survey, we analyzed information from American women aged 20-54 years between 1999 and 2006. After adjusting for relevant covariates, multivariable logistic regression analysis was employed to evaluate correlations.

Results

A total of 4,453 women were included in the study. The multiple linear regression model revealed a positive association between dietary vitamin B6 intake and the risk of endometriosis, even after controlling for confounding variables. Compared to individuals with lower vitamin B6 consumption (Q1: <0.94 mg/day), the adjusted odds ratio (OR) values for dietary vitamin B6 intake and endometriosis in Q2 (0.95-1.39 mg/day), Q3 (1.40-1.99 mg/day), and Q4 (>1.90 mg/day) were 1.22 (95% CI: 0.88-1.69, p = 0.23), 1.22 (95% CI: 0.86-1.73, p = 0. 279), and 1.51 (95% CI, 1.01-2. 24, p = 0.04), respectively.

Conclusion

Our findings suggest a positive correlation between endometriosis and dietary vitamin B6 intake. Further investigations are imperative to establish a causal relationship between dietary vitamin B6 intake and endometriosis.

[The importance of nutrition in the prevention of endometriosis - Systematic review]

Introduction

Background and objective: endometriosis is a hormone-dependent disorder characterized by the presence of endometrial-like tissue in extrauterine sites, which can trigger a chronic inflammatory reaction. This disease mainly affects women of childbearing age and can have a negative impact on their physical, mental and social well-being. There are eating patterns considered as anti-inflammatory, such as the Mediterranean diet, which could help in the prevention and treatment of endometriosis. The objective of this review was to know the relationship between the consumption of different food groups and the prevention of endometriosis. Materials and methods: a systematic review was carried out following the PRISMA methodology. PubMed, Scopus, Cochrane Library and Web of Science databases were consulted. Studies published between 2013 and 2023 were selected, accessible in full text, written in English and Spanish and including a sample of women with endometriosis and/or healthy women, in addition to evaluating the relationship between diet and endometriosis. Unrelated articles, systematic reviews or meta-analyses, pilot studies and studies conducted in animals were excluded. Results: a total of ten studies were included. The consumption of fruits, vegetables (not cruciferous), dairy products, fish, potatoes, legumes, vitamins (A, C, D and B12), monounsaturated and polyunsaturated fatty acids and minerals (calcium, potassium and magnesium) seems to reduce the risk of endometriosis. Conclusions: further studies investigating the relationship between consumption of different food groups and risk of endometriosis are needed.

Association Between the Oxidative Balance Score and Endometriosis: A Population-Based Study

Purpose

To investigate the association between the oxidative balance score (OBS) and endometriosis.

Methods

This cross-sectional study used four cycles of the National Health and Nutrition Examination Survey (NHANES) (1999-2000, 2001-2002, 2003-2004, and 2005-2006). OBS involved 16 dietary nutrients and 4 lifestyle factors, including 5 pro-oxidants and 15 anti-oxidants. According to weighted quartiles, the OBS was divided into four categories: < 12.54, 12.54-18.70, 18.71-24.68, and > 24.68. Endometriosis was diagnosed based on a question from the reproductive health questionnaire. Weighted multivariate logistic analysis was used to investigate the association between OBS and endometriosis. Subgroup analysis was performed based on menstrual regularity and female hormone use.

Results

A total of 5095 women were included, with 1140 (22.37%), 1232 (24.18%), 1224 (24.02%), and 1499 (29.42%) women in the OBS < 12.54, of 12.54-18.70, of 18.71-24.68, and > 24.68 categories, respectively. After adjusting age, race, family poverty-to-income ratio (PIR), education level, uterine fibroids, menstrual regularity, oophorectomy, female hormone use, hypertension, dyslipidemia, and steroid drug, a high OBS (> 24.68) was found to be associated with lower odds of endometriosis [odds ratio (OR) = 0.70, 95% confidence interval (CI): 0.50-0.97, P = 0.033] compared to a low OBS (< 12.54). The similar result was also found in women with irregular menstruation (OR = 0.58, 95% CI: 0.37-0.91, P = 0.020) and with female hormone use (OR = 0.71, 95% CI: 0.52-0.98, P = 0.037).

Conclusion

A high OBS was associated with lower odds of endometriosis, especially in women with irregular menstruation and female hormone use.

Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients

Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.

The Association Between Daily Intake of Dietary Supplements and Self-Reported Endometriosis: A NHANES-Based Study

Dietary supplements are gaining recognition as potential influencers of female reproductive health, but their connection to endometriosis risk remains underexplored. This study addressed this gap, examining the impact of daily dietary supplement intake on the initiation and progression of endometriosis. To explore this, a cross-sectional study was conducted involving 3950 participants representative of the US population from the 1999-2006 National Health and Nutrition Examination Survey (NHANES). Infertility was determined by a question on year-long attempts to become pregnant. Unweighted and weighted multivariate logistic regression analyses assessed the association between dietary supplements and endometriosis risk. Subgroup analysis was conducted based on the participants' body mass index (BMI). The results revealed intriguing patterns. Specifically, higher dietary fiber content (Q4 vs Q1: OR = 0.56, 95% CI = (0.37,0.84), P = 0.0062) and density (Q4 vs Q1: OR = 0.55, 95% CI = (0.38,0.81), P = 0.0035) were linked to reduced risk of endometriosis. Protein content (Q4 vs Q1: OR = 0.47, 95% CI = (0.31,0.74), P = 0.0011) and density (Q4 vs Q1: OR = 0.63, 95% CI = (0.45,0.88), P = 0.0096) similarly exhibited a negative association with endometriosis risk. Interestingly, when stratified by BMI, these effects were pronounced in normal-weight women, whereas they were not evident in the overweight and obese subgroup. Protein content and density showed no significant associations across subpopulations. In conclusion, this study established a negative relationship between dietary fiber and endometriosis, particularly notable in normal-weight women. Future research is essential to validate these findings and establish a causal link between dietary fiber and endometriosis.

Low Diet Quality and Nutritional Knowledge in Women with Endometriosis: A Pilot Study

Endometriosis is a chronic gynecological disease characterized by ectopic endometrial tissue outside the uterus that can cause chronic pain, dysmenorrhea, fatigue, and infertility. The aim of this study was to assess diet quality and nutritional knowledge of women with endometriosis. A questionnaire was used to collect data on lifestyle, dietary habits and nutritional knowledge from 90 women. More than 80% of women with endometriosis (82.2%) confirmed that diet and lifestyle are related to the progression of endometriosis. After being diagnosed with endometriosis, 77.3% of respondents reported a change in their dietary habits and made various changes to their diet by increasing or eliminating the consumption of certain foods. The majority declared reducing pro-inflammatory products, increasing anti-inflammatory foods, including the consumption of vegetables and fruits, avoiding white/or red/or processed meat, and avoiding sweets. Nevertheless, diet quality as assessed by the pro-healthy diet index (pHDI-10) and the Mediterranean Diet Score (MDS) showed a low intensity of consumption of pro-healthy food (average pHDI-10 value 31.4%; MDS 7.55/14 points, p = 0.0001). Women with endometriosis reported lower than recommended consumption of fruits, vegetables, dairy products and whole grains. A higher percentage of healthy controls had a "good" level of nutritional knowledge than women with endometriosis. The results of our study highlight the need to improve diet quality and nutritional knowledge among women with endometriosis as well as developing targeted dietary recommendations to help improve well-being and reduce the pain symptoms of endometriosis.

Diet in Prevention and Treatment of Endometriosis: Current State of Knowledge

PURPOSE OF REVIEW

Endometriosis (EM) is a chronic gynecological disease that affects about 10% of women worldwide. It is characterized by the implantation of endometrial cells at ectopic sites. The most common symptom of EM is painful menstruation, which can often lead to chronic pelvic pain that significantly worsens the quality of life. Because some disease-related processes, such as inflammation, hormonal activity, menstrual cycle, or prostaglandin metabolism, can be modified by diet, nutrition may have a significant impact on development and treatment of EM. The purpose of this article was to overview the current knowledge regarding the dietary management of endometriosis.

RECENT FINDINGS

The attention of researchers has so far concentrated mainly on the role of nutrition in the risk of developing EM, while less attention has been paid to examining the use of diet in the treatment of the disease. Current studies focus primarily on various dietary components that have antiproliferative, anti-inflammatory, antioxidant, analgesic, and estrogen-lowering properties. Exploring different ways of coping with endometriosis can make a significant contribution to improving the quality of life of women at risk or diagnosed with EM.

Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects

The potential for repeated ovulation and menstruation is thought to have provided a Darwinian advantage during the Palaeolithic. Reproductive conditions remained relatively stable until the pre-industrial era, characterized by late menarche, very young age at first birth, multiple pregnancies, and prolonged periods of lactational amenorrhoea. For hundreds of thousands of years, menstruators experienced few ovulatory cycles, even though they were genetically adapted to ovulate and menstruate every month. In the post-industrial era, the age at menarche gradually declined, the age at first birth progressively increased, and breastfeeding became optional and often of short duration. This created a mismatch between genetic adaptation and socio-environmental evolution, so that what was initially a probable reproductive advantage subsequently contributed to increased susceptibility to diseases associated with lifetime oestrogen exposure, such as ovarian, endometrial and breast cancer and, hypothetically, also those associated with the number of ovulatory menstruations, such as endometriosis and adenomyosis. The incidence of endometriosis shows a steep and progressive increase around the age of 25 years, but given the consistently reported delay in diagnosis, the actual incidence curve should be shifted to the left, supporting the possibility that the disease has its roots in adolescence. This raises the question of whether, from an evolutionary point of view, anovulation and amenorrhoea should not still be considered the physiological state, especially in the postmenarchal period. However, an increase in the frequency of endometriosis in recent decades has not been demonstrated, although this deserves further epidemiological investigation. In addition, as endometriosis occurs in a minority of individuals exposed to retrograde menstruation, other important pathogenic factors should be scrutinised. Research should be resumed to explore in more detail the transtubal reflux of not only blood, but also endometrial cells, and whether they are systematically present in the peritoneal fluid after menstruation. If repetitive ovulatory menstruation during the early reproductive years is shown to increase the risk of endometriosis and adenomyosis development and progression in susceptible individuals, hormonal interventions could be used as secondary prevention in symptomatic adolescents.

Irritable bowel syndrome and endometriosis: diagnosis, similarities, and nutritional management

Irritable bowel syndrome (IBS) and endometriosis pose significant challenges to affected individuals. IBS, which is a functional gastrointestinal disorder, affects 5-10% of the population, while endometriosis affects 1 in 10 of those assigned female at birth. Despite distinct origins, symptom often overlap, which may lead to misdiagnosis. Diagnosing IBS and endometriosis requires a comprehensive approach. Nutritional management for IBS emphasises self-help strategies, nutritional changes and gut-brain axis modulation. The low FODMAP diet, which reduces the intake of foods containing specific types of carbohydrate, can be effective but requires the support of trained health professionals. For the management of endometriosis, a Mediterranean-style diet rich in antioxidants shows promise. Gastrointestinal symptoms are common with endometriosis and an individualised approach is recommended. Furthermore, vitamin D status assessment is advised. Collaboration between health professionals and dietitians is vital for tailored interventions, to enhance the wellbeing of individuals with IBS or endometriosis. A holistic approach holds promise in symptom management for both conditions.

Homozygous C677T Methylenetetrahydrofolate Reductase (MTHFR) Polymorphism as a Risk Factor for Endometriosis: A Retrospective Case-Control Study

This study was conducted to evaluate the role of methylenetetrahydrofolate reductase (MTHFR) C677T homozygous polymorphism as a risk factor for endometriosis. A retrospective case-control study was conducted from January 2020 to December 2022 on all patients attending the gynecological outpatient clinic of our institution who had performed an MTHFR polymorphisms test. Patients with endometriosis were considered cases, while those without endometriosis were considered controls. The presence of an MTHFR C677T homozygous polymorphism was defined as exposure. Risk factors for endometriosis were considered confounders in a binomial logistic regression, with endometriosis diagnosis as the dependent variable. Among the 409 included patients, 106 (25.9%) cases and 303 (74.1%) controls were identified. A higher rate of MTHFR C677T homozygous polymorphism was found in patients with endometriosis (24.5% vs. 15.8%, p = 0.0453), with an adOR of 1.889 (95% CI 1.076-3.318, p = 0.0269) at the binomial logistic regression. A history of no previous pregnancy was associated with an endometriosis diagnosis (adOR 2.191, 95% CI 1.295-3.708, p = 0.0035). An MTHFR C677T homozygous polymorphism could be considered a risk factor for endometriosis. Epigenetic modifications may be the most important mechanism explaining the observed association through the processes of altered DNA methylation and reduced activity of antioxidant systems.

Endometriosis Treatment: Role of Natural Polyphenols as Anti-Inflammatory Agents

Endometriosis is an estrogen-dependent common chronic inflammatory disease defined by the presence of extrauterine endometrial tissue that promotes pelvic pain and fertility impairment. Its etiology is complex and multifactorial, and several not completely understood theories have been proposed to describe its pathogenesis. Indeed, this disease affects women's quality of life and their reproductive system. Conventional therapies for endometriosis treatment primarily focus on surgical resection, lowering systemic levels of estrogen, and treatment with non-steroidal anti-inflammatory drugs to counteract the inflammatory response. However, although these strategies have shown to be effective, they also show considerable side effects. Therefore, there is a growing interest in the use of herbal medicine for the treatment of endometriosis; however, to date, only very limited literature is present on this topic. Polyphenols display important anti-endometriotic properties; in particular, they are potent phytoestrogens that in parallel modulates estrogen activity and exerts anti-inflammatory activity. The aim of this review is to provide an overview on anti-inflammatory activity of polyphenols in the treatment of endometriosis.

The Role of Selected Dietary Factors in the Development and Course of Endometriosis

Endometriosis is a chronic disease with a complex, heterogeneous pathogenesis that affects about 10% of women of reproductive age, causing pain and leading to infertility. Treatment consists of administering pharmacological agents (resulting in a reduction of estrogen levels and inflammation), as well as the surgical removal of endometriotic lesions. Unfortunately, despite a wide range of available therapies, there is still a high recurrence rate after surgery. Consequently, it is necessary to improve the outcome of patients with endometriosis. In this context, there is growing interest in possible dietary modification to support or complement classic treatment options and even serve as a potential alternative to hormone therapy. In addition, a growing number of studies indicate positive effects of selected dietary factors on the development and course of endometriosis. This review article focuses on the potentially beneficial effects of compounds from the polyphenol group (curcumin, epigallocatechin gallate, quercetin, resveratrol), vitamins, and selected micronutrients on endometriosis. The results indicate the potential of the selected ingredients in fighting the disease. However, most of the studies have been performed on experimental animal models, with a smaller proportion looking at the actual effects of use among women. Therefore, well-designed studies are needed to assess the importance of a well-chosen diet and the effects of specific dietary factors on the health of women suffering from endometriosis.

The Role of Dietary Fats in the Development and Treatment of Endometriosis

Endometriosis is an estrogen-dependent disease in women of childbearing age that affects approximately 5–15% of the female population. The etiology of endometriosis is complex, multifaceted, and not fully understood. In endometriosis, which is an estrogen-related chronic inflammatory condition, estrogen plays a major role in endometrial cellular growth. High estrogen levels could be another risk factor for developing endometriosis. The aim of this review is to update knowledge on the impact of dietary fats on the development of endometriosis and chronic inflammation in women with endometriosis and diet therapy. Dietary fat may be linked with the progression and development of endometriosis, but studies have been contradictory due to various issues including sample size, different study designs, and different methodological aspects. Results have shown that the risk of endometriosis may increase with a higher consumption of products rich in saturated fats, especially palmitic acid and trans-unsaturated fatty acids. Monounsaturated fats and omega-3 polyunsaturated fatty acids may likely be connected with a lower risk of developing endometriosis and with reductions in the severity of disease. Monounsaturated fats, omega-3 polyunsaturated fatty acids, and a suitable eicosapentaenoic acid to arachidonic acid ratio can be used in diet therapy to improve quality of life by reducing pain and inflammation. Further research is needed in order to fully understand the influence of dietary fats on the risk of development of this disease.