Your Complete Guide to the Use of Vitamins for Endometriosis

By: Michael Lam, MD, MPH; Carrie Lam, MD; Dorine Lam, RDN, MS, MPH

Details of the Endometriosis Protocol

There are many forms of vitamins for endometriosisEndometriosis is a very common condition. Statistics show that approximately 10-15% of women in their reproductive years from age 25 to 45 are affected. About 30% of affected women are infertile. This is why it is important to start taking vitamins for endometriosis.

It is a condition where the endometrium (the lining of the uterus) is found in locations outside the uterus, such as the ovaries, fallopian tubes, vagina, abdomen, deep inside the uterine muscle, bowel, bladder, utero-sacral ligaments (ligaments that hold the uterus in place), peritoneum (lining of the pelvis and abdominal cavity), or other parts of the body. It can grow between organs and cause them to stick together. This can be both painful and harmful, so utilizing vitamins for endometriosis could significantly improve your overall wellbeing.

The causes of endometriosis are not yet fully known. There are quite a few theories, from genetics to toxic environments. Backward bleeding, or “retrograde menstruation” (bleeding that goes up into the uterus) is thought to be the leading cause. Endometrial cells are estrogen responsive, and estrogen dominance is the norm in developed society. Many researchers believe that estrogens and their close relative xenoestrogens (environmental estrogens) play a significant causative role in this disease. Excessive estrogen is the strongest link and a key causative factor in many diseases, including estrogen dominance related illnesses such as endometriosis. Some have tried to link bleached tampons with pollutant residues as the cause, but this has yet to be proven.

Risk Factors

  • Family history of endometriosis, particularly mother or sister
  • Late childbearing (after age 30)
  • History of long menstrual cycles with a shorter than normal time between cycles
  • Abnormal uterus structure
  • Diet high in hyrogenated fat (trans-fat) such as French fries or cookies
  • Stress

Symptoms and Diagnosis

Endometrial cells respond like the cells of the uterus, and may bleed during menstruation. The most common symptom is pain and cramps that coincide with the menstrual cycle, and scar tissue can form wherever the endometrial tissue is located as it can interfere with the function of the organs. Other symptoms include heavy menstrual bleeding, pain during intercourse, abdominal pain and / or low back pain and diarhea during menstruation. Sometimes there are no symptoms at all. The degree of severity of the symptoms do not necessarily correlate with the degree of involvement, as each person reacts differently. Having endometriosis increases the risk for uterine fibroids or breast cyst, and may be accompanied by severe fatigue, chronic fatigue syndrome, or fibromyalgia, for reasons such as these, and those mentioned above, the use of vitamins for endometriosis can also support the reduction or regulation of other ailments.

The only way to diagnosis endometriosis is by laparoscopy, a surgical procedure where the surgeon places a small scope inside the pelvic cavity looking for endometrial tissues. This is often not successful, and diagnosis can take years.

Natural Treatment

Surgical intervention focuses on the removal of endometrial tissues, while drug therapy focuses on balancing the hormonal picture with birth control pills. Both are not very successful. More than 500,000 surgeries are performed each year for endometriosis, and there is upwards of 40% of recurrence, continued pain and disability. This disease often subsides with menopause, when estrogen levels are reduced in absolute terms. It also goes away when the ovaries are non-functional. This can be surgically induced by removing both ovaries, or chemically induced by the use of drugs on a temporary basis.  If surgery is something you want to avoid, or feel is not the best option for you, the use of vitamins for endometriosis may be a better option.

Surgical protocol is designed to reduced the body’s estrogen load, by reducing internal estrogen load though offsetting it with progesterone, increase estrogen clearance out of the body, and reduced external ingestion and environmental estrogen (xenoestrogen) insults.

Endometriosis is a very difficult condition.

1. Natural Progesterone

Vitamins for endometriosis include progesterone.Natural progesterone should be considered vitamins for endometriosis. It helps to reduce the risk of ovarian, endometrial and breast cancers, while unopposed estradiol is frequently associated with fibrocystic breast disease, endometriosis, PMS, fibroids and breast cancer. Specific dosage varies depending on the condition. For endometriosis, apply 20 mg of natural progesterone cream starting at day 8 and continue until day 26 of a usual 28-day cycle. Adjust the dosage to match relief of symptoms as advised by your doctor. It takes upwards of 6 months to notice the effect, and if no results are seen within 2 months, the dosage may have to be increased upwards to 40 mg a day. As the desired results are obtained, the dosage can be adjusted downwards until the lowest effective dose is found. When utilizing vitamins for endometriosis, you must continue until menopause, and if flare up occurs, increase the dosage to reduce symptoms.

Getting a baseline salivary progesterone and estrogen level is best, and it’s best you consult a naturally oriented physician before you get started, especially if the use of vitamins for endometriosis is something you are not at all familiar with.

2. Dietary Adjustments

Overeating with trans-fat is the norm in developed countries. Populations from such countries, especially in the Western hemisphere, derive a large part of their dietary calories from fat. They also show a much higher incidence of menopausal symptoms. Studies have shown that the estrogen level fell in women who switched from a typical high-fat, refined-carbohydrate diet to a low-fat, high-fiber, plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5,000 known sterols that have progestogenic effects. Cultures whose eating habits are more wholesome and who exercise more have a far lower incidence of menopausal symptoms because their pre- and postmenopausal levels of estrogen do not drop as significantly.

Scientists have identified cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choy and Brussels sprouts contain high levels of phytoestrogens that act like vitamins for endometriosis. These important vegetables work by competitively occupying the estrogen receptor sites on the cell membrane to prevent estrogen from exerting its effects on the cell. While phytoestrogen is weaker than estrogen, it nevertheless is estrogenic in nature. If you are working on estrogen reduction and using vitamins for endometriosis, these foods should be eaten in moderation at best. In particular, non-fermented soy products such as tofu or soy milk are not recommended because they have also been linked to low thyroid function. Fermented soy products such as miso or tempeh are acceptable.

A well rounded plant-based unprocessed whole-food diet is recommended. At least 15 grams of fiber should be consumed a day. Avoid high-glycemic foods such as refined sugar. Avoid alcohol or drugs that can damage the liver which will lead to an increase in toxins.

3. Coffee and Tea

Vitamins for endometriosis do not include coffee or teas.Studies have shown that drinking more than two cups of coffee a day may increase estrogen levels in women. It could also lead to problems such as endometriosis and breast pain.  Coffee also makes it more difficult for the body to absorbs vitamins and nutrients, so if you are trying to use vitamins for endometriosis, it is better to limit coffee intake. An average cup of coffee (4 oz) contains about 100 mg of caffeine, and an average cup of tea (8 oz) contains about a third to half the caffeine content of coffee.  

Having high levels of estrogen in such cases can be detrimental as it can lead to breast cancer in women and prostate cancer in men. Those who have a family history of cancer also have a higher risk and should consider taking vitamins for endometriosis.

In a clinical trial conducted, about 500 women between the ages of 36 to 45 were studied. These women were not pregnant, not breast-feeding or having hormonal treatment. They were interviewed regarding their diets, smoking habits, height and weight. Their hormone levels during the first five days of their menstrual cycle were also measured.

The results showed that women who consumed more than one cup of coffee a day had significantly higher levels of estrogen during the early follicular phase of their menstrual cycle. Those who consumed at least 500 mg of caffeine daily, the equivalent of four or five cups of coffee, had nearly 70% more estrogen than women who consumed less than 100 mg of caffeine daily.

Caffeine intake from all sources was associated with higher estrogen levels regardless of the women’s age, body mass index (BMI), caloric intake, smoking habits, alcohol and cholesterol intake. Coffee consumption increases estradiol levels. There are three different forms of estrogen in the body – estrone, estradiol and estriol. Estradiol is the form that is pro-cancerous. Women should limit their intake of coffee to not more than one to two cups daily to decrease their risk of having more serious health problems.

Chronic high caffeine intake can also lead to adrenal gland exhaustion and reduced production of progesterone. The proper progesterone to estrogen ratio is therefore not maintained, resulting in further estrogen dominance.

Coffee (especially when accompanied with sugar) also creates an acidic internal environment. The body will try to neutralize the acid by withdrawing valuable minerals such as magnesium and calcium from bones. If chronic, this leads to mineral depletion and ultimately osteoporosis. This is not the best environment for health and healing and is counter productive to the use of vitamins for endometriosis.

In addition to the above, coffee is a stimulant that causes the body to generate epinephrine as it tries to fend off insults with a flight or fight response. In response to the epinephrine, the adrenal glands (sitting on top of the kidneys) secrete cortisol, an anti-inflammatory hormone and one that is pro-aging to reduce the effects of epinephrine. Chronic excess intake of coffee can lead to adrenal exhaustion over time. The adrenal glands are also responsible for manufacturing pregnenolone, a precursor to progesterone. Deficiency in progesterone in turn upsets the intricate estrogen/progesterone balance, leading to estrogen dominance and a host of symptoms including fatigue, bloating and depression commonly associated with menopausal and pre-menstrual symptoms.

Thus, coffee consumption can lead to increased estrogen, adrenal gland exhaustion and osteoporosis.

4. Detoxification

Estrogen is metabolized in the liver. Herbs that fortify the liver will speed up estrogen clearance from the body. Estrogen that is not metabolized by the liver will continue to circulate and exert its effect on the body, worsening any developing endometriosis.

Vitamins for endometriosis should be naturalThe most impressive research has been done on a special extract of milk thistle (Silybum marianum) known as silymarin, a group of flavonoid compounds. These compounds act like vitamins for endometriosis by protecting the liver from damage and enhance the detoxification process.

Silymarin prevents damage to the liver by acting as an antioxidant. It is much more effective than vitamin E and vitamin C. Numerous research studies have demonstrated its protective effect on the liver. Extremely toxic chemicals such as carbon tetrachloride, amanita toxin, galactosamine and praseodymium nitrate produce experimental liver damage in animals. Silymarin has been shown to protect the liver against these toxins.

Silymarin also works by preventing the depletion of glutathione. The higher the glutathione content, the greater the liver’s capacity to detoxify harmful chemicals. Moreover, silymarin has been shown to increase the level of glutathione by up to 35 %. In human studies, silymarin has been shown to exhibit positive effects in treating liver diseases of various kinds including cirrhosis, chronic hepatitis, fatty infiltration of the liver and inflammation of the bile duct. The common dosage for silymarin is 70 to 200 mg one to three times a day.

In addition, avoid caffeine, alcohol and medications that interfere with the liver’s detoxification mechanism and reduce the impact of vitamins for endometriosis.

5. Maintaining ideal body weight:

Half of the adults in Europe and 61 percent of American adults are overweight. If you are overweight, lose it as fat cells increase estrogen production. The higher the estrogen, the higher the chances of endometriosis. Cancer is more common in overweight people. The evidence on weight is strongest for post-menopausal breast cancer and cancer of the endometrium (lining of the womb), gall bladder and kidney.

Over-consumption of calories leads to increased metabolic activity in the body. This in turn leads to excessive free radical formation. Free radicals damage cells and causes genetic mutation, which ultimately can lead to cancer.

Obesity is normally defined by the body mass index or BMI, which is calculated by dividing weight in kilograms by height in meters squared. An index of between 18.5 and 25 is considered healthy, while those with a score between 25 and 29 are classified as overweight and those whose BMI is higher than that are considered obese. The target weight should be 5 to 10 per cent below the ideal body weight. Your ideal body weight can be calculated easily. For women, the formula is 100 pounds plus 5 pounds for every inch above 5 feet. Therefore, for a woman standing 5 feet 6 inches tall, her ideal weight is 100 + (5 pounds/inch x 6 inches) = 130 pounds. Give or take 5 pounds for large or small frame size respectively.

6. Exercise

Exercise goes hand in hand with vitamins for endometriosis.Properly performed exercises have been shown to modulate hormonal imbalance. Moderate exercise also increase the body’s production of endorphins, the natural pain relievers. Those who exercise regularly are also happier, less depressed and have an optimistic outlook on life. This results in increased life expectancy. Statistically, life expectancy increases by two hours for every hour spent doing the proper exercises.

Precision anti-aging exercises must incorporate flexibility, cardiovascular and strength training exercises. All it takes is 5 minutes of flexibility training every day, 20-30 minutes cardiovascular training 3 times a week, and 15-20 minutes of strength training 2 times a week. A properly structured program takes an average of 30 minutes a day, which is less than 2% of the entire day.

7. Vitamins for Endometriosis

The body of a hormonal imbalanced person needs to be fortified with vitamins for endometriosis. Here is a summary of the daily nutritional consideration for those 45 and over:

Vitamin A (Antioxidant) – 15,000 IU (300% RDA) with no more than 5,000 IU in Vitamin A palmitate and the rest in natural mixed beta carotene. You will not get overdosed or feel toxic effects. More than 100 studies have shown that people with high levels of beta carotene in their diet have half the chance of developing cancer and heart attack.

Vitamin C (Antioxidant) – 1,000 mg (2,000% RDA) in the form of ascorbic acid (no need to spend more money on other forms unless you have a sensitive stomach or taking more than 2,000-3,000 mg per day). A study of Americans show that intake of 300 mg of vitamin C per day adds 6 years to a man’s life and 2 years to a woman’s life. Cardiovascular disease decreased by 40%. Take this in split doses as it is excreted within a few hours. No toxicity has been reported on long-term intake of up to 20,000 mg a day. It is important to incorporate ascorbyl palmitate (the fat soluble form of vitamin C) , L-proline and L-lysine. The three work synergistically to rebuild damaged blood vessels and prevent atherosclerosis.

Vitamin E (Antioxidant) – 400 IU (1,333% RDA) in the form of water dispersible d-alpha tocopherol (the natural form). This amount has been shown in repeated researches to be the optimum  dose for anti-aging and cancer prevention. The risk of not taking Vitamin E is statistically equivalent to the risk of smoking. A large scale Harvard study of 87,000 nurses showed that those taking more than 250 IU a day for 2 years have 41 % lower incidence of major heart disease. To take the equivalent of 400 IU in food would require 2 quarts of corn oil or 28 cups of peanuts a day. Many in the fore front of anti-aging research are now recommending up to 800 IU a day , especially for women in their peri- or postmenopausal period.

Magnesium (Antioxidant) – 500-1,000 mg (125-250 % RDA). Less than 25 % of Americans meet even the low RDA standard. A 2,000 kcal diet is needed if  no supplement is taken. Critical for proper heart function, normalize arrhythmias, and helps to reduce blood pressure. Requirement is higher if you take intake of sugar and fat is high in diet. The calcium to magnesium ratio should be between 1:1 to 1:2.

Vitamin B9 (folic acid) – 800 mcg (200 % RDA) – a non-toxic nutrient that protects our chromosome from DNA damage and cancer. A Harvard study of 16,000 women and 9,500 men showed that those getting the post folic acid has the lowest incidence of getting pre-cancerous polyps in the colon. Folic Acid also helps with depression . No noticeable side effects at up to 10,000 mcg.

Vitamins for endometriosis can include vitamin B12Vitamin B12 – 100 mcg- 1,000 mcg(1,666 % – 16,666 % RDA) – over 24% of people over 60 years old and over 40 % of people over 80 years old are deficient due to decreased absorption with age. Deficiency also causes Alzheimer’s Disease like symptoms. A must take for those over 50 years old as cheap and added insurance. Non toxic at 1,000 mcg daily for many years or up to 100,000 mcg in a single dose.

Chromium – 200 mcg (166 % RDA) in chelated form for better absorption – Very little is contained in food and as a result , 90 % of all Americans are deficient in the RDA of this trace element which is critical to normalize blood sugar. A Israel research shows that daily intake of 200 mcg of chromium improves insulin resistance in Type II Diabetes by up to 50 % in weeks.

Zinc – 30 mg (200 % RDA) in chelated form for better absorption – 33% of healthy Americans over age 50 have zinc deficiency and don’t know it. The percentage increases to 90 % for those older. You need a daily calorie intake of 2,400 kcal to get just the RDA. Zinc is critical for proper thymus gland and immune system function. Research has shown that daily intake of 30 mg of zinc reactive the immune system with dramatic improvements after 6 months in those with zinc deficiency.

Calcium – 500 mg (50 % RDA) in the form of calcium carbonate. In addition to keeping our bones healthy, calcium also fights cancer. Calcium carbonate contains 40 % calcium, compared to others such as calcium gluconate which contain 9 % elemental calcium. Don’t take more than 500 mg at a time for best absorption. Calcium citrate is better absorbed, but only contains 11 % calcium. Calcium should be balanced with magnesium at 1:1 or 1:2 ratio.

Citrus Bioflavonoids – 100 mg – potent antioxidants derived from plants that have metal binding (chelating) properties. Commonly found in grape seed.

Omega-3 Fatty Acid – Eating 8 oz of fish a week is all you need to do. Otherwise, take 1,000 mg from fish oil to contain 360 mg EPA and 240 mg DHA. Most people taking fish oil have a tendency to develop a fishy ” burp”. Over 60 research studies have shown that a variety of ailments from arthritis to heart disease can benefit from fish oil (not cod liver oil which contains
a high dose of Vitamin A and D which are toxic in high doses). 400 IU of Vitamin E should be taken simultaneously to potentiate the effect of fish oil.

Evening Primrose Oil or Borage Oil – 500 mg -1,000 mg (standardized to 9 % GLA) – an essential fatty acid. Strong anti-inflammatory properties and useful for arthritis, PMS and skin conditions. Most researches use 3,000-6,000 mg a day. Borage oil is superior to EPO due to its higher content of GLA .

Digestive Enzyme containing lipase, cellulase, protease, and amylase. 2-3 tablets two times a day between meals.

DIM (diindolymethane) 60-120 mg a day. This is an active metabolited of indole-3-carbinol. It improves estrogen ratio in the body.

Avoid Iron or copper unless you are anemic.

8. Reduced Xenoestrogen Load

Throw out the nail polish and add vitamins for endometriosisThese are external estrogen from the environment that has molecular structure similar and behaves like estrogen once inside the body.

  • Throw away all pesticides, herbicides and fungicides.
  • Throw away cosmetics that have toxic ingredients such and switch to organic and “clean” cosmetics
  • Throw away nail polish and nail polish remover.
  • Use organic soap and toothpaste.
  • Don’t use fabric softeners as it puts petrochemical right on your skin
  • Use only naturally based perfume. Most perfumes are petrochemically based.
  • Have a good water filter for your source of water.
  • Do not use plastic goods since all plastic leach into the environment. This includes intrauterine device (IUD)
  • Eat only organic based whole food.
  • Avoid surfactants found in many condoms and diaphragm gels.
  • New carpet can give off noxious fumes. Beware.
  • Be aware of noxious gas such as that from copies and printers, carpets, fiberboards, computer monitors that emit high level of electromagnetic force (EMF). 
  • Avoid X rays as much as possible.
  • Do not microwave food in plastic container, and especially avoid the use of plastic wrap to cover food for microwaving.
  • Wash your food well to rid the pesticides. Bath the washed food in ozonated water for 20 minutes before cooking.

Protocol disclaimer

There are many different forms of vitamins for endometriosis
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Dear Dr. Lam,
I just read your book, and am very grateful that I found it. I have been through a lot of the same things many of your patients have been through. Thank you so much for your help. Just knowing that I am not alone, and finally knowing what is wrong with me has helped tremendously. I am very grateful to you.