Influence of diet and physical exercise on endometriosis: a systematic review

Authors

  • Alba Fuentes Rodríguez Clinical nurse, Galician Health Service, Santiago de Compostela, Spain.  https://orcid.org/0009-0005-4791-6555
    • Óscar Grela Beres Family and community medicine physician, Galician Health Service, Santiago de Compostela, Spain. 

      DOI:

      https://doi.org/10.15649/cuidarte.5426

      Keywords:

      Endometriosis; Exercise; Diet; Quality of Life; Systematic Review.

      Abstract

      Highlights

      • Chronic pain and impaired quality of life are central symptoms in women with endometriosis and are sometimes difficult to manage with conventional medical treatment.
      • Regular physical exercise, particularly when structured and therapeutically oriented, significantly reduces symptoms and improves quality of life in women with endometriosis.
      • Anti-inflammatory diets may ease endometriosis-related symptoms.
      • Current evidence does not yet support specific recommendations for non-pharmacological interventions in endometriosis, such as diet or exercise, due to the low quality and inconsistency of available studies.

      Introduction: Endometriosis is a chronic inflammatory disease that affects 10% of women, causing pelvic pain, dysmenorrhea, and infertility, with a strong impact on quality of life. Objective: To analyze the current scientific evidence on the influence of diet and physical exercise on symptoms and quality of life in women of reproductive age with endometriosis. Materials and Methods: A systematic review of studies published between 2014 and 2024 was conducted using the descriptors endometriosis, exercise, diet, and quality of life in the following databases: MEDLINE, Web of Science, Scopus, SciELO, Virtual Health Library, Dialnet, and Cochrane Library. Systematic reviews, meta-analyses, case reports, letters, and articles without full-text access were excluded. Two independent reviewers performed study selection and data extraction, and methodological quality was assessed according to study design. Results: Of 523 initial records, 13 articles were included (7 on diet and 6 on exercise). Anti-inflammatory dietary interventions and regular physical exercise were associated with reduced symptoms and improved quality of life. Discussion: Diet and exercise may influence the symptoms and well-being of these patients, although the evidence is limited and inconsistent. The included studies show methodological heterogeneity, small sample sizes, and variability in interventions and outcomes, limiting internal validity and the generalizability of the findings. Conclusions:  Diet and exercise constitute complementary strategies to pharmacological and/or surgical treatment within a comprehensive approach to endometriosis; however, more rigorous research is needed to support their long-term benefits.

      How to cite this article: Fuentes Rodríguez Alba, Grela Beres Óscar. Influence of diet and physical exercise on endometriosis: a systematic review. Revista Cuidarte. 2026;17(1):e5426. https://doi.org/10.15649/cuidarte.5426

      Author Biographies

      • Alba Fuentes Rodríguez, Clinical nurse, Galician Health Service, Santiago de Compostela, Spain. 

        Clinical nurse, Galician Health Service, Santiago de Compostela, Spain. 

      • Óscar Grela Beres, Family and community medicine physician, Galician Health Service, Santiago de Compostela, Spain. 

        Family and community medicine physician, Galician Health Service, Santiago de Compostela, Spain. 

      References

      Ensari I, Lipsky-Gorman S, Horan EN, Bakken S, Elhadad N. Associations between physical exercise patterns and pain symptoms in individuals with endometriosis: a cross-sectional mHealth-based investigation. BMJ Open. 2022;12(7):e059280. https://doi.org/10.1136/bmjopen-2021-059280

      Ghasemisedaghat S, Eslamian G, Kazemi SN, Rashidkhani B, Taheripanah R. Association of fertility diet score with endometriosis: a case–control study. Frontiers in Nutrition. 2023;10:1222018. https://doi.org/10.3389/fnut.2023.1222018

      Xie B, Liao M, Huang Y, Hang F, Ma N, Hu Q. Association between vitamin D and endometriosis among American women: National Health and Nutrition Examination Survey. PLoS ONE. 2024;19(1):e0296190. https://doi.org/10.1371/journal.pone.0296190

      van Haaps A, Wijbers J, Schreurs A, Mijatovic V. A better quality of life could be achieved by applying the endometriosis diet: a cross-sectional study in Dutch endometriosis patients. Reprod Biomed Online. 2023;46(3):623–630. https://doi.org/10.1016/j.rbmo.2022.12.010

      Del Forno S, Cocchi L, Arena A, Pellizzone V, Lenzi J, Raffone A, et al. Effects of Pelvic Floor Muscle Physiotherapy on Urinary, Bowel, and Sexual Functions in Women with Deep Infiltrating Endometriosis: A Randomized Controlled Trial. Medicina (Kaunas). 2023;60(1):67. https://doi.org/10.3390/medicina60010067

      Asociación Colombiana de Endometriosis e Infertilidad (ASOCOEN). Endometriosis Colombia. Consulta: Octubre 10, 2025. Disponible en: https://www.endometriosiscolombia.com/

      Ministerio de Sanidad, Servicios Sociales e Igualdad. Guía de atención a las mujeres con endometriosis en el Sistema Nacional de Salud (SNS), 2013. Madrid (España). Consulta: Junio 26, 2025.

      Krabbenborg I, de Roos N, van der Grinten P, Nap A. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. Reprod Biomed Online. 2021;43(5):952–61. https://doi.org/10.1016/j.rbmo.2021.07.011

      Liu P, Maharjan R, Wang Y, Zhang Y, Zhang Y, Xu C, et al. Association between dietary inflammatory index and risk of endometriosis: A population-based analysis. Frontiers in Nutrition. 2023;10:1077915. https://doi.org/10.3389/fnut.2023.1077915

      Li X, Xie Z, Qiu H, Xie X, Liu L. Exploring the causal associations between diet-derived circulating antioxidants and the risk of endometriosis: a Mendelian randomization study. Frontiers in Nutrition. 2024;11:1453147. https://doi.org/10.3389/fnut.2024.1453147

      Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. https://doi.org/10.1007/s13669-017-0187-1

      Brouns F, Van Haaps A, Keszthelyi D, Venema K, Bongers M, Maas J, et al. Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Front Nutr. 2023;10:1295983. https://doi.org/10.3389/fnut.2023.1166929

      Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022;12:1069557. https://doi.org/10.3389/fcimb.2022.1069557

      Tennfjord MK, Gabrielsen R, Bø K, Engh ME, Molin M. Can general exercise training and pelvic floor muscle training be used as an empowering tool among women with endometriosis? Experiences among women with endometriosis participating in the intervention group of a randomized controlled trial. BMC Womens Health. 2024;24:505. https://doi.org/10.1186/s12905-024-03356-w

      Sachs MK, Dedes I, El-Hadad S, Haufe A, Rueff D, Kohl Schwartz AS, et al. Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control?. Int J Environ Res Public Health. 2023;20(17):6659. https://doi.org/10.3390/ijerph20176659

      Tennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Women's Health. 2021;21(1):355. https://doi.org/10.1186/s12905-021-01500-4

      Martire FG, Costantini E, d’Abate C, Capria G, Piccione E, Andreoli A. Endometriosis and Nutrition: Therapeutic Perspectives. J. Clin. Med. 2025;14(11):3987. . https://doi.org/10.3390/jcm14113987

      Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs. 2004;1(3):176-84. https://doi.org/10.1111/j.1524-475X.2004.04006.x

      Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042

      Fuentes Rodríguez A, Grela Beres O. Análisis de artículos del impacto de dieta y ejercicio físico en endometriosis. 2025. Mendeley Data: Versión 1. https://doi.org/10.17632/mky2ntyknm.1

      Van Haaps AP, Wijbers JV, Schreurs AMF, Vlek S, Tuynman J, Bie BD, et al. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Hum Reprod. 2023;38(12):2433-2446. https://doi.org/10.1093/humrep/dead214

      Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. British Journal Surgery 1995;82(2):216–22. https://doi.org/10.1002/bjs.1800820229

      Looman M, Feskens EJ, Rijk M de, Meijboom S, Biesbroek S, Temme EH, et al. Development and evaluation of the Dutch Healthy Diet index 2015. Public Health Nutrition. 2017; 20(13):2289–99. https://doi.org/10.1017/S136898001700091X

      Artacho-Cordón F, Salinas-Asensio MDM, Galiano-Castillo N, Ocón-Hernández O, Peinado FM, Mundo-López A, et al. Effect of a Multimodal Supervised Therapeutic Exercise Program on Quality of Life, Pain, and Lumbopelvic Impairments in Women With Endometriosis Unresponsive to Conventional Therapy: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2023;104(11):1785–95. https://doi.org/10.1016/j.apmr.2023.06.020

      Del Forno S, Arena A, Pellizzone V, Lenzi J, Raimondo D, Cocchi L, et al. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol. 2021;57(5):726–32. https://doi.org/10.1002/uog.23590

      Nodler JL, Divasta AD, Vitonis AF, Karevicius S, Malsch M, Sarda V, et al. Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): A double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2020;112(1):229–36. https://doi.org/10.1093/ajcn/nqaa096

      Barrea L, Verde L, Annunziata G, Chedraui P, Petraglia F, Cucalón G, et al. 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. Curr Obes Rep. 2025;14:68. https://doi.org/10.1007/s13679-025-00662-8

      Baradwan S, Gari A, Sabban H, Alshahrani MS, Khadawardi K, Bukhari IA, et al. The effect of antioxidant supplementation on dysmenorrhea and endometriosis-associated painful symptoms: a systematic review and meta-analysis of randomized clinical trials. Obstet Gynecol Sci. 2024;67(2):186-98. https://doi.org/10.5468/ogs.23210

      Škegro B, Bjedov S, Mikuš M, Mustač F, Lešin J, Matijević V, et al. Endometriosis, Pain and Mental Health. Psychiatr Danub. 2021;3(l4):632–6. https://pubmed.ncbi.nlm.nih.gov/34718292/

      Nap A, de Roos N. Endometriosis and the effects of dietary interventions: what are we looking for?. Reproduction and Fertility. 2022;3(2):C14–22. https://doi.org/10.1530/RAF-21-0110

      Salinas-Asensio MdM, Ocón-Hernández O, Mundo-López A, Fernández-Lao C, Peinado FM, Padilla-Vinuesa C, et al. “Physio-EndEA” Study: A Randomized, Parallel-Group Controlled Trial to Evaluate the Effect of a Supervised and Adapted Therapeutic Exercise Program to Improve Quality of Life in Symptomatic Women Diagnosed with Endometriosis. Int J Environ Res Public Health. 2022;19(3):1738. https://doi.org/10.3390/ijerph19031738

      Leroy R, Desimpel F, Ombelet S, De Jaeger M, Benahmed N, Camberlin C, et al. How can we improve endometriosis care in Belgium? KCE Report 378. Brussels (BE): Belgian Health Care Knowledge Centre (KCE); 2024. Consulta: octubre 10, 2025.

      European Society of Human Reproduction and Embryology (ESHRE). ESHRE Guideline: Endometriosis. [Internet] Issued 2 February 2022 [Cited 16 June 2025] Disponible en: https://www.eshre.eu/guideline/endometriosis

      Carvalho N, Margatho D, Cursino K, Benetti-Pinto CL, Bahamondes L. Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial. Fertil Steril. 2018;110(6):1129–36. https://doi.org/10.1016/j.fertnstert.2018.07.003

      Harada T, Kobayashi T, Hirakawa A, Takayanagi T, Nogami M, Mochiyama T, et al. Efficacy and safety of the combination of estetrol 15 mg/drospirenone 3 mg in a cyclic regimen for the treatment of endometriosis-associated pain and objective gynecological findings: a multicenter, placebo-controlled, double-blind, randomized study. Fertil Steril. 2024;122(5):894–901. https://doi.org/10.1016/j.fertnstert.2024.07.011

      Lee HJ, Yoon SH, Lee JH, Chung YJ, Park SY, Kim SW, et al. Clinical evaluation and management of endometriosis: 2024 guideline for Korean patients from the Korean Society of Endometriosis. Obstet Gynecol Sci. 2024;68(1):43-58. https://doi.org/10.5468/ogs.24242

      National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE guideline [NG73]. London (UK): NICE; [Internet] 2017 [Cited 2025 Oct 8]. Available from: https://www.nice.org.uk/guidance/ng73/chapter/Recommendations#non-pharmacological-management

      Published

      2026-04-30

      How to Cite

      1.
      Fuentes Rodríguez A, Grela Beres Ó. Influence of diet and physical exercise on endometriosis: a systematic review. Revista Cuidarte [Internet]. 2026 Apr. 30 [cited 2026 May 4];17(1). Available from: https://revistas.udes.edu.co/cuidarte/article/view/5426

      Downloads

      Download data is not yet available.