Review
Endometriosis, dysmenorrhoea and diet

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Abstract

Objective

To review the literature on the effects of diet on endometriosis and dysmenorrhoea.

Study design

A systematic search for trials investigating a relationship between diet and endometriosis/dysmenorrhoea was undertaken, and 23 studies were included in this review.

Results

Data on the relationship between diet and endometriosis were limited to 12 trials, three of which were animal studies, resulting in a total of 74,708 women. One large study (n = 70,709) found a relatively strong association between endometriosis and trans-fatty acid consumption, and a lower risk of endometriosis with increased consumption of long-chain omega-3 fatty acids. The latter finding was also supported by smaller studies. No further dietary recommendations for reducing the risk of endometriosis were possible, and results for intake of vegetable, fibre and fruit were equivocal. The relationship between diet and dysmenorrhoea was investigated in 11 trials with different designs, including a total of 1433 women. Intake of fish oil seemed to reduce dysmenorrhoea.

Conclusion

The literature on endometriosis and dysmenorrhoea in relation to diet is sparse, yielding equivocal results on specific elements. Overall, however, the literature suggests that specific types of dietary fats are associated with endometriosis and/or dysmenorrhoea, thereby indicating that there may be modifiable risk factors. Further research is recommended on both subjects.

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

References (51)

  • S. Netsu et al.

    Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis

    Fertil Steril

    (2008)
  • A.L. Covens et al.

    The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit

    Fertil Steril

    (1988)
  • N. Rahbar et al.

    Effect of omega-3 fatty acids on intensity of primary dysmenorrhea

    Int J Gynaecol Obstet

    (2012)
  • Z. Harel et al.

    Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents

    Am J Obstet Gynecol

    (1996)
  • C. Balbi et al.

    Influence of menstrual factors and dietary habits on menstrual pain in adolescence age

    Eur J Obstet Gynecol Reprod Biol

    (2000)
  • B. Deutch et al.

    Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules)

    Nutr Res

    (2000)
  • M.R. Laufer et al.

    Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy

    J Pediatr Adolesc Gynecol

    (1997)
  • S. Simoens et al.

    The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres

    Hum Reprod

    (2012)
  • D. O’Callanghan

    Endometriosis. An update

    Aust Fam Physician

    (2006)
  • C. Templeman

    Adolescent endometriosis

    Curr Opin Obstet Gynecol

    (2012)
  • K.E. Nnoaham et al.

    World Endometriosis Research Foundation Global Study of Women's Health Consortium, impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries

    Fertil Steril

    (2011)
  • J.A. Garcia-Velasco et al.

    Medical treatment of endometriosis

    Minerva Ginecol

    (2005)
  • K.A. Burns et al.

    Estrogen receptors and human disease: an update

    Arch Toxicol

    (2012)
  • A. Tsubura et al.

    Dietary factors modifying breast cancer risk and relation to time of intake

    J Mammary Gland Biol Neoplasia

    (2005)
  • S.-F. Chang et al.

    Factors that affect self-care behaviour of female high school students with dysmenorrhoea: a cluster sampling study

    Int J Nurs Pract

    (2012)
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