Immune-nutritional interactions in endometriosis: current evidence and future perspectives in disease management

Endometriosis is a chronic estrogen-dependent inflammatory disorder affecting approximately 10% of women of reproductive age. It remains a major contributor to chronic pelvic pain, infertility, and reduced quality of life. Despite considerable advances in elucidating its genetic, hormonal, and immunological basis, current therapeutic strategies frequently provide incomplete symptom relief, may be associated with adverse effects, and fail to prevent disease recurrence. Therefore, increasing attention has been directed toward modifiable environmental factors, particularly nutrition, as supplementary strategies for disease management. This review comprehensively examines the evidence connecting dietary patterns and bioactive food components with the immunopathogenesis of endometriosis. It explores the potential role of nutrition in modulating key biological processes involved in endometriosis pathophysiology and progression, including immune dysregulation, chronic inflammation, oxidative stress, angiogenesis, estrogen metabolism, and gut microbiota imbalance. Particular emphasis is placed on the Mediterranean diet and selected dietary components, such as omega-3 fatty acids, vitamin D, resveratrol, epigallocatechin-3-gallate, and probiotics, as well as dietary interventions like low-FODMAP and gluten-free diets. The findings are discussed in relation to mechanistic evidence and emerging observations. Substantial clinical data supporting specific dietary interventions are scarce, and most dietary guidelines are based on preliminary research. Future investigations that incorporate nutritional interventions alongside immune profiling, microbiome analysis, and multi-omics technologies may facilitate the development of individualized nutritional strategies as adjuncts within the framework of precision medicine for women affected by endometriosis.