Towards subtypes - deep endometriosis oestrogen receptor-α expression

Amy L Shafrir, Shafrir AL
Nature reviews. Endocrinology · 2020 · doi:10.1038/s41574-020-0394-0 · PMID:32678337 · PMC12286639
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

This study investigated deep endometriosis estrogen receptor-α expression, hypothesizing its association with progestin treatment and post-surgical pain response.

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This paper discusses the idea that treating endometriosis as a single condition may mask subtype-specific associations involving risk factors, biomarkers, and treatment response. It highlights a 2020 study proposing that deep endometriosis lesion estrogen receptor-α expression could be associated with progestin treatment and with the degree of post-surgical excision pain. The major caveat stated is that the broader research framing has often lacked subtype resolution, so the subtype hypothesis is presented rather than established in this commentary. This paper is centrally about endometriosis — specifically, it focuses on using estrogen receptor-α expression in deep endometriosis to motivate subtype-specific associations with treatment and pain outcomes.

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Abstract

Endometriosis can lead to life-impacting symptoms and substantial costs. Most research treats endometriosis as a single entity-potentially obscuring informative subtype-specific risk factor, biomarker, and treatment response associations. A recent study raises the hypothesis that deep endometriosis estrogen receptor-α expression may be associated with progestin treatment and post-surgical excision pain response.
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References

Zondervan, K. T., Becker, C. M. & Missmer, S. A. Endometriosis. N. Eng. J. Med. 382, 1244–1256 (2020). Zondervan, K. T. et al. Endometriosis. Nat. Rev. Dis. Primers 4, 9 (2018). Pluchino, N. et al. Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis. Fertil. Steril. 113, 1224–1231 (2020). Becker, C. M., Gattrell, W. T., Gude, K. & Singh, S. S. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil. Steril. 108, 125–136 (2017). Brichant, G. et al. Heterogeneity of estrogen receptor α and progesterone receptor distribution in lesions of deep infiltrating endometriosis of untreated women or during exposure to various hormonal treatments. Gynecol. Endocrinol. 34, 651–655 (2018). American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil. Steril. 67, 817–821 (1997). Schliep, K. C. et al. Pain typology and incident endometriosis. Hum. Reprod. 30, 2427–2438 (2015). Gaudet, M. M. et al. Pooled analysis of nine cohorts reveals breast cancer risk factors by tumor molecular subtype. Cancer Res. 78, 6011–6021 (2018). Dawood, S. et al. Defining breast cancer prognosis based on molecular phenotypes: Results from a large cohort study. Breast Cancer Res. Treat. 126, 185–192 (2011). Zyzanski, S. J., Flocke, S. A. & Dickinson, L. M. On the nature and analysis of clustered data. Ann. Fam. Med. 2, 199–200 (2004).

Acknowledgements

The authors acknowledge the support of Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grants R01 HD094842 and R21 HD096358. Author information Authors and Affiliations Corresponding author Ethics declarations Competing interests S.M. serves as an advisory board member for AbbVie and served as a working group member for Roche. A.S. and S.M. receive funding support from the J. Willard and Alice S. Marriott and the Marriott Daughters’ Foundations – all unrelated to this work. Rights and permissions About this article Cite this article Shafrir, A.L., Missmer, S.A. Towards subtypes — deep endometriosis oestrogen receptor-α expression. Nat Rev Endocrinol 16, 541–542 (2020). https://doi.org/10.1038/s41574-020-0394-0 Published: Version of record: Issue date: DOI: https://doi.org/10.1038/s41574-020-0394-0

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Estrogen Receptor alpha Estrogen Receptor alpha Estrogens Female Humans Pain

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