Combination Treatment of Vitamin C and Vitamin E Reduce Endometriosis-Related Pain Scores

by | Jun 1, 2022 | 2021, Vitamin C, Vitamin E, Women's Health

Written by Taylor Woosley, Staff Writer. Results of this 8-week randomized placebo-controlled trial show the significant effects vitamin C (1000 mg/day) and vitamin E (800 IU/day) supplementation have on decreasing VAS scores related to dysmenorrhea, dyspareunia, and chronic pelvic pain compared to placebo. 

women's health skin healthEndometriosis (EM) is the most common gynecological disease in women of reproductive age, affecting around 10-15% of women of childbearing age 1. EM is a chronic, inflammatory, estrogen-dependent disease, with the appearance of endometrial tissue in the non-uterine cavity 2. It is often a progressive disease and is accompanied by clinical symptoms such as dysmenorrhea (painful menstruation), pelvic pain, and infertility 3. Additionally, EM has been associated with immune dysfunction, such as the evasion of endometrial tissues from natural killer cell-mediated clearance and upregulation of interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α, which promote the proliferation of endometrial cells 4.

Past studies have explored the potential role of vitamin C and vitamin E treatment for the regression of endometriotic cyst volume and overall inflammation 5. Vitamin C and vitamin E provide potent levels of antioxidant, anti-inflammatory, and antiangiogenic properties 6. Antioxidants provide a robust defense against reactive oxygen species (ROS) and may have a significant effect on the progression of various oxidative stress related diseases 7. A previous study with vitamin C supplementation decreased the volume of endometriotic cysts and reduced ectopic oxidant expressions, along with restoring DNA damage to the cells 8.

Amini et. al conducted a randomized placebo-controlled clinical trial to further explore the potential use of vitamin C and Vitamin E supplementation on oxidative stress markers and pain severity in women with EM. Subjects (n=60, aged 15-45 years) with pelvic pain and 1-3 stages of laparoscopic-proven endometriosis were randomly assigned to two groups; group A (n=30) were given a combination of vitamin C (1000 g/day, 2 tablets of 500 mg each) and vitamin E (800 IU/day, 2 tablets of 400 IU each) and group B (n=30) were administered placebo pills (mannitol and magnesium stearate polyvinylpyrrolidone) daily for 8 weeks. Primary outcomes included blood samples being drawn to measure malondialdehyde (MDA), ROS, and TAC by the enzyme-linked immunosorbent assay (ELISA) method. Secondary outcomes were chronic pelvic pain, dysmenorrhea, and dyspareunia which were assessed by VAS at baseline and 2, 4, 6, and 8 weeks of the study.

Groups had no statistically significant differences in age or BMI. Since participants in group B had significantly lower MDA (32.09 ± 22.84 vs. 41 ± 2.37 µM) and ROS (5.46 ± 0.57 vs. 6.08 ± 0.38 µM) than group A before intervention (p < 0.01), the ANCOVA test was performed to compare MDA and ROS between two groups after invention. Significant results after 8-week supplementation are as follows:

  • Compared to placebo, a combination supplement of vitamin C (1000 mg/day) and vitamin E (800 IU/day) statistically reduced MDA (p = 0.002) and ROS (p < 0.001). However, TAC levels did not change.
  • Post-treatment, group A had significantly decreased VAS scores of dysmenorrhea (50.53 ±12 – 17.56 ± 16.65; p < 0.001) , dyspareunia (26.66 ± 28.27 – 15.43 ± 18.47; p < 0.001) and chronic pelvic pain (26.66 ± 27.84 – 12.43 ± 13.28; p < 0.001).
  • Group B experienced a significant reduction of dysmenorrhea (51.00 ±21 – 31.56 ± 26.39; p < 0.001) and dyspareunia (20.73 ± 21.77 – 18.10 ± 19.93; p < 0.001). However, chronic pelvic pain increased (16.96 ± 16.28 – 18.63 ± 18.35; p < 0.571).
  • Intergroup comparison showed a higher significant reduction of dysmenorrhea, dyspareunia, and chronic pelvic pain VAS scores in group A compared to group B.

Findings of the study show the effect of combination supplementation of vitamin C and vitamin E to reduce inflammation and oxidative stress and damage in women with endometriosis. Future research should explore different dose amounts and longer trial lengths to further observe the potential use of antioxidant therapy to reduce markers of pain associated with endometriosis.

Source: Amini, Leila, Razieh Chekini, Mohammad Reza Nateghi, Hamid Haghani, Tannaz Jamialahmadi, Thozhukat Sathyapalan, and Amirhossein Sahebkar. “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 Research and Management 2021 (2021).

© 2021 Leila Amini et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Click here to read the full text study.

Posted June 1, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Da Costa KA, Malvezzi H, Dobo C, et al. Site-Specific Regulation of Sulfatase and Aromatase Pathways for Estrogen Production in Endometriosis. Front Mol Biosci. 2022;9:854991. doi:10.3389/fmolb.2022.854991
  2. Ye Z, Meng Q, Zhang W, et al. Exploration of the Shared Gene and Molecular Mechanisms Between Endometriosis and Recurrent Pregnancy Loss. Frontiers in veterinary science. 2022;9:867405. doi:10.3389/fvets.2022.867405
  3. Chopyak VV, Koval HD, Havrylyuk AM, Lishchuk-Yakymovych KA, Potomkina HA, Kurpisz MK. Immunopathogenesis of endometriosis – a novel look at an old problem. Cent Eur J Immunol. 2022;47(1):109-116. doi:10.5114/ceji.2022.113830
  4. Chao YH, Liu CH, Pan YA, Yen FS, Chiou JY, Wei JC. Association Between Endometriosis and Subsequent Risk of Sjögren’s Syndrome: A Nationwide Population-Based Cohort Study. Frontiers in immunology. 2022;13:845944. doi:10.3389/fimmu.2022.845944
  5. Yalçın Bahat P, Ayhan I, Üreyen Özdemir E, İnceboz Ü, Oral E. Dietary supplements for treatment of endometriosis: A review. Acta bio-medica : Atenei Parmensis. Mar 14 2022;93(1):e2022159. doi:10.23750/abm.v93i1.11237
  6. Hoorsan H, Simbar M, Tehrani FR, et al. The effectiveness of antioxidant therapy (vitamin C) in an experimentally induced mouse model of ovarian endometriosis. Women’s health (London, England). Jan-Dec 2022;18:17455057221096218. doi:10.1177/17455057221096218
  7. Kajszczak D, Zakłos-Szyda M, Podsędek A. Viburnum opulus L.-A Review of Phytochemistry and Biological Effects. Nutrients. Nov 5 2020;12(11)doi:10.3390/nu12113398
  8. Dai Y, Lin X, Xu W, et al. MiR-210-3p protects endometriotic cells from oxidative stress-induced cell cycle arrest by targeting BARD1. Cell Death Dis. Feb 13 2019;10(2):144. doi:10.1038/s41419-019-1395-6