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Progress made in understanding causes and treatment of endometriosis
January 20, 2009CHICAGO --- Endometriosis is a poorly understood chronic disease characterized by infertility and chronic pelvic pain during intercourse. It affects between 5 to 10 million women in the U.S.
Serdar Bulun, M.D., George H. Gardner Professor of Clinical Gynecology at Northwestern University's Feinberg School of Medicine, has spent the past 15 years investigating and identifying the causes of this disease. Bulun, and colleagues in his lab, discovered key epigenetic abnormalities in endometriosis and identified existing chemicals that now help treat it.
Bulun describes his lab's findings over the past 10 years in the Jan. 15 issue of the New England Journal of Medicine.
One of the abnormalities he discovered is the presence of the enzyme aromatase -- which produces estrogen -- in endometriosis, the diseased tissue that exists on pelvic organs and mimics the uterine lining. (Normal endometrium, located in the uterine cavity, does not contain aromatase.) As a result, women with endometriosis have excessive estrogen in this abnormal tissue found on surfaces of pelvic organs such as the ovaries. Bulun found the protein SF1 that produces aromatase, which is supposed to be shut down, is active in endometriosis.
"Estrogen is like fuel for fire in endometriosis," Bulun said. "It triggers the endometriosis and makes it grow fast."
As a result of the aromatase finding, Bulun launched clinical trials in 2004 and 2005 testing aromatase inhibitors -- currently used in breast cancer treatment -- for women with endometriosis. The drug blocks estrogen formation and secondarily improves progesterone responsiveness.
"We came up with a new treatment of choice for post-menopausal women with endometriosis," Bulun said. Moreover, treatment with an aromatase inhibitor is a very good option for premenopausal women with endometriosis not responding to existing treatments, he noted.
Another molecular abnormality Bulun found is that women with endometriosis have a progesterone receptor that is inappropriately turned off. Normal progesterone action would be beneficial because it blocks the growth of endometriosis. In the absence of appropriate progesterone action, endometriosis tissue remains inflamed and continues to grow.
Bulun believes that these abnormalities result from epigenetic defects that occur very early on during embryonic development and may be the result of early exposure to environmental toxins. In fact, other investigators have implicated the environmental pollutant dioxin and the synthetic estrogen DES in the etiology of endometriosis.
"This may be a disease that women are born with," Bulun said. "Perhaps when a baby girl is born, it has already been determined that she is predisposed to have endometriosis. Maybe research can now be directed toward the fetal origins of the disease and raise the awareness of how the disease develops."
Northwestern University
One of the abnormalities he discovered is the presence of the enzyme aromatase -- which produces estrogen -- in endometriosis, the diseased tissue that exists on pelvic organs and mimics the uterine lining. (Normal endometrium, located in the uterine cavity, does not contain aromatase.) As a result, women with endometriosis have excessive estrogen in this abnormal tissue found on surfaces of pelvic organs such as the ovaries. Bulun found the protein SF1 that produces aromatase, which is supposed to be shut down, is active in endometriosis.
"Estrogen is like fuel for fire in endometriosis," Bulun said. "It triggers the endometriosis and makes it grow fast."
As a result of the aromatase finding, Bulun launched clinical trials in 2004 and 2005 testing aromatase inhibitors -- currently used in breast cancer treatment -- for women with endometriosis. The drug blocks estrogen formation and secondarily improves progesterone responsiveness.
"We came up with a new treatment of choice for post-menopausal women with endometriosis," Bulun said. Moreover, treatment with an aromatase inhibitor is a very good option for premenopausal women with endometriosis not responding to existing treatments, he noted.
Another molecular abnormality Bulun found is that women with endometriosis have a progesterone receptor that is inappropriately turned off. Normal progesterone action would be beneficial because it blocks the growth of endometriosis. In the absence of appropriate progesterone action, endometriosis tissue remains inflamed and continues to grow.
Bulun believes that these abnormalities result from epigenetic defects that occur very early on during embryonic development and may be the result of early exposure to environmental toxins. In fact, other investigators have implicated the environmental pollutant dioxin and the synthetic estrogen DES in the etiology of endometriosis.
"This may be a disease that women are born with," Bulun said. "Perhaps when a baby girl is born, it has already been determined that she is predisposed to have endometriosis. Maybe research can now be directed toward the fetal origins of the disease and raise the awareness of how the disease develops."
Northwestern University
Endometriosis Current Events and Endometriosis News RSSAt last -- a quick and accurate way of diagnosing endometriosis
A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online today (Wednesday 19 August) in Europe's leading reproductive medicine journal Human Reproduction.
Uterine cells produce their own estrogen during pregnancy
For decades, scientists assumed that the ovary alone produced steroid hormones during pregnancy.
MRI accurately depicts deep endometriosis
Using magnetic resonance imaging (MRI), radiologists may be able to diagnose deep endometriosis and accurately locate lesions prior to surgery, according to a new study published in the online edition of Radiology.
Study identifies how tamoxifen stimulates uterine cell growth and cancer
UCSF researchers have identified a new "feed-forward" pathway linking estrogen receptors in the membrane of the uterus to a process that increases local estrogen levels and promotes cell growth.
Women with endometriosis need special care during pregnancy to avoid risk of premature birth
The largest study to date of endometriosis in pregnant women has found that the condition is a major risk factor for premature birth.
UC Davis researchers find decrease in hysterectomy complications
UC Davis researchers who studied hospital discharge records for nearly 650,000 California women over a 13-year period have found that complications from hysterectomies have significantly declined.
Scientists identify possible cause of endometriosis
Endometriosis is a condition whereby patches of the inner lining of the womb appear in parts of the body other than the womb cavity. It can cause severe pain and affects approximately 15% of women of reproductive age. Endometriosis is also associated with infertility, with 50% of infertile women affected by the condition.
Treatment advances for fibroids, menopause
Women with fibroids and endometriosis facing the possibility of hysterectomy may now choose less invasive treatment options to preserve fertility, according to Yale professor Aydin Arici, M.D., who will direct a scientific session exploring these alternatives at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting May 3-7 in New Orleans, Louisiana.
New Study Finds Uncontrollable Stress Worsens Symptoms Of Endometriosis
Endometriosis is a poorly understood condition that incapacitates and affects the productivity and lifestyle of millions of women around the world. In the US, it affects approximately six million women and adolescents at a cost of some $1.6 billion per year.
May inflammatory bowel disease mimic gynecological disorders in its clinical presentation
Endometriosis is a condition of unknown etiology in which endometrial tissue occurs at extra-uterine sites, including ovaries, fallopian tubes, and gastrointestinal tract.
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