Systematic Review of Dietary Interventions and Lifestyle Modifications for Symptom Relief in Endometriosis

Introduction: Endometriosis is a chronic gynecologic disorder involving endometrial-like tissue outside the uterine cavity, affecting roughly ۱۰% of women of reproductive age. Key symptoms include pelvic pain, dysmenorrhea, and impaired quality of life (QoL). Conventional management with hormonal agents or surgery frequently falls short and is associated with adverse effects. Recent data point to the potential of dietary strategies—such as anti-inflammatory or low-FODMAP regimens—and lifestyle adjustments, including physical activity, to influence inflammation, hormonal milieu, and pain thresholds. This systematic review consolidates evidence to appraise the effectiveness of these non-pharmacologic measures in mitigating endometriosis-related symptoms. Methods: The review adhered to PRISMA reporting standards. PubMed, Scopus, and the Cochrane Library were queried from database inception through October ۲۰۲۵ using search terms encompassing "endometriosis," "dietary interventions," "lifestyle changes," "pain relief," "RCT," and "case-control." Eligibility was restricted to English-language randomized controlled trials (RCTs) and case-control studies evaluating dietary approaches (e.g., plant-based or low-FODMAP diets) or lifestyle interventions on symptoms (pain, QoL) in women with laparoscopically or imaging-confirmed endometriosis. Studies lacking controls, those conducted in animal models, or non-peer-reviewed reports were excluded. Methodologic quality was appraised with the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for case-control designs. Data abstraction targeted intervention details, participant numbers, outcome metrics (e.g., Visual Analog Scale [VAS] pain scores), and effect estimates. Marked heterogeneity precluded formal meta-analysis; narrative synthesis was therefore applied. Results: Ten investigations satisfied criteria: six RCTs and four case-control studies, enrolling ۱,۲۵۰ women in total. RCTs consistently documented benefits from dietary measures. A pooled analysis of four RCTs indicated that low-FODMAP and plant-based diets lowered pain by ۲۰–۳۰% (mean difference: –۱.۵ to –۲.۸ VAS points). One RCT (n=۷۸) linked a ۶-month anti-inflammatory diet to reduced dysmenorrhea and enhanced QoL (۱۵% gain on Endometriosis Health Profile-۳۰). Another RCT (n=۱۰۰) showed low-FODMAP intake relieved gastrointestinal and pelvic symptoms in ۷۰% of intervention participants versus ۴۰% of controls. Case-control evidence corroborated these observations; a study (n=۳۰۰) associated greater MIND diet adherence with ۴۰% reduced odds of severe symptomatology (OR=۰.۶۰, ۹۵% CI: ۰.۴۵–۰.۸۰). Two RCTs demonstrated moderate exercise yielded ۲۵% pain attenuation (VAS reduction: –۲.۰ points). Serious adverse events were absent throughout. Discussion: The aggregated data affirm that dietary strategies, particularly those curtailing fermentable carbohydrates or prioritizing anti-inflammatory foods, attenuate pain and bolster QoL. Putative pathways involve dampened systemic inflammation and gut microbiome shifts, as evidenced by lowered cytokine profiles in treated cohorts. Case-control findings reinforce ties between nutrient-dense intake and diminished symptom load, though establishing causality demands additional RCTs. Variability in intervention length (۴–۲۴ weeks) and endpoints constrains broader applicability. High-caliber studies exhibited minimal bias, yet limited participant numbers in select trials necessitate interpretive caution. Conclusion: Dietary and lifestyle modifications constitute evidence-supported adjuncts for alleviating endometriosis symptoms, with RCTs indicating modest pain decrements and QoL gains. Subsequent investigations should emphasize large-scale, extended-duration RCTs to validate efficacy and refine implementation protocols.

کلیدواژه ها:

Systematic Review ، Dietary Interventions ، Lifestyle Modifications ، Symptom Relief ، Endometriosis