Obstet Gynecol Sci.  2024 Mar;67(2):186-198. 10.5468/ogs.23210.

The effect of antioxidant supplementation on dysmenorrhea and endometriosis-associated painful symptoms: a systematic review and meta-analysis of randomized clinical trials

• Baradwan S
• Gari A
• Sabban H
• Alshahrani MS
• Khadawardi K
• Bukhari IA
• Alyousef A
• Abu-Zaid A

• KMID: 2553426
• DOI: http://doi.org/10.5468/ogs.23210

Abstract

This study aimed to review randomized controlled trials (RCTs) investigating the effects of dietary antioxidant supplements on the severity of endometriosis-related pain symptoms. The PubMed/Medline, Scopus, and Web of Science databases were searched until April 2022. Additionally, we manually searched the reference lists. Endpoints were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) in a random-effects model. The I² statistic was used to assess heterogeneity. Ten RCTs were included in this meta-analysis. Overall, 10 studies were related to dysmenorrhea, four to dyspareunia, and four to pelvic pain. Antioxidants significantly reduced dysmenorrhea (SMD, -0.48; 95% CI, -0.82 to -0.13; I²=75.14%). In a subgroup analysis, a significant reduction of dysmenorrhea was observed only in a subset of trials that administered vitamin D (SMD, -0.59; 95% CI, -1.13 to -0.06; I²=69.59%) and melatonin (SMD, -1.40; 95% CI, -2.47 to -0.32; I²=79.15%). Meta-analysis results also suggested that antioxidant supplementation significantly improved pelvic pain (SMD, -1.51; 95% CI, -2.74 to -0.29; I²=93.96%), although they seem not to have a significant beneficial impact on the severity of dyspareunia. Dietary antioxidant supplementation seems to beneficially impact the severity of endometriosis-related dysmenorrhea (with an emphasis on vitamin D and melatonin) and pelvic pain. However, due to the relatively small sample size and high heterogeneity, the findings should be interpreted cautiously, and the importance of further well-designed clinical studies cannot be overstated.

Keyword

Antioxidant; Endometriosis; Dysmenorrhea; Dyspareunia; Pelvic pain

Figure

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  Fig. 1 The flow diagram of literature search and selection of studies. RCT, randomized controlled trials.

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  Fig. 2 The summary of risk of bias assessments.

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  Fig. 3 Forest plot of the effect of antioxidants on dysmenorrhea pain. N, number; SD, standard deviation; CI, confidence interval; FA, fatty acid.

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  Fig. 4 Subgroup forest plot of the effect of antioxidants on dysmenorrhea pain. N, number; SD, standard deviation; CI, confidence interval.

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  Fig. 5 Forest plot of the effect of antioxidants on dyspareunia pain. N, number; SD, standard deviation; CI, confidence interval.

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  Fig. 6 Forest plot of the effect of antioxidants on pelvic pain. N, number; SD, standard deviation; CI, confidence interval; REML, restricted maximum likelihood.

Reference

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