Worldwide, millions of people who menstruate have endometriosis, a gynecological condition that can cause debilitating symptoms and severely impact a person’s quality of life, mental health, and productivity. Yet treatments for endometriosis remain limited, and many people continue to struggle with symptom management. Could dietary and herbal interventions help?
Endometriosis is a gynecological condition in which endometrial-type tissue — similar to the tissue lining the inside of the uterus — grows in other parts of the body.
While endometrial-like tissue most commonly affects other organs in the pelvic and abdominal areas — such as the fallopian tubes, bladder, and intestines — research shows that in some cases it is much more far-reaching, impacting the heart, lungs, and even brain. Some research suggests that endometriosis can affect every single organ in the human body.
This condition can cause long menstrual periods (longer than seven days), heavy bleeding, excruciatingly painful cramps that may cause a person to faint, nausea and vomiting, pain during and after sex with vaginal penetration, fatigue, and spotting between periods, among several other symptoms.
For people who receive a diagnosis of endometriosis, there are relatively few treatment and management options, which are not effective for everyone, and which do not guarantee long-term relief even for those for whom they do work.
This has led medical doctors, researchers, and individuals with endometriosis alike to search for additional relief methods, and one of these is centered on herbal medicine and nutrition.
Researchers have demonstrated in human trials that aged garlic extract could be used as a potential prophylactic to reduce the progression of endometriosis and associated pain burden.
The study was published in Frontiers in Pain Research.
There is emerging evidence that biological compounds found in garlic (Allium sativum) may be effective for attenuating endometrial pain. Suggested mechanisms for efficacy include modulation of inflammation and potent antioxidant effects. Aged-garlic-extract (AGE) is a centuries old process describing ethanolic extracts of garlic bulbs for 12–20 months. The AGE formulation realised contains a complex array of stabilised biologics with significant immunomodulatory effects relevant to inflammatory conditions. This perspective article puts forward a hypothesis that AGE should be considered as a prophylactic to manage endometriosis pain.
In recent years nutraceuticals have gained increased attention as an alternative for endometriosis related pain relief. Bioactive compounds naturally occurring in plants have emerging evidence for anti-endometriotic effects, including quercetin, curcumin, resveratrol and naringenin. It has been suggested that garlic has anti-inflammatory and antioxidant effects that may be relevant in the context of endometriosis. A recent study by Amirsalari et al. found that consumption of 400 mg of garlic powder results in a significant reduction of pain symptoms in women with endometriosis. They suggest that garlic can reduce oxidative stress, prostaglandin production, limit proliferation of endometrial cells, and improve estrogen elimination. While this is the first human trial known using garlic as a nutraceutical for endometriosis, the results are consistent with a substantial body of literature describing the anti-inflammatory and antinociceptive effects of garlic.
A spoon of Turmeric | Photo: News Network
Kim et al. found that in an in vitro model of activated endometrial stromal cells, vascular adhesion molecule-1 and intercellular adhesion molecule-1 expression was reduced in response to 500 ml hexane-extract of aged black garlic (HEABG). This study reported that HEABG resulted in a reduction in the proliferation of endometrial stromal cells that were activated by tumour necrosis factor (TNF)-α. The biological elements of garlic may also be important in attenuating the damaging effects of oxidative stress associated with inflammation. Infertile women with endometriosis were found to have lower levels of peritoneal fluid and serum antioxidant markers (total antioxidant capacity, catalase enzyme and superoxide dismutase enzyme) content compared to infertile women without endometriosis.
Garlic is rich in N-acetylcysteine (NAC) which has been reported to have anti-proliferative effects in endometriomas. With three months of NAC supplementation, taken orally, mean diameter of lesions was reduced by 1.5 mm whereas those without treatment had a significant increase in lesion size diameter of 6.6 mm. These effects were attributed to the down regulatory effects of NAC on inflammatory pathways and inhibiting cell migration.
In humans, antinociceptive effects of garlic have been indicated in patients with knee osteoarthritis which has similar inflammatory sequelae to endometriosis with increased inflammatory factors and associated TNF-α. Similar findings have been reported in rheumatoid arthritis, which is subject to increased oxidative stress, and peripheral arterial occlusive disease. It has been suggested that pain reduction may be directly attributable to the antioxidant effect of garlic. In animal studies there have been a number of induced models of pain demonstrating an attenuation with the provision of garlic derivatives. In murine models with central and peripheral induced pain, there was increased antinociception through the provision of garlic shoot extract.
AGE is processed by chopping raw garlic cloves and storing them in 15 per cent–20 per cent ethanol for up to 20 months. The main organosulphur compounds in AGE are water-soluble S-allyl-cysteine (SAC), allin, ɣ-glutamylcysteines, ɣ-glutamyl-S-allylcystine, and S-allylmercaptocysteine (SAMC). The SAC and SAMC concentrations in AGE are estimated to be >60-fold more abundant per unit weight than in raw garlic due to the ageing process, enabling a pharmacological dose to be tested more readily clinically. These specific compounds have exceedingly potent immunomodulatory and antioxidant properties that may be relevant to endometriosis progression and pain management. Phenolic compounds in AGE such as allicin also contribute to antioxidant activity.
The researchers concluded: “Endometriosis can result in a high burden of disability and is costly to treat. Prophylactive therapies that delay progression and/or decrease endometrial pain are a global health priority. A body of literature suggests that Allium sativum and particularly, ethanolic extracts of the garlic bulb containing enriched stabilised biologicals may be effective in attenuating endometrial progression and pain burden.”
Meanwhile, researchers have demonstrated the effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms. The study was published in PlosOne.
The use of cannabis for symptoms of endometriosis was investigated utilising retrospective archival data from Strainprint Technologies Ltd., a Canadian data technology company with a mobile phone application that tracks a range of data including dose, mode of administration, chemovar and their effects on various self-reported outcomes, including pelvic pain.
A retrospective, electronic record-based cohort study of StrainprintTM users with self-reported endometriosis was conducted. Self-rated cannabis efficacy, defined as a function of initial and final symptom ratings, was investigated across the included symptom clusters of cramps, pelvic pain, gastrointestinal pain, nausea, depression, and low libido. Cannabis dosage form, dose and cannabinoid ratio information was also recorded.
The researchers concluded: “Cannabis appears to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion. The greater propensity for use of an inhaled dosage delivery may be due to the rapid onset of pain-relieving effects versus the slower onset of oral products. Oral forms appeared to be superior compared to inhaled forms in the less commonly reported mood or gastrointestinal categories. Clinical trials investigating the tolerability and effectiveness of cannabis for endometriosis pain and associated symptoms are urgently required.”
Also, a comprehensive review of the effects of Syzygium aromaticum (clove) and its constituents on the reproductive system showed promise.
The study was published in the September 2023 edition of the journal Reproduction Science.
The aim of this study was to investigate the reported contradictory effects of clove and its phytochemicals on the reproductive system of both males and females. All types of in vitro, animal, and human studies of clove and its main constituents in the field of reproductive systems were collected via searching electronic databases including PubMed and Scopus from the onset till 2021.
In this review, 76 articles were included, of which 25 were related to male reproduction, 32 were related to female reproduction, and 19 were related to reproductive malignancies. Analysis of the literature indicates the effects of clove and its constituents especially eugenol and β-caryophyllene on the level of sex hormones, fertility, sperm abnormalities, endometriosis, menstrual cycle, as well as gynecological infections, and reproductive tumors.
The researchers concluded: “The main mechanism of clove has not been understood yet but it seems that different parameters affect its pharmacological activity including the type of extract, dose, and duration of administration as well as the primary cause of the disorder. According to the effects of clove on different parts of the reproductive system, it seems that it can be a suitable candidate for related disorders, provided that more and more detailed studies are done on it.”
