What is endometriosis?
Endometriosis is a chronic, inflammatory and estrogen-dependent gynecologic disorder[1].
It happens when endometrium, tissue lining the uterus, is located at other parts of the body where it is not supposed to be at. The commonest place is peritoneium, the part that covers the inside of abdominal cavity, ovaries and fallopian tubes.
Pain is caused when the misplaced endometrial tissue is triggered by the hormones that cause your period to come, causing this tissue to shed and irritating the nerves beside as well, causing the pain that is unbearable to most.
This cause chronic inflammation and scar tissue formation over time, triggering abnormal immune responses leading to more inflammation and scarring.
How many women are affected?
About 11% of women of reproductive age is affected worldwide [2] and its pathogenesis is due to the presence of endometrial cells outside the endometrium, ie outside of the uterus[3]. Most women with endometriosis (up to 50%) are also diagnosed with infertility due to the following factors:[4]
Diminished ovarian reserve
Alteration of oocyte quality by inflammation or disruption of the oocyte mitochondrial activity
Peritoneal inflammation that affects the endometrial receptivity
What are the symptoms of endometriosis?
The most common is the intense cramps when your period comes, even with the intake of painkillers. Others include
Long periods
Constipation
Painful sex
Lower back pain
Chronic fatigue
Infertility
What causes endometriosis?
Nobody is for sure what caused endometriosis, but inflammation is the leading theory for endometriosis, coupled with an abnormal immune response triggered by hormonal changes, environmental hormonal exposures and other pro-inflammatory factors.
Underlying pathogenesis involves pro-inflammatory cytokines such as Il-6, IL-8 or TNFa. However, another important factor is oxidative stress. Oxidative stress can cause infertility due to its DNA damage to ooctye, which can affect its quality.[5]
Therefore, currently there are a lot of interest in targeting oxidative stress while treating endometriosis.
How is endometriosis treated?
Usually doctors prescribed painkillers like ibuprofen and NSAIDs but they often cause gastroinestinal discomfort. Oral contraceptives and progestins may also relieve some pain but they dont treat the underlying root causes of the problem. Once oral medications don't work, in come a surgery known as laparoscopy.
Laparoscopy is ordered to remove endometrial tissue, which can relieve symptoms for probably longest 2 years, symptoms usually resurface and the irony is the surgery increases the chances of scar tissue forming. Hysterectomy is sometimes preferred, but it is not ideal for woman trying to conceive.
My endometriosis diet
What i recommend is an anti-inflammatory diet, which comprise of fresh vegetables and leafy greens, particularly kale, broccoli, Brussels's sprouts and fresh fruits.
I always ask patients avoid three pro-inflammatory food items : dairy products, gluten-containing products and most sugar. Red meat is also considered pro-inflammatory, therefore I would recommend a plant-based, wholesome food diet for most endometriosis patients.
Also, keep your bloody sugar and body weight in check!
What supplements can we take to treat endometriosis?
1) Melatonin
We have a hormone inside us that controls our wake/sleep cycles, and yes you've got it, it is called melatonin.
It is a potent anti-oxidant that prevents oxidative stress induced by reactive oxygen species, which in layman's terms, it decreases inflammation. [6]
In animal studies, melatonin has been shown to decrease endometriotic lesions recurrence rate[7], reverses progression of endometriosis implants[8] as well as preventing peritoneal adhesion[9], all which helps to treat endometriosis.
In a human trial, melatonin has been shown to be able to treat pain caused by endometriosis and dysmenorrhea [10].
How safe is melatonin?
Melatonin has been shown to be safe and does not exhibit any adverse effects even at high doses [10].
How can we take melatonin?
At my practice, I recommend patients to start 1-3mg/day, best taken in the evening as it helps with sleep. We can increase it to 10mg at bedtime after one month. This helps with the body detoxification process.
What are some natural vegan melatonin supplements?
Now Foods, Melatonin, 5 mg, 180 Veg Capsules
Ingredients:
Cellulose, vegetable polysaccharide (capsule) and magnesium stearate (vegetable source).
Not manufactured with wheat, gluten, soy, milk, egg, fish, shellfish or tree nut ingredients. Produced in a GMP facility that processes other ingredients containing these allergens.
Out of 187 reviews given, 137 gave 5 star review, 15 gave 4 star reviews. 17 gave 1 star review.
Pros: It helps with sleep quality with no after effects.
I have been taking these tablets for a week now and they work like a charm for getting a good nights' sleep. My dreams have also been more vivid (in a good way) when taking these, and I do not feel drowsy the following morning. I found that these tablets work best for me when taking one 30-45 minutes before bedtime. Will be purchasing these again in the future! ~ January 16 2019
I have used this product for over year and you fall asleep quickly with no after effect in the morning. ~March 5 2019
Cons: It probably didn't work for some.
Didn't help me get to sleep; out of sheer desperation I even tried taking 3-6 capsules but to no avail; whether I took one capsule or exceeded the recommended/suggested dose it didn't make any difference. Disappointed. Almost finished the bottle and will not repurchase; trying liquid Melatonin next. ~September 30 2018
2) Evening Primose Oil(EPO)
Gamma-linolenic acid (GLA), an essential fatty acid found in EPO helps fight inflammation and inhibit tumor growth in patients with endometriosis. This is because GLA when ingested converts to prostaglandins to fight pain and tumor stimulating prostaglandins. Prostaglandins are differentiated into three clasess - PgE 1,2,3. PgE 2 is the one which causes pain, while PgE 1 and 3 are antispasmodic, which reduce pain. So by increasing the good PgE, contractions will be at its minimal. The GLA in primrose oil evens out prostaglandin production and can reduce pain from uterine contractions. [11]
EPO has also been found to help with breast tenderness, bloating, acne and headaches. [12]
How to take EPO?
The recommended dosage is 500 milligrams of evening primrose oil, three times a day. Days to take is from day one through day 14. You can double the dose the next cycle if results aren't showing.
When not to take EPO?
You should not take evening primrose oil if you are taking antipsychotic medications, medications that may increase bleeding, or if you have a history of seizures. Also if you are trying naturally to get pregnant, you have to stop EPO after ovulation time.
How safe is EPO?
Evening primrose oil is generally safe when used in recommended dosages, which is 2 to 8 grams daily. Some rare reported side effects include stomachache, headache, rashes and nausea.
Vegan Evening Primrose Oil Supplement
New Chapter Menopause Supplement - Estrotone with Evening Primrose Oil + Black Cohosh for Hormone Health - 60 ct Vegetarian Capsule
I have searched the amazon high and low for quality EPO product with vegetarian capsule and have managed to find this product. This comes with a bonus because other than EPO, black cohosh and chasteberry is also provided in each capsule, both shown to help with hormonal regulation.
Ingredients
Evening Primrose SCE, Org.; Schizandra HE D1; Black Cohosh HE D1; Chaste Tree HE D1; Ginger SCE, Organic; Ginger HE; Rosemary SCE; Extra Virgin Olive Oil; Yellow Beeswax, Organic; Candelilla Wax
Our of 257 reviews, 81% gave either a 5 star or 4 star ratings.Only 9% gave 1 star ratings.
Positive review:
The new once a day formula is cheaply made and ineffective. I really wish that manufacturers would understand that changing the formula might save money short term but in the long run it ruins the product.
I had a total hysterectomy at the age of 35 years old and was placed on Premarin. It work ok however I did not want to take prescribed hormones for fear of getting cancer.
A pharmacist friend of mine told me about estrotone and I began taking it, and it saved my life! The hot flashes, mood swings, low libido and listlessness all went away!
Please do yourself a favor and make estrotone your friend. I have recommended this supplement to my friends and family.
I was forced to go without it for months due to the halt in production. When I stopped taking it all of my symptoms returned with a vengeance!
Estrotone recently returned and I have ordered a years supply and have vowed to never let my supply drop below 6 months. That's how much this product has helped keep me balanced. ~AcematRN
Cons: It might cause some allergic reactions.
I really hoped this would help, but I had an allergic reaction to the New Chapter Estrotone softgels. Three days using as directed caused my skin have a rash, mostly on my neck. The search is on again for something that can help. ~Bevie
3) Milk Thistle
Silymarin, a component found in milk thistle seeds, helps to combat anti-inflammatory and supports normal liver functioning. Liver is a major detoxification factory, responsible for filtering toxins out of our body, including excess estrogen. Estrogen is the reason why endometriosis lesions grow, therefore promoting healthy liver function is essential for removing excess estrogen in the body.
Gaia Herbs Milk Thistle Seed, Vegan Liquid Capsules, 120 Count
Ingredients
Milk Thistle Seed Extract (Silybum marianum), Milk Thistle Seed Extract (Silybum marianum) Capsule (vegetable cellulose), Water, Vegetable Glycerin, Lecithin (non-GMO)
This bottle contains 40 days supply, each serving deliver 32,400mg of crude herb equivalent.
The downside of this is that you have to take 3 capsules at each serving, once in the evening each day.
Out of 128 reviews, 93% gave 4 or 5 star ratings.
Positive review:
I can't believe how amazing this is. I have had acne since I was about 10. It got better in my 20s, but after having my son in April 2015, my hormones have been out of whack and my skin has been worse than it ever has been. I have tried EVERYTHING in regards to healing my acne and nothing has worked. All sorts of creams, cleansers, serums... I stopped washing my face completely, washed it with honey, used apple cider vinegar, lemon juice, etc. I've taken inositol, vitex, various vitamins, tons of different brands of probiotics, cod liver oil, and more.
After only 1 WEEK of this milk thistle, I can tell my acne is healing. And I didn't even take it every day, and I only take 1 capsule as opposed to the 3 recommended by the product package. I haven't had but a few new bumps along my jawline. And this was through PMS and my period!
This stuff also makes me feel amazing! Like I could take on the world. I take it at night and feel great the next day. The only problem is that if I take it too often, it gives me wicked insomnia.. like zooming around the house cleaning at 3am insomnia. So I cut back to taking it every other night and that pretty much fixed it.
I will update this review if anything changes in the future, but if you have acne and have struggled to find anything that works, try this! NOW
For reference, I am a 26 year old white female, 5'5", 120 pounds. I am also autistic. ~Ashley Steer
4) Curcumin (turmeric)
Turmeric is used daily across the world as a spice for food, flavoring, coloring, dietary supplement, and more. It is native to Asia and is related to the ginger root.
A clinical study done suggest that curcumin can counteract the proliferative response of estradiol(increasing endometriotic lesions growth) by inducing apoptosis. Curcumin exhibit anti-inflammatory properties and has been shown to be effective in preventing and treating endometriosis. [14]
Gaia Herbs Turmeric Supreme Extra Strength, Vegan Liquid Capsules, 120 Count
Containing 60 days supply, recommended dosage is 1 capsule 1-2 times daily after meals.
Ingredients
Turmeric Root Extract (Curcuma longa), Turmeric Root Supercritical Extract (Curcuma longa), Black Pepper Fruit Supercritical Extract (Piper nigrum) Capsule (vegetable cellulose), Water, Vegetable Glycerin, Lecithin (non-GMO)
Not to be used during pregnancy or lactation. If you have a medical condition or take medications, please consult with your doctor before using this product.
Out of 931 reviews, 88% gives 4 or 5 star ratings.
Positive review:
After a serious knee injury from running a couple of years ago and the subsequent surgeries to repair it, my knee has not returned to normal. If I over-exert or twist it during heavy exercise, it tends to swell and become very painful.
My orthopedist put me on regular daily doses of anti-inflammatories; but I had a problem with stomach irritation so I've tried a number of natural supplements which provided some relief. Turmeric had been mentioned to me by a nutritionist, but I had waited to try it. I started out with a couple of different name brands of turmeric/curcumen. After a few days on the it, the pain in my knee improved noticeably but I still had a fair amount of pain after workouts.
While I use the Gaia Herbs brand for a couple of other supplements and have been extremely happy with their quality, I avoided buying Gaia Herbs' version of turmeric since the other brands I was using were less expensive. I decided to try one bottle's worth to see if it made a difference. It did! Several weeks after switching brands to the Gaia Herbs version, my knee pain improved dramatically...often to the extent that I don't even notice the pain (haven't been without knee pain in 2 years).
In researching the most effective way of taking turmeric for joint pain, I learned that it's important to include an extract of the black pepper berry which aids in the absorption of the curcumin. Basically, it helps the curcumin to get into your bloodstream rather than just passing through your intestines. Gaia Herbs version contains 7mg of this black pepper berry extract and uses an alcohol extraction method to best capture the curcumin. I've also read that it's helpful to pair the turmeric/curcumin with Bromelain because it forms a synergistic combination that helps to support a healthy inflammatory response.
The recommended daily dosage on the bottle is 1-2 capsules per day. I take two capsules daily -- one in the morning and one later in the day. I can't take more than one at a time because too much can result in upset stomach or acid indigestion.
(NOTE: Turmeric grows as a rhizome (large root) and has been used since early times to treat gastrointestinal upset, arthritic pain, and other ailments. Curcumin, which is a constituent of turmeric, is known for for its anti-inflammatory and antioxidant activity and it's being studied as having a potential role in the battle against cancer, Alzheimer's disease, psoriasis and cystic fibrosis. For joint pain and inflammation, a number of orthopedists claim that it offers the same degree of pain relief as NSAIDs (anti-inflammatories)...without the health risks.) ~Catrinka
Cons: Might cause dizziness in some
I don't understand how or why... but I've been taking this daily for 3 months and I've been getting progressively dizzier as it built up. I never thought it could be this since it's just a spice.
I saw an ENT and physician for testing and they couldn’t figure it out, but I finally cut out all of my supplements recently one-by-one and I am now realizing it was the turmeric! so strange...
I'm relieved that the vertigo & dizzy spells are gone now that I no longer use this product! If you’re dizzy, stop taking this immediately! ~B
Bottom Line Endometriosis is by far one of the hardest gynecological disorders to be treated. Other than painkillers, trying natural therapy is one of the best choice you can ever make.
[1] Burney, R.O., Giudice, L.C., 2012. Pathogenesis and pathophysiology of endometriosis. Fertil. Steril. 98, 511–519.
[2] Giudice, L.C., Kao, L.C., 2004. Endometriosis. Lancet 364, 1789–1799.
[3] Buck Louis, G.M., Hediger, M.L., Peterson, C.M., Croughan, M., Sundaram, R., Stanford, J., Chen, Z., Fujimoto, V.Y., Varner, M.W., Trumble, A., Giudice, L.C., 2011. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil. Steril. 96, 360–365.
[4] Rawson JM. Prevalence of endometriosis in asymptomatic women. JRM 1991; 36:513–5.
[5] Riley CF, Moen MH, Videm V. Inflammatory markers in endometriosis: reduced peritoneal neutrophil response in minimal endometriosis. Acta Obstet Gynecol Scand. 2007; 86:877‐881.
[6]Tan DX, Chen LD, Poeggeler B, Manchester LC, Reiter RJ. Melatonin: a potent endogenous hydroxyl radical scavenger. Endocr J 1993; 1:57– 60.
[7]Yildirim G, Attar R, Ozkan F, Kumbak B, Ficicioglu C, Yesildaglar N. The effects of letrozole and melatonin on surgically induced endometriosis in a rat model: a preliminary study. Fertil Steril. 2010 Apr;93(6):1787-92.
[8]Koc O, Gunduz B, Topcuoglu A, Bugdayci G, Yilmaz F, Duran B. Effects of pinealectomy and melatonin supplementation onendometrial explants in a rat model. Eur J Obstet Gynecol Reprod Biol. 2010; 153:72‐76.
[9] Ozcelik B, Serin IS, Basbug M, Uludag S, Narin F, Tayyar M. Effect of melatonin in the prevention of post-operative adhesion formation in a rat uterine horn adhesion model. Hum Reprod. 2003; 18:1703‐1706.
[10] Schwertner A, Conceição Dos Santos CC, Costa GD, Deitos A, de Souza A, de Souza IC, Torres IL, da Cunha Filho JS, Caumo W. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013 Jun;154(6):874-81.
[11] Obgyn.ucla.edu. (2019). Endometriosis: What is Endometriosis? Endometriosis Symptoms, Treatment, Diagnosis – UCLA. [online] Available at: http://obgyn.ucla.edu/endometriosis. Accessed 13 Mar. 2019.
[13] Schäfer L, Kragballe K. Supplementation with evening primrose oil in atopic dermatitis: effect on fatty acids in neutrophils and epidermis. Lipids. 1991 Jul;26(7):557-60.
[14] Singh M, Singh N. Curcumin counteracts the proliferative effect of estradiol and induces apoptosis in cervical cancer cells. Mol Cell Biochem 2011; 347: 1-11.