Nutrition and Pain Management in Endometriosis

A key strength of the work lies in its refusal to oversimplify. Rather than framing diet as a treatment, the authors situate nutritional patterns within the broader biological context of endometriosis—intersecting with inflammation, estrogen signaling, immune modulation, oxidative stress, and gut-related mechanisms. This integrative perspective reflects the multifactorial nature of the disease and helps explain why dietary responses are often heterogeneous.

Equally important is the authors’ critical assessment of the evidence base. Most data supporting dietary interventions derive from observational studies or small, heterogeneous trials, limiting causal inference. While patterns such as the Mediterranean diet or low-FODMAP approaches show signals of benefit in selected patients—particularly those with overlapping gastrointestinal symptoms—these findings cannot yet be generalized across disease phenotypes or clinical settings.

From a clinical standpoint, the review reinforces a necessary distinction: dietary strategies may complement medical and surgical management, but they should not be positioned as substitutes. The absence of robust randomized controlled trials evaluating whole-diet interventions underscores the need for restraint in clinical recommendation and clarity in patient counseling.

Overall, this review contributes by bringing balance to a highly patient-driven area of care. It supports informed, individualized discussions about nutrition while emphasizing that meaningful progress will depend on rigorously designed studies capable of defining who benefits, how, and why. In endometriosis, scientific credibility in dietary research will be earned not through enthusiasm, but through methodological discipline."