EP.343/ What’s low vitamin A got to do with endo and period pain?
Today we’re continuing with our series on low micronutrient levels and the impact on period and endo-related period pain.
Vitamin A is an antioxidant, which may have significant benefits for endometriosis pain.
First up, let’s understand what an antioxidant is - and to do that, we need to understand oxidation.
Oxidation is a process that occurs in the body naturally, as a part of certain biological processes. Oxidation causes DNA damage and triggers inflammation, so antioxidants protect us from that damage and rising inflammation levels. However, there are other factors that can influence the amount of oxidation we’re exposed to (like the foods we eat), and when we have an imbalance of oxidation and too few antioxidants to deal with it, we have something called oxidative stress.
Oxidative stress is higher in people with endo, and it’s a key driver of endo growth and symptoms, but it also plays a role in period pain. In fact, a 2020 systematic review found a higher level of oxidative stress in those with dysmenorrhea (a.k.a. period pain) and theorised that the resulting inflammation levels from the higher oxidative stress is likely to be contributing to the elevated period pain.
So, that brings us back to vitamin A and its antioxidant capabilities.
A large 2020 study of 897 adolescent girls found an association with low vitamin A levels and period pain, as well as PMS, and higher inflammation levels.
A recent 2024 showed that those who ate a higher intake of vitamin A rich plant based foods were 40% less likely to experience dysmenorrhea.
In terms of endo, various studies have shown an association between low vitamin A intake and endometriosis risk. Researchers believe that low vitamin A levels may be involved in the pathogenesis (development) of endo, as the active form of vitamin A has anti-prolific and anti-oestrogenic properties, that can halt growth of endo tissue.
So, what about treatment with vitamin A?
I couldn’t find any studies on the use of vitamin A for dysmenorrhea as a treatment, but for endo, research has shown that three month’s of a high antioxidant diet, rich in vitamin A, increased vitamin A levels and significantly reduced oxidative stress markers.
Unfortunately, they didn’t measure the pain levels of these participants in this study, but a 2023 meta analysis looked at the use of antioxidant supplementation for endometriosis and concluded that supplementation of antioxidant vitamins effectively reduced period pain in those with endo - though the meta analysis did not look at the use of vitamin A supplementation specifically.
So, if you want to try vitamin A for reducing period pain and endo, how do we do that? Based on the data, it looks as though an intake of vitamin A through food could potentially be beneficial as we have seen a reduction of oxidative stress with increased vitamin A intake, and we also have research showing lower levels of vitamin A intake linked with higher period pain severity, as discussed earlier.
Sources of vitamin A include:
Liver, especially beef and lamb
Cod liver oil
Sweet potato
Spinach
Kale
Collard greens
Swiss chard
Carrots
Pumpkin
Butternut squash
Peppers
Herring
Mackerel
Tuna
Cantaloupe
Mango
Grapefruit
Apricots
Eggs and dairy products - though I will say they are not a significant source
Additionally, it’s worth noting that when it comes to dietary intake, the endo study used plant-based sources of vitamin A, not animal based sources, and the association with reduced risk of period pain and vitamin A intake was again found with plant-based vitamin A foods, but the same was not found with animal based vitamin A foods. Now, that’s not to say animal based vitamin A foods should be avoided, or can’t help, but it may be about intake frequency, the types of animal foods, how they’re cooked (for example, frying increases oxidation levels in meat, whereas stewing lower levels) and so on.
If you’re curious about vitamin A from animal products and it could help with endo, I’ve linked to an episode in the show notes with Katie Edmunds, and additionally, I am planning on doing a whole series on meat and endo, and all the considerations and research around it in the future, so you can make informed decisions - because it is very, very far from black and white!
Finally, another thing to note is some people have genetic variants which mean they have trouble converting vitamin A from plant foods into the active form of vitamin A our bodies use, so in some cases, a higher intake of vit A plant based foods plus animal based vitamin A would be required. Fish would be a great option because the fish listed as high in vit A are also high in omega 3, which again helps with period pain.
In terms of supplementation of vitamin A, none of the studies look at this so we don’t have any specific doses, and supplementing with vitamin A can come with risks if you take too much for too long, so I would suggest the first port of call is to try and increase your vitamin A intake form food, and to further target oxidative stress with the other antioxidants we’ve looked at, like vitamin E and C, if you want to use supplements. Additionally, you could use cod liver oil, which contains naturally occurring vitamin A in levels that are typically safe, so this could be a great way to get in your omega 3 and vitamin A. However, of course, please consult with your doctor or healthcare practitioner.
Show notes
Oxidative stress, endo and period pain
https://link.springer.com/article/10.1186/1477-7827-7-54
https://pmc.ncbi.nlm.nih.gov/articles/PMC5625949/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7602455/
https://www.mdpi.com/2075-1729/13/6/1308
Low levels of vitamin A
https://pubmed.ncbi.nlm.nih.gov/31734759/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10303710/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0310995
https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-024-01895-x
https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-015-0179-6
https://link.springer.com/article/10.1186/1477-7827-7-54
Treatment with diet
https://link.springer.com/article/10.1186/1477-7827-7-54
https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01126-1
https://pmc.ncbi.nlm.nih.gov/articles/PMC9096837/
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-a/
https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3704564/
https://www.theendobellycoach.com/podcast/endo-pain-low-vitamin-c
https://www.theendobellycoach.com/podcast/endo-pain-low-vitamin-e
https://www.theendobellycoach.com/podcast/fatty-acid-deficiency-period-pain-endo
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Produced by Chris Robson