Endometriosis – hormones and treatment

Abstract

Endometriosis is a prevalent condition, affecting 10-15% of women of reproductive age and approximately 70% of those with chronic pelvic pain. An estimated 176 million women worldwide are affected by this disease. The condition occurs predominantly between menarche and menopause, with peak incidence between the ages of 25 and 45. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterine cavity, leading to the formation of lesions most commonly in the ovaries but also in the fallopian tubes, gastrointestinal tract, and occasionally in distant locations like the pleura and central nervous system. Symptoms include chronic pelvic pain, heavy and painful menstrual periods, dyspareunia, painful urination, and defecation. Diagnosis involves a combination of medical history, physical examination, imaging techniques, and the gold standard, diagnostic laparoscopy. There is an average delay of 6.7 years between symptom onset and diagnosis, often due to variable and confusing symptoms resembling other conditions. The pathogenesis of endometriosis involves genetic, hormonal, and environmental factors, with significant roles played by estrogens and progesterone. Treatment strategies focus on managing symptoms through pain relief, hormonal therapy, and surgical interventions, although no permanent cure exists. Hormonal imbalances, particularly the interaction of progesterone and estrogens, play a crucial role in disease progression. Current research explores various treatment options, including hormonal therapy, nonsteroidal anti-inflammatory drugs, antioxidants, and surgical methods to improve the quality of life for patients.