Endometriosis is a chronic inflammatory disease significantly impairing quality of life (QoL). While the Mediterranean diet (MD) may modulate inflammation, evidence regarding its relationship with symptom burden is limited. This study aimed to examine the association between MD adherence, symptomatology, and QoL in women with endometriosis.

In this cross-sectional study, 254 women with endometriosis recruited through Spanish patient associations completed the 14-item Mediterranean Diet Adherence Screener (MEDAS) and the Endometriosis Health Profile-30 (EHP-30). Binary logistic regression models examined associations between MEDAS score and symptoms. Fully adjusted models included age, body mass index, previous endometriosis-related surgery, current hormonal treatment, current analgesic/opioid use, and educational attainment. Multiple linear regression models assessed EHP-30 domains.

Mean age was 37.6 ± 6.4 years and mean MEDAS score was 8.2 ± 1.9. Higher MEDAS scores were associated with lower odds of pelvic pain in the fully adjusted model (OR=0.85; 95% CI: 0.73–1.00; p=0.044). The association with fatigue was attenuated after broader adjustment (OR=0.84; 95% CI: 0.71–1.01; p=0.062). MEDAS score was not independently associated with any EHP-30 domain, whereas pelvic pain and fatigue were consistently associated with poorer QoL.

Greater Mediterranean diet adherence was cross-sectionally associated with lower odds of pelvic pain, but not independently with fatigue or disease-specific QoL. Longitudinal and intervention studies are needed to determine whether Mediterranean dietary patterns influence symptom burden in women with endometriosis.