N-Acetyl Cysteine (NAC) for Endometriosis

N-acetylcysteine 600 mg three times daily on a three-days-on schedule reduced endometrioma size and cancelled planned surgery in a notable proportion of women in an Italian randomised trial.

Overview

N-acetylcysteine 600 mg three times daily on a three-days-on schedule reduced endometrioma size and cancelled planned surgery in a notable proportion of women in an Italian randomised trial.

Verdict

Mixed evidence

One notable randomised trial found NAC 600 mg three times daily on a three-days-on schedule shrank endometriomas and averted planned surgery in a meaningful proportion of women.

How It Works

N-acetylcysteine replenishes glutathione and acts as an antioxidant; in endometriosis models it reduces oxidative stress within endometriomas and modulates the inflammatory environment that sustains lesions.

Dosing & Protocol

Typical dose

Recommended dose: Trial protocol: 600 mg three times daily for three consecutive days per week, for 3 months
Expected timeframe: 3 months, then re-image to assess cyst response

Protocol

notes: Best absorbed on an empty stomach; discuss with your gynaecologist before using in place of any planned treatment
dosage: 600 mg three times daily for three consecutive days each week, then four days off — the schedule used in the trial
duration: 3 months, then re-image to assess cyst response

Evidence

What the studies say

A single Italian randomised trial (Porpora et al., 2013) compared NAC 600 mg three times daily for three consecutive days per week against observation in women with ovarian endometriomas. Cysts shrank in the NAC group while growing in controls, pain scores improved, and a notable number of scheduled surgeries were cancelled. The results are striking but unreplicated after more than a decade, from a single centre, with modest numbers. It is the most interesting supplement lead in endometriosis — and precisely because it is one trial, it should be discussed with a specialist rather than self-prescribed as a surgical alternative.

A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine

Score: 4/10

2013

observational

Porpora MG, Brunelli R, Costa G +8 more

Endometrioma size decreased with N-acetylcysteine while it increased in untreated controls.

View source

Safety

Caveats

{"A single unreplicated trial — the entire evidence base","Not a substitute for surgery where surgery is indicated","Causes gastrointestinal upset in some; may interact with nitroglycerin"}

Less likely to help if

Women with large symptomatic endometriomas, deep infiltrating disease or fertility-threatening anatomy should not delay indicated surgery on the basis of one trial.

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