Endometriosis and the estrogen threshold theory. Relation to surgical and medical treatment
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Endometriosis-associated pelvic pain improved with estrogen reduction, but adding low-dose estrogen or steroids counteracted hypoestrogenic side effects from oophorectomy or GnRH agonists.
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Abstract
Estrogen-dependent diseases often regress when estrogen production is reduced. Endometriosis is an estrogen-responsive disease, and the pelvic pain associated with it improves when estrogen production is reduced with bilateral oophorectomy or chronic gonadotropin releasing hormone (GnRH) agonist treatment. Unfortunately, reduction of estrogen production is associated with adverse side effects, such as vasomotor symptoms and bone loss. In women with endometriosis and pelvic pain, the combination of bilateral oophorectomy plus postoperative low-dose estrogen treatment produces sustained improvement in pain symptoms and reduces the hypoestrogenic side effects associated with bilateral oophorectomy. In a parallel manner, chronic GnRH agonist treatment plus low-dose steroid therapy (estrogen plus progestin or progestin only) is effective in the treatment of pelvic pain caused by endometriosis and reduces the hypoestrogenic effects associated with hypoestrogenism caused by the GnRH agonist. Since chronic GnRH agonist treatment is reversible and avoids surgery, it may become an important alternative to bilateral oophorectomy for the treatment of endometriosis.
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Cited by (50)
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- Uterine Adenomyosis Treated by Linzagolix, an Oral Gonadotropin-Releasing Hormone Receptor Antagonist: A Pilot Study with a New 'Hit Hard First and then Maintain' Regimen of Administration 2021
- Endometriosis Pain Management: a Review 2020
- Neue Behandlungsmöglichkeiten der Endometriose mit GnRH-Antagonisten 2020
- Neurotrophins and Cytokines in Endometriosis Pain 2020
- Long-term use of dienogest for the treatment of primary and secondary dysmenorrhea 2020
- Neue Behandlungsoptionen mit GnRH-Antagonisten bei Endometriose und Uterus myomatosus 2020
- Gonadotropin-releasing hormone antagonist (linzagolix): a new therapy for uterine adenomyosis 2020
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- Pathogenesis of endometriosis: Interaction between Endocrine and inflammatory pathways 2018
- Epidemiological and Clinical Risk Factors for Endometriosis 2017
- Curative effect of 1.88-mg and 3.75-mg gonadotrophin-releasing hormone agonist on stage III-IV endometriosis: Randomized controlled study 2017
- Medical treatment of endometriosis: an update 2017
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- Pharmacokinetics, pharmacodynamics, safety and tolerability of an intravaginal ring releasing anastrozole and levonorgestrel in healthy premenopausal women: a Phase 1 randomized controlled trial 2016
- Medikamentöse Therapie der Endometriose und Adenomyose 2015
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- Treatment of Endometriosis with the GnRHa Deslorelin and Add-Back Estradiol and Supplementary Testosterone 2015
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- Rotating nightshift work and the risk of endometriosis in premenopausal women 2011
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- The emerging role of epigenetics in the aetiology of endometriosis. 2011
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- Adolescent physical activity and endometriosis risk 2009
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- Return of chronic pelvic pain from endometriosis after raloxifene treatment: a randomized controlled trial 2008
- Emerging drugs in endometriosis 2006
- GnRH-antagonists in reproductive medicine 2005
- A life shaped by pain: women and endometriosis 2005
- Nonsteroidal antiinflammatory drugs differentially suppress endometriosis in a murine model 2005
- Emerging drugs for endometriosis 2004
- In utero exposures and the incidence of endometriosis 2004
- Reproductive history and endometriosis among premenopausal women 2004
- Quantitative assessment of human endometriotic tissue maintenance and regression in a noninvasive mouse model of endometriosis 2004
- The epidemiology of endometriosis 2003
- Acute abdomen due to endometriosis in a premenopausal woman taking tamoxifen 2003
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