Proper Nutrition Improves Treatment Outcome for Severe Endometriosis
May 31, 2007—Nutritional therapy is as effective at managing postoperative pain from endometriosis as hormone therapy, new research reports. A combination of vitamins, minerals, probiotic bacteria, and fatty acids from fish oil, combined with customized dietary changes, was found to be effective at relieving pain in women who had recently had surgery to treat endometriosis, a painful condition in which tissue that normally lines the uterus occurs in abnormal locations such as the ovaries, fallopian tubes, and abdominal cavity.
“Endometriosis is a multifactorial disease associated with a chronic inflammatory response within the abdomen,” said Francesco Sesti, MD, of Tor Vergata University Hospital in Rome, Italy, and lead author of the new study. “Oxidative stress has been proposed as a potential factor involved in the development of the disease.” In other words, endometriosis may be caused by insufficient antioxidant activity in the body’s tissues.
Endometriosis is a common condition that affects women during their reproductive years, with the greatest incidence occurring between the ages of 30 and 45. In advanced endometriosis, surgical removal of the abnormal tissue using laparoscopy (insertion of a narrow, telescope-like instrument through a small incision in the abdomen) or laparotomy (a larger surgical incision in the abdominal wall) is considered the treatment of choice by most gynecologists.
Women treated with laparoscopic surgery for endometriosis may experience significantly less pain and improved quality of life for up to five years after pelvic surgery. However, over the long term, 25% of women experience worsening of pain (in other words, the improvement after surgery was not maintained) and the chance of requiring further surgery is as high as 36%. For this reason, it is important to find additional postoperative therapies that may prolong freedom from pain.
Nutrition may play an important role in the treatment of painful symptoms such as endometriosis-related dysmenorrhea. Reviews of medical research in this area have found that vitamin B6, vitamin B1, vitamin E, magnesium, and omega-3 fatty acids (fish oil) supplements relieve pain and have beneficial anti-inflammatory effects in women with endometriosis. However, before this new study, there was not enough evidence from clinical trials to make strong conclusions about the effectiveness of dietary therapy after surgery for severe endometriosis.
Italian researchers enrolled 234 women with endometriosis to participate in a double-blind clinical trial. After surgery, the women were randomly assigned to receive a placebo or a postoperative adjunctive therapy (either hormones or diet plus supplements) for six months. In the diet and supplements group, women were given personal diet and supplement recommendations, including vitamins (B6, A, C, and E), mineral salts (calcium, magnesium, selenium, zinc, and iron), probiotic bacteria preparations (Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus), and omega-3 and omega-6 fatty acids. The women were on diets that ranged from 1,600 to 2,000 calories per day.
Both the hormones and the nutrition changes were successful in reducing painful symptoms of endometriosis, including menstrual pain (dysmenorrhea), nonmenstrual pelvic pain, and pain during sexual intercourse (dyspareunia). The two hormonal therapies were equally effective at reducing endometriosis symptoms but are associated in the long-term with undesirable risks and side effects including loss of bone mineral density and development of menopausal symptoms. No such adverse effects have been reported from the diet therapy and supplements.
(Fertil Steril 2007 Apr 13;[e-pub ahead of print])
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Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.
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