Endometriosis is an inflammatory condition and an estrogen dependent disease.

Estrogen is a hormone which plays an important role in the female reproductive cycle; it assists in the growth and thickening of the endometrial tissue, when fertilisation doesn't take place progesterone (another hormone) and estrogen levels decline which causes menstruation. Estrogen can also be spelt oestrogen (just to clear up any confusion). Estrogen is processed through the liver and excess estrogen is then excreted via the gastrointestinal system; therefore the liver and gut both to be functioning well to process and remove excess estrogen.

Endometriosis is defined as ‘a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. Endometriosis can start at a person's first menstrual period and last until menopause’ (World Health Organisation).

Therefore a diet that is anti-inflammatory is an important component when managing endometriosis symptoms. Taking this into consideration, what should the endo-diet look like? I've seen many different approaches through social media; some may say that being vegan is the answer to managing endo symptoms, others prefer paleo, or a low-carbohydrate diet (such as the keto-diet). There are so many opinions out there, it would be perfectly understandable if you're feeling confused!

So what is the best approach? It actually depends on the individual, what works for one person may not work for another; for example, if other health issues are coinciding with endo, then the diet may need to be modified accordingly. There is no one-size-fits-all approach when it comes to nutrition.

However, there are some guidelines of what dietary approaches can be followed to help manage endo:

• A diet high in fibre will help remove excess estrogen. A diet rich in plant based foods such as vegetables, fruit, wholegrains and legumes (except soy based foods). Cruciferous vegetables such as cabbage, cauliflower and broccoli get a special mention for their detoxifying effect and their benefits on estrogen metabolism, turmeric also gets a special mention for its anti-inflammatory and antioxidant properties, so be sure to consume these regularly.

• Eat anti-inflammatory foods, this means avoiding sugar, processed food, fried food, gluten and animal products that are a product of factory farming. An anti-inflammatory diet is rich in vegetables, fruit, wholegrains, legumes, nuts, wild caught fish and healthy fats such as olive oil. Meat and poultry are okay as long as they are free from chemicals and not char-grilled, try cooking slowly instead. Eat red meat sparingly and always choose grass fed, as it's suggested that grass fed meat offers the benefits of omega-3 fatty acids (which are anti-inflammatory).

• Dairy may be ok, it depends on the individual. Stick to small amounts of organic, additive free goats or sheep's yogurt, cheese or kefir as these are lower in lactose and casein which can cause inflammation. Kefir has shown to be beneficial for a range of therapeutic actions including improving gut health, blood sugar, cholesterol control and immune function.

• Stick to oils with health benefits such as cold pressed olive oil as it is high in monounsaturated fatty acids and vitamin E, but don't cook with extra virgin olive oil as it becomes unstable and loses its health benefits with heat. When cooking over high heat, use fats and oils with a high smoke point, for example ghee, avocado oil or olive oil.

• Avoid alcohol, limit coffee to 1 cup per day (or avoid it altogether) and drink at least 2 litres of water throughout the day.

Gut issues are common for those who have endometriosis. If you have other conditions co-existing with endo such as IBS or SIBO, a high fibre diet could make you feel worse. Talk to a nutritionist for individual support and guidance.