This document discusses hormonal influences in endometriosis. It explains that several hormones such as estrogen, growth hormone releasing hormone, and gonadotropic hormones like LH and FSH are involved in the development of endometriosis and treatments. Hormone treatments are commonly used to reduce pain caused by endometriosis by targeting these hormonal factors. GnRH agonists are particularly effective clinical treatments that work by reducing estrogen levels.

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 reproductive
age. This paper aims to explain the influence of hormones in endometriosis development and
treatments. 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 also
explains the effect of GnRH agonist in endometrial tissue.
Endometriosis, also called Endo, is the menstrual blood flows back through the
presence of endometrial tissue outside the fallopian tubes and enters the pelvic or
uterine cavity. It is a condition where the abdominal cavities instead of flowing out
endometrial tissue is misplaced and grows in
through the vagina. Another theory is that it
other places outside the uterus, such as the
pelvic and abdominal areas. These can be caused by Coelomic Metaplasia, a
endometrial tissues thicken and bleed during process in which undifferentiated cells
a 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 endometriosis
and 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 the
patients that suffer from endometriosis; in
general, we speak of 10% of the female possibilities of hormones being related to the
population of reproductive age” ( Vilalobos development of endometriosis.
2009). Endometriosis can affect any
menstruating woman; it can appear at her Endometriosis can cause severe pain
first period until menopause or at the middle in the abdominal and pelvic areas and
of her reproductive age. The exact cause of infertility. “Endometriosis pain tends to get
endometriosis 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 cause
women have endometriosis and others don’t, is not proportional to the amount of tissue
we 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 of
endometriosis is still unknown there are tissue, while others present extensive
some theories that could explain the reason endometriosis tissue and have little or no
for it. One of the theories is that pain at all. Infertility is not a side effect that
endometriosis may be caused by Retrograde all endometriosis patients will present but
Menstruation. Sampson postulates in 1920s it’s said that about 30% of woman who
that endometriosis is caused by retrograde suffer from endometriosis will have it. “The
menstruation; a process in which the

2. findings of physical examination can be as a. Relationship with endometriosis
diverse as the symptom complex of the
history” (Rose,2005) Growth hormone releasing hormone
(GHRH) and GH hormone promote
endometrial proliferation and may be
involved in the pathogenesis of ovarian and
II. 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 that
regulates growth and development in the 3) Gonadotropic Hormones
human body, produced by the pituitary. It’s
Gonadotropic Hormones are
involved in the increase of height, muscle
hormones that are required for both male
mass, and body fat. Growth hormone is
and female reproduction. These hormones
involved in the process of sexual
stimulate the production and development of
differentiation, pubertal maturation and it
the human reproductive system. There are
participates in gonadal steroidogenesis,
two kinds of gonadotropic hormones:
gametogenesis, and ovulation (Slater et al.
Luteinizing Hormone (LH) and Follicle
2006). Growth- Hormone Releasing
stimulating hormone (FSH). These
Hormone is a peptide hormone produced by
hormones are produced by the pituitary and
the hypothalamus, which stimulates the
stimulate male and woman gonads. LH
release of Growth Hormone.
stimulates sex steroid secretion. In women it
stimulates the amount of estrogen produced

3. by the follicle cells and triggers ovulation by
controlling the menstrual cycle. FSH
Hypotalamus GnRH
stimulates the growth and maturation of the
ovarian follicles.
Pituitary
a. Production of Gonadotropic Hormone
LH FSH
The pituitary gland is located at the
base of the brain and is one of the glands
that compose the endocrine system. It is
divided into two lobes: the anterior lobe, Gonads
also called the anterior pituitary and the
posterior lobe. The posterior pituitary
secretes two different kinds of hormones
produced 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 posterior
pituitary does not. The anterior pituitary is
located in the bone cavity at the base of the b. Relationship with endometriosis
brain and produces six different kinds of
Gonadotropin releasing hormone is
hormones, such as Luteinizing Hormone and
used in the form of an agonist to treat
Follicle Stimulating Hormone. The
endometriosis pain, and is called
hypothalamus produces hormones that
Gonadotropin releasing hormone agonist. ,
stimulate the pituitary to produce other
. It is the most used and effective clinical
hormones. In this case, the hypothalamus
treatment for endometriosis pain.
produces Gonadotropin releasing hormone,
whose function is to stimulate the pituitary
to produce and release gonadotropic
hormones, such as LH and FSH by the
pituitary. 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 after
enough for the disease. Hormones had been initiation of treatment” (Raffi and
used to control the thickening and bleeding Amer 2010). It had been considered
of the tissue and are proved to be the most to extend the months of treatment to
effective in pain reduction. (MedlinePlus improve the effectiveness.
2011).
A. Hormonal treatments
Even though GnRH agonist is the
1. Growth hormone releasing hormone most effective hormone treatment, it
agonist contains several side effects. The most
common side effect present in women who
Gonadotropin releasing hormone are undergoing GnHR therapy is the early
agonist is one of the most frequently symptoms of menopause. When GnHR
administered treatments for reducing the hormones turn off the ovaries, a pseudo-
pain produced by endometriosis. GnRH menopause occurs. These women can
agonist inhibits the secretion of GnRH to the experience hot flashes, mood swings,
gonadotrophs, which are secreted to the vaginal dryness and in some cases
human gonads. There are seven types of depression.
GnRH agonist that are used clinically to
treat endometriosis (leuprorelin, buserelin, One of the most common concerns
goserelin, histrelin, deslorelin, nafarelin, of GnRH therapy is the surge of
and 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 a
pseudo-menopause. They inhibit the effect possible cause to produce osteoporosis.
of hormones that cause ovulation, especially GnRH treatments can only be extended for
estrogen, 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 severe
agonist 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 Fundation
enhancing 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.pdf
III. Discussion
Infoplease [Internet].[2007].
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.html
uterus causing severe pain and infertility.
Even though there are some theories that Mayo Clinic [Internet].[2011].
could explain the cause of endometriosis, USA:Mayo Foundation for Medical
the 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/DR600403
to it treatments. Previous studies have
shown a direct relationship of growth MedlinePlus. 2011. USA:
hormones during the development of Department of Health and Human
endometriosis. Several treatments had been Services,National Institutes of
applied to treat endometriosis, but there is Health.[unknown].Available in:
no definitive cure for it. Hormonal http://www.nlm.nih.gov/medlineplus/spanis
treatments are the most utilized to reduce h/ency/article/000915.htm
and treat endometriosis pain and growth.
GnRH agonist therapy is the most effective
and most frequently used hormonal
treatment for it.
Meresman G, Bilotas M,Buquet
R,Baraño R,Sueldo C,Tesone
M.2003.“Gonadotropin- releasing hormone
agonist induces apoptosis and reduces cell
References proliferation in eutopic endometrial cultures
Endometriosis Therapy [internet]; from women with endometriosis”. Fertility
[unknown]. Washington (GA):Biggerstaff B and sterility. [Internet];[revised 2002 May
III; [unknown]. Available in: 17] Vol 80: Available in: http://www.s
http://www.endometriosistherapy.com/conta ciencedirect.com/science/article/pii/S001502
ctus.asp 8203007696

6. Mona.Endometriosis-what is it http://www.viveplena.com/index.php?
[video].USA:icyou, A Benefitfocus option=com_content&view=article&id=42:e
Company. Available in: stadisticas-en-endometrio sis&catid
http://www.youtube.com/user/icyouhealth#p/s
=2:seccespecialista&Itemid=6
earch/0/pVrKiBUPoL4
National Institute of Health
[Internet].[unknown].USA: National
Institute of Health;[unknown]. Available
in:http://www.nichd.nih.gov/health/topics/E
ndometriosis.cfm
Raffi F, Amer S. 2010.
Endometriosis.Obstertrics, Gynecology and
Reproductive Medicine
[Internet];[unknown]. Available in: Science
Direct.
Rose G.2005.What is
endometriosis.Women’s Health Medicine
[Internet];[unknown].Available in:Science
Direct
Slater M,Copper M,Murphy CR.
2006. Human Growth Hormone and
Interleukin-6 are Unregulated in
Endometriosis and
Endometriod Adenocarcinoma.Acta
Histochemica [internet];[revised 2005 Oct
5];[cited 2008 Jan 18].108,13-18:Available
in: http://www.sciencedirect.com/ science
/article/pii/S0065128106000158
The hormone foundation
[Internet].[2011].Connecticut: The hormone
foundation;[cited unknown].
http://www.hormone.org/Endo101/page2.cf
m
Villalobos S.2009.”Estadísticas en
endometriosis”ENDO vive
plena.[Internet];[uknown];[2009 july 6].