Endometriosis is rated as one of the most painful conditions and it affects 1 in 9 women of reproductive age, a chronic inflammatory condition, typically characterised by endometrial cell-like lesions and/or cysts concentrated on or around the female reproductive organs. However, endometriotic lesions have been found elsewhere in the body including the lungs and even the brain, so it’s certainly a whole body disease. Endometriosis not only causes debilitating pain but is also a key contributor to female factor infertility.

Sadly, there is no cure for endometriosis. Surgical excision and a variety of medical and non-medical management strategies may be helpful in alleviating commonly experienced symptoms such as pain with menstruation and ovulation, painful sexual intercourse, painful bowel motions or with urination, amongst many others. Digestive upset including constipation, diarrhoea, gas and bloating are also commonly experienced by those with endometriosis¹

Diet and lifestyle strategies are particularly valuable in the management of endometriosis to help with inflammation, pelvic pain and to optimise fertility, as well as manage gastrointestinal related symptoms.

Ensuring an appropriate ratio of fats is a key strategy for management of endometriosis symptoms, as well as a high intake of antioxidant containing foods such as fruit, vegetables, herbs and spices. The correct balance of unsaturated and saturated fats is important in reducing endometriosis flare ups and as a result reduce pain and discomfort.

A common question asked by those with endometriosis is, “what the best fat or oil is to use for endometriosis?”

It is well-known that the broader guidelines around heart and general health lean towards minimising saturated fats and choosing monounsaturated and polyunsaturated varieties², and it is safe to say that this aligns quite closely with the nutrition research around endometriosis to date.

When considering which oil for endometriosis management, there are three key features to factor in, including:

• Fat profile – proportion of monounsaturated, saturated & polyunsaturated fats.
  Ideally, this will be a high content of unsaturated fats, as saturated fats have been researched to have a potential negative impact on inflammation including amongst those with endometriosis^3,4.
• Antioxidant content – depending on the quality of the oil, and content, each oil will have different antioxidant properties.
• Heat stability – this is commonly misunderstood to be the “smoke point” of oils, however, smoke point is a poor indicator of oil stability and other factors such as the formation of polar compounds are considered more relevant according to the scientific literature⁵.

Let’s compare a variety of commonly used cooking oils based on the above criteria and explore which oil is best to include in the diets of those with endometriosis.

Canola Oil

A commonly used oil in most households, is high (62%) in monounsaturated fats (highest quality fats) and low in saturated fat (7%). It is high in ALA (alpha lipoic acid) which is an omega 3 fatty acid. Unfortunately, this omega 3 fatty acid has poor bioavailability, which means despite is being an omega 3, it has poor antioxidant properties compared to other counterparts. Canola oil has a high smoke point at around 256°C meaning that it is useful for cooking at high temperatures however has a neutral effect when it comes to endometriosis management, and not necessarily recommended as management strategy.

Vegetable Oil

Vegetable oil isusually made from a blend of oils, making it an inexpensive option globally. Given that it is made of multiple oils, it can be difficult to determine the ratio of each. Vegetable oil is equally high in monounsaturated and polyunsaturated fats (42%) and sits at around 14% saturated fat. Like canola oil, it is higher in ALA which gives it poor antioxidant properties, and not recommended in endometriosis management⁶.

Peanut Oil

Peanut oil is high in omega 6 fatty acids. A high omega 6 to omega 3 ratio is associated with a more pro inflammatory state. Given endometriosis is an inflammatory condition, it is recommended that you minimise the use of peanut oil. In the common western diet, the omega 6 to omega 3 ratio is predicted to stand at 15:1. The ideal aim is a ratio of at least 5:1. Minimising omega 6 fatty acids in the diet where you can, is important when managing endometriosis⁶.

Coconut Oil

Coconut oil has become very popular in recent years given the rise in popularity of eating patterns such as the ketogenic diet. Coconut oil, like other coconut products, contains predominantly saturated fat (91%). A high intake of saturated fats in unfavourable for endometriosis sufferers, as it is pro inflammatory and contributes to worsened pain with menstrual cycles³.

Avocado Oil

Avocado oil is rich in vitamin E and has an omega 6 to omega 3 ratio of 13:1. Whilst this ratio is not ideal for endometriosis management, the total amount of omega 6 is low, with a 70% content of monounsaturated fats. Avocado has good antioxidant properties, likely due to its high vitamin E content. Antioxidant intake in endometriosis sufferers has been associated with improved pain during menstruation, intercourse, and mid cycle⁷.

Extra Virgin Olive Oil (EVOO)

EVOOis our gold standard of oils for health and for endometriosis too.  Not only does it have a good fat profile (up to 85% monounsaturated fats, depending on the type of olive, seasonal produce, and quality of olive oil), but most importantly, is has an excellent antioxidant profile.

EVOO contains antioxidants including oleocanthal, oleuropein and oleic acid. Antioxidants are paramount in managing endometriosis. As antioxidants protect cells against damage, they are helpful in reducing inflammatory markers in those with endometriosis⁷

EVOO is high in omega 3 fats, which may be helpful with inflammation management and pain management in endometriosis sufferers⁸. Oleocanthal in particular, has been studied for its unique anti-inflammatory characteristics. It was shown to exhibit multiple modes of action in targeting inflammatory related disease including arthritis, neurodegenerative disease, and some cancers. It has been shown to have similar properties to that of ibuprofen, which is commonly used in endometriosis management for pain relief⁹.

A common point of debate when it comes to EVOO is the smoke point. Research has shown that extra virgin olive oil, is comparable to or better than other plant-based oils for cooking or frying at temperatures between 180 and 200°C deeming it safe for cooking at moderately high temperatures^5,10.

Summary

In summary, when deciding on which oil to use, as a management strategy for endometriosis or for improved health benefits, the standout is extra virgin olive oil. It has a higher quality fat profile and wins out against other oils in its antioxidant properties, which are a key feature in dietary endometriosis management.

Whilst small amounts of other fats and oils will certainly not be harmful, the aim is to choose an antioxidant rich oil with an optimal fat profile and EVOO is truly the winner in both cooking and salads, and even desserts – just use the light flavoured variety!

To learn more about endometriosis nutrition, follow @endo.dietitian or visit thedietologist.com.au

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