Meredith East Powell Brisbane Nutrition, Yoga and Mentoring

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Supplements that help manage Endometriosis naturally

Meredith

If you’re looking for natural remedies to help manage endometriosis, thankfully there are many. A good quality wholefoods diet combined specific nutrients and supplements can help manage endometriosis symptoms. As a nutritionist, the decisions I make around supplementation really depends on what is going on for my patients individually. 

The supplements (and foods) that provide real benefits to endometriosis patients usually offer the following benefits:

  • Anti-inflammatory support

  • Antioxidant support

  • Immune support

  • Promote gut health

  • Promote sleep

And the supplements listed below are no exception:

SUPPLEMENTS THAT HELP MANAGE ENDOMETRIOSIS

MELATONIN

Melatonin is known as the sleep hormone. It helps regulate the sleep cycle and many people take it to help support their sleep and to treat jet lag. However, melatonin is also an effective supporting therapy for endometriosis, it can help in a number of ways: as an anti-inflammatory, an antioxidant and as an analgesic (pain relief); studies have shown that taking 10mg of melatonin can reduce pain, improve sleep quality, reduce lesion growth and also has anti-estrogenic effects, which is helpful considering estrogen can fuel endometriosis (1, 2, 3).

Starting with 10mg of melatonin may be too high for many, if you’re new to this supplement, or if you have other health conditions, talk to your health professional about the appropriate dose or whether melatonin is right for you.

The natural production of melatonin is dependent on a number of other things such as the availability of tryptophan, an amino acid, therefore eating adequate levels of protein are important. Other nutrients are also involved in the synthesis of melatonin such as vitamin C, zinc, iron, magnesium and some B vitamins, so eating a varied, wholefoods diet will support its production.

Melatonin can be found in a range of fruits, vegetables and wholegrains, including tart cherries so try my hot cherry chocolate recipe provided in this link.

MAGNESIUM

Magnesium is a mineral I prescribe to most of my patients, it offers so many benefits and can help manage endometriosis in a number of ways:

It helps calm the nervous system which has a range of beneficial flow on effects, including supporting the hypothalamic pituitary adrenal axis (HPA) which is central to the stress response, which in turn supports healthy hormone production (4).

Magnesium is involved in energy production and it’s depleted in states of inflammation and stress, it has an anti-inflammatory effect and reduces oxidative stress which are seen in higher levels in women with endo. 

Therefore magnesium helps with a range of symptoms such as period pain, menstrual migraine, bloating, breast tenderness, fluid retention, depression and anxiety (5).

Magnesium is found in a wide variety of foods such as nuts, legumes, wholegrains, spices, seafood, cacao and green leafy vegetables. Epsom salt baths are another great (and relaxing) way of absorbing magnesium. The dose for taking magnesium orally is approximately 350mg daily either in a glycinate or citrate form.

ZINC

Zinc is important because it’s involved in a number of reactions within the body, it essential for the immune system, offers anti-inflammatory and antioxidant benefits and supports tissue repair. Zinc is also important for the utilisation of vitamin A. It’s been suspected that zinc might be implicated in the development of endo as one study demonstrated that women with endometriosis had decreased levels of the micronutrient (6).

Good sources of zinc are found in red meat (especially organ meat), seafood (especially oysters), poultry and dairy products. Wholegrains, vegetables, nuts and seeds also provide some zinc. When it comes to supplementation, the dosage can range from 5mg to 40mg daily.

FISH OIL

Processed and red meat contain higher levels of arachidonic or omega 6 fatty acids, which in excess causes inflammation. However, fish and fish oil offer anti-inflammatory benefits due to higher levels of omega 3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid)‎.

Studies have shown that fish oil decreases period pain and nonsteroidal anti-inflammatory drug (NSAID) consumption (7, 8). 

You can consume fish regularly such as wild Alaskan salmon, sardines, anchovies and trout to boost your omega 3 levels. Women with endometriosis or adenomyosis however, may need to supplement, so aim for a high-quality purified fish oil with both EPA and DHA at a dose between 1 and 3g per day.

TURMERIC (CURCUMIN)

Curcumin is a constituent of turmeric which has been well studied for its anti-inflammatory, antioxidant properties and its effect on preventing endometriosis lesions from growing new blood vessels.

Turmeric can be incorporated into the diet easily by adding it to meals and drinks such as a turmeric latte. To gain a therapeutic dose to manage the symptoms of endometriosis, a lot of turmeric needs to be consumed, additionally the levels of curcumin contained in turmeric can vary therefore, curcumin is often taken instead as a supplement, the dose varies but is approximately 100g of curcumin is taken with food twice daily.

VITAMIN A, E AND C

Ok so I’ve grouped 3 vitamins in one here. I often prescribe these nutrients together so read on!

There have been some studies on Vitamin E, some with vitamin C, with fewer studies on vitamin A for inflammation, endometriosis and period pain. All offer the benefits of antioxidants along with a number of other functions: 

Vitamin A is vital for a number of actions such as vision, immune health and reproduction. The active form of vitamin A is found in animal products such as meat, dairy and eggs, the form that needs to be converted into vitamin A is found in fruit and vegetables. The dose for vitamin A can range from 2500IU to 8000IU daily.

Vitamin E comprises several fat-soluble compounds that are potent antioxidants and has anti-inflammatory action through its effects on the production of prostaglandin. Vitamin E can be found is nuts and seeds and green leafy vegetables. For supplementation the approximate daily dose is 400IU, however studies have used 1200 IU daily for shorter timeframes (10).

Vitamin C has a number of roles in the body, but is best known for as a powerful antioxidant. It acts as an antioxidant by working synergistically with other antioxidants such as vitamin E and glutathione. Which is why vitamin C is often prescribed with vitamin E. Vitamin C can be found in fruit and vegetables such as berries, capsicum, papaya, oranges, broccoli and kale. Supplementation of vitamin C usually ranges from 500mg to 1000mg daily.

N-ACETYLCYSTEINE (NAC)

N-acetylcysteine or NAC is a protein (a form of the amino acid cysteine), which acts as an antioxidant through its ability to restore glutathione, an important antioxidant within the body.

2 studies on NAC showed real benefits on women with endometriosis. One study showed that taking 600mg 3 times daily for 3 consecutive days a week for 3 months NAC was effective in a reduction of ovarian endometriosis cyst size (11). Another study showed a preparation containing 600mg of NAC consumed twice daily, combined with other antioxidants, showed a significant reduction of endometriosis related pain and a lower intake of pain relief medication (12).

PARTIALLY HYDROLYSED GUAR GUM (PHGG)

Ok so this is a prebiotic and a form of soluble fibre. Gut health is important for endometriosis as it can contribute to pain (particularly if you have IBS) and because of the need to efficiently be clearing excess hormones such as estrogen. PHGG has shown to be very good at promoting regular bowel movements so it’s great for those dealing with constipation and can also help with those tackling diarrhoea, additionally it’s a prebiotic so it feeds the microbes in the gut. The other positive about PHGG is that it dissolves in liquid and doesn’t really taste like anything, so it’s very easy to take.

Other fibre supplements that can help with gut health are psyllium husk powder or slippery elm. I’d suggest avoiding processed / branded fibre supplements because they have additives to make them taste good. 

PALMITOYLETHANOLAMIDE (PEA)

PEA is used for those who have endometriosis and experience chronic pelvic pain. PEA works by reducing the activity of mast cells, which have been found in high numbers in endometriosis lesions, especially those who have deep infiltrating endometriosis.

A WORD OF CAUTION

Be careful taking supplements if you have other health conditions, are on medications, considering pregnancy (or are pregnant) and tell your doctor if considering surgery. I also recommend exercising caution when purchasing off the internet as some brands may be of lower quality than others. 

It’s always best to try and obtain nutrients through the diet, but if you’d like to try supplementing and feeling unsure about what supplements are right for you, reach out and schedule an appointment with me.

References

  1. Acuña-Castroviejo, D., Escames, G., Venegas, C., Díaz-Casado, M. E., Lima-Cabello, E., López, L. C., … Reiter, R. J. (2014). Extrapineal melatonin: sources, regulation, and potential functions. Cellular and Molecular Life Sciences, 71(16), 2997–3025. doi:10.1007/s00018-014-1579-2

  2. Schwertner, A., Conceição dos Santos, C. C., Costa, G. D., Deitos, A., de Souza, A., de Souza, I. C. C., … Caumo, W. (2013). Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. Pain, 154(6), 874–881. doi:10.1016/j.pain.2013.02.025

  3. Anderson, G. (2019). Endometriosis Pathoetiology and Pathophysiology: Roles of Vitamin A, Estrogen, Immunity, Adipocytes, Gut Microbiome and Melatonergic Pathway on Mitochondria Regulation. Biomolecular Concepts, 10(1), 133–149. doi:10.1515/bmc-2019-0017

  4. Boyle, N. B., Lawton, C., & Dye, L. (2017). The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients, 9(5), 429. doi:10.3390/nu9050429

  5. Parazzini F, Di Martino M, Pellegrino P. Magnesium in the gynecological practice: a literature review. Magnesium in the gynecological practice: a literature review. Magnes Res. 2017;30(1):1–7. doi:10.1684/mrh.2017.0419

  6. Messalli, E. M., Schettino, M. T., Mainini, G., Ercolano, S., Fuschillo, G., Falcone, F., … Torella, M. (2014). The possible role of zinc in the etiopathogenesis of endometriosis. Clinical and experimental obstetrics & gynecology, 41(5), 541–546.

  7. Jurkiewicz-Przondziono, J., Lemm, M., Kwiatkowska-Pamuła, A., Ziółko, E., & Wójtowicz, M.  (2017). Influence of diet on the risk of developing endometriosis. Ginekologia Polska, 88(2), 96-102. DOI: 10.5603/GP.a2017.0017

  8. Hansen, S. O., & Knudsen, U. B. (2013). Endometriosis, dysmenorrhoea and diet. European Journal of Obstetrics & Gynecology and Reproductive Biology, 169(2), 162–171. doi:10.1016/j.ejogrb.2013.03.02

  9. Bahrami, A., Bahrami-Taghanaki, H., Khorasanchi, Z., Timar, A., Jaberi, N., Azaryan, E., … Ghayour-Mobarhan, M. (2019). Menstrual problems in adolescence: relationship to serum vitamins A and E, and systemic inflammation. Archives of Gynecology and Obstetrics. doi:10.1007/s00404-019-05343-1

  10. Santanam, N., Kavtaradze, N., Murphy, A., Dominguez, C., & Parthasarathy, S. (2013). Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational research : the journal of laboratory and clinical medicine, 161(3), 189–195. doi:10.1016/j.trsl.2012.05.001

  11. Porpora, M. G., Brunelli, R., Costa, G., Imperiale, L., Krasnowska, E. K., Lundeberg, T., … Parasassi, T. (2013). A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-based complementary and alternative medicine : eCAM, 2013, 240702. doi:10.1155/2013/240702

  12. Lete, I., Mendoza, N., de la Viuda, E., & Carmona, F. (2018). Effectiveness of an antioxidant preparation with N -acetyl cysteine, alpha lipoic acid and bromelain in the treatment of endometriosis-associated pelvic pain: LEAP study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 228, 221–224. doi:10.1016/j.ejogrb.2018.07.002

  13. Stochino Loi, E., Pontis, A., Cofelice, V., Pirarba, S., Fais, M. F., Daniilidis, A., Melis, I., Paoletti, A. M., & Angioni, S. (2019). Effect of ultramicronized-palmitoylethanolamide and co-micronized palmitoylethanolamide/polydatin on chronic pelvic pain and quality of life in endometriosis patients: An open-label pilot study. International journal of women's health, 11, 443–449. https://doi.org/10.2147/IJWH.S204275