{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:37:48Z","timestamp":1792798668728,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,4]]},"abstract":"Abstract<\/jats:title>\n \n STUDY QUESTION<\/jats:title>\n What is the influence of dietary interventions, namely the low fermentable oligo-, di-, mono-saccharides, and polyols (Low FODMAP) diet and endometriosis diet, on endometriosis-related pain and quality of life (QoL) compared to a control group?<\/jats:p>\n <\/jats:sec>\n \n SUMMARY ANSWER<\/jats:title>\n After adhering to a dietary intervention for 6\u2009months, women with endometriosis reported less pain and an improved QoL compared to baseline whereas, compared to the control group, they reported less bloating and a better QoL in 3 of 11 domains.<\/jats:p>\n <\/jats:sec>\n \n WHAT IS KNOWN ALREADY<\/jats:title>\n Standard endometriosis treatment can be insufficient or may be accompanied by unacceptable side effects. This has resulted in an increasing interest in self-management strategies, including the appliance of the Low FODMAP diet and the endometriosis diet (an experience-based avoidance diet, developed by women with endometriosis). The Low FODMAP diet has previously been found effective in reducing endometriosis-related pain symptoms, whereas only limited studies are available on the efficacy of the endometriosis diet. A survey study recently found the endometriosis diet effective in improving QoL but currently no guidelines on use of the diet exist.<\/jats:p>\n <\/jats:sec>\n \n STUDY DESIGN, SIZE, DURATION<\/jats:title>\n A prospective one-center pilot study was performed between April 2021 and December 2022. Participants could choose between adherence to a diet\u2014the Low FODMAP diet or endometriosis diet\u2014or no diet (control group). Women adhering to a diet received extensive guidance from a dietician in training. The follow-up period was 6\u2009months for all three groups. For all outcomes, women adhering to the diets were compared to their baseline situation and to the control group.<\/jats:p>\n <\/jats:sec>\n \n PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n We included women diagnosed with endometriosis (surgically and\/or by radiologic imaging) who reported pain scores \u22653\u2009cm on the visual analogue score (0\u201310\u2009cm) for dysmenorrhea, deep dyspareunia, and\/or chronic pelvic pain. The primary endpoint focused on pain reduction for all pain symptoms, including dysuria, bloating, and tiredness. Secondary endpoints, assessed via questionnaires, focused on QoL, gastro-intestinal health, and diet adherence.<\/jats:p>\n <\/jats:sec>\n \n MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n A total of 62 participants were included in the low FODMAP diet (n\u2009=\u200922), endometriosis diet (n\u2009=\u200921), and control group (n\u2009=\u200919). Compared to their baseline pain scores, participants adhering to a diet reported less pain in four of six symptoms (range P\u2009&lt;\u20090.001 to P\u2009=\u20090.012) and better scores in 6 of 11 QoL domains (range P\u2009&lt;\u20090.001 to P\u2009=\u20090.023) after 6\u2009months. Compared to the control group, analyzed longitudinally over the 6-month follow-up period, participants applying a diet reported significant less bloating (P\u2009=\u20090.049), and better scores in 3 of 11 QoL domains (range P\u2009=\u20090.002 to P\u2009=\u20090.035).<\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n No sample size was calculated since efficacy data were lacking in the literature. In order to optimize dietary adherence, randomization was not applied, possibly resulting in selection bias.<\/jats:p>\n <\/jats:sec>\n \n WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n Our study suggests that women could benefit from adherence to a dietary intervention, since we found lower pain scores and better QoL after 6\u2009months. However, caution is implied since this is a pilot study, no sample size was calculated, and data on long-term effects (&gt;6\u2009months) are lacking. The results of this pilot study underline the importance of further research and the drawing up of guidelines.<\/jats:p>\n <\/jats:sec>\n \n STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n A.v.H. reports receiving a travel grant from Merck outside the scope of this study. J.W., S.V., J.T., and B.D.B. have no conflicts of interest to report. A.d.V. reports having received KP-register points for internship guidance of J.W., performing paid consultations with endometriosis patients outside the study and receiving reimbursements for educational lectures at the local hospital (Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands). A.S. reports having received expenses for travel and hotel costs as an invited speaker from ESHRE. This was outside the scope of this study. M.v.W. reports that she is a Co-Ed of Cochrane Gynecology and Fertility. V.M. reports receiving travel and speaker\u2019s fees from Guerbet and research grants from Guerbet, Merck and Ferring. The department of reproductive medicine (V.M.) of the Amsterdam UMC, location VUmc, has received several research and educational grants from Guerbet, Merck and Ferring not related to the submitted work.<\/jats:p>\n <\/jats:sec>\n \n TRIAL REGISTRATION NUMBER<\/jats:title>\n N\/A.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/humrep\/dead214","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T08:12:49Z","timestamp":1696493569000},"page":"2433-2446","source":"Crossref","is-referenced-by-count":53,"title":["The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3616-5328","authenticated-orcid":false,"given":"A P","family":"van Haaps","sequence":"first","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit , Amsterdam, The Netherlands"},{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4467-1531","authenticated-orcid":false,"given":"J V","family":"Wijbers","sequence":"additional","affiliation":[{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences , Den Haag, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-0632","authenticated-orcid":false,"given":"A M F","family":"Schreurs","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit , Amsterdam, The Netherlands"},{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Vlek","sequence":"additional","affiliation":[{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Tuynman","sequence":"additional","affiliation":[{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"De Bie","sequence":"additional","affiliation":[{"name":"Endometriose Stichting, Dutch Patient Organization for Endometriosis , Sittard, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A L","family":"de Vogel","sequence":"additional","affiliation":[{"name":"Dietician Practice Aileen de Vogel , Dordrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-213X","authenticated-orcid":false,"given":"M","family":"van Wely","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Mijatovic","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit , Amsterdam, The Netherlands"},{"name":"Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center , Amsterdam, The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute , Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,24]]},"reference":[{"key":"2023122817450481000_dead214-B1","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1089\/acm.2021.0068","article-title":"Dietary practices of women with endometriosis: a cross-sectional survey","volume":"27","author":"Armour","year":"2021","journal-title":"J Altern Complement Med"},{"key":"2023122817450481000_dead214-B2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12906-019-2431-x","article-title":"Self-management strategies amongst Australian women with endometriosis: a national online survey","volume":"19","author":"Armour","year":"2019","journal-title":"BMC Complement Altern Med"},{"key":"2023122817450481000_dead214-B3","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: endometriosis","volume":"2","author":"Becker","year":"2022","journal-title":"Hum Reprod Open"},{"key":"2023122817450481000_dead214-B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/nu12010148","article-title":"Low FODMAP diet: evidence, doubts, and hopes","volume":"12","author":"Bellini","year":"2020","journal-title":"Nutrients"},{"key":"2023122817450481000_dead214-B5","doi-asserted-by":"crossref","first-page":"1166929","DOI":"10.3389\/fnut.2023.1166929","article-title":"Diet associations in endometriosis: a critical narrative assessment with special reference to gluten","volume":"10","author":"Brouns","year":"2023","journal-title":"Front Nutr"},{"key":"2023122817450481000_dead214-B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/nu13041178","article-title":"Nutrition in gynecological diseases: current perspectives","volume":"13","author":"Ciebiera","year":"2021","journal-title":"Nutrients"},{"key":"2023122817450481000_dead214-B7","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/humupd\/dmt027","article-title":"The social and psychological impact of endometriosis on women's lives: a critical narrative review","volume":"19","author":"Culley","year":"2013","journal-title":"Hum Reprod Update"},{"key":"2023122817450481000_dead214-B8","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1093\/humrep\/det284","article-title":"The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey","volume":"28","author":"De Graaff","year":"2013","journal-title":"Hum Reprod"},{"key":"2023122817450481000_dead214-B9","first-page":"1","article-title":"The burden of endometriosis on women's lifespan: a narrative overview on quality of life and psychosocial wellbeing","volume":"13","author":"Della Corte","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2023122817450481000_dead214-B10","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/humrep\/det457","article-title":"ESHRE guideline: management of women with endometriosis","volume":"29","author":"Dunselman","year":"2014","journal-title":"Hum Reprod"},{"key":"2023122817450481000_dead214-B11","article-title":"Endometriose Stichting","author":"Endometriosestichting","year":"2023"},{"key":"2023122817450481000_dead214-B12","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/j.1440-1746.2009.06149.x","article-title":"Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach","volume":"25","author":"Gibson","year":"2010","journal-title":"J Gastroenterol Hepatol"},{"key":"2023122817450481000_dead214-B13","first-page":"1","article-title":"Lifestyle and chronic pain in the pelvis: state of the art and future directions","volume":"22","author":"Gutke","year":"2021","journal-title":"J Clin Med"},{"key":"2023122817450481000_dead214-B14","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.rbmo.2020.04.014","article-title":"The effects of nutrients on symptoms in women with endometriosis: a systematic review","volume":"41","author":"Huijs","year":"2020","journal-title":"Reprod Biomed Online"},{"key":"2023122817450481000_dead214-B15","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1136\/gutjnl-2011-301095","article-title":"Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study","volume":"61","author":"Jess","year":"2012","journal-title":"Gut"},{"key":"2023122817450481000_dead214-B16","first-page":"258","article-title":"Development of an endometriosis quality-of-life instrument: the endometriosis health profile","volume":"98","author":"Jones","year":"2001","journal-title":"Obstet Gynecol"},{"key":"2023122817450481000_dead214-B17","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.rbmo.2021.07.011","article-title":"Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study","volume":"43","author":"Krabbenborg","year":"2021","journal-title":"Reprod Biomed Online"},{"key":"2023122817450481000_dead214-B18","volume-title":"Het Di\u00ebtistisch Consult","author":"Leibbrandt","year":"2016"},{"key":"2023122817450481000_dead214-B19","doi-asserted-by":"crossref","first-page":"920","DOI":"10.3109\/00365529709011203","article-title":"Stool form scale as a useful guide to intestinal transit time","volume":"32","author":"Lewis","year":"1997","journal-title":"Scand J Gastroenterol"},{"key":"2023122817450481000_dead214-B20","first-page":"499","article-title":"Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?","volume":"6","author":"Marziali","year":"2012","journal-title":"Minerva Chir"},{"key":"2023122817450481000_dead214-B21","author":"Monash","year":"2019"},{"key":"2023122817450481000_dead214-B22","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/ajo.12594","article-title":"Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP diet","volume":"57","author":"Moore","year":"2017","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2023122817450481000_dead214-B23","first-page":"5","article-title":"Het endometriosedieet: ook iets voor jou?","volume":"3","author":"Muntslag","year":"2020","journal-title":"De Buikspreker"},{"key":"2023122817450481000_dead214-B24","first-page":"1","article-title":"Recurrence patterns after surgery in patients with different endometriosis subtypes: a long-term hospital-based cohort study","volume":"2","author":"Nirgianakis","year":"2020","journal-title":"J Clin Med"},{"key":"2023122817450481000_dead214-B25","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12905-019-0774-6","article-title":"Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis","volume":"1","author":"O'Hara","year":"2019","journal-title":"BMC Womens Health"},{"key":"2023122817450481000_dead214-B26","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1093\/humrep\/deaa330","article-title":"Self-management factors associated with quality of life among women with endometriosis: a cross-sectional Australian survey","volume":"36","author":"O'Hara","year":"2021","journal-title":"Hum Reprod"},{"key":"2023122817450481000_dead214-B27","doi-asserted-by":"crossref","first-page":"4566","DOI":"10.3390\/nu5114566","article-title":"Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review","volume":"5","author":"Saulle","year":"2013","journal-title":"Nutrients"},{"key":"2023122817450481000_dead214-B28","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1016\/j.cell.2021.04.041","article-title":"Endometriosis: Etiology, pathobiology, and therapeutic prospects","volume":"184","author":"Saunders","year":"2021","journal-title":"Cell"},{"key":"2023122817450481000_dead214-B29","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1093\/jn\/nxac107","article-title":"Glycemic index, glycemic load, fiber, and gluten intake and risk of laparoscopically confirmed endometriosis in premenopausal women","volume":"152","author":"Schwartz","year":"2022","journal-title":"J Nutr"},{"key":"2023122817450481000_dead214-B30","doi-asserted-by":"crossref","first-page":"h4672","DOI":"10.1136\/bmj.h4672","article-title":"Understanding the Hawthorne effect","volume":"351","author":"Sedgwick","year":"2015","journal-title":"BMJ"},{"key":"2023122817450481000_dead214-B31","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.fertnstert.2007.01.053","article-title":"Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial","volume":"88","author":"Sesti","year":"2007","journal-title":"Fertil Steril"},{"key":"2023122817450481000_dead214-B32","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1080\/0167482X.2017.1289512","article-title":"The burden of endometriosis symptoms on health-related quality of life in women in the United States: a cross-sectional study","volume":"38","author":"Soliman","year":"2017","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"2023122817450481000_dead214-B33","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1136\/gutjnl-2017-313750","article-title":"The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS","volume":"66","author":"Staudacher","year":"2017","journal-title":"Gut"},{"key":"2023122817450481000_dead214-B34","doi-asserted-by":"crossref","first-page":"e29480","DOI":"10.2196\/29480","article-title":"Real-time symptom assessment in patients with endometriosis: psychometric evaluation of an electronic patient-reported outcome measure, based on the experience sampling method","volume":"7","author":"van Barneveld","year":"2023","journal-title":"JMIR Form Res"},{"key":"2023122817450481000_dead214-B35","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1016\/j.fertnstert.2010.11.009","article-title":"Quality of life in endometriosis: evaluation of the Dutch-version Endometriosis Health Profile-30 (EHP-30)","volume":"95","author":"van de Burgt","year":"2011","journal-title":"Fertil Steril"},{"key":"2023122817450481000_dead214-B36","author":"van der Marel-Sluijter","year":"2009"},{"key":"2023122817450481000_dead214-B37","author":"van Dijk","year":"2019"},{"key":"2023122817450481000_dead214-B38","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.rbmo.2022.12.010","article-title":"A better quality of life could be achieved by applying the endometriosis diet: a cross-sectional study in Dutch endometriosis patients","volume":"46","author":"van Haaps","year":"2023","journal-title":"Reprod Biomed Online"},{"key":"2023122817450481000_dead214-B39","doi-asserted-by":"crossref","first-page":"e032321","DOI":"10.1136\/bmjopen-2019-032321","article-title":"Experiences of health after dietary changes in endometriosis: a qualitative interview study","volume":"10","author":"Vennberg Karlsson","year":"2020","journal-title":"BMJ Open"},{"key":"2023122817450481000_dead214-B40","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/jhn.12318","article-title":"Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome","volume":"28","author":"Whigham","year":"2015","journal-title":"J Hum Nutr Diet"},{"key":"2023122817450481000_dead214-B41","first-page":"e2022159","article-title":"Dietary supplements for treatment of endometriosis: a review","volume":"1","author":"Yalcin Bahat","year":"2022","journal-title":"Acta Biomed"},{"key":"2023122817450481000_dead214-B42","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"13","author":"Zondervan","year":"2020","journal-title":"N Engl J Med"}],"container-title":["Human Reproduction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/humrep\/article-pdf\/38\/12\/2433\/54917237\/dead214.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/humrep\/article-pdf\/38\/12\/2433\/54917237\/dead214.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T13:20:55Z","timestamp":1703769655000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/humrep\/article\/38\/12\/2433\/7329302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,24]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,10,24]]},"published-print":{"date-parts":[[2023,12,4]]}},"URL":"https:\/\/doi.org\/10.1093\/humrep\/dead214","relation":{},"ISSN":["0268-1161","1460-2350"],"issn-type":[{"value":"0268-1161","type":"print"},{"value":"1460-2350","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,1]]},"published":{"date-parts":[[2023,10,24]]}}}