on June 07, 2026
Endometriosis: a systemic inflammatory disease
Endometriosis is a chronic gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity. These ectopic implants can be located in the ovaries, fallopian tubes, peritoneum, rectovaginal septum, intestine, bladder, and, more rarely, in other organs.
According to international estimates, it affects approximately 10% of women of childbearing age and is one of the main causes of chronic pelvic pain and female infertility.
Although for many years it was considered exclusively a gynecological condition, today endometriosis is increasingly recognized as a systemic inflammatory disease in which immunological, metabolic, endocrine, and intestinal factors contribute to the progression of the disease and the appearance of symptoms.
Why does endometriosis cause pain?
Ectopic endometrial tissue responds to the hormonal stimuli of the menstrual cycle in the same way as the endometrium present in the uterus.
During each menstrual cycle, these tissues:
- proliferate;
- bleed;
- activate the immune response;
- release inflammatory mediators.
Since the blood cannot be eliminated outside the body, persistent inflammatory processes develop that promote:
- chronic pelvic pain;
- severe dysmenorrhea;
- dyspareunia;
- abdominal bloating;
- intestinal disorders;
- adhesion formation;
- infertility.
Among the main mediators involved are prostaglandins, inflammatory cytokines, tumor necrosis factor alpha (TNF-α), and pro-inflammatory interleukins.
The role of estrogens
Endometriosis is an estrogen-dependent condition.
Estrogens promote:
- the proliferation of endometrial cells;
- the survival of ectopic implants;
- the production of inflammatory mediators;
- the formation of new blood vessels that nourish the lesions.
For this reason, all strategies that contribute to maintaining a proper hormonal balance can have favorable effects on symptoms.
Excess adipose tissue is an aggravating factor because body fat produces aromatase, the enzyme responsible for converting androgens into estrogens.
Maintaining an adequate body weight therefore becomes an important therapeutic goal.
Endometriosis and the intestinal microbiota
In recent years, the concept of the "estrobolome" has emerged, which is the set of intestinal microorganisms involved in estrogen metabolism.
Intestinal dysbiosis can:
- alter estrogen metabolism;
- promote their reabsorption;
- increase systemic inflammation;
- worsen endometriosis symptoms.
In addition, many women with endometriosis present gastrointestinal symptoms such as:
- bloating;
- constipation;
- diarrhea;
- irritable bowel syndrome;
- pain during defecation.
Maintaining a balanced microbiota therefore represents an important therapeutic goal.
Anti-inflammatory diet: a pillar of treatment
Although diet cannot cure endometriosis, numerous pieces of evidence suggest that a proper nutritional strategy can contribute significantly to symptom reduction.
The main goal is to reduce:
- systemic inflammation;
- oxidative stress;
- hyperinsulinemia;
- estrogen excess.
Dietary fiber and estrogen control
Fiber promotes:
- proper intestinal transit;
- the elimination of metabolized estrogens;
- the nourishment of the microbiota;
- the reduction of inflammation.
It is recommended to increase the consumption of:
- vegetables;
- green vegetables;
- fresh fruit;
- legumes;
- seeds;
- whole grains.
Fiber can contribute to reducing the intestinal reabsorption of estrogens and improving hormonal balance.
The role of Omega-3s
Omega-3 fatty acids are among the most studied nutrients in endometriosis.
EPA and DHA promote the production of less inflammatory prostaglandins and contribute to pain reduction.
The main food sources are:
- oily fish;
- sardines;
- mackerel;
- salmon;
- tuna;
- chia seeds;
- flaxseeds;
- walnuts.
Several observational studies have shown that high omega-3 consumption is associated with a lower incidence and severity of endometriosis symptoms.
Stabilizing blood sugar to reduce inflammation
Chronic hyperinsulinemia is associated with:
- increased inflammation;
- hormonal alterations;
- increased oxidative stress.
For this reason, it is useful to:
- limit simple sugars;
- reduce sugary drinks;
- avoid processed sweets;
- prefer whole grains;
- always combine carbohydrates and proteins in the same meal.
Improved insulin sensitivity also promotes a more balanced endocrine regulation.
Foods to limit
Red meats
Numerous epidemiological studies have shown an association between high red meat consumption and an increased risk of endometriosis.
Possible mechanisms include:
- increased inflammation;
- increased oxidative stress;
- exposure to pro-inflammatory substances.
Alcohol
Alcohol can increase circulating estrogen levels and promote inflammatory processes.
Ultra-processed products
Foods rich in:
- trans fats;
- refined sugars;
- additives;
- preservatives;
can contribute to maintaining chronic inflammation.
Vitamin D and the immune system
Vitamin D plays a fundamental role in immune regulation.
Women with endometriosis frequently have reduced vitamin D levels.
Several studies suggest that adequate levels may help to:
- modulate the inflammatory response;
- reduce pain;
- improve quality of life.
Curcumin and polyphenols
Curcumin, the main active compound in Curcuma longa, has shown interesting properties:
- anti-inflammatory;
- antioxidant;
- anti-angiogenic.
Experimental models have shown a reduction in the growth of endometriotic lesions through the modulation of NF-kB, COX-2, and several inflammatory cytokines.
Quercetin, green tea, and other plant polyphenols also show potentially beneficial biological activity.
Movement and physical activity
Regular physical activity helps to:
- improve insulin sensitivity;
- reduce systemic inflammation;
- promote estrogen metabolism;
- improve mood;
- reduce pain perception.
Intense activity is not necessary.
Brisk walking, yoga, Pilates, swimming, and moderate exercise are excellent strategies.
Stress and pain: an underestimated link
Chronic stress can amplify pain perception and contribute to the activation of inflammatory pathways.
Techniques such as:
- diaphragmatic breathing;
- mindfulness;
- meditation;
- yoga;
can significantly improve patients' quality of life.
The modern approach to endometriosis considers intestinal, metabolic, hormonal, and psychological health as closely interconnected aspects.
Conclusions
Endometriosis is a complex condition in which inflammation, hormones, intestinal microbiota, and the immune system continuously interact.
Proper nutrition does not replace medical therapies but is a fundamental tool that can help control inflammation, improve hormonal balance, and reduce symptom severity.
Integrating an anti-inflammatory diet, adequate omega-3 intake, maintenance of an optimal body weight, regular physical activity, and proper stress management can constitute an effective strategy for improving the quality of life of women with endometriosis.
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