A new review argues that medical nutrition therapy (MNT) should be part of routine care for endometriosis—especially when obesity is also present. It highlights the Mediterranean diet as first‑line, a short‑term ketogenic diet in select patients with obesity, and targeted supplements with early promise. Personalization and guidance from a clinical nutritionist are essential.
Why this matters
Endometriosis affects about 1 in 10 women of reproductive age, driving pelvic pain, fatigue and fertility problems. Traditional care leans on pain control, hormones and surgery, but symptoms often recur. The 2025 review in Current Obesity Reports says nutrition can target the biology behind symptoms—chronic inflammation, oxidative stress and hormone imbalance—offering a low‑risk, supportive add‑on to standard treatment.
What the review found
- Mediterranean diet = best starting point. Rich in vegetables, fruit, whole grains, legumes, nuts, olive oil and fish, this pattern is associated with less pain and better quality of life in women with endometriosis and has broad anti‑inflammatory effects.
- When obesity is part of the picture. Although older observational work linked higher BMI to lower endometriosis risk, newer evidence shows obesity can worsen disease severity. The authors suggest considering a short, supervised ketogenic phase to quickly improve insulin resistance and inflammation—then transitioning to a Mediterranean pattern for the long haul. Do this only with clinician oversight.
- Supplements with emerging evidence. Omega‑3 fatty acids, N‑acetylcysteine (NAC), resveratrol, vitamins C and E, and probiotics show anti‑inflammatory/antioxidant activity in preclinical and small clinical studies. Results are promising but larger trials are needed.
- Gut–immune–hormone axis. The gut microbiome appears to interact with immunity and estrogen metabolism in endometriosis, making fiber‑rich, plant‑forward eating a biologically plausible strategy.
- For IBS‑like symptoms. Several small controlled studies suggest a short course of a low‑FODMAP diet can ease gastrointestinal symptoms that commonly accompany endometriosis; this should be time‑limited and dietitian‑guided to protect nutrient intake.
At‑a‑glance guidance from the paper: A schematic in the review (Fig. 1) recommends the Mediterranean diet for all women with endometriosis and as a long‑term plan for those with obesity; it positions the ketogenic diet as a short‑term tool in obesity, and notes that personalized plans plus clinician‑supervised supplements (e.g., omega‑3s, NAC, antioxidants, probiotics) may provide added benefit.
What this means for patients
- Think “pattern,” not perfection. Build meals around plants, extra‑virgin olive oil, legumes, fish and nuts; limit red/processed meats and ultra‑processed snacks. (Mediterranean pattern)
- Personalize—especially if you live with obesity. Rapid, unsupervised ketogenic dieting isn’t recommended; if considered, it should be short‑term and clinician‑guided, followed by a sustainable Mediterranean plan.
- Supplements aren’t one‑size‑fits‑all. Some have supportive evidence, but dosing, quality and interactions matter—talk to your care team before starting anything new.
- Loop in a nutrition professional. The review emphasizes the central role of a clinical nutritionist within a multidisciplinary team to tailor diet, time any ketogenic phase, and select evidence‑based supplements safely.
The bottom line
Nutrition won’t replace medical therapy, but this 2025 synthesis makes a strong case that food can be part of the treatment plan—with the Mediterranean diet as a safe foundation, targeted short‑term strategies for women with obesity, and select supplements as adjuncts. The authors call for larger, longer trials, but the direction of travel is clear: precision nutrition belongs in endometriosis care.
Source: Barrea L., Verde L., Annunziata G., et al. “Effectiveness of Medical Nutrition Therapy in the Management of Patients with Obesity and Endometriosis,” Current Obesity Reports*, 2025.*
Editor’s note: This article is informational and not a substitute for professional medical advice.