Medical nutrition therapy, targeted supplementation, and microbiota modulation in endometriosis: A narrative review

Endometriosis is a chronic, estrogen-dependent inflammatory disease for which conventional treatments often prove insufficient. This narrative review comprehensively evaluates the impact of Medical Nutrition Therapy (MNT), targeted supplementation, and the intestinal microbiota on the pathomechanism and clinical course of endometriosis. A structured literature search was conducted across PubMed, Scopus, and Google Scholar databases, analyzing evidence-based studies published primarily between 2016 and 2026. The synthesized findings demonstrate that personalized non-pharmacological interventions exhibit significant therapeutic potential. Specifically, the low-FODMAP diet effectively alleviates overlapping gastrointestinal symptoms, while the Mediterranean diet reduces oxidative stress and modulates estrogen metabolism. Conversely, routine gluten elimination lacks justification without specific medical indications. Targeted supplementation with vitamin D, Omega-3 fatty acids, and antioxidants exhibits immunomodulatory properties, though clinical efficacy often varies due to phenotypic heterogeneity. Furthermore, emerging evidence highlights the gut-uterine axis as a key etiopathogenetic paradigm; dysbiosis and endotoxin translocation actively drive pelvic inflammation, making estrobolome modulation highly promising. Ultimately, nutritional interventions serve as a synergistic complement to conventional medicine, highlighting the urgent need to shift from universal protocols toward multidisciplinary, precision dietary care tailored to the patient’s individual metabolic and microbial phenotype.