As many of you may know, I’ve been busy delivery my course, Live and Thrive with Endo, which has just finished! As part of the course, I created a bonus module all about supplements for endometriosis, pain, inflammation and hormones.

In my book This EndoLife: It Starts with Breakfast I actually go into supplements that have been shown to target endometriosis, but in this module, I dive even deeper. For those of you who are in need of some extra support with your symptoms or who are curious about the evidence behind supplementing for endo, I wanted to share a part of this module, specifically, the supplements which has been shown to directly target endometriosis and reduce its symptoms, severity and growth rate.

Also, I want to make it clear that I believe in using diet and lifestyle changes to manage endometriosis, and getting to the root cause(s) of our symptoms. I usually use supplements later in my coaching with clients, to allow them to experience changes in their symptoms from an anti-inflammatory diet, physio, gut healing, etc. but if a client is really struggling then we do bring supplements in sooner. My point is, these shouldn't be used in isolation, but rather in tandem with healthy habits that support you to live well with endo and resolve the root problem behind your inflammation, hormonal imbalances, fatigue, etc.

I’ve also distinguished between studies on animals or in vitro in contrast to studies on humans, as of course, for those supplements which haven’t been tested on humans yet, we need more research and larger studies would be helpful for all of these supplements.

Here’s the transcript from the module:

Disclaimer

So before we get started I just wanted to share a quick disclaimer as supplements can occasionally come with side effects and health risks.

So as outlined in the agreement you signed when you enrolled into the course, you should consult with your doctor before starting a new supplement regime, this is especially important if you are on medication as some supplements can change how the medication works. It may also be important to get tested first before taking some supplements, like with vitamin D and iron. I’ll mention this in the slide if this is necessary, though I do generally recommend getting your levels tested either way.

This is even more important when you’re trying to conceive or are pregnant, as some supplements aren’t safe during conception and pregnancy.

As you’re aware, I am not a dietician or medical professional. These practitioners are licenced to give specific prescriptive doses to individuals whereas I am not. Instead, these are general yet therapeutic doses (which essentially means effective) for the specific issues I highlight them as useful for in this lesson, provided to you for educational purposes with the intention that you will then discuss these with your doctor or the practitioner you’re working with before beginning. These doses are either from the studies, from my training or from other practitioners and are generally safe to use - if there are any risks, I have highlighted them in the slides.

Finally, you’ve probably heard the phrase ‘you can’t out-supplement a bad diet or lifestyle’ and it’s especially true with a chronic condition. You’re not going to reap the full benefits of these supplements if your diet choices and lifestyle are standing in direct opposition to them. I do think supplements play a role with endometriosis, especially as gut health issues, deficiencies and high inflammatory markers and low antioxidant markers are factors we see in our population, but they need to be alongside healthy choices. So keep that in mind as we go through this lesson today.

Okay, now that’s the boring bit over! Let’s get to supplements!

Endo Specific

So of course, I wanted to start with endometriosis specific supplements that have been shown to target endometriosis, while also have numerous other benefits.

Curcumin

Let’s start with my absolute favourite, curcumin. Now in terms of endometriosis, the research is unfortunately only in rats or in vitro (meaning outside of a human or animal such as in a test tube or a petri dish) but hopefully we’ll soon have some human studies.

• Curcumin has been shown to inhibit the spread of endometriosis and lesion formation by reducing cell proliferation (the process where cells divide to make new cells) and by reducing the adhesion molecules which allow endometriosis cells to stick to surfaces and form lesions.
• It also been shown to reduce endometriosis by speeding up the death of endo cells, known as apoptosis. Apoptosis is the normal death of cells in their life cycle, which endometrial cells are more resistant to than normal, healthy cells.
• ·Research also found that curcumin slows down growth rate by reducing oestrogen levels inside the endometrial cells, so they essentially have less fuel to feed them.
• Of course, as you probably know, there are now countless studies on curcumin’s powerful anti-inflammatory and antioxidant effects. In fact, in research it’s been shown to reduce oxidation levels in mice with endometriosis, which we know are high in people with endometriosis and contribute to endometriosis growth.

In studies not on endometriosis, curcumin has been shown to…

• Be as effective as ibuprofen for pain relief when taken daily for 4 weeks at 1,500mg. It was also shown to have less GI side effects that ibuprofen.
• It has additionally been shown to boost mood and cognitive function in several studies. One study on healthy adults showed that just one hour after taking curcumin, attention and memory improved and with longer term use fatigue, mood, stress and mood significantly improved.
• It can also help to repair leaky gut and lowers intestinal inflammation by reducing the immune system’s reaction to LPS, which is why I tend to use it as one of the first supplements to try as it can heal the gut, lower inflammation in the body/gut/pelvic cavity and directly target endo. All important factors in better managing endo.
• Finally, it’s been shown to support blood sugar, which as you know is important for keeping energy levels up, inflammation down and hormone levels balanced. In one study on people with prediabetes, it was 100% effective in preventing the development of type 2 diabetes.

So the general therapeutic dose is 500mg to 1000mg a day, ideally divided in doses but don’t worry if all you can find is a single large dose. Curcumin is generally metabolised quickly and so dividing the doses means we can have it hanging around in our body for longer, doing good work!

You may feel the benefits of curcumin in a month or so, especially if you’re taking it at higher doses. However, for others it can take longer and for the best benefit we need to give curcumin at least six months to a year as the processes of directly targeting endo and reducing the effects of inflammation can take time. Of course, if you have adverse reactions, stop immediately and consult with your practitioner.

Finally, curcumin can be difficult to adsorb so when choosing a product, go for one either with piperine (which is an extract from black pepper) or is paired with fat or is labelled as ‘bioavailable’. Really, fat or piperine are the best options and take with a fat containing meal to aid absorption further. If you have interstitial cystitis, black pepper is irritating to the bladder, so definitely avoid supplements that just add black pepper itself and experiment with how you feel on the extract, as that may be less irritating. In the handout I’ve linked to one of my favourite brands which do a bioavailable form without piperine. Also, if you do have IC, avoid turmeric supplements and rather go for curcumin, which is the active extract from turmeric, as turmeric can also be irritating to the bladder. Generally, you’re also going to get more bang for your buck with curcumin because it’s in a more concentrated form than just taking turmeric.

Quercetin

Okay so quercetin is another one of my absolute favourites!

• Quercetin has been shown in studies on rats to inhibit endometriosis growth by lowering oestrogen levels, stunting development.
• In another rat study, quercetin significantly reduced the size of endometriosis lesions.
• Quercetin is anti-inflammatory and immune supportive, which is of course important with endo as we know inflammation is high and the immune system is compromised.
• It’s also a great leaky gut healer and is one of the supplements I recommend trying first for leaky gut due to its other benefits listed in this slide.
• It’s also a powerful antihistamine which can be used for reducing allergic reactions, histamine intolerance and asthma symptoms.

Dose wise, I don’t have a specific dose for endometriosis but for histamine issues, the dose varies from 100mg to 500mg. Dr Jessica Drummond recommends 100mg in our training, whereas I know Dr Aviva Romm recommends 500mg in her article on allergies. My personal feeling is that to reap the benefits for both inflammation, endo and histamine (which we know is often a problem in people with endo), the higher dose is probably going to be better here.

Like with all of these supplements, we’re really looking at about six months at a minimum, unless you react, in which case, stop immediately.

Finally, a gentle caution here, from the studies and reviews, quercetin is deemed as safe and I’ve not seen any warnings from practitioners, but it does lower both oestrogen and progesterone through lowering FSH and LH. I don’t think this is a problem because as I’ve mentioned, it’s not come with any warnings in my trainings or by practitioners who use it regularly in their practice, but if you have low progesterone I would maybe use with caution. If you can’t afford testing and you’re not sure, I would just observe your cycle and if you start getting low progesterone symptoms, ease up on your dose or remove completely if necessary. Ideally track your cycle with the FAM to ensure you’re ovulating. Again, I don’t think this is a huge issue or risk but keep it in mind when using just to be safe.

N-Acetyl Cysteine

Okay, another great supplement is n-acetyl cysteine.

N-acetyl cysteine has been shown in human studies to reduce the growth rate of endometriomas.

• It’s also been shown to reduce the size of endometriomas and endometriosis lesions, in some to the point where the endometriomas disappeared entirely. In fact, in one study, half of the patients treated with NAC cancelled their laps due to a reduction or resolution in symptoms and/or a decrease or total disappearance in endometriosis lesions and endometriomas.
• As I mentioned, these studies also showed significant reduction or total eradication of pain and symptoms.
• An added bonus is that in these studies, there were more pregnancies in the groups treated with NAC than those without so it may support fertility.
• Finally, it also supports liver function as it is the precursor to the antioxidant glutathione (which basically means NAC makes glutathione). Glutathione is essential for protecting the liver from inflammation and damage from the toxins and waste materials it processes, allowing it to function optimally and aiding oestrogen clearance.

Dose wise, the studies used 1800mg, split into three doses of 600mg for three months. However, in my training we tend to use lower levels of 500mg - 1000mg.

One word of caution is that Dr Allison Siebecker warns that NAC may possibly aggravate hydrogen sulphide SIBO symptoms because this amino acid contains sulphur, which can worsen symptoms for some people. If you know or suspect you have H2S, I will just see how you respond as this isn’t proven, it’s just something she cautions as sulphur containing foods often aggravate those with H2S.

Omega 3 Fatty Acids

• Next up is fish oil or omega 3 fatty acids, and as we know these fats are essential and most of us aren’t getting enough, so there’s definitely a real benefit of adding these into our supplement regime whether we have endo or not!
• Fish oil was shown to reduce adhesion formation following surgery on mice with induced endometriosis and reduced the inflammatory healing process post-surgery which could contribute to further endo development due to the heightened inflammatory chemicals. This led to the mice who were fed with fish to have fewer lesions than those who were fed a standard diet without fish oil supplementation; therefore this could be a potential helpful supplement before and after surgery (though I would argue it’s an essential daily supplement).
• In rabbits, 8 weeks of fish oil treatment led to a significant reduction in size of endometriosis lesions.
• In humans, several studies have demonstrated a reduction in pain and inflammation with endometriosis and pelvic pain.
• It’s also been shown to significantly reduce pain in those with primary and secondary dysmenorrhea (primary means period pain with no disease or condition behind it, whereas secondary is period pain due to a condition like endo) to the point where less pain medication was needed.
• Additionally, it’s been shown to be a powerful anti-inflammatory pain reliever for issues like chronic back ache and neck pain.
• One of the ways that omega 3 fatty acids do this is through lowering inflammatory prostaglandins and raising the levels of anti-inflammatory prostaglandins.
• Additionally, because of the powerful anti-inflammatory processes of omega 3 fatty acids, they may play a role in healing leaky gut and lowering intestinal inflammation. Many gut health practitioners use fish oil for this purpose.

The dose is between 1000mg to 3000mg a day. I personally find I get more relief from the higher doses, but it can be tricky to get hold of those levels without exceeding the dose recommendations on the bottle. I have linked to a few higher dose supplements in the handout, but if you chose to exceed the dose recommendations on the label, obviously that’s your choice but you’ll need to consult with a practitioner to be on the safe side. However, omega 3 fatty acids are generally very safe at these doses.

At minimum it’s advised to continue these for six months, but arguably omega 3 fatty acids should be kept in our supplement regime generally.

If you’re vegan, look for an algae-based supplement that contains both DHA and EPA, because we need both. I’ve linked to a few in the handout.

The only risk is that they can sometimes thin blood, so speak to your surgeon ahead of surgery to see whether you need to stop taking them a few days beforehand, for keyhole surgery it’s unlikely, but just check.

Pine Bark

Okay so now let’s move onto pine bark, also known as pycnogenol.

• In one study on humans, pine bark was shown to reduce endometriosis-associated pain.
• The study compared pine bark to hormonal therapy and what was interesting was that the results were much slower in the pine bark group, but the pain reduction was long-lasting, whereas the symptoms returned in the group treated with hormones once they came off the medication.

The dose used in the study was 60mg daily, split into two doses of 30mg for 48 weeks.

Combined Vitamin E and C

Now let’s move on to a combination of Vitamins E and C.

• In one study, high doses of vitamin E and C were shown to significantly reduce pelvic pain in people with endo. 43% of participants had a reduction in daily pain, pain during menstruation was reduced in 37% and pain during sex was reduced in 24%.

• The same study also demonstrated a reduction in inflammatory markers (which means measurements of inflammation) in the pelvic cavity.

• Additionally, vitamin C raises progesterone levels and is commonly used by naturopathic and functional medicine practitioners to support those with low levels.
• Vitamins E and C are also antioxidants and anti-inflammatories so can lower oxidation levels and inflammatory processes which can lead to endo progression, which is why there was a reduction in inflammatory markers in the study.
• Finally, vitamin E has been shown to reduce pain, pain duration and blood loss in people with primary dysmenorrhea.

In the endometriosis study, the doses used were 1000mg of vitamin C and 1200 IU of vitamin E for 8 weeks.

Now I don’t think this is really a problem because I know plenty of industry leaders in the hormone/period space who use vitamin C for low progesterone, but it does also raise oestrogen too so if you have elevated oestrogen levels it may be better to consult with a practitioner. General daily doses of vitamin C using a supplement are at much lower doses, so just taking a standard vitamin C supplement would be fine, but if you wanted to increase the dose to something like 1000mg, I would just either carefully track your cycle and how you respond and ideally, consult with a practitioner. Again, vitamin C seems to be standardly used to elevate progesterone without any warnings regarding oestrogen rising too, but I wanted to let you know in case.

Also, if you have interstitial cystitis, vitamin C supplements can irritate the bladder so you may find it better to use an oral spray which you swirl around you mouth for a few minutes before spitting out. The vitamin C absorbs through the cheek, so you’ll still get the benefits, just without the bladder burn!

Melatonin

Next up is melatonin, which I don’t presently use in my practice because it can actually affect the menstrual cycle by delaying or preventing ovulation. Also, in my training we’ve seen case studies of people not responding too well to it as it can come with side effects such as fatigue, dizziness and headaches. If I were to use it, I would do so in collaboration with a naturopathic or functional medicine doctor who could provide further guidance and supervision.

However, it’s been shown to be beneficial for endometriosis so it’s worth discussing and many leading practitioners do recommend it.

• In a study on rats melatonin was found to significantly reduce the size of lesions.
• In a human study, it was also found to lower daily pelvic pain by 39% and period pain by 38% in women with endometriosis.

The study used 10mg every evening for 8 weeks. In his book, The Endometriosis Health and Diet programme, Dr Andrew Cook advises trying between 0.5mg and 10mg daily, each evening and it’s recommended to build up to the full dose.

If you plan to try melatonin I would recommend working with someone to find the right dose for you, that doesn’t interfere with your cycle.

Resveratrol

Finally, let’s look at resveratrol.

• In studies in rats, resveratrol has been shown to reduce the size, severity and number of endometriosis lesions.
• In human studies, it was shown to enhance the benefits of oral contraceptives by further reducing pain and inflammation through inhibiting aromatase (that hormone which converts testosterone to oestrogen). This was a small study on 12 patient who didn’t find oral contraceptives helpful, but when combined with resveratrol, 82% experienced total alleviation of their pain within two months.
• It’s also a powerful anti-inflammatory, which has been shown to reduce inflammatory prostaglandins.
• And finally, it has been shown to inhibit the formation of new blood vessels in endometriosis lesions, inhibiting growth.

The study used 30mg daily for two months, though you of course could continue this for longer.

Now like many of the warnings in this lesson, I’ve not seen any health practitioners caution the use of resveratrol for endometriosis, but at certain doses it can have the opposite effect, so for example, it can become pro-inflammatory. To my knowledge, 30mg daily is both a safe and effective dose for endometriosis which practitioners like Dr Andrew Cook recommend (in his book The Endometriosis Health and Diet Program), but as with all of these supplements, consult your doctor before beginning.

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This episode is sponsored by my free Endometriosis Diet Grocery List. This pdf list includes all the foods I buy on a monthly basis, categorised into easy sections. I share my personal endometriosis diet plan, free recipe resources, recommendations to help you get started with the endometriosis diet and nutrition tips. Download here.

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If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website.

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Show Notes

References:

Curcumin

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533742/

https://www.karger.com/Article/FullText/491886

https://www.sciencedirect.com/science/article/abs/pii/S0753332217346838?via%3Dihub

https://www.sciencedirect.com/science/article/pii/S1756464615000092

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407015/

https://pubmed.ncbi.nlm.nih.gov/24672232/

https://pubmed.ncbi.nlm.nih.gov/25277322/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476912/

Quercetin

https://pubmed.ncbi.nlm.nih.gov/19462895/

https://www.hindawi.com/journals/ecam/2014/781684/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808895/

https://pubmed.ncbi.nlm.nih.gov/19297429/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273625/

https://avivaromm.com/remedies-seasonal-allergies/

NAC

https://www.hindawi.com/journals/ecam/2013/240702/

Omega 3 Fatty Acids

https://pubmed.ncbi.nlm.nih.gov/16531187/

https://pubmed.ncbi.nlm.nih.gov/2832216/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614254/

https://pubmed.ncbi.nlm.nih.gov/11687013/

https://pubmed.ncbi.nlm.nih.gov/17434511/

https://pubmed.ncbi.nlm.nih.gov/22261128/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/

Pine Bark

https://pubmed.ncbi.nlm.nih.gov/17879831/

Combined Vit C & E

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856484/

https://pubmed.ncbi.nlm.nih.gov/11762659/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484190/

http://www.usa-journals.com/wp-content/uploads/2013/07/Al-Katib_Vol18.pdf

https://www.fertstert.org/article/S0015-0282(03)00657-5/pdf

Melatonin

https://pubmed.ncbi.nlm.nih.gov/23602498/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881748/

Resveratrol

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413140/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191968/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413140/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164842/

https://pubmed.ncbi.nlm.nih.gov/25462211/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164842/

https://pubmed.ncbi.nlm.nih.gov/23091400/