A influência de padrões alimentares saudáveis na melhora dos sintomas clínicos da endometriose
Keywords:
Endometriosis; Healthy eating; Dietary patterns; Signs and Symptoms; Inflammation.Abstract
INTRODUCTION: Endometriosis is characterized as an estrogen-dependent inflammatory disease that affects 190 million people globally. This condition primarily affects organs in the pelvic region, impacting social, economic, and public health. Its pathophysiology is related to immunological alterations, oxidative stress, and the possible influence of the gut microbiota. OBJECTIVE: To review the literature regarding the influence of healthy dietary patterns on improving the clinical symptoms of endometriosis. METHODS: This is an integrative review following the PRISMA recommendations and the PICOS strategy to understand the effects of different dietary strategies on pain, gastrointestinal symptoms, and quality of life in women affected by the disease. Searches were conducted in the PubMed, LILACS, and Web of Science databases, covering the years 2020 to 2025, in Portuguese, English, and Spanish, limited to human studies. RESULTS: Of the 209 records, 6 studies were included. The sample consisted of 280 women with endometriosis, with a mean age ranging from 27 to 39.1 years. The discussion identified three articles on low-FODMAP diets, one article on the Mediterranean diet, one on a low-nickel diet, and another on the modified ketogenic diet with MCTs. In general, the studies demonstrated that appropriate dietary adjustments can act as adjuncts to conventional treatment, promoting a significant reduction in pelvic pain, dyspareunia, dyschezia, dysuria, and gastrointestinal discomfort, as well as improvements in quality of life. Diets with anti-inflammatory and antioxidant properties proved particularly effective by contributing to an adequate immune response and oxidative stress, factors associated with the pathophysiology of the disease. CONCLUSION: Thus, the adoption of balanced and individualized dietary patterns constitutes a promising strategy in the clinical management of endometriosis, highlighting the need for further studies to consolidate this evidence and support nutritional practices based on scientific evidence.
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References
Ministério da Saúde (BR). Endometriose [Internet]. Brasília: Ministério da Saúde; 2024 [citado em 2025 jun. 27]. Disponível em: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/e/endometriose#:~:text=A%20endometriose%20%C3%A9%20uma%20doen%C3%A7a%20cl%C3%ADnica%2C%20ou%20seja%2C%20se%20a,a%20qualidade%20de%20vida%20dessa.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Endometriosis: Clinical practice guideline [Internet]. Melbourne: RANZCOG; 2021 [citado em 2025 jun. 27]. Disponível em: https://ranzcog.edu.au/wp-content/uploads/Endometriosis-Foundation-Clinical-Guideline-2021.pdf.
Moradi Y, Beyranvand-Shams M, Khateri S, Gharahjeh S, Tehrani S, Varse F et al. A systematic review on the prevalence of endometriosis in women. Indian J Med Res. 2021; 154(3):446-54. DOI: 10.4103/ijmr.IJMR_817_18.
World Health Organization (WHO). Endometriosis [Internet]. Geneva: WHO; 2023 [citado em 2025 jun. 27]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/endometriosis.
Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022; 2022 (2):hoac009. DOI: 10.1093/hropen/hoac009.
Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-73.e8. DOI: 10.1016/j.fertnstert.2011.05.090.
Ferreira ALL, Bessa MMM, Drezett J, Abreu LC. Quality of life of the woman carrier of endometriosis: systematized review. Reprodução & Climatério. 2016; 31 (1):48-54. DOI: 10.1016/j.recli.2015.12.002.
Lamceva J, Uljanovs R, Strumfa I. The Main Theories on the Pathogenesis of Endometriosis. Int J Mol Sci. 2023; 24(5):4254. DOI: 10.3390/ijms24054254.
Sampson JA. The development of the implantation theory for the origin of peritoneal endometriosis. Am J of Obstet Gynecol MFM. 1940; 40(4): 549-557. DOI: 10.1016/S0002-9378(40)91238-8.
Monnin N, Fattet AJ, Koscinski I. Endometriosis: Update of Pathophysiology, (Epi) Genetic and Environmental Involvement. Biomedicines. 2023; 11(3):978. DOI:10.3390/biomedicines11030978.
Gruenwald P. Origin of endometriosis from the mesenchyme of the celomic walls. Am J of Obstet Gynecol MFM. 1942; 44 (1): 470-474. DOI: 10.1016/s0002-9378(42)90484-8.
Sourial S, Tempest N, Hapangama DK. Theories on the Pathogenesis of Endometriosis. Int J Reprod Med. 2014; 2014:179515. DOI: 10.1155/2014/179515.
Sampson JA. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation.[Internet] Am J Pathol. 1927; [citado em 2025 jun. 30] 3(2):93-110.43. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC1931779/.
Christodoulakos G, Augoulea A, Lambrinoudaki I, Sioulas V, Creatsas G. Pathogenesis of endometriosis: the role of defective ‘immunosurveillance’. Eur J Contracept Reprod Health Care. 2007; 12(3):194-202. DOI: 10.1080/13625180701387266.
Ahmed RS, Sherif M, Alghamdi MA, El-Tallawy SN, Alzaydan OK, Pergolizzi JV et al. Exploring the Immune System’s Role in Endometriosis: Insights Into Pathogenesis, Pain, and Treatment. Cureus. 2025; 17 (7):e87091. DOI: 10.7759/cureus.87091.
Xu X, Mei J, Zhang B, Jiang X, Wang L, Zhang A et al. Association Between Circulating Cytokines and Endometriosis: A Mendelian Ranomization Study. J Cell Mol Med. 2025; 29 (7):e70532. DOI: 10.1111/jcmm.70532.
Machairiotis N, Vasilakaki S, Thomakos N. Inflammatory Mediators and Pain in Endometriosis: A Systematic Review. Biomedicines. 2021; 9 (1):54. DOI: 10.3390/biomedicines9010054.
Jones RK, Searle RF, Bulmer JN. Apoptosis and bcl-2 expression in normal human endometrium, endometriosis and adenomyosis. Human Reprod. 1998; 13 (12):3496-3502. DOI: 10.1093/humrep/13.12.3496.
Santos JXB, Rodrigues IBA, Brasil NB, Amorim LVM, Cedrim LF, Sampaio MFCM et al. Associação entre a endometriose e o estresse oxidativo: uma revisão de literatura. Rev Bras Implant Ciênc Saúde. 2024; 6(5):1096-1115. DOI: 10.36557/2674-8169.2024v6n5p1096-1115.
Jiang I, Yong PJ, Allaire C, Bedaiwy MA. Intricate Connections between the Microbiota and Endometriosis. Int J Mol Sci. 2021; 22(11):5644. DOI: 10.3390/ijms22115644.
Benner M, Ferwerda G, Joosten I, van der Molen RG. How uterine microbiota might be responsible for a receptive, fertile endometrium. Hum Reprod Update. 2018; 24(4):393-415. DOI: 10.1093/humupd/dmy012.
Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022; 12:1069557. DOI:10.3389/fcimb.2022.1069557.
Wei Y, Tan H, Yang R, Yang F, Liu D, Huang B et al. O Gut dysbiosis-derived β-glucuronidase promotes the development of endometriosis. Fertil Steril. 2023; 120(3 Pt 2):682-94. DOI: 10.1016/j.fertnstert.2023.03.032.
Possemiers S, Bolca S, Verstraete W, Heyerick A. The intestinal microbiome: a separate organ inside the body with the metabolic potential to influence the bioactivity of botanicals. Fitoterapia. 2011; 82(1):53-66. DOI: 10.1016/j.fitote.2010.07.012.
França PRC, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules. 2022; 27(13):4034. DOI:10.3390/molecules27134034.
FEBRASGO. Endometriose: aspectos clínicos do diagnóstico ao tratamento [Internet]. Femina. 2021; [citado em 2025 jul. 10] 49(3):134 141. Disponível em: https://www.febrasgo.org.br/media/k2/attachments/FeminaZ2021Z49Z-Z3.pdf.
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014; 29(3):400-412. DOI:10.1093/humrep/det457.
Carvalho M de SR de, Pereira AMG, Martins JA, Lopes RCG. Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico. Rev Bras Ginecol Obstet. 2015; 37(2):77–81. DOI: 10.1590/SO100-720320140005199.
Zaragoza-Martí A, Cabrera-González K, Martín-Manchado L, Moya-Yeste AM, Sánchez-Sansegundo M, Hurtado-Sánchez JA. La importancia de la alimentación en la prevención de la endometriosis: revisión sistemática. Nutr Hosp. 2024; 41(4):906-15. DOI:10.20960/nh.04909.
Tennfjord MK, Gabrielsen R, Bø K, Engh ME, Molin M. Can general exercise training and pelvic floor muscle training be used as an empowering tool among women with endometriosis? Experiences among women with endometriosis participating in the intervention group of a randomized controlled trial. BMC Womens Health. 2024; 24(1):505. DOI:10.1186/s12905-024-03356-w.
Moustakli E, Zagorianakou N, Makrydimas S, Oikonomou ED, Miltiadous A, Makrydimas G. The Gut-Endometriosis Axis: Genetic Mechanisms and Public Health Implications. Genes (Basel). 202; 16(8):918. DOI: 10.3390/genes16080918.
Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto contexto - enferm. 2008; 17(4):758-64. DOI:10.1590/S0104-07072008000400018.
Santos CMC, Pimenta CAM, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Latino-Am Enfermagem. 2007; 15 (3):508-11. DOI: 10.1590/s0104-11692007000300023.
Keukens A, Veth VB, van de Kar MMA, Bongers MY, Coppus SFPJ, Maas JWM. Effects of a low-FODMAP diet on patients with endometriosis, a prospective cohort study. BMC Womens Health. 2025; 25(1):174. DOI:10.1186/s12905-025-03715-1.
Naeini F, Tanha FD, Mahmoudi M, Ansar H, Hosseinzadeh-Attar MJ. MCT-modified ketogenic diet as an adjunct to standard treatment regimen could alleviate clinical symptoms in women with endometriosis. BMC Womens Health. 2025; 25(1):232. DOI:10.1186/s12905-025-03798-w.
Varney JE, So D, Gibson PR, Jones-Rhys D, Lee YSJ, Fisher J et al. Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)-A Randomised, Controlled Crossover Feeding Study. Aliment Pharmacol Ther. 2025;61(12):1889-1903. DOI:10.1111/apt.70161.
Cirillo M, Argento FR, Becatti M, Fiorillo C, Coccia ME, Fatini C. Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis. Int J Mol Sci. 2023; 24(19):14601. DOI: 10.3390/ijms241914601.
Van Haaps AP, Wijbers JV, Schreurs AMF, Vlek S, Tuynman J, De Bie B et al. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Hum Reprod. 2023; 38(12):2433-2446. DOI:10.1093/humrep/dead214.
Borghini R, Porpora MG, Casale R, Marino M, Palmieri E, Greco N et al. Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study. Nutrients. 2020 Jan 28; 12(2):341. DOI: 10.3390/nu12020341.
Zapara PL, Navarro EG, Koninckx CR. The low-FODMAP diet. An Pediatr (Engl Ed). 2024;101(1):36-45. DOI: 10.1016/j.anpede.2024.06.005.
Martins A, Pequito A, Baltazar AL. Disbiose intestinal e síndrome do intestino irritável: efeito de uma dieta baixa em FODMAPs. Acta Portuguesa de Nutrição. 2020; 22:38–41. DOI:10.21011/apn.2020.2207.
Cardoso YAP, Paula TA, Vasconcelos FC, Souza RFPC, Garcia DCS, Silva JMS et al. Dieta low FODMAP para adultos com síndrome do intestino irritável: uma revisão sistemática. Arch Health. 2025; 6(2):1-13. DOI: 10.46919/archv6n2-001.
Kiani AK, Medori MC, Bonetti G , Aquilanti B, Velluti V, Matera G et al. Modern vision of the Mediterranean diet. J Prev Med Hyg. 2022; 63(2 Suppl 3):E36-E43. DOI:10.15167/2421-4248/jpmh2022.63.2S3.2745.
Smidowicz A, Regula J. Effect of nutritional status and dietary patterns on human serum C-reactive protein and interleukin-6 concentrations. Adv Nutr. 2015; 6(6):738-47. DOI: 10.3945/an.115.009415.
Wagenaar CA, Van de Put M, Bisschops M, Walrabenstein W, de Jonge CS, Herrema H et al. The Effect of Dietary Interventions on Chronic Inflammatory Diseases in Relation to the Microbiome: A Systematic Review. Nutrients. 2021; 13(9):3208. DOI: 10.3390/nu13093208.
Mukherjee A, Lordan C, Ross RP, Cotter PD. Gut microbes from the phylogenetically diverse genus Eubacterium and their various contributions to gut health. Gut Microbes. 2020; 12(1):1802866. DOI: 10.1080/19490976.2020.1802866.
Sharma AD. Low nickel diet in dermatology. Indian J Dermatol. 2013; 58(3):240. DOI: 10.4103/0019-5154.110846.
Lombardi F, Fiasca F, Minelli M, Maio D, Mattei A, Vergallo I et al. The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis. Nutrients. 2020; 12(4):1040. DOI:10.3390/nu12041040.
Borghini R, De Amicis N, Bella A, Greco N, Donato G, Picarelli A. Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease. Nutrients. 2020; 12(8):2277. DOI: 10.3390/nu12082277.
Wilder RM. Os efeitos da cetonemia no curso da epilepsia. Mayo Clin Proc. 1921;2:307–8.
Li H, Wang Y, Guo J, Zhang P, Xu Z, Peng K et al. Efficacy and safety of modified medium-chain triglyceride ketogenic diet in patients with drug-resistant epilepsy. Acta Epileptol. 2024; 6(1):9. DOI: 10.1186/s42494-024-00150-x.
Greco T, Glenn TC, Hovda DA, Prins ML. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab. 2016; 36(9):1603-13. DOI: 10.1177/0271678X15610584.
Ministério da Saúde (BR). Guia alimentar para a população Brasileira [Internet]. [citado em 2025 out. 26] 2014. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf.
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