Antioxidant dietary patterns mitigate pain and raise psychological wellbeing in ovarian endometrioma: surgical status shapes associations.

INTRODUCTION: Endometriosis is a systemic inflammatory disease in which immune dysregulation and oxidative stress contribute to pain and impaired quality of life. This study aimed to examine whether antioxidant and inflammatory dietary patterns are associated with pain, sexual and reproductive function, and psychological wellbeing in women with ovarian endometrioma (OMA), and whether these associations differ according to surgical status. METHODS: This observational cross-sectional study included women with OMA undergoing hormonal therapy, classified according to whether they had surgery (S, n = 10) or not (NS, n = 17), and healthy controls (n = 15). Dietary intake was assessed using a validated food frequency q uestionnaire to derive antioxidant and inflammatory dietary patterns, while pain, sexual and reproductive function, and psychological wellbeing were evaluated using standardized questionnaires, together with systemic immune and biochemical markers. Multivariate and principal component analyses were used to examine associations between dietary patterns (Nut PCs), immune markers, and functional outcomes. RESULTS: Women with OMA showed significantly lower psychological wellbeing, sexual and reproductive function, and higher pain sensitivity compared with controls, with poorer reproductive function in OMA NS. Lymphocyte levels were higher in women with OMA. Higher antioxidant dietary scores (Nut PC1 and DAI) were associated with lower pain sensitivity and better psychological wellbeing. In contrast, protein-related patterns (Nut PC2) were positively, and lipid-related patterns (Nut PC3) were negatively associated with menstrual characteristics and sexual function. Psychological wellbeing was inversely associated with OMA and but positively related to antioxidant dietary patterns. Antioxidant dietary index (DAI) was higher in women with OMA S than in controls and OMA NS, while dietary inflammatory index (DII) was lower in OMA NS versus control, with no differences compared to OMA S. DISCUSSION: Nutrition may modulate symptom perception in women with OMA undergoing hormonal therapy, particularly through antioxidant-rich dietary patterns. These associations appear to be influenced by surgical history and systemic inflammation. Integrating personalized nutritional counseling alongside conventional treatments may offer a feasible strategy to enhance quality of life in this population.