Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis

Estrogen receptor (ER-a) expression in deep endometriosis predicts severity of symptoms and disease recurrence.

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Volume 113, Issue 6, Pages 1224–1231.e1

Authors:

Nicola Pluchino, M.D., Ph.D., Ramanaiah Mamillapalli, Ph.D., Jean-Marie Wenger, M.D., Lauriane Ramyead, M.D., Panagiotis Drakopoulos, M.D., Ph.D., Jean-Christophe Tille, M.D., Hugh S. Taylor, M.D.

Abstract:

Objective

To determine the relationship between steroid receptor expression and pain symptoms in endometriosis.

Design

Cross-sectional

Setting

University Hospital

Patient(s)

Women with endometriosis (N = 92).

Intervention(s)

Tissue samples were obtained from patients with surgically diagnosed endometriosis.

Main Outcome Measure(s)

A tissue microarray (TMA) was generated from patients with endometriosis. Data were collected on the presence and severity of dysmenorrhea, deep dyspareunia, dyschezia, and nonmenstrual pain by use of a numerical rating scale (NRS) at the time of surgery and after 1 year. The intensity of receptor expression was evaluated through immunohistochemistry and measured according to an immunoreactive score (IRS). Clinical variables were correlated to IRS by multivariate logistic regression analysis.

Results

Estrogen receptor-α (ER-α), progesterone receptor (PR), androgen receptor (AR), and aromatase expression differed among study participants. ER-α expression was reduced by progestin therapy, whereas of expressions of PR, AR, and aromatase were unchanged. Higher ER-α expression increased the likelihood of moderate to severe dysmenorrhea and deep dyspareunia in women not receiving hormonal treatment. In women receiving progestin therapy, persistently higher ER-α expression was correlated with greater likelihood of deep dyspareunia, severe dyschezia, and endometriosis-associated pain persistence at 1 year.

Conclusion(s)

ER-α, PR, AR, and aromatase were all expressed in deep endometriosis. ER-α levels best correlated with severity of symptoms, which suggests that ER is a key driver of deep endometriosis. Progestin treatment was associated with a reduction of ER-α expression; however, failure of ER suppression by progestins was also a predictor of pain severity and recurrence at 1 year.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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