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Meta-Analysis
. 2024 May 31;19(5):e0301867.
doi: 10.1371/journal.pone.0301867. eCollection 2024.

Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomized controlled trials

Patrick Bayu  1 , Jacobus Jeno Wibisono  1
Affiliations
Meta-Analysis

Vitamin C and E antioxidant supplementation may significantly reduce pain symptoms in endometriosis: A systematic review and meta-analysis of randomized controlled trials

Patrick Bayu et al. PLoS One. .

Abstract

Background: The primary challenge encountered by individuals diagnosed with endometriosis is the experience of pain. Emerging research indicates that oxidative stress is implicated in the initiation of pain associated with endometriosis. Vitamins C and E are known for their antioxidative properties. The primary objective of this study is to assess the efficacy of antioxidant supplementation, consisting of these vitamins, in the management of pain associated with endometriosis.

Methods: A comprehensive search was conducted on the ClinicalTrials.gov, Scopus, Europe PMC, and Medline databases up until August 23rd, 2023, utilizing a combination of relevant keywords. This review incorporates literature that examines the relationship between antioxidant supplementation and pain in endometriosis. We employed fixed-effect models to analyze the risk ratio (RR) and present the outcomes together with their corresponding 95% confidence intervals (CI).

Results: A total of five RCTs were incorporated. The results of our meta-analysis indicated that antioxidant supplementation with vitamin C and E combination was associated with higher proportion of endometriosis patients reporting reduced chronic pelvic pain (RR 7.30; 95%CI: 3.27-16.31, p<0.00001, I2 = 0%), alleviations of dysmenorrhea (RR 1.96; 95%CI: 1.25-3.07, p = 0.003, I2 = 39%), and dyspareunia (RR 5.08; 95%CI: 2.10-12.26, p = 0.0003, I2 = 0%) than patients only receiving placebo.

Conclusions: This study suggests the potential ability of vitamin C and E in alleviating pain symptoms experienced by individuals with endometriosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram of the detailed process of selection of studies for inclusion in the systematic review and meta-analysis.
Fig 2
Fig 2. Risk of Bias version 2 (RoB v2) quality assessment of clinical trial studies that shows some-concern risk of bias in four clinical trials and low-risk of bias in one clinical trial study.
Fig 3
Fig 3
Forest plot that demonstrates antioxidant supplementation containing combination of vitamin C and vitamin E was associated with higher proportion of endometriosis patients who achieved reduction in the chronic pelvic pain (A), dysmenorrhea (B), and dyspareunia (C) symptoms.
See this image and copyright information in PMC

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