MEDICAL NUTRITION THERAPY, TARGETED SUPPLEMENTATION, AND MICROBIOTA MODULATION IN ENDOMETRIOSIS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6204Keywords:
Endometriosis, Mediterranean Diet, Low-FODMAP, Supplementation, Microbiota, Oxidative StressAbstract
Endometriosis is a chronic, estrogen-dependent inflammatory disease for which conventional treatments often prove insufficient. This narrative review comprehensively evaluates the impact of Medical Nutrition Therapy (MNT), targeted supplementation, and the intestinal microbiota on the pathomechanism and clinical course of endometriosis. A structured literature search was conducted across PubMed, Scopus, and Google Scholar databases, analyzing evidence-based studies published primarily between 2016 and 2026. The synthesized findings demonstrate that personalized non-pharmacological interventions exhibit significant therapeutic potential. Specifically, the low-FODMAP diet effectively alleviates overlapping gastrointestinal symptoms, while the Mediterranean diet reduces oxidative stress and modulates estrogen metabolism. Conversely, routine gluten elimination lacks justification without specific medical indications. Targeted supplementation with vitamin D, Omega-3 fatty acids, and antioxidants exhibits immunomodulatory properties, though clinical efficacy often varies due to phenotypic heterogeneity. Furthermore, emerging evidence highlights the gut-uterine axis as a key etiopathogenetic paradigm; dysbiosis and endotoxin translocation actively drive pelvic inflammation, making estrobolome modulation highly promising. Ultimately, nutritional interventions serve as a synergistic complement to conventional medicine, highlighting the urgent need to shift from universal protocols toward multidisciplinary, precision dietary care tailored to the patient’s individual metabolic and microbial phenotype.
References
Abokhrais, I. M., Denison, F. C., Whitaker, L. H. R., Saunders, P. T. K., Doust, A., Williams, L. J., & Horne, A. W. (2020). A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1). PLoS One, 15(2), e0230055. https://doi.org/10.1371/journal.pone.0230055
Almassinokiani, F., Khodaverdi, S., Solaymani-Dodaran, M., Akbari, P., & Pazouki, A. (2016). Effects of vitamin D on endometriosis-related pain: A double-blind clinical trial. Medical Science Monitor, 22, 5110–5115. https://doi.org/10.12659/msm.901838
Barrea, L., Verde, L., Annunziata, G., Chedraui, P., Petraglia, F., Cucalón, G., ... & Muscogiuri, G. (2025). Effectiveness of medical nutrition therapy in the management of patients with obesity and endometriosis: From the Mediterranean diet to the ketogenic diet, through supplementation. The role of the nutritionist in clinical management. Current Obesity Reports, 14(1), 1–15. https://doi.org/10.1007/s13679-025-00662-8
Brouns, F., Van Haaps, A., Keszthelyi, D., Venema, K., Bongers, M., Maas, J., & Mijatovic, V. (2023). Diet associations in endometriosis: A critical narrative assessment with special reference to gluten. Frontiers in Nutrition, 10, 1166929. https://doi.org/10.3389/fnut.2023.1166929
Buggio, L., Barbara, G., Facchin, F., Frattaruolo, M. P., Aimi, G., & Berlanda, N. (2017). Self-management and psychological-sexological interventions in patients with endometriosis: Strategies, outcomes, and integration into clinical care. International Journal of Women’s Health, 9, 327–340. https://doi.org/10.2147/IJWH.S119724
Cuadrado-Torroglosa, I., García-Velasco, J. A., & Alecsandru, D. (2024). The impacts of inflammatory and autoimmune conditions on the endometrium and reproductive outcomes. Journal of Clinical Medicine, 13(13), 3724. https://doi.org/10.3390/jcm13133724
Habib, N., Buzzaccarini, G., Centini, G., Moawad, G. N., Ceccaldi, P. F., Gitas, G., Alkatout, I., Gullo, G., Terzic, S., & Sleiman, Z. (2022). Impact of lifestyle and diet on endometriosis: A fresh look to a busy corner. Menopause Review, 21(2), 124–132. https://doi.org/10.5114/pm.2022.116437
Indraccolo, U., & Indraccolo, S. R. (2017). Effect of palmitoylethanolamide-polydatin combination on chronic pelvic pain associated with endometriosis: A retrospective observation. European Journal of Obstetrics & Gynecology and Reproductive Biology, 213, 135–138. https://doi.org/10.1016/j.ejogrb.2017.04.011
Jiang, I., Yong, P. J., Allaire, C., & Bedaiwy, M. A. (2021). Intricate connections between the microbiota and endometriosis. International Journal of Molecular Sciences, 22(11), 5644. https://doi.org/10.3390/ijms22115644
Liu, P., Maharjan, R., Wang, Y., Zhang, Y., Zhang, Y., Xu, C., ... & Miao, J. (2023). Association between dietary inflammatory index and risk of endometriosis: A population-based analysis. Frontiers in Nutrition, 10, 1077915. https://doi.org/10.3389/fnut.2023.1077915
Mehdizadehkashi, A., Rokhgireh, S., Tahermanesh, K., Eslahi, N., Minaeian, S., & Samimi, M. (2021). The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis. Journal of Obstetrics and Gynaecology, 41(7), 1146–1151. https://doi.org/10.1080/09513590.2021.1878138
Muharam, R., Yo, E. C., Irzanti, A. N., Mutia, K., Sumapraja, K., Harzif, A. K., ... & Hestiantoro, A. (2025). The role of nutrition in endometriosis prevention and management: A comprehensive review. International Journal of Fertility and Sterility, 19(2), 79–89. https://doi.org/10.22074/ijfs.2025.2029021.1683
Nodler, J. L., DiVasta, A. D., Vitonis, A. F., Karevicius, S., Malsch, M., Sarda, V., ... & Missmer, S. A. (2020). Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (DYNAMIC): A double-blind, randomized, placebo-controlled trial. The American Journal of Clinical Nutrition, 112(1), 187–195. https://doi.org/10.1093/ajcn/nqaa096
O'Brien, L., Kasti, A., Halmos, E. P., Tuck, C., & Varney, J. (2024). Evolution, adaptation, and new applications of the FODMAP diet. Journal of Gastroenterology and Hepatology, 39(7), 1332–1341. https://doi.org/10.1002/jgh3.13066
Pellegrini, C., Maggio, R., & Blandini, F. (2020). Resveratrol in endometriosis: A review of the molecular mechanisms. International Journal of Molecular Sciences, 21(21), 8089. https://doi.org/10.3390/ijms21218089
Porpora, M. G., Brunelli, R., Costa, G., Imperiale, L., Krasnowska, E. K., Lundeberg, T., Nofroni, I., Piccioni, M. G., Pittaluga, E., Ticconi, C., & Parasassi, T. (2013). A promise in the treatment of endometriosis: An observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-Based Complementary and Alternative Medicine, 2013, 240702. https://doi.org/10.1155/2013/240702
Sienko, A., Cichosz, A., Urban, A., Smolarczyk, R., Czajkowski, K., & Sienko, J. (2023). The effect of two anti-inflammatory dietary components, omega-3 and resveratrol, on endometriosis. Ginekologia Polska, 94(10), 820–826. https://doi.org/10.5603/gpl.97573
Stochino Loi, E., Pontis, A., Cofelice, V., Pirarba, S., Fida, M., Daniilidis, A., ... & Angioni, S. (2020). Effect of melatonin in endometriosis: A systematic review. International Journal of Molecular Sciences, 21(5), 1772. https://doi.org/10.3390/ijms21051772
Sverrisdóttir, U. Á., Hansen, S., & Rudnicki, M. (2022). Impact of diet on pain perception in women with endometriosis: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 271, 1–7. https://doi.org/10.1016/j.ejogrb.2022.02.028
Tassinari, V., Smeriglio, A., Stillittano, V., Trombetta, D., Zilli, R., Tassinari, R., ... & Marcoccia, D. (2023). Endometriosis treatment: Role of natural polyphenols as anti-inflammatory agents. International Journal of Molecular Sciences, 24(14), 11467. https://doi.org/10.3390/ijms241411467
van Haaps, A. P., Wijbers, J. V., Schreurs, A. M. F., Vlek, S., Tuynman, J., De Bie, B., ... & Mijatovic, V. (2023). The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: A prospective study with control group. Human Reproduction, 38(11), 2216–2227. https://doi.org/10.1093/humrep/dead214
Varney, J. E., So, D., Gibson, P. R., Rhys-Jones, D., Lee, Y. S. J., Fisher, J., ... & Muir, J. G. (2025). Effect of a 28-day low FODMAP diet on gastrointestinal symptoms associated with endometriosis (EndoFOD)—A randomised, controlled crossover feeding study. Alimentary Pharmacology & Therapeutics, 61(4), 450–462. https://doi.org/10.1111/apt.70161
Wilder, L. H., Cabre, H. E., Dickey, M. S., & Redman, L. M. (2025). Endometriosis: Pathophysiology and the potential role of diet. Advances in Physiology Education, 49(1), 12–25. https://doi.org/10.1152/advan.00198.2025
Wójtowicz, M., Małek, P., & Olszanecka-Glinianowicz, M. (2025). The role of dietary supplements in the treatment of endometriosis: A critical review. Nutrients, 18(8), 1274. https://doi.org/10.3390/nu18081274
Xholli, A., Cremonini, F., Perugi, I., Londero, A. P., & Cagnacci, A. (2023). Gut microbiota and endometriosis: Exploring the relationship and therapeutic implications. Pharmaceuticals, 16(12), 1696. https://doi.org/10.3390/ph16121696
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Copyright (c) 2026 Aneta Sobek, Katarzyna Kraska, Jan Potoniec, Weronika Kępa, Joanna Kadłuczka, Aleksandra Papuga, Magdalena Grzymek, Aleksandra Pawłucka, Katarzyna Pawłucka, Justyna Bury, Martyna Więcławek
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