European Journal of Obstetrics & Gynecology and Reproductive Biology
ReviewEndometriosis, dysmenorrhoea and diet
Introduction
Endometriosis is one of the main reasons for hospitalization in gynaecology departments, and its prevalence seems to be increasing in the western world [1], [2]. Endometriosis is a condition where ectopic endometrial tissue is present in the peritoneal cavity [1], and can cause symptoms of pelvic pain, dysmenorrhoea, dyspareunia and infertility [3], [4]. The prevalence of endometriosis is unknown, as diagnoses usually need to be confirmed by laparoscopy. The best population-based estimate is that 10% of all women of reproductive age and 30–50% of women with symptoms are affected by endometriosis [5].
Existing treatment, which includes hormonal medication and surgery, has not shown impressive results [5]. Pain is often reported after therapy, and normal fertility rates are not restored after treatment [6], [7]. Therefore, any type of intervention that could prevent, modify or cure endometriosis would be of great benefit.
Several aetiologies of endometriosis have been proposed. As oestrogen is a common denominator among several known risk factors for endometriosis, and an association has been found between diet and oestrogen-dependent diseases (e.g. breast or endometrial cancer), endometriosis may also be influenced by diet [8], [9], [10].
Dysmenorrhoea is defined as painful menstrual cramps of uterine origin with normal pelvic anatomy. It is a very common gynaecological disorder with a high prevalence in adolescent girls. Prevalence ranges from 45% to 95% in developed countries [11], [12], [13]. Women with endometriosis have a high prevalence of dysmenorrhoea, and this symptom has been shown to be an important predictor of endometriosis among women with infertility problems [14], [15]. It is therefore possible that a large number of patients who are suffering from dysmenorrhoea have undiagnosed endometriosis. Therefore, factors affecting one condition (e.g. diet) might also affect the other condition.
In both endometriosis and dysmenorrhea, prostaglandins (PGs) are thought to play a pathogenetic role [16], [17], [18], [19], [20], [21], [22]. Fish oils/polyunsaturated fatty acids (PUFAs) may be of benefit in cases of endometriosis and/or dysmenorrhea, as an enriched diet of omega-3 fatty acids (FAs) resulting in an anti-inflammatory profile may reduce the pro-inflammatory PGs derived from omega-6 FAs, and the symptoms of endometriosis and/or dysmenorrhoea [23], [24], [25].
This review is an update of a previous review [26], further to the publication of 11 new studies. The objectives of this review were to assess a possible association between dietary components and endometriosis and/or dysmenorrhoea from the existing literature; and, if possible, to specify any dietary recommendations for women suffering from these conditions.
Section snippets
Materials and methods
A systematic search was undertaken to identify relevant studies to investigate the effect of diet on endometriosis and/or dysmenorrhea. The following databases were searched: Cochrane Database of Systematic Reviews (Cochrane Library), MEDLINE (1966–December 2012) and EMBASE (1973–December 2012). The following MESH terms were used: [endometriosis] AND [diet] OR [food], [dysmenorrhoea] AND [diet] OR [food], [endometriosis] AND [fish oil]/[polyunsaturated fatty acids], and [dysmenorrhoea] AND
Results
Table 1 lists the articles on endometriosis and diet, and Table 2 lists the articles on dysmenorrhoea and diet. The articles are listed by dietary compound and therefore the same articles can be found under more than one heading. The methodological quality of the studies is discussed below.
Methodological quality
Few studies were found on each subject, and as the study methodologies and outcome measures varied, interpretation of the data was difficult. Quality problems are listed below.
A general problem in terms of comparison was that not all studies had an exact diagnosis of endometriosis, as this generally requires surgery. Additionally, the disease stage and location of endometriosis differed. Furthermore, some of the articles did not mention whether the women were suffering from primary or secondary
Discussion
Most studies on endometriosis, dysmenorrhoea and diet have been small studies, giving equivocal results on specific elements. Overall, however, the literature suggests that specific types of dietary fats are associated with endometriosis and/or dysmenorrhoea, and these relationships indicate several modifiable risks.
Conclusion
There is an urgent need to improve understanding of the impact of dietary components on the risk of endometriosis and dysmenorrhoea in order to modify and/or prevent these prevalent gynaecological diseases. The literature on endometriosis, dysmenorrhoea and diet is sparse, with equivocal results on specific elements. Overall, the literature suggested that increased consumption of omega-3 FAs, fish oils and PUFAs has a positive effect on endometriosis and dysmenorrhoea, indicating that there may
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