For many women with endometriosis, chronic and painful gastrointestinal symptoms are part of daily life, yet they often go untreated due to under-recognition by healthcare providers and a lack of evidence-based treatment options. Endometriosis is a chronic, inflammatory gynaecological disorder affecting one in seven Australian women. It causes a range of unpredictable and often severe symptoms, including dysmenorrhoea (painful periods), pelvic pain (below the belly button and between the hips), and dyspareunia (pain during sexual intercourse). These symptoms disrupt daily life, impacting finances, relationships, mental health, and the ability to work, learn, socialise, exercise, and have children.According to Jane Varney, Senior Research Dietitian at the Department of Gastroenterology, Monash University, gastrointestinal symptoms such as abdominal pain, bloating, distension, diarrhoea, constipation, and painful defecation affect more than three-quarters of sufferers. These symptoms often intensify during menstruation, occur regardless of bowel involvement, and overlap with irritable bowel syndrome (IBS), which affects between 10.6 per cent and 52 per cent of women with endometriosis.Why current treatments fall shortDespite the high prevalence and burden of gut symptoms in endometriosis, treatment options are limited. Few treatments specifically target these gastrointestinal issues, and some, such as progesterone and opioid medications, can make them worse. Surgery can come with long waiting times, high costs, ongoing pain, and the need for repeat procedures, while hormone treatments and pain relief medicines are limited by modest effectiveness and troublesome side effects.It is no surprise that many women turn to self-management strategies such as diet and nutritional supplements to help control symptoms and take an active role in their care. International data shows that more than 58 per cent of women with endometriosis have tried supplements, though only 43 per cent reported an improvement in pain. In Australia, three-quarters use fish oil, multivitamins, vitamin B, or vitamin D.Dietary changes are also common. Surveys from Australia, Holland, the UK, and beyond reveal that between 27 per cent and 84 per cent of women with endometriosis use dietary modifications to manage symptoms, with many reporting benefits. Popular approaches include anti-inflammatory diets or avoiding red meat, gluten, dairy, lactose, FODMAPs, caffeine, soy, and alcohol. However, the evidence for most of these is limited or absent.The EndoFOD studyRecognising the gap in evidence and the similarity of symptoms between IBS and endometriosis, Monash University researchers recently examined the effect of a low FODMAP diet on women with endometriosis and persistent gut symptoms.The study was the first randomised controlled crossover feeding trial in this patient group. Thirty-five participants were assigned to a 28-day low FODMAP diet or a control diet based on Australian dietary guidelines, with both diets nutritionally matched except for their FODMAP content. After a washout period of at least 28 days, they switched to the other diet. Each diet began on the first day of a menstrual cycle to account for hormonal symptom fluctuations.By the end of the trial, 60 per cent of participants responded to the low FODMAP diet, with significant improvements in gut symptom severity. Abdominal pain, bloating, stool consistency, and quality of life all improved. Changes were noticeable by week two, continuing steadily until the end of the intervention.What it means for endometriosis careThese results offer the first evidence-based diet therapy for women with endometriosis. While the low FODMAP diet is not a replacement for medical or surgical treatment, it provides an effective additional tool for managing troublesome gut symptoms.What’s next for diet researchResearchers emphasise that further studies are needed to confirm these results in real-world conditions. The trial controlled variables tightly by supplying participants with most of their food, ensuring adherence. In everyday life, however, patients face barriers such as motivation, understanding the diet, food availability, and convenience. The next step is a larger, multicentre trial involving dietitians teaching the approach, with participants applying it in their own kitchens. If these results are replicated outside the research setting, the low FODMAP diet could become a valuable and widely accessible adjunct to endometriosis management.
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