{"paper_id":"d4f81577-fc09-4ffa-b7e4-c5f14f8099a6","body_text":"Abstract\nResearch has shown that endometriosis is an estrogen-dependent disease. Dysregulation of steroid action appears to be one of the key pathogenetic factors in altered cellular function in the endometrium as well as in lesions in women suffering from endometriosis. The normal hormonal balance and homeostasis are disturbed, leading to an increased estrogen activity and progesterone resistance. In particular, an increased activity of the enzyme aromatase and a decreased expression of 17β-hydroxysteroid-dehydrogenase (17β-HSD-2) are main characteristics of endometriosis. This results in an enhanced bioavailability of estradiol and further stimulation of aromatase. Together with a reduced number of the progesterone receptors PR-A and PR-B, increased cellular estradiol levels, and altered signaling pathways, this causes relative progesterone resistance – one of the most important mechanisms in the pathogenesis of the enigmatic disease. What is more, resistance to progesterone is also linked to failure of long-term treatment for pain and infertility. Consequently, women often suffer from high recurrence rates following surgery and medical therapies. This provides evidence for the need to develop new modalities with long-term efficacy to possibly overcome progesterone resistance. 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Fertil Steril. 2012;98(6):1521–1530.e2. https://doi.org/10.1016/j.fertnstert.2012.08.003.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nKiesel, L., Vogel, M., Le, Q.K., Schäfer, S.D. (2022). Pathogenesis of Endometriosis: Progesterone Resistance in Women with Endometriosis. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_7\nDownload citation\nDOI: https://doi.org/10.1007/978-3-030-97236-3_7\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-030-97235-6\nOnline ISBN: 978-3-030-97236-3\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}