Endometriosis is an estrogen-dependent inflammatory disease, affecting almost 5% of the
female population during the reproductive period. The most common symptom of women with
endometriosis is dysmenorrhea. Nowadays, the main therapy is pharmacological treatment
(estrogen-progestins and progestins); diet and physical exercises may represent a
complementary and feasible approach to reduce the pain symptoms related to this disease.
Indeed, diet may be involved in several pathophysiological mechanisms linked to
endometriosis, due to its ability to influence positively or negatively prostaglandins'
metabolism, chronic inflammatory processes and circulating estrogen levels.
Among the various dietary regimes, the Mediterranean diet shows many anti-inflammatory and
anti-oxidant properties.
Also regular physical activity can affect positively endometriosis, due to various
etiopathogenetic mechanisms including the decrease of estrogenic levels and ovulatory
frequency, the increase in SHBG levels, and the modulation of cytokines in an
anti-inflammatory way.
One of the reasons of low regular physical activity is the lack of free time. For this
reason, the American College of Sports Medicine developed a program designed for most of the
population, called "7-minutes workout". It consists in 12 high-intensity physical exercises,
lasting 30 seconds each and spaced out 10 seconds of short breaks, to be performed 2-3 times
a week.
Currently, there are few studies evaluating the impact of regular physical activity and
Mediterranean diet regimen on endometriosis.
The objective of this randomized controlled trial is to evaluate the potential beneficial
impact of regular aerobic physical activity and Mediterranean diet on endometriosis pain
symptoms.
Eligible women will be selected among those attending the Endometriosis Clinic of the "L.
Mangiagalli ", IRCCS Ca 'Granda Foundation and Ospedale Maggiore Policlinico, and will be
randomized into two homogeneous groups ("intervention" and "control") with a 1:1 ratio,
according to the type of therapy: estro-progestins or progestins.
The "intervention" group will be composed of women with symptomatic endometriosis in
estro-progestins or only progestin therapy, who will be asked to follow a Mediterranean diet
and to practice a regular exercise program according to the "7-minutes workout" model. The
"control" group will be composed of women with symptomatic endometriosis under therapy with
estro-progestins or progestins who will continue to receive the routine clinical care.
All patients participating in the study will undergo clinical and ultrasonographic evaluation
every fourth months. On these occasions, women will be routinely asked to complete some
questionnaires, one on pain (a numerical rating scale, NRS), one on quality of life (the
Short Form-12 questionnaire, SF-12), one on psychological status (the Hospital Anxiety and
Depression scale, HADS), one on sexual functioning (theFemale Sexual Function Index, FSFI)
and one on the global impression of change (Patients' Global Impression of Change scale,
PGIC). Women will be also asked to rate the degree of satisfaction with their treatment.
Moreover, at the beginning and at the end of the study all participants will be asked to
complete a dietary questionnaire, a physical activity questionnaire (International Physical
Activity Questionnaire, IPAQ) and a sleep quality questionnaire (The Pittsburgh Sleep Quality
Index, PSQI).
Only the patients in the "intervention" group will be asked to follow a Mediterranean diet.
They will receive a nutritional counseling with the investigator's hospital dietician
periodically. Furthermore, these patients will follow an aerobic physical activity program
2-3 times a week for one year.