Endometriosis: pathophysiology and the potential role of diet

Endometriosis (ENDO) is a chronic, estrogen-dependent condition affecting over 190 million females worldwide. Characterized by cyclic pelvic pain, infertility, and systemic inflammation, its symptoms profoundly impact quality of life, interfering with mental health, relationships, education, work, and sexual well-being. Despite this burden, treatment options remain limited. For symptom relief, many females turn to self-management strategies, particularly dietary modifications. This review explores the relationship between ENDO, quality of life, and diet. First, we summarize the ENDO classification and assessment. Second, we provide an overview of the pathophysiology and etiology of ENDO including current diagnosis methods. Finally, we review evidence on anti-inflammatory and elimination diets, such as the Mediterranean and low fermentable oligo-, di-, monosaccharides and polyols (low-FODMAP) diets, which are adopted to reduce ENDO-associated pain through inflammatory and estrogen-mediated mechanisms. Retrospective studies suggest the adoption of diets with anti-inflammatory properties may improve ENDO symptoms and quality of life, yet high-quality randomized controlled trials remain scarce. Before clinical recommendations regarding dietary management strategies for ENDO are developed, rigorous and comprehensive randomized trials are needed.<b>NEW & NOTEWORTHY</b> This review synthesizes current evidence for the potential of utilizing diet as a nonpharmacological strategy for managing endometriosis-associated pain and other symptomatology. It emphasizes the importance of addressing patient-identified barriers and patient-centered research designs. By bridging clinical findings with current data, this work offers educators and clinicians a more holistic framework to guide discussions around symptom management and the role of nutrition in chronic disease care.