Research into the impact of nutrition on endometriosis coupled to the benefits that pain management methods can provide using natural approaches to symptom relief and treatment are at last being taken more seriously. The following provides details of some of the research carried out into endometriosis and dysmenorrhoea.
Anti-oxidants form an important part in maintaining our health and providing defence against oxidation and pro-oxidants in our diet and environment. As with all aspects of nutrition, it is not sufficient to take a single anti-oxidant nutrient and expect this to fulfil the body’s needs. Anti-oxidants, like many nutrients in the body, require additional vitamins, minerals and nutrients as an essential co-factor to the process to address the various forms of oxidative stress in the body.
Some of the major anti-oxidant nutrients required by the body are;
- Vitamins: A, C, E, B.
- Minerals: Selenium, Zinc, Manganese, Copper, Iron.
- Additional factors: Flavonoids, Carotenoids, CoQ10.
Studies are linking oxidative stress and the presence of endometriosis, although it is felt larger study groups are still needed. (1)
Research reported in 2007 looked at the antioxidant intake of vitamin C, vitamin E, selenium and zinc in women with endometriosis. Results showed a significant statistical difference when data was compared with a control group, and concluded, ‘As endometriosis severity intensifies, a lesser intake of antioxidants is present. There is a positive association between the pathology development and the lipoperoxidation status’. (2) Interesting research has demonstrated the pain relief achieved with the vitamins C and E in dysmenorrhoea and endometriosis with several studies. (3,4,5)
The additional benefits to health of increasing the anti-oxidant status, with two of the most well know and easily accessible anti-oxidants, whilst assisting in symptomatic pain relief provides an interesting approach.
Essential fatty Acids
Dietary intake and supplementation with essential fatty acids found in fish, fish oils, seeds, seed oil and nuts provide EPA, DHA, LA, ALA, and GLA found in evening primrose oil, borage and blackcurrant oil is now recognised as providing benefits to health. In particular, the omega 3 from fish oil has been demonstrated to reduce inflammation. It would therefore be logical to include these in a healthy diet, and particularly in any pro-inflammatory situation.
Specific research into dysmenorrhoea with a group of 44 girls aged 15-19 years demonstrated a significant reduction in loss of school time and a reduced need for pain relief in those taking fish oil. (6)
A comparison study of linoleic acid (LA) and eicosapentaenoic acid (EPA) concluded that EPA supplementation might be a valid strategy for the treatment of endometriosis. In the EPA group, the active site for inflammation was significantly suppressed. (7)
Research is now taking a closer look at this aspect of the inflammatory nature of the condition, with the suggestion that this should be treated as an auto-immune disease and supporting the treatment of endometriosis with immunomodulators and inflammatory modulators. (8,9). A further review in 2007 considered inadequate immune and neuroendocrine responses are significantly involved in endometriosis. Amongst their discussion they considered that the flavonoid quercetin may have the potential to ameliorate symptoms in endometriosis, as this flavonoid has been shown to inhibit the release of pro-inflammatory mediators. (10).
Research carried out between 2004 and 2005 with a group of 98 patients concluded that, ‘Endometriosis is an inflammatory disease involving a possible shift towards Th2 immune response component, as demonstrated by the relative increase in cytokines characteristic of this pattern of immune response’. 11.
(Th2 refers to the T helper cells which play an important role in our immune function)
When the body is in a predominant Th2 state, the body becomes locked in a chronic inflammatory response. The fine balance required between Th1 and Th2 leads to decreased Th1 levels, when Th2 remains elevated. This results in lower NK (natural killer) cell counts and difficulty in eliminating viral and bacterial pathogens. It would appear relevant that immune support and anti-inflammatory treatment should be considered in patients with endometriosis in view of this research.
1. Jackson LW, Schisternman EF, Dey-Rao R. Browne R, Armstrong D. “Oxidative Stress and Endometriosis”. Human Reproduction Vol20, No7 pp2014-2020. 2005.
2. Hernández Guerrero CA, Bujalil Montenegro L, de la Jara Díaz J, Mier Cabrera J, Bouchán Valencia P. “Endometriosis and Deficient Intake of Antioxidants Molecules Related to Peripheral and Peritoneal Oxidative Stress”. Ginecol Obstet Mex. 2006 Jan;74(1):20-8.
3. Nino Kavtaradze, Celia E. Dominguez, John A. Rock, Sampath Parthasarathy and Ana A; Murphy. “Vitamin E and C Supplementation Reduces Endometriosis Related Pelvic Pain”. Fertility and Sterility. Volume 80, Supplement 3, September 2003, Pages 221-222.
4. Ziaei S, Zakeri M, Kazemmejad A. A “Randomised Controlled Trial of Vitamin E in the Treatment of Primary Dysmenorrhoea”. GJOG 2005;112(4):466-9.
5. Ziaei S, Faghihzadeh S, Sohrabyand F. A “Randomised Placebo-Controlled Trial to Determine the Effect of Vitamin E in Treatment of Primary Dysmenorrhea.”. BJOG 2001; 108:1181-1183.
6. Demirturk, Fazli; Gungor, Tayfun: Demirturk, Funda; Akbayrak, Turkan; Aker, E. Munire; “Relief of Primary Dysmenorrhea by Supplementation with Omega-3 Fatty Acids”. The Pain Clinic, Volume 14, Number 1, 2002, pp. 81-84(4)
7. Sachiho Netsu M.D Ryo Konno M.D;, Ph.d. Kohei Odagiri M.D Masaaki Soma Ph.D. Hiroyuki Fujiwara M.D., Ph.D. Mitsuaki Suzuki M.D.Ph.D. “Oral Eicosapentaenoic Acid Supplementation as Possible Therapy for Endometriosis”. Fertility and Sterility Volume 90, Issue 4, Supplement 1, October 2008, pages 1496-1502.
8. Ulukus M, Arici A. “Immunology of Endometriosis”. Minerva Ginecol 2005 Jun:57(3):237-48
9. W B Nothnick. “Treating endometriosis as an Autoimmune Disease”. Fertil Steril 2001;76(2):223-231
10. N Tariverdian, TC Theoharides, F Siedentopf, G Gutiérrez, U Jeschke, GA Rabinovich, SM Blois & PC Arck. “Neuroendocrine-immune Disequilibrium and Endometrosis: An Interdisciplinary Approach”. Semin Immunopathol (2007) 29:193-210
11. S Podgaec, MS. Abrao, JA. Dias Jr, LV. Rizzo2, RM. De Oliveira and EC. Baracat. “Endometriosis: An Inflammatory Disease With A Th2 Immune Response Component Human Reproduction”. Reprod. Advance Access, published January 18, 2007. dio:10.1093/humrep/del516 pp. 1H-7u, m200.7.