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Endometriosis is a prevalent and challenging medical condition that affects millions of women worldwide. This article delves into the role of estrogen in the development and progression of endometriosis, exploring its impact on pelvic pain, infertility, and the associated physiological changes. By understanding the mechanisms underlying this estrogen-dependent disease, we can shed light on potential treatment avenues and enhance the quality of life for affected individuals.
Estradiol: A Key Stimulant for Endometriosis Growth
Estradiol, a primary female sex hormone, plays a vital role in the growth and development of endometriosis. It is widely acknowledged as the most influential factor driving the progression of this condition. Traditionally, it was believed that estrogen reached endometriotic implants solely through the bloodstream, following an endocrine pathway. However, recent research has revealed additional mechanisms of estrogen delivery, providing new insights into the pathogenesis of endometriosis.
Everything the Body Does is Defensive in Nature: Living Endometrial tissue needs a blood supply to stay “alive” outside the uterus – inside the body. To prevent death of the endometrial tissue, the body grows new blood vessels to maintain the endometrial tissue. Death of tissue inside the body is a bad life threatening problem.
Endometriosis: An Overview
Endometriosis manifests as endometrial-like tissue found outside the uterus. These tissue growths can be located on various pelvic structures, such as the pelvic peritoneum, ovaries, rectovaginal septum, and, although rare, even on the diaphragm, pleura, and pericardium (Fig. 1). Its prevalence is significant, affecting approximately 6 to 10% of women of reproductive age. Additionally, 50 to 60% of women and teenage girls experiencing pelvic pain and up to 50% of women dealing with infertility are found to have endometriosis.
Peritoneal Disease: A Consequence of Retrograde Menstruation
Peritoneal disease, a form of endometriosis, relies on estrogen for its growth. It arises from the retrograde menstruation of endometrial cells and tissues sensitive to steroid hormones (Fig. 2). During menstruation, these cells implant on peritoneal surfaces, leading to an inflammatory response. This response is accompanied by various physiological changes, including angiogenesis, adhesions, fibrosis, scarring, neuronal infiltration, and anatomical distortion (Fig. 1 and 2). Collectively, these alterations contribute to the development of pain and infertility, which are hallmark symptoms of endometriosis.
The Role of Immune Dysfunction
While retrograde menstruation is a common occurrence in most women, not all women with this process develop endometriosis. Normally functioning Immune cells break up the endometrial tissue into small bits for easier absorption and clearance by the appendix. The presence of immune dysfunction is believed to be a contributing factor in preventing the clearance of lesions in affected individuals. This immune dysfunction disrupts the normal processes that eliminate endometriotic implants, allowing them to persist and continuously produce estrogen and prostaglandin (PGE2) in an autocrine positive feedback manner.
Retrograde Menstruation: A Physiological Phenomenon
Retrograde menstruation involves the backflow of menstrual blood through the fallopian tubes into the peritoneal cavity. This physiological event is observed in all menstruating women with open fallopian tubes. Notably, more than 90% of women with healthy fallopian tubes have detectable blood in their peritoneal fluid during menstruation.
Conclusion
Understanding the role of estrogen in endometriosis is crucial for comprehending the underlying mechanisms and developing effective treatment strategies. Estradiol serves as a potent stimulant for endometriosis growth, contributing to pelvic pain, infertility, and a range of physiological changes. By further investigating the immune dysfunction associated with this condition, researchers and healthcare professionals can strive towards developing interventions that alleviate symptoms and improve the quality of life for individuals affected by endometriosis.