Tailored hormone therapy improves postoperative endometriosis outcomes

Tailored hormone therapy improves postoperative endometriosis outcomes | Image Credit: © Pixel-Shot - © Pixel-Shot - stock.adobe.com.

Quality of life may be improved among postoperative endometriosis patients through prescription of an appropriate hormone therapy based on a specific immunohistochemistry staining pattern, according to a recent study published in the International Journal of Reproductive Biomedicine.¹

Approximately 10% of reproductive-aged women experience endometriosis, leading to symptoms such as dysmenorrhea, dyschezia, dyspareunia, and infertility. Endometriosis treatment manages these symptoms by reducing pain, inflammation, and disease activity.

Estrogen dependence and progesterone resistance have been linked to endometriotic lesion recurrence, as estrogen receptors (ERs) and progesterone receptors (PRs) mediate the function of ovarian hormones.² This has led to progesterone being used as one of the most common hormonal therapies for patients with endometriosis.¹

Data has indicated a lack of adequate response to progesterone from endometriotic lesions in some patients. However, long-term hormone therapy use remains the recommended method of preventing lesion recurrence after surgery.

To measure PR and ER levels in endometriotic lesions and determine a cut-off point for using the appropriate treatment, investigators conducted a cross-sectional study. Participants included endometriotic women referred to Shahid Faghihi and Hazrate Zeinab hospitals, Shiraz, Iran for endometriosis surgery between March 2017 and March 2019.

Patients were grouped based on responsiveness vs unresponsiveness to medical treatment and surgery. A lack of improvement in endometriosis pain before surgery of pain recurrence with a visual analogue scale (VAS) score over 5 during follow-up determined unresponsiveness.

The 2 most common symptoms of endometriosis, dysmenorrhea and dyspareunia, were analyzed separately. Additionally, pain response was reported based on the resulting amount of tissue hormone receptors.

Women were eligible for inclusion if they had a definitive endometriosis diagnosis, moderate to severe VAS scores in pain symptoms of endometriosis before surgery, data about pain response to progesterone-based therapies after surgery, and a tendency to continue treatment over a 2-year period with no conception after surgery.

Collected data included body mass index, pain symptoms, age, stage of endometriosis disease, the affected area, types of hormone therapies, treatment duration, and response to treatment. Treatment options were based on patient preference and included 30 mg daily medroxyprogesterone (Medrofem tablet, Iran Hormone Co) and contraceptive pills.

There were 96 women included in the final analysis, 100% of whom complained of dysmenorrhea and 80% complained of simultaneous preoperative dyspareunia. Similar demographic characteristics were reported between the responsive and nonresponsive groups, with a mean age of 34.71 ± 6.01 and body mass index of 24.04 ± 4.16.

The histopathologic score (H-score) was directly linked to patients’ response to dysmenorrhea and dyspareunia treatment with a VAS under 3. A rise in treatment response was reported when elevating the PR and estrogen H-score from medium to high.

A direct influence from the H-score was reported for the receiver operating characteristic curve, with an area below the curve of 0.677 for ER. The response dysmenorrhea to treatment had a sensitivity of 77.27% and specificity of 55.56% for 60% ER in the tissue sample.

An area below the curve of 0.642 was reported for PR, indicating a sensitivity of 95.45% and a specificity of 33.33% in the treatment response to dysmenorrhea with 40% PR in the tissue sample.

For dyspareunia response based on the H-score for the ER, the area under the curve was 0.743, indicating a sensitivity of 60.66% and a specificity of 100% with 70% ER in the tissue sample. For PR, the area under the curve was 0.742, indicating a sensitivity of 41.67% and a specificity of 100% with 80% PR in the tissue sample.

These results indicated improved quality of life for postoperative endometriosis patients from prescription of hormone therapy based on a specific staining pattern. Investigators concluded gynecologists can prescribe appropriate hormonal treatments by analyzing patient surgical samples.

References

1. Poordast T, Alborzi S, Kiani Z, et al. The role of progesterone and estrogen receptors in treatment choice after endometriosis surgery: A cross-sectional study. Int J Reprod Biomed. 2024;22(7):567-578. doi:10.18502/ijrm.v22i7.16970
2. Greene AD, Lang SA, Kendziorski JA, Sroga-Rios JM, Herzog TJ, Burns KA. Endometriosis: Where are we and where are we going? Reproduction. 2016;152:R63-R78.