Table 2.
Summary of modifiable factors and complementary alternative factors associated with endometriosis
| Intervention | Processes potentially involved | Effect on the disease |
|---|---|---|
| Diet | ||
| – Fish, ω3 PUFAs | Anti-inflammatory profile and reduce proinflammatory prostaglandin production and cytokines | Debated ↓ |
| – Red meat | High amount of fat (ω6 FAs) involved in the production of proinflammatory prostaglandins; increased plasma concentration of estradiol and estrogen-mediated disease maintenance | Debated ↑ |
| – Fruit and vegetables | Antioxidant properties; potential beneficial effects counterbalanced by large use of pesticides and dioxins in cultivation process | Debated |
| – Coffee | Aromatase inhibitor; ability to act on SHBG, reducing the bioavailability of testosterone | No association |
| – Gluten-free diet | Avoids the consumption of gluten, a nutrient with proinflammatory properties | Improvement in pain symptoms |
| Physical activity | Reduction in estrogen levels and frequency of ovulation (when performed at high levels of intensity); increase of SHBG levels with a subsequent reduction of bioavailable estrogens; reduction of insulin resistance and hyperinsulinemia | Debated ↓ |
| Osteopathy and massage | Improvement of musculoskeletal symptoms could reduce inflammation of internal organs | Improvement in pain symptoms (low level of evidence) |
| Acupuncture | Release of endogenous opioids, anti-inflammatory systemic effect, deactivation of brain areas linked to the transmission of pain sensations, and intensification of local blood flow at needle-insertion site | Improvement in pain symptoms (low level of evidence due to small sample sizes) |
| Chinese herbal medicine | Anti-inflammatory activity; on animal model, suppression of endometriotic implants | Debated (limited quality of data) |
| Vitamins | ||
| – Vitamin D | Antiproliferative, anti-inflammatory, and immunomodulatory properties | Debated |
| – Vitamin A, vitamin C, and β-carotene | Antioxidant properties; involved in the production of ROS and cell proliferation | Debated |
| N-acetylcysteine | Reduction in the release of proinflammatory cytokines; reduction of cell proliferation and downregulation of the inflammatory cascade | Improvement in pain symptoms and reduction of ovarian endometrioma-lesion size |
| Resveratrol | Antiangiogenic, anti-inflammatory, and antioxidant properties | Reduction in the number and volume of endometriotic lesions (experimental studies) |
| Endocrine disruptors (ie, dioxin, dioxin-like compounds, and bisphenol A) | Alteration of hormone synthesis and receptor activity | Debated ↑ |
Note: Arrows indicate risk direction.
Abbreviations: FAs, fatty acids; PUFAs, polyunsaturated fatty acids; ROS, reactive oxygen species; SHBG, sex hormone binding globulin.