EP.370/ Study Spotlight: Can Magnesium Reduce Endometriosis Pain and How?
Today we’re continuing with our Study Spotlight Series looking at the study: Dietary Modification and Supplement Use For Endometriosis Pain, and if you need a recap on this study overall, go to episode 365.
But today, we’re looking at supplements and specifically, magnesium.
The study found that out of those who tried magnesium, 33% reported an improvement in pain levels.
Now, there are limitations here. Firstly, everyone would have used different brands, doses and magnesium forms, so certainly there will be varying results from that. Secondly, people would have taken them for different lengths of time as well, so someone may have tried a week, others a month and so on.
And with magnesium, it’s very important to note that there are different types:
Magnesium oxide and citrate are best used for constipation and regular bowel movements, because they are not absorbed well and instead, make their way to the large intestine, where they draw water in, and help keep us regular. So, if people in this study were using magnesium citrate or oxide - which many probably were because they are the cheapest forms and are easier to get hold of than the others - then it’s less likely they would experience improvements in pain from these forms, unless the pain was being caused by constipation.
Another form is magnesium l-threonate, which is best for crossing the blood-brain barrier and has been shown to improve cognitive function.
Magnesium Glycinate is one of the best absorbed forms of magnesium, and due to this, it’s the typical recommended form to use for reducing period pain, PMS, inflammation, etc.
So, are there any previous studies that back up the use of magnesium for endo or period pain?
Research has shown magnesium to be an effective treatment in preventing dysmenorrhea (period pain). In fact, in recent research, magnesium is being explored as a dietary treatment for endo and a higher intake of magnesium rich foods were associated with a lower risk of endo.
In my clinic, I see magnesium glycinate, combined with other anti-inflammatory supplements such as omega 3, as very effective for improving pain levels, as well as PMS, in my clients (who, as you know, all have endometriosis).
So, why is magnesium helpful for some of us with endo?
Prostaglandins
Let’s start with prostaglandins. Prostaglandin E2 and F2α are elevated in people with endometriosis and people with dysmenorrhea. When they get high we get pain, heat and swelling.
It’s these inflammatory prostaglandins that are the key cause of our pain with endometriosis.
They also play a major role in the development and progression of endo.
Magnesium actually reduces these inflammatory immune chemicals. One study showed that six months of magnesium treatment reduced prostaglandin F2a by over half! In contrast, the placebo group’s levels stayed at 90% of their original baseline levels.
Oxidative stress
But let’s go further back in the inflammatory immune cascade. One of the reasons we have higher levels of prostaglandin production, is due to higher levels of oxidative stress. People with endo have higher levels of oxidative stress and lower levels of antioxidants to fight that oxidative stress, and oxidative stress is one of the key ‘fertilisers’ in endo growth, not just because it triggers the production of prostaglandins, but because it triggers numerous inflammatory pathways involved in the development of endo.
Now we’ve seen in the research that lower levels of magnesium are associated with a higher risk of endometriosis, and magnesium deficiency is directly linked to higher levels of oxidative stress in the research, so this may possibly be why. Additionally, a systematic review found that period pain is associated with significantly higher levels of oxidative stress, likely due to how oxidative stress impacts our inflammation and prostaglandin levels.
Smooth muscle
Next up is how magnesium affects our smooth muscle. You’ve probably heard magnesium is a muscle relaxant, and this is absolutely true. Magnesium has been shown to ease the contraction of smooth muscles, and the uterus is made up of smooth muscle. Now, yes, endo grows outside of the uterus, but that does’t mean the contractions of the uterus during menstruation aren’t contributing to our pain levels. Don’t forget, prostaglandins and oxidative stress affect the uterus and period pain severity too, and so with endo, we have higher levels of these, not just inflaming the endo lesions, but the uterus too.
In my clinic, I actually use topical magnesium spray with my clients to lessen the severity of pelvic pain and period cramps, in the moment they’re occurring. It’s not going to resolve your pain entirely on its own, but it can actually take the edge of for some people, and for others, it can entirely ease cramps when combined with other tools or supplements.
Oestrogen clearance
Lastly, let’s look at how magnesium can affect hormones and how that may be playing a role.
Magnesium supports the liver to break down oestrogen through a series of key enzymes, it then helps to package oestrogen up in bile, ready for delivery in the gut.
Next, magnesium plays a role in healthy bowel movements, which are essential and the final step for clearing oestrogen. When we don’t have regular, daily bowel movements, oestrogen can be reabsorbed into the blood stream.
Magnesium also supports healthy progesterone production. It does this by helping to regulate something called our hypothalamus-pituitary-adrenal axis, which is a bit like the command centre of our hormones. When it’s off-track, this has a downstream effect on our hormones, particularly progesterone, which can be lowered when this system isn’t functioning properly.
Magnesium is so good at supporting our hormones, that it is a recognised treatment for preventing PMS.
We know that endo is an oestrogen dependent disease, and so when we have too much oestrogen or too little progesterone, it can increase endo activity and symptoms.
So, I would love to see more research done on magnesium supplementation and endometriosis, with controlled studies, however, for now, we can see that it’s possible that magnesium could contribute to pain reduction.
If you want to give magnesium supplementation a go, I recommend you look for magnesium glycinate, and always check the back of the bottle, because often, it’s mixed with citrate or oxide or something else, and actually the amount of magnesium glycinate you’re getting is very small, so try to get a pure formula. You may notice that some brands call their magnesium glycinate magnesium bis-glycinate, it’s the same thing, so don’t worry about that.
The dose we use in my training is between 150-450mg per day. Most of the time, I see better results with the higher doses, but that does often require you to take around three capsules a day because it’s near on impossible to find that dose in one capsule. You can try powder, which means you can get that dose in one go, but I haven’t found a good tasting formulation. For ease, I am going to link to a brand I use regularly with clients in the show notes, but to be clear - I am not sponsored or affiliated with this brand.
I do recommend you give magnesium at least three months to notice improvements from, and ideally six, as remember, one of the studies showed that it took six months of magnesium treatment to halve prostaglandin levels, so we do need to give this one time, but often, you’ll see small improvements each cycle, that accumulate over time.
Okay, so I hope this has been both helpful and insightful!
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References
Study Spotlight
https://www.theendobellycoach.com/podcast/new-endo-survey-study-review
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831953
Magnesium citrate/oxide
https://pmc.ncbi.nlm.nih.gov/articles/PMC6683096/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6786451/
Magnesium l-threonate
https://pubmed.ncbi.nlm.nih.gov/36558392/
Magnesium glycinate
https://link.springer.com/article/10.1007/s12011-019-01663-0
Magnesium, endo and period pain research
https://www.ijwhr.net/pdf/pdf_IJWHR_624.pdf
https://www.jle.com/fr/revues/mrh/e-docs/magnesium_in_the_gynecological_practice_a_literature_review_309489/article.phtml
https://pmc.ncbi.nlm.nih.gov/articles/PMC8972862/#ref18
https://pmc.ncbi.nlm.nih.gov/articles/PMC3626048/
Prostaglandins
https://pmc.ncbi.nlm.nih.gov/articles/PMC4512562/
https://pubmed.ncbi.nlm.nih.gov/6790261/
https://www.tandfonline.com/doi/full/10.3109/09513590.2011.588753#
https://pubmed.ncbi.nlm.nih.gov/20511671/#
https://www.sciencedirect.com/science/article/abs/pii/S1130862119303158
https://pubmed.ncbi.nlm.nih.gov/2675496/
Oxidative stress
https://pmc.ncbi.nlm.nih.gov/articles/PMC5625949/#:~:text=It is now widely accepted,of deleterious ROS [15].
https://link.springer.com/article/10.1186/1477-7827-7-54
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/19E868FB1BE3A08DCFC0D00D7489ACAF/S0954422410000272a.pdf/dietary-therapy-a-new-strategy-for-management-of-chronic-pelvic-pain.pdf
Low levels of magnesium and endo risk
https://pmc.ncbi.nlm.nih.gov/articles/PMC10781184/
https://pmc.ncbi.nlm.nih.gov/articles/PMC8972862/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3626048/
Mag and oxidative stress link
https://pmc.ncbi.nlm.nih.gov/articles/PMC5112180/
Period pain and oxidative stress review
https://pmc.ncbi.nlm.nih.gov/articles/PMC7602455/
Magnesium and hormones
https://www.jle.com/fr/revues/mrh/e-docs/magnesium_in_the_gynecological_practice_a_literature_review_309489/article.phtml
Magnesium and smooth muscle
https://pubmed.ncbi.nlm.nih.gov/1602005/
https://www.ijwhr.net/pdf/pdf_IJWHR_624.pdf
https://pmc.ncbi.nlm.nih.gov/articles/PMC7215544/
Produced by Chris Robson