1. Hormonal influence in Endometriosis Nicole Colón Carrión Universidad de Puerto Rico, Cayey 1 Endometriosis is one of the most common diseases present in women of reproductiveage. This paper aims to explain the influence of hormones in endometriosis development andtreatments. Several hormones, such as oestrigen, GnHR and GnH, are mentioned and studied.Several Hormone treatments are used to reduce pain caused by endometriosis. This paper alsoexplains the effect of GnRH agonist in endometrial tissue. Endometriosis, also called Endo, is the menstrual blood flows back through thepresence of endometrial tissue outside the fallopian tubes and enters the pelvic oruterine cavity. It is a condition where the abdominal cavities instead of flowing outendometrial tissue is misplaced and grows in through the vagina. Another theory is that itother places outside the uterus, such as thepelvic and abdominal areas. These can be caused by Coelomic Metaplasia, aendometrial tissues thicken and bleed during process in which undifferentiated cellsa process called menstruation. When develop into endometrial cells.endometriosis occurs this tissue continues to Endometriosis could be a hereditary disease;bleed, accumulating blood outside the uterus women with family history in endometriosisand causing inflammation and pain. “It’s could be more prone to develop this disease.difficult to point out the exact percentage of Some researchers are exploring thepatients that suffer from endometriosis; ingeneral, we speak of 10% of the female possibilities of hormones being related to thepopulation of reproductive age” ( Vilalobos development of endometriosis.2009). Endometriosis can affect anymenstruating woman; it can appear at her Endometriosis can cause severe painfirst period until menopause or at the middle in the abdominal and pelvic areas andof her reproductive age. The exact cause of infertility. “Endometriosis pain tends to getendometriosis is still unknown. worst as time goes on, it can be mild, modern or severe” (Mona, [unknown]). The “Because we don’t know why some amount of pain that endometriosis can causewomen have endometriosis and others don’t, is not proportional to the amount of tissuewe don’t know the cause of it” (Mona, the body contains. Some women may[unknown]). Even though the exact cause of present severe pain having small quantity ofendometriosis is still unknown there are tissue, while others present extensivesome theories that could explain the reason endometriosis tissue and have little or nofor it. One of the theories is that pain at all. Infertility is not a side effect thatendometriosis may be caused by Retrograde all endometriosis patients will present butMenstruation. Sampson postulates in 1920s it’s said that about 30% of woman whothat endometriosis is caused by retrograde suffer from endometriosis will have it. “Themenstruation; a process in which the
2. findings of physical examination can be as a. Relationship with endometriosisdiverse as the symptom complex of thehistory” (Rose,2005) Growth hormone releasing hormone (GHRH) and GH hormone promote endometrial proliferation and may be involved in the pathogenesis of ovarian andII. Hormones related to endometriosis endometrial cancer such as endometriosis (Khorram et al. 2001; Schindler 2004; Slater et al. 2006). Slater (2006) concluded 1) Oestrogen that the growth hormone is increased 3.4 fold in endometriosis and 3.8 fold in Oestrogen is a group of endometrial adenocarcinoma. During this hormones that promotes the study banked tissue were selected, some reproductive system and secondary demonstrating cases of endometriosis and characteristics in females. They are some demonstrating normal uterine tissue. produced in the female ovaries, and The immunochemistry of each tissue was simulate the production of Follicle analyzed using different antibodies, Stimulating Hormone. For validated by previous studies. The endometriosis to occur oestregon endometric tissue showed an increase in needs to be present, therefore, immunolabelling of growth hormone and endometriosis is an oestrogen- interleukin-6 compared to normal tissue. dependant disease. “Our results suggest that both IL-6 and GH may play a role in the progression of both endometriosis and endometrial carcinoma 2) Growth hormone and Growth- (Slater 2006). Hormone releasing hormone Growth hormone is a hormone thatregulates growth and development in the 3) Gonadotropic Hormoneshuman body, produced by the pituitary. It’s Gonadotropic Hormones areinvolved in the increase of height, muscle hormones that are required for both malemass, and body fat. Growth hormone is and female reproduction. These hormonesinvolved in the process of sexual stimulate the production and development ofdifferentiation, pubertal maturation and it the human reproductive system. There areparticipates in gonadal steroidogenesis, two kinds of gonadotropic hormones:gametogenesis, and ovulation (Slater et al. Luteinizing Hormone (LH) and Follicle2006). Growth- Hormone Releasing stimulating hormone (FSH). TheseHormone is a peptide hormone produced by hormones are produced by the pituitary andthe hypothalamus, which stimulates the stimulate male and woman gonads. LHrelease of Growth Hormone. stimulates sex steroid secretion. In women it stimulates the amount of estrogen produced
3. by the follicle cells and triggers ovulation bycontrolling the menstrual cycle. FSH Hypotalamus GnRHstimulates the growth and maturation of theovarian follicles. Pituitarya. Production of Gonadotropic Hormone LH FSH The pituitary gland is located at thebase of the brain and is one of the glandsthat compose the endocrine system. It isdivided into two lobes: the anterior lobe, Gonadsalso called the anterior pituitary and theposterior lobe. The posterior pituitarysecretes two different kinds of hormonesproduced by the hypothalamus, oxytocin Picture 2: Represent the sequence of(OT) and antidiuretic hormones (ADH). production of Gonadotropic Hormones to The anterior pituitary produces the the reproductive system.hormones it releases while the posteriorpituitary does not. The anterior pituitary islocated in the bone cavity at the base of the b. Relationship with endometriosisbrain and produces six different kinds of Gonadotropin releasing hormone ishormones, such as Luteinizing Hormone and used in the form of an agonist to treatFollicle Stimulating Hormone. The endometriosis pain, and is calledhypothalamus produces hormones that Gonadotropin releasing hormone agonist. ,stimulate the pituitary to produce other . It is the most used and effective clinicalhormones. In this case, the hypothalamus treatment for endometriosis pain.produces Gonadotropin releasing hormone,whose function is to stimulate the pituitaryto produce and release gonadotropichormones, such as LH and FSH by thepituitary. Picture 2 can explain this process. III. Treatments for endometriosis Even though there are several kinds of treatments for endometriosis, there is not a definitive cure for it. Apart from surgery, the treatments administered for endometriosis are mostly to reduce pain. Laparoscopy Surgery had been practiced to remove the misplaced tissue but previous
4. studies have shown that this surgery is not relief of pain about 4 week afterenough for the disease. Hormones had been initiation of treatment” (Raffi andused to control the thickening and bleeding Amer 2010). It had been consideredof the tissue and are proved to be the most to extend the months of treatment toeffective in pain reduction. (MedlinePlus improve the effectiveness.2011).A. Hormonal treatments Even though GnRH agonist is the1. Growth hormone releasing hormone most effective hormone treatment, itagonist contains several side effects. The most common side effect present in women who Gonadotropin releasing hormone are undergoing GnHR therapy is the earlyagonist is one of the most frequently symptoms of menopause. When GnHRadministered treatments for reducing the hormones turn off the ovaries, a pseudo-pain produced by endometriosis. GnRH menopause occurs. These women canagonist inhibits the secretion of GnRH to the experience hot flashes, mood swings,gonadotrophs, which are secreted to the vaginal dryness and in some caseshuman gonads. There are seven types of depression.GnRH agonist that are used clinically totreat endometriosis (leuprorelin, buserelin, One of the most common concernsgoserelin, histrelin, deslorelin, nafarelin, of GnRH therapy is the surge ofand triptorelin). In females, these hormones osteoporosis. By using GnRH agonist,work by turning off the ovaries causing a estrogen is inhibited and lost and this is apseudo-menopause. They inhibit the effect possible cause to produce osteoporosis.of hormones that cause ovulation, especially GnRH treatments can only be extended forestrogen, and leads to inflammation and six months. If they are extended too much,pain. For women with endometriosis, GnRH a great loss of estrogen may cause severeagonist has proven to eliminate pain and cases of osteoporosis.reduce endometrial growth. Studies conducted by the hospital GnRH agonist therapy “Jose de San Martin” in Buenos Aires, consists of several injections or the Argentina (Meresman et al. 2003) indicate application of nasal spray during that GnRH may play an important role in the approximately three months. During reduction of cell proliferation in the first two weeks of treatment the endometriosis. Merseman and collaborators patient can experience worsening of evaluated the effect of GnRH, especially the symptoms and irregular bleeding. LA, on in vitro eutopic endometrial cell “About 80% of patients start to proliferation. They concluded that GnRH experience improvement or complete alone had no effect on basal DNA but
5. combined with TGFß it presented an Goldberg L, Rogol A, Sonksen P.inhibitory effect on cell proliferation. 2009. Growth Hormone: Use and Abuse.“GnRH-a appears to have a direct effect by Hormones & You, The Hormone Fundationenhancing the apoptotic index and [internet];[unknown];[cited 2009 june].decreasing the cell proliferation in Available in: http://www.hormone.org/endometrial cells” (Meresman et al. 2003). Resources /upload/growth-hormone-use- and-abuse-bilingual-052509.pdfIII. Discussion Infoplease [Internet].. Endometriosis is a common disease USA:Columbia University Press;[unknown].affecting females of reproductive age. Available in: http://www.Endometrial tissue starts to grow outside the infoplease.com/ce6/sci/A0821232.htmluterus causing severe pain and infertility.Even though there are some theories that Mayo Clinic [Internet]..could explain the cause of endometriosis, USA:Mayo Foundation for Medicalthe exact cause of it is still unknown. Education and Research;[unknown].Several hormones had been related not only Available in: http://www.to the development of endometriosis but also mayoclinic.com/health/drug- information/DR600403to it treatments. Previous studies haveshown a direct relationship of growth MedlinePlus. 2011. USA:hormones during the development of Department of Health and Humanendometriosis. Several treatments had been Services,National Institutes ofapplied to treat endometriosis, but there is Health.[unknown].Available in:no definitive cure for it. Hormonal http://www.nlm.nih.gov/medlineplus/spanistreatments are the most utilized to reduce h/ency/article/000915.htmand treat endometriosis pain and growth.GnRH agonist therapy is the most effectiveand most frequently used hormonaltreatment for it. Meresman G, Bilotas M,Buquet R,Baraño R,Sueldo C,Tesone M.2003.“Gonadotropin- releasing hormone agonist induces apoptosis and reduces cellReferences proliferation in eutopic endometrial cultures Endometriosis Therapy [internet]; from women with endometriosis”. Fertility[unknown]. Washington (GA):Biggerstaff B and sterility. [Internet];[revised 2002 MayIII; [unknown]. Available in: 17] Vol 80: Available in: http://www.shttp://www.endometriosistherapy.com/conta ciencedirect.com/science/article/pii/S001502ctus.asp 8203007696
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