Estrogen and Endometriosis

by Kate
Posted on July 22, 2020August 12, 2020

Hormone suppression (combined pill, progestin-only pill, IUD, etc) can absolutely help the pain associated with Endometriosis in some individuals. This is not to be confused with the suppression of the actual disease.

Estrogen is produced in granulosa cells of the ovaries – an enzyme, aromatase, catalyzes the transformation of testosterone and androstenedione into Estradiol and Estrone. Our primary source of Estrogen is in the form of Estradiol. I have this pathway detailed in a previous post. BUT – this is not the only way or place Estradiol is produced. It is also made in adipose (fat) tissue, adrenal glands, skin, pancreas, and more for local or nearby use.

In Endometriosis lesions, local Estrogen is produced, so no, you aren’t necessarily going to have some increased circulating concentration of Estradiol showing up on a blood test.
The lesions contain the necessary cellular components and enzymes (remember, Aromatase is a super important one) to make Estrogen. This is why Aromatase Inhibitors have been trialed as an Endometriosis treatment. The idea is to block Aromatase from converting testosterone and androstenedione into Estrogen.

Localized Estrogen is produced and does its job to cause inflammation of Endometriosis, and ultimately damage from the disease, despite what the ovaries are doing.

So, what helps? Complete and meticulous excision of the lesions. The same complete and meticulous excision required for a cancerous tumor.

Your OBGYN should refer you to an Endometriosis specialist, the way they would refer you to an oncologist for cancer. It is just as critical.

Sources below.

Mori T, Ito F, Koshiba A, et al. Local estrogen formation and its regulation in endometriosis. Reprod Med Biol. 2019;18(4):305-311. Published 2019 Jun 18. doi:10.1002/rmb2.12285
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780031/
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Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol. 2001;45(3 Suppl):S116-S124. doi:10.1067/mjd.2001.117432
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Barakat R, Oakley O, Kim H, Jin J, Ko CJ. Extra-gonadal sites of estrogen biosynthesis and function. BMB Rep. 2016;49(9):488-496. doi:10.5483/bmbrep.2016.49.9.141
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227141/