Now a new study finds there may be a biomarker that might pinpoint the right treatment.
Endometriosis can be so painful for many women that they undergo surgery, including hysterectomy (removal of uterus) or oophorectomy (removal of ovary) in search of relief.
The condition, where the lining of the uterus grows throughout other parts of the body, can strike many women. Even young women who appear healthy.
Last week, Lena Dunham, the actress and creator of the HBO series “Girls” and “Camping,” announced she had her left ovary removed in hopes of putting an end to the chronic pain she’s been experiencing from endometriosis.
Like many women living with endometriosis, Dunham has spent years looking for an effective treatment to manage her endometriosis-associated pain.
Earlier this year, the 32-year-old had a hysterectomy to help alleviate some of her endometrial symptoms. But the pain again worsened, which brought Dunham back to the operating room.
Dunham is hardly alone. About
It can take years or longer to find a treatment that brings relief.
But now, new research may change the way doctors treat endometriosis and allow for a more precise, targeted approach.
Biomarkers could help determine which medication each patient will respond to best and allow for a more personalized approach to managing endometriosis, according to a new study published in The Journal of Clinical Endocrinology & Metabolism.
In the retrospective cohort study, researchers from the Yale School of Medicine studied 52 women who have endometriosis. The team analyzed lesion samples from them and performed immunohistochemistry — which involves staining for progesterone receptors — to measure whether their progesterone levels were low, medium, or high.
The researchers found that progesterone receptor levels are strongly connected to the body’s response to progestin-based therapy.
Knowing the receptor status could be used to tailor hormone-based regimens after surgery, the findings suggest.
Furthermore, understanding how a patient will respond to progestin-based therapies could significantly decrease the likelihood of the disease reoccurring, along with the need for multiple surgeries.
When endometrial tissue — aka the uterine lining — grows outside of the uterus as it does with endometriosis, the tissue becomes inflamed. Many women experience painful periods, infertility, painful intercourse, and chronic pelvic pain.
Urinary complications, such as urinary urgency or frequency, along with gastrointestinal issues like constipation, diarrhea, and bloating, are common issues as well.
Symptoms vary in each person. Most of these symptoms go undetected for years, health experts say.
“Unfortunately, endometriosis is often not recognized early enough. It takes approximately 10 years to receive an endometriosis diagnosis starting from the time that they first experience symptoms,” Dr. Lisa Valle, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California, said.
The condition has no known cause. It affects approximately 1 in 10 American women of reproductive age, estimates the American College of Obstetricians and Gynecologists.
If women don’t respond to nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) for endometriosis pain, hormonal therapy is the next-line treatment for the condition.
It comes in two forms. One lowers estrogen levels and stops lesions from growing. The other, like many birth control pills, contains progestin, a hormone that suppresses the lesions.
“Endometriosis is considered an estrogen-dependent condition [and] progesterone has antiproliferative effects within the lining of the uterus,” Valle said.
According to Valle, estrogen acts as a “fertilizer” to endometriosis, allowing it to grow and proliferate, while progesterone works like a “lawn mower,” keeping the condition from spreading and multiplying.
However, because women with endometriosis have differing progesterone receptor levels, everyone responds to the hormonal therapies differently.
In fact, many women spend up to six weeks trialing hormonal therapies before finding a treatment that works.
Progesterone receptors are necessary for progesterone to perform its functions. If there are little to no receptors, the progesterone won’t be able to bind to anything and carry out its job.
Knowing whether a woman has low, medium, or high progesterone receptor levels could drastically improve the way their endometriosis is treated.
For example, if a woman has low progesterone receptor levels, she likely would be prescribed a hormonal therapy that reduces estrogen levels. If she has medium or high progesterone receptor levels, a progestin therapy would be administered.
“This study provides hope that by assessing progesterone receptor status in endometriosis tissue, the most effective hormonal treatment can be offered to each individual patient,” Dr. Gerardo Bustillo, an OB-GYN at Memorial Care Orange Coast Medical Center in Fountain Valley, California, said.
“Of course, obtaining the tissue would generally require some type of surgical procedure, however, so the study would be most relevant in postsurgical treatment of endometriosis,” he added.
So, while surgery is still required to evaluate progesterone receptor levels, this new information can help doctors determine which therapy patients with endometriosis will respond best to.
Hopefully, then, healthcare providers can put an end to the reoccurring, chronic pain that afflicts so many.
Endometriosis, where the lining of the uterus grows throughout other parts of the body, affects many women. Even young women who appear healthy.
Now researchers have found that progesterone receptor levels are strongly connected to the body’s response to progestin-based therapy. This may help physicians pinpoint the right treatment for patients earlier.