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By Jo Cunningham


March is Endometriosis Action Month (previously known as awareness month), and this year the focus is on tackling the fact that half of the UK don’t know about the condition. Endometriosis (endo) affects 176 million women worldwide. In the UK, that means it’s affecting 1 in 10 women of reproductive age. That makes it the second most common gynaecological condition. Shockingly, on average it takes 8 years from the onset of symptoms to get a diagnosis. 


It’s a chronic inflammatory condition where cells similar to those that line the uterus are found in other parts of the body. Often, within the pelvic cavity (including the ovaries, fallopian tubes, and bowel) but it is also found elsewhere such as the bladder and the diaphragm.

These cells react similarly to the monthly menstrual cycle to those within the womb – building up and then breaking down and bleeding. However, the blood is unable to leave the body as a period does. It leads to inflammation and can result in adhesions and scarring that causes significant pain, and in some cases infertility. 

The cause of endo remains unknown which means there’s no way of knowing if we can prevent it. It is thought that there’s a combination of factors, including genetics and environmental toxins, that may lead to developing the condition. For more information on this, you can read here.


Commonly these include painful periods, pelvic and back pain, painful intercourse, pain when pooping, abdominal bloating, nausea, constipation, diarrhoea, and fatigue. The condition can also lead to relationship problems, depression, isolation and affect someone’s work and social life. Getting the right help, therefore, is really important. 

There’s a big overlap between endo and IBS symptoms which may play a role in missing the diagnosis for many years. If you suspect endo: see your doctor and perhaps ask for a referral to a gynaecologist. It is something we discuss with our clients where appropriate. 


There’s, unfortunately, no known cure so far, and so current treatment plans aim to improve the quality of life for those women living with the condition which may be via surgical removal(s) of affected tissue as well as hormone therapy and pain relief. 

Women should ideally be seen by an endometriosis specialist gynaecologist and have access to a multidisciplinary (MDT) for a collaborative approach to treatment. This may mean that apart from the specialist gynaecologist they have access to a clinical nurse specialist, pain consultant and emotional support. Also within that team women should have access to a colorectal surgeon, urologist and fertility services where necessary. 


There’s limited scientific evidence for following a particular diet. That means there’s no diet that can cure endo. So be wary of anyone pushing intense or restrictive diet plans. 

We do know that a diet rich in plants (and so lots of anti-inflammatory properties) can help reduce endo-associated pain. Studies also suggest that fatty acids found in oily fish, nuts, seeds, and olive oils can also be helpful. Here at The Gut Health Clinic, we can provide tailored advice to make sure that you’re hitting your fibre targets.  

Some research suggests that a low FODMAP diet may improve the bowel symptoms endo sufferers experience. A study showed that women with endo and IBS had a higher response to the low FODMAP diet than patients with IBS alone. Note that the low FODMAP diet should be done under the guidance of a FODMAP-trained dietitian (we all are here at The Clinic). The reason is, it involves a restriction phase, followed by an all-important reintroduction phase. It’s not intended to be a long-term diet. For more info on FODMAPs stay tuned for IBS awareness month as we’ll be doing some IG lives and blog posts.  

Soy is a controversial topic for many, but a comprehensive review showed that soy products have no adverse effects when it comes to endo. However, for those with abnormal thyroid function, there are some considerations that need to be taken into account. Our recommendations are to include some whole food sources of soy in the diet such as tofu, tempeh and edamame beans (which are low FODMAP). 


When it comes to supplements, the evidence isn’t conclusive, and supplement recommendations should be tailored to the individual by a qualified healthcare professional, ideally based on lab results of vitamin/mineral levels to guide supplement choices and doses. Where possible, we recommend a food approach over what can be expensive supplement regimes. 

This list isn’t exhaustive, but includes some supplements which we often discuss with our clients here at The Gut Health Clinic:

  • Omega 3 – especially if an individual doesn’t consume oily fish. It provides anti-inflammatory benefits, and can help improve your omega 6:3 ratio which is something that we can offer as a test if a client wishes to see what their balance of omega 6 to omega 3 levels are. 
  • NAC (N-Acetyl Cystein) – studies suggest this may help reduce inflammation and pain as well as decrease abnormal cell growth. 
  • Vitamin D – this plays an important role in the immune system (see our previous post here), and so optimising levels for endo ladies is important. If necessary we can arrange testing for this to provide a personalised vitamin D plan. 
  • Magnesium – choosing a gentle blend supplement can help with muscle relaxation, improved sleep, as well as softening stools.
  • Zinc – another one that plays an important role within the immune system. Studies suggest that zinc levels may be lower in those with endometriosis – we can test for this if necessary. 
  • Fibre supplements such as psyllium, flaxseed, chia or PHGG (partially hydrolysed guar gum) can be useful for those who have bloating and irregular stool habits. This is something that we always discuss with our endo ladies in The Gut Health Clinic as pooping regularly can help flush out excess oestrogen which is important when considering endo. 
  • Probiotics – there’s nothing conclusive, but studies suggest that endo ladies may have lower levels of certain strains of bacteria within their gut microbiome meaning a multi-strain probiotic supplement may be helpful. This should be tailored to the individual, which is what we discuss in our clinic with clients. In some cases, the benefits of a probiotic are only seen whilst taking it (i.e. benefits cease when the supplement stops). So before starting a probiotic it should be considered whether it is something an individual can afford or wishes to take for the long term if necessary. 

 * Note that it is important to discuss supplements with your doctor/pharmacist before starting in case of any drug-interactions. 


Endo sufferers are often living with daily pain or discomfort which can affect the quality of life, mood and relationships. That way it can have a knock-on effect on the gut via our GBA which is the constant communication between our gut and our brain via millions of nerves. You can read our post on the GBA here.

Techniques such as breathing exercises, yoga or mindfulness can help induce that “rest and digest” state which can not only improve digestion but can turn off that stress response which we know is associated with inflammation if over prolonged periods of time. 


If you’re interested in getting involved in Endometriosis Action Month take a look at EndometriosisUK (IG: @endometriosis.uk). It is the UK’s largest charity supporting those affected by endo. Their website has more information about the actions you can take this month. You can also find out more information including downloadable resources as well as how to access the support groups or helpline. 

Jo Cunningham is a gut specialist dietitian with in-depth clinical dietetic experience ranging across both NHS and private healthcare settings. Jo is experienced in helping clients to resolve gut symptoms including reflux, bloating, constipation, diarrhoea, and abdominal pain. She also specialises in the management of Irritable Bowel Syndrome (IBS) and in the use of the low FODMAP diet.

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