Endometriosis: which supplements should you take?

Reminder: what is endometriosis?

Endometriosis is a common gynaecological disorder affecting 1 in 10 women of reproductive age, in which cells similar to the endometrium (the lining of the inside of the uterus) grow outside the uterus. Developing as benign lesions or adhesions (1), they can appear in the fallopian tubes, ovaries or even the bladder and rectum.

Since they’re composed of endometrial tissue, these lesions are subject to hormonal variations. During each menstrual cycle, they will proliferate, bleed and thicken, in much the same way as the lining of the uterus does. It is this which causes the intense pain felt during a period.

For some women, the condition remains asymptomatic, while others suffer the recurrent, acute pelvic pain indicative of the condition, especially during menstruation (2). Over time, this pain may become chronic due to tissue retraction and increasing neurological sensitivity.

Depending on the location of the endometrial tissue, women may also experience dyspareunia (pain during intercourse), difficulty urinating or the frequent urge to urinate, or pain during a bowel movement (3). And between 30% and 50% of women affected by endometriosis experience infertility (4).

What medical treatments are offered to those with endometriosis?

If the patient is symptom-free and experiencing no functional impairment, treatment is usually considered unnecessary. If the reverse is true, there are potentially several therapeutic strategies available.

To reduce pain levels, hormone treatments (combined oestrogen and progesterone contraceptive pills, progestogens GnRH analogues…) are one option. In inducing amenorrhea (absence of periods), they usually succeed in stabilising and even shrinking lesions, though they will not eliminate them altogether. Analgesics of varying intensity (paracetamol, NSAIDs, anti-convulsant drugs, anti-depressants …) may also be prescribed depending on pain severity (5).

It’s worth noting that neurostimulation, in which controlled electric impulses are used to block nerve signals transmitted to the brain, are often effective in reducing neuropathic pelvic pain (6).

For women who wish to try for a family or who do not respond to these first-line treatments, surgery may be offered as a last resort. Here, the objective is to remove or destroy the offending lesions (by coagulation or laser vaporisation). However, this is a complex procedure, especially where lesions have spread, and requires thorough assessment of the risk-benefit ratio before proceeding (7).

Endometriosis: can dietary supplements help?

Let’s be clear at the outset: no dietary supplement can treat endometriosis. However, certain substances can complement conventional treatments by providing sufferers with physical or mental support. But before starting any course of supplementation, it’s important to consult a health professional for advice on which products best suit your particular situation.

The natural compounds mentioned most often in the literature include turmeric. This legendary spice from Ayurvedic medicine helps reduce the inflammatory response and has antioxidant properties, benefits mainly due to its high content of curcumin (8). Scientists are currently working to understand its effects both on oestrogen production and on the development, adhesion and angiogenesis of endometrial lesions (9-10).

Produced primarily by exposing the skin to sunlight, vitamin D is involved in the process of cell division and normal immune system function (11-12). It’s also been established that the ovaries and endometrium have vitamin D receptors, as well as several enzymes involved in its metabolism. This vitamin may therefore act in an immunological environment specific to the uterine region by mediating, amongst others, the ratio between pro-inflammatory and anti-inflammatory cytokines (13).

A higher intake of omega-3 fatty acids particularly marine-source EPA and DHA, may also offer benefits in compensating for our over-consumption of omega-6. Arachidonic acid, a specific form of omega-6, may act as a substrate for the production of prostaglandins (PGE2) and leukotrienes (LTB4), which potentially play a part in endometriosis-related pelvic pain (14).

Another study has underlined the fact that the fallopian tubes of endometriosis-sufferers are subject to more spasmodic and irregular contractions (15). This could aggravate retrograde menstruation (when menstrual blood flows upwards to the fallopian tubes), an abnormality seen in this disease. What’s more, endometriosis is frequently accompanied by intense mental exhaustion due to the chronic nature of the disease (16). While studies on this subject are lacking, supplementing with magnesium, which plays a role in normal muscle and nervous system function, could well prove beneficial (17-18).

Some forms of endometriosis are accompanied by dysbiosis - an imbalance in gut flora in which harmful bacteria outweigh beneficial ones (19). This can affect the immune system and make it easier for uterine cells to become implanted in areas where they are not normally tolerated. In repopulating the intestinal tract with ‘friendly’ microorganisms, probiotics help maintain balance in the gut microbiota. Specific strains such as Lactobacillus gasseri have been investigated in relation to endometriosis (20).

It’s worth noting that certain plants used for relieving menstrual discomfort, such as chasteberry, are sometimes recommended for endometriosis (21). However they can seriously upset the hormone system by directly affecting prolactin and progesterone levels. They should therefore only be used under medical supervision.

In addition to dietary supplements, there are other complementary and alternative approaches worth exploring. Yoga, sophrology, relaxation, acupuncture and osteopathy are all valuable in helping you to deal with pain better on a daily basis and improve your quality of life (22). The role nutrition can play, specifically an anti-inflammatory diet rich in fruits, vegetables and antioxidants, also merits greater consideration (23).