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It is metabolized from tryptophan into its active forms, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) (, , )

According to the Symptoms, including severe pain during menstruation, heavy menstrual bleeding, back and pelvic pain, pain during intercourse, and, in some people, problems with fertility, occur when tissue similar to the endometrium, or uterine lining, grows outside the uterus

The following stacking strategies are based on mechanistic logic and the available evidence base, though human clinical trials of specific combinations remain limited