Combined vitamin supplementation improves some symptoms in endometriosis patients, study shows


A randomized controlled study in Pain Research & Management validates the potential role of antioxidants in managing endometriosis.

Specifically, vitamin C and vitamin E supplements effectively reduced dysmenorrhea severity and improved dyspareunia and severity of pelvic pain.

The triple-blind, placebo-controlled clinical trial enrolled 60 reproductive-aged women between the ages of 15 and 45 with pelvic pain and stages 1 to 3 of laparoscopic-verified endometriosis who were referred to Sarem Hospital in Tehran, Iran, from June to November 2017.

Participants were randomized to 1 of 2 groups. Group A (n = 30) was given a combination of vitamin C (1000 mg/day, 2 tablets of 500 mg each) and vitamin E (800 IU/day, 2 tablets of 400 IU each) for 8 weeks, whereas group B (n = 30) was given placebo pills daily for the same duration.

A visual analogue scale (VAS) estimated the pain intensity score before and every 2 weeks after treatment initiation.

Blood samples were drawn by venipuncture and an enzyme-linked immunosorbent assay (ELISA) measured malondialdehyde (MDA), reactive oxygen spices (ROS) and total antioxidant capacity (TAC).

After 8 weeks, the combination vitamin group showed a significant reduction in MDA and ROS compared to the placebo group.

But there was no significant decline in TAC after treatment.

However, the severity of pelvic pain (P < .001), dysmenorrhea (P < .001) and dyspareunia (P < .001) significantly decreased in the treatment group after 8 weeks of vitamin supplementation.

“Vitamin C and vitamin E can have interactive effects to reduce cellular damage induced by ROS,” wrote the authors. “It seems vitamin C and vitamin E can be used to neutralize the oxidative damage in endometriosis. These vitamins can scrub free radicals and oxidative stress.”

Vitamin C is a water-soluble vitamin that acts as a physiological antioxidant and can protect cells against disease caused by oxidative stress such as endometriosis, according to the authors.

Conversely, vitamin E is a lipid-soluble antioxidant that can also delay or prevent oxidative stress-induced diseases.

“These vitamins may be considered as neutralizing agents against free radicals and ROS generated by endometriotic cells,” wrote the authors.

Study results are consistent with previous studies, according to the authors, noting that some studies have concluded that vitamin C reduces endometriotic cyst volume and weight.

Moreover, vitamin C has a significant dose-dependent effect in natural killer cells and endometriotic tissue implantation.

Both vitamins appear to prevent the peroxidative process spread by their chain-breaking property and help tissue to balance oxidant-antioxidant levels.

ROS reduction is key in endometriosis treatment, according to the authors, and that the antioxidant action of vitamins might reduce the clinical symptoms of endometriosis.

It also has been proposed that the decreased inflammation with the combination vitamin treatment protocol can suppress pain-generating molecules.

The finds of the current and other studies support the use of vitamin C as a safe, widely available and inexpensive therapeutic agent for endometriosis, at least for symptomatic relief.

The authors advocate large-scale studies with long follow-up to confirm the role of antioxidant supplementation in improving oxidative stress state, chronic pelvic pain, dysmenorrhea, and dyspareunia in endometriosis.



Amini L, Chekini R, Nateghi MR, et al. The effect of combined vitamin C and vitamin E supplementation on oxidative stress markers in women with endometriosis: a randomized, triple-blind placebo-controlled clinical trial. Pain Res Manag. 2021 May 26;2021:5529741.


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