Got endometriosis? Approach Iron with care.

New research suggests that dysregulated iron has a role in the formation and progression of endometriosis.

It’s not uncommon for people with endometriosis to have been diagnosed with iron deficiency.

Several years ago, I wouldn’t have blinked an eyelid at the inclusion of an iron supplement in the regime of someone with endo, but given some of the emerging research, I am starting to be concerned.

While the research refers solely to endometriosis, it’s likely that this also relates to adenomysosis.

Here is a TLDR: Endometriosis is the presence of cells from inside the endometrium sitting elsewhere, where they shouldn’t be. This causes inflammation and pain. When the endotriosis cysts bleed in response to the hormones at that time of the month, iron escapes into the area. This iron contributes towards an inflammatory reaction that perpetuates endometriosis. If endometriosis is on the ovaries, where is commonly can be, this can affect the egg maturation and quality. You can have dysregulated iron because of a deficiency of other nutrients that regulate it. It is possible to feel iron deficiency symptoms and to have iron overload in the endometrial cells causing the inflammation.

Okay phew. If you’re still reading, let’s get a bit more detailed.

In order to understand this, I want to discuss the concept of ferroptosis.

If you remember much from high school biology, the term apoptosis or autophagy may ring some bells – it’s a type of programmed cell death that occurs. Well ferroptosis is similar, but this is a lot more inflammatory, as there can be an accumulation of lipid peroxides, which causes oxidative stress, worsening inflammation. Ferroptosis seems to be associated with a few other inflammatory conditions as well, but because it’s a newish concept, the understanding and research is still growing.

Ferroptosis seems to be worsened by dysregulation of iron in the body. This could look like not having the right co factors for iron to be used properly (copper and retinol)

In people with endometriosis, iron overload in the reproductive tissues, alongside the presence of altered iron homeostasis causes problems. Too much iron in the cells causes increased intracellular oxidative stress via the Fenton reaction, which worsens inflammation. Free iron in endometriosis cysts is significantly higher (100-1000 times) than in other types of benign cysts.

Iron may be high in these cells because of the bleeding of endometrial cysts that occurs in response to hormonal triggers each cycle. But when iron levels are dysregulated because of deficiency of co-factors, this will likely be much worse. Plus, you may also still feel the other symptoms of iron deficiency.

The cells in endometriosis cysts seem to form a resistance to ferroptosis. But unfortunately the granulosa cells (the cells in the ovaries) do not. Ferroptosis in follicular fluid has an association with poorer oocyte quality (egg), which may be part of the reason why fertility is impaired in those with endometriosis.

The research is still growing. It’s possible that modulation of ferroptosis is going to be a new treatment strategy for endometriosis. But for now, we can work on a few things. Reducing inflammation and oxidative stress e.g with ubiquinol and maybe vitamin e. And also making sure we’re not taking iron if deficient without the necessary co-factors.

By the way – head over to the GUIDES section on my instagram page and read through my iron information to help understand more about iron cofactors.

PMID: 37296777

PMID: 19165662