Science Update

Recent Review Evaluates Dietary Supplementation and Endometriosis

Endometriosis is a complex disorder involving the endocrine, immune, and inflammatory pathways. It often involves severe chronic pelvic pain that can greatly impact the quality of life of the individual. The average time between symptom onset and diagnosis is 7 to 12 years, and its pathophysiology is still not fully known. Current medical treatment for endometriosis may be inefficient or associated with complications. Recent research has explored micronutrient use to support healthy inflammatory and immune responses and healthy hormone levels in the presence of endometriosis. 

A recently published review article by Bahat and colleagues evaluated recent literature regarding the use of certain dietary supplements in the presence of endometriosis. The article highlights several micronutrients with the potential to support the body’s response to endometriosis. 

Polyunsaturated fatty acids (PUFAs), particularly omega-3 PUFAs such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well-known for their role in support of a healthy inflammatory response and have been the subject of many studies related to endometriosis. A laboratory study indicated that a high omega-3 to omega-6 ratio showed a significant reduction in the survival of endometrial cells. Omega-3 supplementation in animal studies was shown to decrease endometriosis-associated pain.

In clinical studies related to PUFAs and endometriosis, individuals with higher circulating levels of EPA were associated with a reduced risk of incidence. A study in adolescents receiving supplementation including omega-3s showed a significant drop in pain scores. 

Vitamin D is an essential nutrient for many processes in the human body and is critical for immune health and may help support the body in the presence of endometriosis. It modulates pro-inflammatory cytokines, such as tumor necrosis factor, interleukin (IL)-2, and IL-6. It also influences anti-inflammatory cytokines that included transforming growth factor (TGF) and IL-4. Vitamin D receptors are located throughout the body and can be found on the ovaries and endometrium. Clinical studies have associated lower vitamin D levels and the incidence and severity of endometriosis. Studies involving surgically confirmed endometriosis correlated decreased risk with higher dietary intake of vitamin D.

Trace minerals, such as zinc, are involved in critical cellular functions. Zinc plays many important roles in the body’s response to oxidative stress and inflammation. It also participates in intracellular signaling and immune health. One study reported by Bahat and colleagues indicates that dietary intake of zinc may be associated with the incidence of endometriosis. In the research sphere, clinical studies relating zinc and endometriosis are scant; more research is needed before conclusions can be made. 

The study published by Bahat and colleagues also describes the potential supportive roles of other micronutrients beyond the scope of this article. Of note, animal studies involving alpha-lipoic acid have resulted in significant improvements in endometriosis-associated pain. In addition, dose-dependent supplementation with vitamin C has been shown to improve endometriotic cysts. Other micronutrients with promising data include curcumin, vitamin E, and epigallocatechin-3-gallate (EGCG). 

Micronutrients, such as zinc, vitamin D, and PUFAs, may support the body’s response to oxidative stress and inflammation in the presence of endometriosis. Further research is needed, but studies suggest that other micronutrients, including curcumin may also play a role in endometrial health.

By Colleen Ambrose, ND, MAT