Non-diet strategies for managing endometriosis

I once learned that it takes, on average, 7 years for people to receive a diagnosis for endometriosis. It was years ago when I heard this statistic and I was horrified and shocked. Strangely enough, I also had endo at the time and had no idea, and my time to diagnosis ended up being about 20 years. The signs were there, but I thought what I was experiencing was normal. (Dear reader, it was not!)

I was diagnosed with endometriosis in October 2025 and I expect I'll be learning new things about managing it for the rest of my life. Today I want to speak about strategies to help manage endometriosis that are evidence-based and of course, not restrictive.

Living with endometriosis has made me really, really understand why people will try anything to get relief. Living with chronic, sometimes daily, pain is horrendous and something that is hard to explain unless you've been there. I'm thankfully feeling so much better after surgery, but of course I worry about endo returning and want to do everything I can (within reason and comfort) to keep it at bay.

Just like with any health condition, you or I could do all the things and still end up with something negative happening, or needing more medical interventions but it can feel good and worthwhile to try things that might help.

Okay, so with those disclaimers, what does evidence actually show about endometriosis management?

Like any health condition I help clients manage, I think about different pillars of treatment options and then it's up to each person to decide if/how/when/where they want to try things!

These typically are: medical treatments, supplements, food, exercise, and other lifestyle modifications.

Let's start with the medical treatment category of surgery and medications.

I won't be touching much on those in this post since I am not a medical provider, but of course those are front line treatments for endometriosis. I joke, but it's true, that no amount of kale or supplements was going to treat my endo - I needed surgery. Endo is different for everyone so some people may manage it without surgery or medications, but many do (myself included).

For more details, The Endo Foundation has helpful pages on surgery and hormone therapy. I don't love their "diet and lifestyle" category but the other pages are helpful IMO!

Supplement support

Many of the supplements recommended for endo fall under antioxidant support, because is a highly inflammatory disease. Essentially, endometrial tissue grows in places where it should not be. The body recognizes this and mounts an inflammatory response which can trigger pain and other symptoms. Increasing antioxidant intake may help counteract this inflammation.

• N-acetylcysteine (NAC) is a precursor to the antioxidant glutathione, which is sometimes called the "master antioxidant." NAC in supplement form is derived from the amino acid L-cysteine and is more readily available than taking glutathione. Once you take it, it does convert into glutathione and it may offer benefits on its own.

  • This study of 120 patients found used 600 mg three times per day, three times per week, for three months and it was associated with reduction in pain and the size of endometriomas. It's a small study, but has promising results, and other lab studies and older studies are also suggestive that NAC is helpful for endometriosis management.

• Omega 3 fatty acids are a type of polysaturated fatty acid that have antioxidant properties. They are often noted for their heart health properties and can be supportive for other inflammatory diseases like rheumatoid arthritis. This study suggests omega-3 supplementation may reduce symptoms of endometriosis, and higher circulating levels of EPA (an omega 3) are associated with lower risk (source).

• Vitamin C & Vitamin E are both antioxidants. Vitamin C is water soluble and Vitamin E is fat soluble which means it needs to be taken with fat-containing food for best absorption. This study found decreased pelvic pain, pain during intercourse, and inflammatory markers among patients supplementing with both Vitamin C & E.

This review I've linked a few times already is a great resource if you want to look at even more options. The few I've mentioned here tend to be well-tolerated, and of course I always recommend talking to your medical provider and/or dietitian before starting anything new!

Food category

As a dietitian and especially an eating disorder dietitian, my first recommendation is to eat enough food. Work with a dietitian if you need clarity on what that looks like, or need help getting there. This can absolutely be complicated with endo - pain can make it harder to eat and so can the GI-related symptoms that some people with endo experience. In addition, dealing with such a frustrating, painful disease can also lead to folks turning to disordered eating behaviors to cope and manage. We completely get the mental and physical barriers that can get in the way and are here to help.

Your body needs enough carbs, fat, protein, vitamin & minerals in general and everything is harder for your body to do when you are not eating enough. Also, remember all those awesome antioxidants we already mentioned? If you are eating enough and including carbs/fat/protein/fiber at meals, chances are you'll be getting a good bit of those in through food (supplements can still help, though).

In addition to eating enough overall, increasing fiber and antioxidant intake can be useful. We've covered antioxidants extensively already, so let's shift the focus to fiber.

Fiber is an indigestible carbohydrate found in plant foods. Human bodies cannot break it down! This is one reason fiber can be helpful for bowel regularity (it helps move things along, so it can also be helpful if constipation is one of your endo symptoms). Fiber intake is also associated with reduced risk of certain cancers and heart disease.

Increased fiber intake can be useful in endo because fiber acts as a binding agent. Endo is marked by high levels of estrogen, which fuels further endometriosis growth. Fiber can help bind some of this estrogen which is then excreted through waste, thus lowering levels in the blood/body. This is supported by this recent review. This study also found that higher fiber intake was associated with a lower risk of developing endo.

Fiber-rich foods are also typically high in antioxidants, so it's a win-win for endo (as long as you can tolerate it digestively and it feels good mentally to gently focus on. A fiber supplement could also be helpful if you struggle to get enough through food. Don't forget to increase water consumption as you increase fiber consumption to help avoid constipation!

Please do not take this to think - "if only I'd eaten more fiber, I wouldn't have endo!" That is not my takeaway. These studies are observational and do not prove that fiber causes or does not cause endo (same for any other research listed here... unfortunately the etiology of endo is still not well understood). My takeaway is that the two seem to be connected, so eating more fiber could be helpful. In addition, another study actually found the reverse where higher fiber intake was associated with higher endo risk, so more studies are needed to clarify the relationship and look at possible confounding variables.

Exercise

When I was dealing with regular endo pain this section would have made me roll my eyes on a bad day, so if that's you - I totally get it. There are many days when dealing with endo means strapping on a heating pad and simply making it through the day, and exercise is totally off the table. This is part of a healthy relationship with exercise- knowing when your body is up for it and being okay with rest when that is what is needed. Just like nutrition, exercise and its relation to health is about patterns over time. There is room for flexibility.

Research suggests that exercise can generally be beneficial for endometriosis management. There is not a great volume of research on this, but a 2025 review found that exercise has a positive impact on quality of life, pain intensity, mental health, pelvic floor dysfunction, and bone density. Physical activity has the capability of reducing inflammation in the body and also lowering estrogen levels - both potentially beneficial for endo symptoms.

Start low-impact if you're new or in an endo flare or post surgery, and adjust based on how your body feels. Higher-intensity exercise can sometimes worsen symptoms, so listening to your body is key.

Other lifestyle factors

One other category I can't leave out is taking care of yourself overall. Sleep, stress, and mental health can all be impacted by living with endometriosis and are important to pay attention to. Rest, relaxation, and support for your mental health is just as important as all the other areas we've touched on.

It’s also important to remember that you won’t always be able to focus on every pillar equally. For example, after surgery, you might not be able to cook as much or exercise, but you can stay consistent with supplements or prioritize rest and mental health. At other times, being more consistent with exercise might be your main focus while something else takes a backseat. That's okay-we can't do all the things all the time, that's a recipe for burnout! Plus, life happens. Revisiting the pillars listed here can help you remember the things you are doing to take care of yourself.

I hope this was helpful! Unfortunately, endometriosis is a disease that still needs much more funding and research, but the studies we do have give us clues about where to focus our time, energy, and resources. Hopefully over the coming years we will learn more about new medications, supplements, and other strategies that are helpful.

I’d love to hear from you about anything else you’ve found helpful, and if you’re struggling with food, body image, or exercise while managing endo, we’d be happy to support you.