Endometriosis is one of the most frequent benign gynecological diseases, characterized by the implantation and growth of endometrial tissue outside the uterine cavity, producing a general and systemic inflammatory response. In this clinical condition, the most common symptoms include chronic abdominal and pelvic pain, dysmenorrhea, dyspareunia, abnormal uterine bleeding, and infertility. Check out everything the most important about n-acetylcysteine and endometriosis.
Surgical removal of ectopic lesions represents the first-line intervention, but may be impaired by a series of recurrences. In addition, a variety of hormone therapies aimed at reducing circulating estrogen levels are currently available. However, these treatments are usually unsatisfactory and cannot be used for long periods of time due to the occurrence of serious adverse effects.
Thus, new and improved therapeutic solutions that can efficiently reduce lesions with limited side effects and without interference in the patient’s fertility are desirable.
Why N-Acetylcysteine?
Recently, the literature has shown that the administration of N-acetylcysteine (NAC), an acetyl form of the amino acid cysteine naturally present in some substances such as garlic, exerts an antiproliferative action on cancer cells of epithelial origin, where endometrial cells also originate.
Its action is due to the establishment of a complex route of differentiation, including the activation of several molecular mechanisms that converge to interrupt proliferation-differentiation, implying a decrease in cell proliferation and cellular locomotor behavior, relevant in endometriosis.
In addition, NAC also negatively regulates the activity of inflammatory proteins and their gene expression due to effects that are far beyond an antioxidant capacity. Due to this set of activities, treatment with NAC has been shown to induce a significant reduction in endometriomas size associated with decreased tissue inflammation and cell invasion. So when we think of n-acetylcysteine and endometriosis, we will teach you what you need to know!
N-acetylcysteine and endometriosis: what do we have in the literature?
A study was published that analyzed the evolution of ovarian endometriomas in terms of average diameter and volume, evaluated by ultrasound, in patients treated and not treated with NAC, through oral administration for 3 months according to the following protocol: 600 mg three times a day, three consecutive days a week demonstrated that, in fact, the group supplemented when compared to untreated controls, treatment with NAC led to an increase in the number of cysts that shrank or disappeared, as well as in a smaller number of enlarged and neoformed cysts.
In addition, it was possible to record pregnancies in the supplemented group, indicating that, in marked contrast to all other hormonal treatments available for endometriosis (e.g., danazol, gonadotropin-releasing hormone analogues, progestágens and oral contraceptives), NAC does not interfere with the patient’s fertility and represents an appropriate approach to treat endometriosis in women who wish to become pregnant.
Pathogenesis
Although the pathogenesis of endometriosis is still debated, several evidences highlight that both the onset and progression of this disease are sustained by a disarray of the invasive, proliferative, adhesive and locomotor properties of endometrial cells, along with an increase in the production of inflammatory molecules. In this context, NAC through its action on thionl and redox signaling positively modulates several relevant pathways that are involved in the pathogenesis of endometriosis.
Clinical practice
According to the data demonstrated in the literature, it is clear that the action of NAC in cell signaling and protein activity, with the general effect of reversing a disorderly proliferation to a physiological behavior, can help in the prevention of recurrences. However, both the complete elucidation of the mechanisms activated by N-acetylcysteine and its possible role in the prevention of recurrences deserve broader future studies. However, the nutritionist can use this supplement to ensure greater effectiveness in the management of patients with endometriosis.
Bibliographic references
Reading Suggestion: Influence
of diet on the risk of developing endometriosis
Watch nutritionist Débora Valadão’s video on science play –
SOP and endometriosis: efficient integrative approach
Porpora MG, Brunelli R, Costa G, Imperiale L, Krasnowska EK, Lundeberg T, Nofroni I, Piccioni MG, Pittaluga E, Ticino A, Parasassi T. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine.
Evid Based Complement Alternat Med. 2013;2013:240702. doi: 10.1155/2013/240702. Epub 2013 May 7. PMID: 23737821; PMCID: PMC3662115.
