How Fibre Can Help With Endometriosis Symptoms

In this episode, we explore how dietary fibre can play a supportive role in managing endometriosis symptoms through hormone regulation, inflammation reduction, and improved gut health. Whether you're a dietitian or a health professional, you'll learn practical strategies for tailoring fibre intake to support your clients living with endometriosis.

You can find the blog post and references here:

https://www.whnlearninghub.com/post/the-role-of-dietary-fibre-in-managing-endometriosis-evidence-and-practical-insights-for-dietitians 

Check out the WHN Learning Hub Here:

www.whnlearninhub.com

Feedback or suggestions for future episodes? 

Reach out to Nilou at hello@whnlearninghub.com 

Transcript

Nilou: 0:00

Hi, and welcome to the Femme Health Nutrition Podcast. My name is Nilou Deilami, and I'm a registered dietitian and the founder of the Women's Health Nutrition Learning Hub—a forum where dietitians and nutrition professionals can learn about all things related to female health and nutrition. If you haven't already, you can check out the website at whnlearninghub.com. On the site, you'll find blog posts on women's health topics, free downloadable resources for your practice, and access to my biweekly newsletter where I share the latest research updates and new learning opportunities. I’ll include the website link in the episode description. This is the 11th episode of the podcast. If you’re new here, welcome—I’m so glad you’re joining us on this learning journey. And if you’ve been listening for a while, thank you for your continued support and your commitment to learning about and advancing women’s health. Whether you’re new or have been tuning in for a while, if you’ve found value in this podcast, I’d be so grateful if you’d consider subscribing, leaving a rating, or sharing it with your colleagues or friends. Podcasts don’t always have a built-in feedback loop like live sessions do, so your support really helps me know this work is resonating—and it motivates me to keep creating more episodes. Before we dive into today’s topic, just a quick reminder that this podcast is for educational purposes only and is intended for dietitians, healthcare professionals, and anyone interested in female health and nutrition. The content is not medical advice, and if you have any questions or concerns about your health, please consult your physician or healthcare team. Now, let’s get into today’s topic: endometriosis and the role that fibre plays in its management. This topic is very close to my heart because I personally live with endometriosis. It’s a condition that affects millions of people globally and is often misunderstood or goes undiagnosed for many years. Endometriosis is a chronic inflammatory condition where tissue similar to the endometrium—the lining of the uterus—grows outside the uterus. This can happen in places like the ovaries, fallopian tubes, pelvic cavity, and in rare cases, even the lungs. Unlike the normal endometrial tissue, which thickens and sheds during the menstrual cycle, this ectopic tissue has nowhere to go. It becomes trapped, which leads to inflammation, scarring, significant pain, and sometimes infertility. If you’ve worked with clients who have endometriosis—or you or someone close to you lives with it—you’ll know how intense the pain can be. It’s often described as “sharp knives,” “barbed wire,” or “shooting pain.” It's far beyond your typical menstrual cramps and can be truly debilitating. In addition to pain, people with endometriosis often experience bowel symptoms like constipation, hemorrhoids, and extreme bloating—what’s sometimes referred to as “endo belly.” All of these symptoms together can severely impact quality of life. Standard treatments for endometriosis typically involve a multifaceted and personalized approach. These may include: NSAIDs like ibuprofen Hormonal therapies such as oral contraceptives or GnRH agonists Laparoscopic surgery to remove lesions Hysterectomy in severe cases Pelvic physiotherapy Psychotherapy for pain and symptom management And increasingly, there’s recognition of the important role of lifestyle factors, including nutrition and physical activity. That brings us to today’s focus: fibre. Fibre is something we talk about frequently in general health and nutrition, but it also offers a unique opportunity to support individuals managing endometriosis. There are three main ways that fibre can support symptom management: Regulating estrogen levels Reducing systemic inflammation Improving gastrointestinal symptoms, which are common with endometriosis Let’s go through each of these in more detail. 1. Regulating Estrogen Levels Endometriosis is an estrogen-dependent condition. Elevated levels of estrogen, particularly estradiol, fuel the growth and maintenance of endometriotic lesions. Interestingly, these lesions can even produce estradiol themselves, which perpetuates the inflammation and lesion growth. Fibre helps by binding to estrogen in the gut. After estrogen is metabolized by the liver, it's excreted into the intestines via bile. Without fibre, some of that estrogen can be reabsorbed into the bloodstream. But fibre binds to it, preventing reabsorption and facilitating excretion through feces. Research has shown that high-fibre diets can reduce circulating estradiol levels by about 10 to 25%, which is quite significant for an estrogen-fueled condition. 2. Reducing Systemic Inflammation Inflammation is one of the key drivers of endometriosis symptoms. Fibre contributes to lowering inflammation indirectly, through its impact on the gut microbiome. When fibre is fermented by gut bacteria, it produces short-chain fatty acids like butyrate, propionate, and acetate. These SCFAs have anti-inflammatory effects and reduce the production of pro-inflammatory cytokines such as TNF-alpha and IL-6. Interestingly, research also shows that people with endometriosis tend to have an altered gut microbiome. In mouse models, this dysbiosis was found to contribute to lesion growth. When researchers introduced SCFAs like butyrate, lesion sizes decreased, and inflammation was reduced. While this research is still emerging—and mostly in animals—it highlights an exciting area for future human studies. 3. Supporting Digestive Health Many people with endometriosis experience significant GI symptoms—bloating, constipation, abdominal discomfort—which can make their pain and overall experience even worse. Fibre, when introduced strategically, can help. It improves gut motility, adds bulk to stools, and helps ease constipation—often reducing bloating in the process. That said, some bloating and distension may also be related to inflammation, so fibre won’t address everything, but it can make a meaningful difference. However, it’s important to be cautious. Not all fibre is created equal, and not everyone tolerates it the same way. Many individuals with endometriosis also have coexisting IBS, and fermentable fibres—like those high in FODMAPs—can worsen symptoms. So before increasing fibre, assess your client’s GI health, symptom patterns, and FODMAP tolerance. Always introduce fibre gradually, ideally starting with 3 to 5 grams per day, and monitor the response. A Note on Cruciferous Vegetables Cruciferous vegetables—like broccoli, cauliflower, and cabbage—are rich in fibre and antioxidants, but they’re also high in sulfur and FODMAPs. For some, these compounds can trigger gas, bloating, and discomfort. Some observational research has even linked higher cruciferous vegetable intake with endometriosis diagnosis. That doesn’t mean these vegetables cause endometriosis—but it’s possible that the GI symptoms they provoke lead people to seek care sooner and get diagnosed. The takeaway? If someone tolerates them well, they can be included in moderation. Cooking cruciferous vegetables can reduce their FODMAP content, making them easier to digest. Practical Recommendations for Dietitians If you’re working with someone who has endometriosis, here are some practical ways to use fibre in your approach: Encourage 25–30 grams of fibre per day from a wide variety of plant-based sources: fruits, vegetables, legumes, nuts, seeds, and whole grains Tailor fibre types and amounts based on digestive health—favoring soluble or non-fermentable fibres as needed Monitor cruciferous and FODMAP intake, especially if symptoms are present Introduce fibre gradually to avoid worsening symptoms Encourage clients to track symptoms—using a food and symptom journal across a few cycles can provide useful insights Pair fibre with anti-inflammatory foods, like omega-3s from flaxseeds or walnuts, and antioxidants from berries There’s never a one-size-fits-all strategy—our strength as dietitians lies in personalizing recommendations based on each individual’s unique physiology and symptom profile. That includes supporting their gut, reducing inflammation, managing hormones, and respecting their lived experience. That brings us to the end of today’s episode. Thank you so much for tuning in. If you enjoyed this content, please consider following the podcast, leaving a rating, or sharing it with others. And if you have feedback or suggestions for future episodes, feel free to email me at hello@whnlearninghub.com. I’ll include that in the show notes as well. Thanks again—and I hope you have a lovely day.