EP.338/ Being low in vitamin e could worsen your period (and endo) pain
Today we’re continuing with our series on endo and period pain and their associations with low nutrient levels. And I was going to make today’s episode all about vitamins, but there are so many vitamins to cover, that I thought it would be less overwhelming to break them up, so today, we’re starting with vitamin E.
However, before we get into today’s episode, if you haven’t listened to the previous episodes in this series then you’ll be missing some of the essential science behind endo and period pain, which will help you to understand how vitamin E plays a role.
So, let’s do a quick recap.
Prostaglandin E2 and prostaglandin F2α are types of inflammatory immune compounds that are involved in various processes in the body, including menstruation. They are elevated in people with endometriosis and people with dysmenorrhea, and it’s these inflammatory prostaglandins that are the key cause of our pain with endometriosis and menstruation, as well as playing a major role in endo development and progression.
A type of omega 6 fatty acids called arachidonic acid is converted into these inflammatory prostaglandins, whilst omega 3 fatty acids makes our anti-inflammatory prostaglandins. In fact, an imbalance between these two is thought to be a key player behind endometriosis and period pain. I covered this last week on the show, so have linked to the episode in the show notes.
But it’s not just omega 3 that affects prostaglandin production.
Vitamin E is an antioxidant, which means it helps to fight oxidation, a damaging inflammatory process involved in aging, disease but also endometriosis growth and progression. Its antioxidant benefits help to inhibit the production of inflammatory prostaglandins, the chemicals responsible for endo and period pain. They do this by preventing the release of omega 6 fatty acid arachidonic acid and its conversion into inflammatory prostaglandins E2 and F2α, so we end up making less of these pain causing immune chemicals.
And here’s where it gets really interesting. Whilst I couldn’t find much research associating low vitamin E with period pain, there are several studies associating low vitamin E intake or levels with a greater risk of endometriosis, as well as endo severity. For example, one study found that vitamin E was lower in patients with moderate and severe endometriosis, in contrast to those with mild endometriosis.
And in terms of endo-related period pain reduction, two studies found that supplementation with both vitamin E and vitamin C reduced menstrual pain and inflammatory markers. One study used 1200 units of vitamin E and 1000mg of vitamin C, daily for eight weeks and another used 400 units of vitamin E twice a day (so 800 units total) and 500mg of vitamin C twice a day (so 1000mg total), daily, for eight weeks. And a recent meta analysis found that vitamin E, both in combination with vitamin C and without, significantly reduced pelvic pain with endo, including menstrual pain and that the longer the duration of taking vitamin E and the higher the dose, the greater the reduction in inflammatory markers and oxidative stress that cause endo pain and progression.
In terms of period pain, a systematic review and meta-analysis of 8 studies and over 1000 people concluded that vitamin E significantly reduced period pain and could be used as a treatment for primary dysmennorhea.
The doses used in these studies varied. Most studies used 100 or 200 units somewhere between twice to four times a day and the majority of them used vitamin E two days prior to menstruation and for the first three days of bleeding. All studies repeated these for at least two cycles and some up to four cycles, and demonstrated that better effects were experienced with continued use across multiple cycles.
Now in terms of safety, the NHS advises to not take more than 800 units per day, which equates to 540mg, so these levels for period pain are way below that, and you’re not taking daily either, just a couple of days a month.
If you wanted to try daily, for endometriosis, I can’t advise you go to 1200 units because it’s quite high and there are risks with high doses of vitamin E, so if you wanted to replicate that study, you could discuss trying that with your doctor, or you could replicate the other study, which used 800 units per day for eight weeks, and see whether that is enough to help.
Now something to be aware of, is that these studies can’t go on forever, so they have to end somewhere hence why some did two cycles, others did four, etc. But that doesn’t mean you have to stop there or that once you take vitamin E for two cycles, you can stop and your pain will still be lower and will stay that way. The idea with managing endo related period pain is that we want to keep prostaglandin production at bay, and we know that people with endo have elevated levels, so it’s likely that we need to always keep an active role in reducing those. That doesn’t mean you’ll have to take vitamin E or tonnes of supplements forever, you might find dietary changes such as more omega 3 or reduced sugar, is enough to move the needle for you. But you may well find that vitamin E is so helpful for you, that you choose to take it just before and during your period for the foreseeable, as an example. You need to work out what’s best and realistic for you.
Of course, speak to your doctor or health practitioner when making these changes.
Now, we don’t just want to supplement - ideally, we want to improve our nutritional intake of vitamin E too. Especially as research has shown that women with endo have a 40% lower intake of vitamin E than those without endo and that vitamin E levels improved and inflammatory oxidative stress markers reduced with a high antioxidant diet across three months, that included adequate intake of vitamin E.
So, what foods are rich in vitamin E?
Almonds
Olive oil
Sunflower seeds
Peanuts
Hazelnuts
Pinenuts
Salmon
Trout
Peppers
Avocado
Turnips
Incorporating a couple of these into your daily diet is a fantastic way to raise your vitamin E levels and actually fight the inflammatory processes that cause endo pain and growth.
Okay, that’s it! I’ll see you next week for the next episode in this series.
Show notes
Endo, period pain and prostaglandins
https://pubmed.ncbi.nlm.nih.gov/6790261/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7068519/
https://www.tandfonline.com/doi/full/10.3109/09513590.2011.588753
https://pmc.ncbi.nlm.nih.gov/articles/PMC4512562
Oxidative stress and vit E
https://pmc.ncbi.nlm.nih.gov/articles/PMC5625949/
https://www.clinicalnutritionespen.com/article/S2405-4577(22)00500-9/abstract
Vit E and endo risk
https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01126-1
https://pmc.ncbi.nlm.nih.gov/articles/PMC8972862/
https://www.mdpi.com/2072-6643/15/12/2773
Vit E supplementation for Endo
https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01126-1
https://www.mdpi.com/2072-6643/15/12/2773
https://onlinelibrary.wiley.com/doi/full/10.1155/2021/5529741
https://pmc.ncbi.nlm.nih.gov/articles/PMC3484190/
Vit E supplementation for dysmenorrhea
https://www.clinicalnutritionespen.com/article/S2405-4577(22)00500-9/abstract
https://www.mdpi.com/2075-1729/13/6/1308
https://pmc.ncbi.nlm.nih.gov/articles/PMC6856484
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-e/
High antioxidant diet and endo
https://www.mdpi.com/2072-6643/15/12/2773
https://link.springer.com/article/10.1186/1477-7827-7-54
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