Foods That May Make Endometriosis Worse: What the Research Says and What I Found
Updated: Oct 14
If you've ever typed "what foods make endometriosis worse" into your phone at 2am with a hot water bottle on your stomach, this post is for you.
The short answer: Here’s what the evidence actually shows for each of the foods that may make endometriosis worse, what I found when I tested them on myself, and how you can find your own triggers without cutting out half your life. But a handful of foods come up again and again, both in the research and in what thousands of women say about their own bodies. Alcohol, ultra-processed food, added sugar, red and processed meat, gluten, caffeine and dairy are the usual suspects. Some of them deserve their reputation. One of them probably doesn't.
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Here's what the evidence actually shows for each one, what I found when I tested them on myself, and how you can find your own triggers without cutting out half your life.
Foods that may make endometriosis worse, at a glance
Food | What the research suggests | What women report | My experience |
Alcohol | The most consistent link of the five classic suspects | 53% felt less pain after cutting back | One of my biggest triggers |
Ultra-processed food | No endo-specific studies yet, but trans fats were linked to higher risk | 38% felt less pain after cutting back | Cut it in 2024, along with everything else |
Added sugar | Indirect evidence only | 41% felt less pain after cutting back | Cut it fully for 8 weeks |
Red and processed meat | Linked to higher risk in several large studies | Not measured separately | Once or twice a year |
Gluten | No link with risk, but a real link with coeliac disease | 45% felt less pain after cutting back | Occasional, with some discomfort |
Caffeine | Only high intakes (over 300 mg a day) linked to risk | 43% felt less pain after cutting back | The hardest thing to give up |
Dairy | Linked to lower risk, butter aside | 45% felt less pain after cutting back | Milk is fine, cheese and dairy yoghurt are triggers |
Survey figures are from the Edinburgh study of 2,388 women with endometriosis described below.
Why "may" is the honest word here
I want to explain the word in the title, because it changes how you read everything below.
Most diet research asks a different question to yours. The big studies follow thousands of women for years and ask: did the women who ate more of a food get diagnosed with endometriosis more often? That's useful, but it isn't the same as asking whether a food makes your pain worse once you already have endo.
The research that does ask about symptoms is newer and smaller. The largest is a 2025 survey from the University of Edinburgh. It asked 2,388 women with a confirmed endometriosis diagnosis which changes they'd tried and whether their pain improved.
Two in three of those who changed their diet said at least one change helped. The researchers also found that no single change helped everyone.
So the final test is your own body. The research tells you where to look first. Your symptoms tell you what's true for you. I'll show you exactly how I did that at the end of this post.
If you're new here, the Anti-Inflammatory Diet for Endometriosis post is the bigger picture this series is built on.
Alcohol: the one that comes up most
Of the classic suspects, alcohol has the most consistent research behind it, and it tops the list of what women say helped.
What the studies show. A 2013 analysis pooling 15 studies found that women who drank had a 24% higher risk of endometriosis than women who didn't. When the same Italian research group updated it in 2022, the overall link became weaker, but moderate, regular drinking was still linked to a 22% higher risk. A large 2021 review of 354 studies named alcohol as one of only two environmental factors with suggestive evidence behind it.
There's a twist the researchers point out themselves. Many women with endo pain may drink because of the pain, to switch off after a hard day. That could make alcohol look worse in these studies than it really is. They also suggest alcohol could feed inflammation and oxidative stress, so both things may be happening at once.
What women report. In the Edinburgh survey, cutting back on alcohol was the most popular change, and the one most often reported as helpful: 666 of 1,252 women (53%) said their pain improved.
The European endometriosis guideline (ESHRE 2022) doesn't recommend any specific diet, but it does include reducing alcohol as part of a healthy lifestyle.
My experience. Alcohol was one of my three biggest triggers when I reintroduced foods, along with cheese and dairy yoghurt. Since I stopped drinking, I've noticed the difference in how I feel, especially during my period, but every day too. As I shared in Best Foods for Endometriosis, I've also dealt with SIBO and other gut issues, so it makes sense to me that dropping alcohol made such a big difference.
If you want to try cutting back:
Start with a few drink-free weeks rather than forever. It's far easier to commit to, and long enough to notice a difference.
Have a ready swap for the moments you'd normally pour a glass. Sparkling water with lime and fresh mint in a wine glass does more for the ritual than you'd think. These Luigi Bormioli stemless glasses* are lovely for it, made in Italy from lead-free crystal. Make it by the jugful in a glass jug like this Luminarc one*, so there's always some ready in the fridge.
If you do drink, stay within the NHS guidance: no more than 14 units a week, spread over three or more days, with several drink-free days each week.
Ultra-processed foods, ready meals and supermarket snacks
This is the section I most wanted to write, because it's where most of us actually live: the meal deal, the ready meal on a busy night, and the crisps, snacks and chocolate we reach for every evening.
What "ultra-processed" actually means. It isn't about whether food has been chopped, frozen or cooked. Ultra-processed foods are made mostly from industrial ingredients you wouldn't keep in your own kitchen: emulsifiers, flavourings, modified starches, sweeteners and colourings. Think packaged snacks, sweets, fizzy drinks, most ready meals, processed meats and many "healthy" bars.
What the research shows. I couldn't find a single study that has looked at ultra-processed food as a whole in endometriosis. What we do have is evidence on some of the things inside it. In a study following 70,709 nurses for 12 years, women who ate the most trans fats were 48% more likely to be diagnosed with endometriosis. Industrial trans fats come from partially hydrogenated oils, which were common in margarines, baked goods and fried food at the time.
The good news for UK readers: industrial trans fats are now legally limited to 2 g per 100 g of fat, so you'll meet far fewer of them than the women in that study did. If you spot "partially hydrogenated" on a label, put it back.
What women report. In the Edinburgh survey, 38% of women who cut back on processed foods such as deli meats, crisps, sausage rolls and chocolate said their pain improved.
There's also the packaging. Ultra-processed food almost always comes wrapped in plastic or in a tin, and that matters for a reason I explain further down.
My experience. In 2024 I cut snacks and processed food along with everything else. My advice now is to keep meals simple and steer clear of processed food.
Realistic swaps:
The meal deal: batch-cook one extra portion at dinner and take it in a stainless steel lunch box like this Ecolunchbox nesting set*, or Pyrex Cook & Go glass boxes* if you prefer glass, with a leakproof lid for soups and curries. Ideal: home-cooked. Realistic: a supermarket salad you add your own protein to.
The ready meal: cook double on Sunday and freeze portions, so your "ready meal" is one you made (more on how to store it below).
The evening snacking: a handful of nuts, an apple with nut butter, or hummus with veg sticks. Small change is always better than no change.
Need snack ideas that don't come from a packet? My free guide, Snack Smart: 10 Anti-Inflammatory Treats, has ten treat ideas to get you started.
Added sugar and the places it hides
What the research shows. No study has tested added sugar on its own in women with endometriosis, so the direct evidence here is thin. The closest is a study of 81,961 women in the Nurses' Health Study II, where those whose diets had the highest glycaemic index (foods that raise blood sugar quickly) had around a 12% higher risk of diagnosis.
What women report. Cutting back on processed sugar, such as sweets, cakes, biscuits and fizzy drinks, helped 41% of women in the Edinburgh survey.
Why it's worth cutting back anyway. The NHS advises adults to have no more than 30 g of free sugars a day, about 7 sugar cubes. A single can of cola can contain as much as 9. "Free sugars" include honey, syrups and fruit juice too, not just white sugar.
Where it hides. Flavoured yoghurts, granola, cereal bars, pasta sauces, salad dressings and "healthy" smoothies. On the ingredients list, look out for:
cane sugar, brown sugar, glucose, fructose, sucrose, dextrose and maltose
corn syrup, glucose syrup, agave, maple syrup, honey, molasses and treacle
fruit juice concentrate
On the nutrition label, more than 22.5 g of sugars per 100 g counts as high, and 5 g or less counts as low.
My experience. I cut sugar completely for 8 weeks, and fruit too during that time, because I was dealing with other health issues and it was what my body needed then. Today I still keep sugar very limited and stick to natural sugars. I wouldn't suggest cutting fruit as your starting point, though. Whole fruit isn't a "free sugar", and citrus in particular is linked with a lower risk of endometriosis, as I explain in Best Foods for Endometriosis.
Realistic swaps: plain yoghurt with berries instead of a fruit yoghurt, a homemade dressing of extra virgin olive oil (I use Odysea*) and lemon, shaken up in a small glass jar like a Le Parfait 500ml jar*, and fruit or a couple of squares of dark chocolate after dinner instead of pudding.
Red and processed meat
Red meat wasn't on my original list for this post, but it has some of the strongest risk data of anything here, so it earned its place.
What the studies show. A 2022 analysis of 8 studies covering nearly half a million women found that those eating the most red meat had a 17% higher risk of endometriosis. An older Italian study of 504 women with endo and 504 without found the highest red meat eaters had about twice the odds, and ham eaters 1.8 times.
The other side. The results between studies varied a lot, and some found no link at all. A 2023 review pointed out that women who eat the most meat also tend to weigh more, which on its own can raise oestrogen and inflammation, and not every study fully accounted for that. One worry you can put to rest in the UK: growth hormones have been banned in British and EU beef since 1989.
My experience. I cut red meat and ham completely in 2024. Now red meat is my guilty pleasure once or twice a year, not something I'd recommend building meals around.
What I eat instead: chicken and turkey, ideally from higher-welfare farms, wild salmon (or sardines and mackerel) and other fish, eggs, lentils and beans. I explain how to choose better chicken and eggs in Best Foods for Endometriosis.
It's not only what you eat: cans, plastic and how food is stored
Remember the review that flagged alcohol? The only other factor it found suggestive evidence for was endocrine-disrupting chemicals: substances that can mimic or interfere with our hormones. Two of the best known, BPA and phthalates, reach us mainly through food.
Where they come from. BPA has been used in the linings of tins and in some hard plastics. Phthalates soften plastics and turn up in food wrap, tubing and packaging. Both can move into food, especially fatty or hot food.
What the research shows. A 2024 analysis of 22 studies found women with higher BPA exposure had a higher risk of endometriosis, with an effect size of 1.82. The phthalate results were mixed: two breakdown products of one common phthalate were linked to endometriosis, while four others weren't.
These studies have real limits. Most measured chemicals from a single urine or blood sample, and both clear from the body within hours to days, so one sample is a snapshot rather than a lifetime of exposure.
The hopeful part: your exposure is changeable. In a small US study, 20 people from 5 families ate only fresh food for three days, with nothing canned or packed in plastic and everything stored in glass or stainless steel. Their BPA levels fell by 66% and phthalate levels by more than half. When they went back to their usual food, the levels came back. A separate study of 8,877 Americans found people who ate the most fast food had 24% to 39% higher levels of two phthalates.
What the law says. The EU has now banned BPA in food packaging, including the linings of tins, and the ban applies in Northern Ireland. In England, Scotland and Wales, the food regulators have said they intend to bring in the same ban, but they have postponed enforcement until new UK legislation is passed. So for now, tins and plastics on British shelves can still contain it.
Simple swaps that make a difference:
Never heat food in plastic. Microwave in a glass bowl, like these Duralex Lys bowls*, which are lead-free and made in France, or reheat on the hob.
Store leftovers in glass or stainless steel. I like these Pyrex Cook & Freeze glass dishes*, which go from freezer to oven. Just take the plastic lid off before heating.
Freeze your own "ready meals" in portions. Souper Cubes* are platinum-cured silicone trays in four portion sizes, from a tablespoon of pesto to a full dinner.
Keep pantry staples and leftovers in glass jars. Le Parfait jars* have a glass lid and a rubber seal, with no plastic touching the food.
Swap cling film. These Lékué stretch lids* fit bowls, jars and half a lemon, or try Queen Bee Wraps, handmade in Scotland. I earn nothing from Queen Bee, I recommend them because they use gentler dammar resin and jojoba oil.
Choose fewer tins. Beans and tomatoes in glass jars or cartons are easy swaps, and frozen veg needs no tin at all.
Carry water in steel, not plastic. A Klean Kanteen bottle* has an uncoated stainless steel inside, so no plastic touches your water.
You don't need to throw out every plastic box tomorrow. Start with whatever touches hot or fatty food, because heat and fat make it easier for these chemicals to move into food. Pans are a whole topic of their own, and they're coming in my non-stick and PFAS post soon. In the meantime, my everyday pan is the Demeyere Industry 5-ply frying pan*: uncoated stainless steel, with nothing to scratch or wear off.
Gluten: get tested before you cut it
If there's one thing I'd love you to take from this post, it's this section.
The study everyone quotes. You've probably read that going gluten-free reduces endometriosis pain by 75%. That comes from a 2012 Italian study of 207 women who followed a gluten-free diet for 12 months, and 156 of them (75%) reported significantly less pain. There was no comparison group, though, and none of the women were tested for coeliac disease first.
Why coeliac disease matters here. Coeliac disease is an autoimmune reaction to gluten, and it seems to travel with endometriosis more often than chance. In a large Swedish study, women aged 16 to 45 with coeliac disease were 35% more likely to be diagnosed with endometriosis later. Smaller studies have found coeliac disease in around 2% of women with endo, compared with under 1% of other women. If some of the women in that Italian study had undiagnosed coeliac disease, going gluten-free would naturally have helped them.
What the bigger studies show. In 81,961 women followed in the Nurses' Health Study II, eating more gluten was not linked to a higher risk of endometriosis.
What women report. Cutting back on gluten helped 523 of 1,151 women (45%) in the Edinburgh survey.
It might not be the gluten at all. Wheat also contains fructans, a type of FODMAP that ferments in the gut and causes bloating. In carefully blinded trials, only 38 of 231 people who believed they were sensitive to gluten actually reacted to gluten itself. Other trials found that fructans, not gluten, triggered symptoms in many people with self-reported gluten sensitivity. And no, spelt and einkorn don't help here: these older wheats contain as much gluten as modern wheat, or more.
Why you need to test first
The coeliac blood test looks for antibodies your body only makes while you're eating gluten. Coeliac UK advises eating gluten in more than one meal every day for at least six weeks before testing. If you cut gluten first, you can get a false negative and never know.
So the order is: ask your GP for a coeliac blood test while you're still eating gluten. Then, whatever the result, you can test gluten on yourself properly.
My experience. I can eat gluten occasionally, but it gives me some discomfort, so I keep it minimal. If you do go gluten-free, build it around naturally gluten-free whole foods like potatoes, rice, quinoa and buckwheat. Many packaged gluten-free breads and biscuits are lower in fibre and protein and raise blood sugar faster than the foods they replace.
Bloating that seems linked to bread and pasta is a whole topic of its own, and it'll be covered in a coming post on endo belly and gut symptoms.
Caffeine: a ceiling, not a ban
Good news if your morning coffee is sacred: the research doesn't support cutting caffeine out completely, but it does suggest a sensible ceiling.
What the studies show. A 2021 analysis of 10 studies and 38,601 participants found no overall link between caffeine and endometriosis. The exception was high intake: more than 300 mg a day was linked to a 30% higher risk. A 2025 review of all the diet evidence found the same for intakes over 300 mg. The authors note that heavy caffeine use may partly be a marker of other habits the studies didn't measure.
What women report. Cutting back on caffeine helped 473 of 1,091 women (43%) in the Edinburgh survey.
What 300 mg looks like. These are the NHS estimates:
a cup of instant coffee: 100 mg (filter and coffee-shop coffee can contain more)
a cup of black or green tea: 75 mg
a can of cola: 40 mg
a 250 ml can of energy drink: 80 mg
a 50 g bar of plain dark chocolate: under 25 mg
So three cups of instant coffee, or four cups of tea, take you to around 300 mg. One large coffee-shop coffee can take you a long way there on its own.
My experience. Caffeine was the hardest thing for me to give up. During my travels in Asia I'd drink two or three coffees a day, because coffee there is more of a dessert than a drink on its own. There are so many choices it's hard to resist, and the more you have, the more your body craves. But I could feel what it was doing to my sleep and my energy, so I cut down to two or three cups a week. Truly one of the best decisions I've made.
If you want to cut back:
Go gradually over a week or two, swapping one drink a day, to avoid withdrawal headaches.
Try half-caf or decaf for your second cup.
Find a caffeine-free ritual you enjoy. Clearspring's Kuwa matcha* is made from organic mulberry leaf, so you get the whisking ritual without the caffeine. I also drink Huntly Herbs organic raspberry leaf tea, and I keep my loose leaf teas fresh in an Airscape stainless steel canister*. I share more about the teas I drink in Best Foods for Endometriosis.
Dairy: maybe not the villain you've heard
Dairy shows up on a lot of "endo foods to avoid" lists, so this one may surprise you.
What the studies show. In the Nurses' Health Study II, which followed 70,556 women, those who had more than three servings of dairy a day were 18% less likely to be diagnosed with endometriosis than women who had two or fewer. A 2021 analysis of all the studies found the same pattern: three or more servings a day was linked to a lower risk, including for full-fat dairy.
The exception is butter. A 2025 review linked high butter intake to a 27% higher risk.
Why this still doesn't make dairy a health food for endo. These studies are observational. Part of the link may come from vitamin D, since women with the highest predicted vitamin D levels in the same study had a 24% lower risk. Researchers have also pointed out that women with gut symptoms before diagnosis may avoid milk, which could make dairy look more protective than it is.
What women report. Even so, cutting back on dairy helped 512 of 1,132 women (45%) in the Edinburgh survey. Lactose, the natural sugar in milk, is a FODMAP, so women with sensitive guts may feel better without it, whatever it does to their risk.
My experience. This is exactly why I say test it on yourself. Milk is fine for me occasionally, but cheese and dairy yoghurt are two of my three biggest triggers. Coconut yoghurt with live cultures, on the other hand, is one of the ferments I eat regularly.
Getting enough calcium without dairy
If you cut dairy, calcium is the nutrient to watch. Adults need 700 mg a day, and dairy is where most of us get the bulk of it. The good news is there are plenty of other sources, including a few you might not expect.
Food | Amount | Calcium |
Stinging nettle leaves, blanched | 100 g | 481 mg |
Whitebait | small portion (50 g) | 430 mg |
Calcium-fortified plant milk | 200 ml | 240 to 380 mg |
Tofu set with calcium (E509 or E516 on the label) | 100 g | 300 mg |
Sardines, with bones | half a tin (60 g) | 240 mg |
Kale, boiled | 100 g | 150 mg |
Dandelion greens, boiled | 100 g | 140 mg |
Figures from the British Dietetic Association, and from USDA data for nettles and dandelion greens.
How much you absorb matters as much as the number. In a small study of 11 women, the body absorbed 41% of the calcium in kale, compared with 32% from milk. Kale, broccoli and pak choi are low in oxalates, natural compounds that lock calcium away, which is why their calcium is so well absorbed. Spinach is the opposite: it looks rich in calcium on paper, but very little of it gets absorbed. The BDA also advises not relying on nuts, seeds, beans and dried fruit as your main sources for the same reason.
The forgotten greens. Nettles and dandelion leaves were everyday spring greens for generations, and on paper they're among the richest plant sources of calcium there are. Blanched nettle leaves have more than three times the calcium of boiled kale. How well we absorb it hasn't been measured the way it has for kale. Pick young nettle tops in spring with gloves on, away from roadsides and sprayed verges, and cook them briefly to remove the sting. Then use them like spinach in soups, omelettes or pesto. If you're pregnant or on medication, check with your GP before eating them regularly.
Two easy things to check:
Organic plant milks usually aren't fortified. If you buy organic, check the label for added calcium, or you may be getting very little.
Calcium needs vitamin D. Your body needs it to absorb calcium, so it's worth keeping an eye on both.
For more on separating endo facts from fiction, see Endometriosis Myths and Truths.
How to find your own triggers
This is where the research hands over to you.
What I did. After surgery at the end of 2023, I felt much better for a while, with far less pain. Then, around the middle of 2024, my health collapsed. Looking back, it had been building for years: chronic pain and inflammation, gut issues, burnout from work and an immune system that was completely run down. That's when I cut everything at once: sugar (and fruit for 8 weeks), alcohol, caffeine, gluten, bread and baked goods, dairy, red meat and ham, cooking oils, fried food, snacks and processed food. Within the first few weeks my gut pain stopped, and my energy, brain fog, mood and anxiety improved. By around two months the changes were stronger. After about a year, my periods came with barely any cramps and no painkillers. You can read the fuller story in Life with Endometriosis: My Story.
Cutting everything at once worked for me, but it meant I couldn't tell which change was doing the work. That only became clear when I added foods back one at a time.
Here's where I've landed:
Food | How my body responds now |
Eggs | Great |
Milk | Fine occasionally |
Gluten | Fine occasionally, with some discomfort |
Caffeine | Down to two or three cups a week |
Red meat | Once or twice a year |
Cheese | One of my three biggest triggers |
Dairy yoghurt | One of my three biggest triggers |
Alcohol | One of my three biggest triggers |
Chickpeas, raw onion and raw garlic | I can't eat them |
Chickpeas, onion and garlic are all high in FODMAPs, the fermentable carbs I mentioned in the gluten section. So I suspect that's my gut talking rather than my endo, which is a good reminder that not every reaction is about endometriosis. I'll go deeper into this in my upcoming post on endo belly and gut symptoms.
A gentler way to test it yourself
If you suspect gluten, get the coeliac blood test first, while you're still eating it.
Keep a simple food and symptom diary for two weeks before you change anything. Note what you eat and drink, your pain out of 10, bloating, energy and where you are in your cycle.
Remove one food, or one small group, at a time. Give it at least three to four weeks. Because endo pain follows your cycle, compare like with like: this period against your last one, not a good week against a bad one.
Bring it back deliberately. Have it once or twice over a day or two, then watch for 48 to 72 hours.
Keep only the changes that clearly help. If nothing changed, you've learned something too, and you get that food back.
Please look after yourself while you do this. If you notice you're cutting out more and more foods, or eating starts to feel stressful, talk to your GP or a registered dietitian. The goal is to eat more freely, not less.
And be kind to yourself on the bad days. Any change is better than no change.
From me to you
I know how it feels to read a list of "foods to avoid" and feel your whole plate disappear. That's not what I want this post to do.
What I hope you take from it is permission to get curious instead of scared. Some of these foods may be playing a part in how you feel, and some may be completely fine for you. The only way to know is to listen to your own body, gently, one change at a time.
You don't have to do it all at once, and you don't have to do it perfectly. Start with the one that's been nagging at you. 💛
Coming next in The Endo Kitchen
Next up is Best Cooking Oils for Endometriosis: which oils I cook with, which I avoid, and what the research really says about olive oil, seed oils and butter.
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Keep reading
This post shares research and my personal experience, not medical advice. Please talk to your GP, specialist or a registered dietitian before making big changes to your diet, especially if you're on medication or have other health conditions.
With love, Lena
Founder of Live Beyond Endo
Stay connected, stay informed, and above all, stay empowered.
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