Endometriosis & Omega-3 Fatty Acids

Endometriosis is an inflammatory condition where the endometrial tissue grows outside of the endometrium and will grow in other parts of the body such as the abdomen, ovaries, pelvis and/or the rectum ("Endometriosis", 2020). 

Individuals with endometriosis will often experience pain during menstruation (dysmenorrhea), during sex (dyspareunia), during ovulation, right before their menstrual period and during bowel movements (Eisenberg & Chahine, 2019). Women have reported endometrial pain negatively affects their social relationships, their ability to work and their quality of life. In Australia, it is believed 1 in 9 women will be diagnosed with endometriosis by the time they reach 44 years (Rowlands, 2019).

Non-steroidal anti-inflammatory drugs (NSAIDs) are often the 1st line of therapy to treat pain associated with endometriosis. They work by inhibiting cyclooxygenase which synthesises prostaglandins (compounds associated with inflammation, pain, redness and heat) (Ghlichloo & Gerriets, 2020).

 However, NSAIDs are often associated with negative adverse effects and are contraindicated in some individuals (including those with gastritis, renal insufficiency and peptic ulcer disease) (Calis, 2019). Common adverse effects include dyspepsia, gastrointestinal bleeding, stomach ulcers and colitis (Russell, 2001).

 Omega-3 fatty acids are long-chain polyunsaturated fatty acids (PUFA’s), found in high amounts in fatty fish, walnuts, chia and flaxseeds). They have anti-inflammatory effects by reducing pro-inflammatory prostaglandins (PGs) (Tomio et al., 2013). Animal studies have observed omega-3 supplementation to decrease endometrial lesions and endometrial implants (Bruner-Tran, Mokshagundam, Herington, Ding & Osteen, 2018) (Tomio et al., 2013). Furthermore, observational and epidemiological studies have associated a higher intake of omega-3 fatty acids and higher serum omega-3 levels with a lower risk for endometriosis (Hopeman, Riley, Frolova, Jiang & Jungheim, 2014) (Parazzini, Viganò, Candiani & Fedele, 2013).

Every 1% of total energy intake from omega-3 fatty acids instead of omega-6 fatty acids has been associated with a halved risk for endometriosis (Missmer et al., 2010). Finally, a recent 2020 study found daily supplementation of 2000mg of omega-3 to improve pelvic pain and quality of life over 8 weeks (Abokhrais et al., 2020).

 So how to increase your intake of omega-3 fatty acids through nutrition?

1. Consume fatty fish 3 times per week instead of other protein sources. Fatty fish include salmon, tuna, sardines and mackerel. Some ideas are miso salmon noodles, sardines on toast, grilled mackerel with a side of roast sweet potatoes and salad.

2. Snack on walnuts, chia pudding and edamame

3. Add in ground flaxseed and hemp seeds on top of yoghurt, on cereal,

4. Try a tofu ‘scramble’ in replacement of eggs on top of sourdough toast.

REFERENCES

Abokhrais, I., Denison, F., Whitaker, L., Saunders, P., Doust, A., Williams, L., & Horne, A. (2020). A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1). PLOS ONE, 15(1), 227695. doi: 10.1371/journal.pone.0227695

Bruner-Tran, K., Mokshagundam, S., Herington, J., Ding, T., & Osteen, K. (2018). Rodent Models of Experimental Endometriosis: Identifying Mechanisms of Disease and Therapeutic Targets. Current Women S Health Reviews, 14(2), 173-188. doi: 10.2174/1573404813666170921162041

Calis, K. (2019). When are NSAIDs contraindicated for the treatment of dysmenorrhea?. Retrieved 16 November 2020, from https://www.medscape.com/answers/253812-55152/when-are-nsaids-contraindicated-for-the-treatment-of-dysmenorrhea

Eisenberg, E., & Chahine, E. (2019). Endometriosis. Retrieved 16 November 2020, from https://www.womenshealth.gov/a-z-topics/endometriosis

Endometriosis. (2020). Retrieved 16 November 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

Ghlichloo, I., & Gerriets, V. (2020). Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Retrieved 16 November 2020, from https://www.ncbi.nlm.nih.gov/books/NBK547742/

Hopeman, M., Riley, J., Frolova, A., Jiang, H., & Jungheim, E. (2014). Serum Polyunsaturated Fatty Acids and Endometriosis. Reproductive Sciences, 22(9), 1083-1087. doi: 10.1177/1933719114565030

Missmer, S., Chavarro, J., Malspeis, S., Bertone-Johnson, E., Hornstein, M., & Spiegelman, D. et al. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction, 25(6), 1528-1535. doi: 10.1093/humrep/deq044

Parazzini, F., Viganò, P., Candiani, M., & Fedele, L. (2013). Diet and endometriosis risk: A literature review. Reproductive Biomedicine Online, 26(4), 323-336. doi: 10.1016/j.rbmo.2012.12.011

Rowlands, I. (2019). One in nine Australian women live with endometriosis. Retrieved 16 November 2020, from https://public-health.uq.edu.au/article/2019/08/one-nine-australian-women-live-endometriosis 

Russell, R. (2001). Non-steroidal anti-inflammatory drugs and gastrointestinal damage---problems and solutions. Postgraduate Medical Journal, 77(904), 82-88. doi: 10.1136/pmj.77.904.82

Tomio, K., Kawana, K., Taguchi, A., Isobe, Y., Iwamoto, R., & Yamashita, A. et al. (2013). Omega-3 Polyunsaturated Fatty Acids Suppress the Cystic Lesion Formation of Peritoneal Endometriosis in Transgenic Mouse Models. Plos ONE, 8(9), 73085. doi: 10.1371/journal.pone.0073085