The Potential of Under-Researched Supplements on Endometriosis Pain

Did you know that there is a chronic pain and inflammation disease that effects up to 1 out of every 10 women(1)? The disease is endometriosis and even though it effects 10% of women there is a lack of direct studies on pain management outside of the pharmaceutical world. According to Mayo Clinic, Endometriosis is defined as, "an often-painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus - the endometrium - grows outside your uterus(2) ." It comes with a myriad of potential symptoms such as excessive bleeding, painful periods and intercourse, infertility, fatigue, pain with bowel movements/urination and bloating(3) . The standard treatment for endometriosis is birth control, laparoscopic excision of the use of medications such as Orlissa which puts your body into a medically induced menopause. Pharmaceutical drugs may come with unwanted side effects and for some surgery may be an invasive option to consider, so are there any other options to help manage the day-to-day pain of Endometriosis? Although direct studies are lacking there are supplements such as NAC, DIM and Curcumin that have the mechanisms of action to potentially target certain aspects of Endometriosis such as size of endometrioma, relief of estrogen dominance and reduction in inflammation.

NAC (N-acetyl cysteine) which is the supplement form of the amino acid cysteine has the potential to reduce the size of endometrioma and reduce daily pain with those diagnosed with Endometriosis. Endometriosis is a chronic inflammatory disease and NAC has been shown to reduce inflammation and decrease abnormal cell growth. In a single study, women that were diagnosed with Endometriosis who were scheduled to have a laparoscopic surgery due to either pain, large endometrioma or infertility were given 600mg of NAC 3x per day for 3 days in a row, followed by 4 days off for 3 months straight. Although 3 months may seem like a short period of time, there was a surprising change in the size of the endometrioma cysts with an average shrinkage of 28.9ml in volume and 8.2mm in diameter. There was also shown to be a promising reduction in pain with a 59% reduction in chronic pelvic pain, 55% reduction in dysmenorrhea (painful menstruation) and 50% in dyspareunia (painful intercourse) after the 3-month trial was concluded. Due to the combination of cyst reduction and pain relief 24 of the patients canceled their laparoscopic surgeries vs. only 1 in the control group(4) . As you can see, NAC shows potential in reducing pain in patients with Endometriosis and is a supplement that if further studied could prove to be a non-invasive and non-pharmaceutical option for treatment.

DIM (diindolylmethane) is a phytonutrient found in plants and has the potential to reduce estrogen dominance in those with endometriosis. Estrogen dominance is a factor in the cause of pain and inflammation in diagnosed women and correcting the balance of estrogen in the body therefore ay play a role in pain management(5) . DIM has not been directly studied on estrogen dominance in women with Endometriosis but a direct study of patients with thyroid proliferative disease which is also an estrogen dominance disease shows promise. The patients received 300mg of DIM orally for 14 days and the levels of estrogen were analyzed through urine and serum to check the metabolism of estrogen(6) . The results are as follows, "... our results indicate an increase in the 2-OHE level for six out of seven patients, with a mean increase of 6.98 ng/mg creatinine. A decrease in the 16-OHE1 level was observed for all seven patients, with a mean decrease of 7.47 ng/mg of creatinine (range 0-7.9 ng/mg of creatinine.)"(6) 16-OHE1 and 2-OHE are both types of estrogen in the body and a dominance specifically of 16-OHE1 to 2-OHE has been shown to be harmful for estrogen dominant diseases such as breast cancer(7) . This direct study on DIM and its ability to improve the balance of estrogen dominance on an estrogen dependent disease such as thyroid disease shows promise as a supplement that could improvesymptoms of endometriosis if studied directly and improve day to day quality of life for many women.