Endometriosis cells are abnormal in 3 ways:
- They produce abnormally high levels of estrogen
- They possess abnormally high levels of estrogen receptors
- They produce abnormal levels of prostaglandins and cytokines (inflammation molecules that cause pain, infertility, and other problems)
Advancing the Treatment for Endometriosis: Aromatase Inhibitors and Ablation
The key for advancing the treatment of endometriosis lies in finding ways to selectively eliminate endometriosis cells. One promising new treatment involves “debulking” the endometriosis cells using aromatase inhibitors alone, or if fertility is not desired, combining aromatase inhibitors with endometrial ablation.
Endometriosis: Abnormal Cells Within and Outside the Uterus
Endometriosis implants possess abnormal amounts of an enzyme called “aromatase”. This enzyme converts estrogen-precursor molecules to estrogen. Endometriosis implants also have high levels of estrogen receptors.
For a more complete explanation of the pathophysiology (underlying causes) of endometriosis see related post here.
The endometrium, or uterus lining, also contains abnormal amounts of aromatase and estrogen receptors in women with endometriosis.
Endometriosis: a Self-Perpetuating Process
Endometriosis implants can both synthesize estrogen independent of the ovarian hormones; and they are more sensitive to estrogen. They are analogous to self-sustaining, self-perpetuating machines.
Endometriosis located outside the uterus can re-generate itself and spread through self-stimulation, whether or not the uterus and ovaries are present.
This explains why some women who have hysterectomy for endometriosis have recurrent pain after total hysterectomy. Hysterectomy and oophorectomy (removal of ovaries) “debulks” endometriosis tissue present in the uterus and ovaries, but it does not remove endometriosis implants present outside the uterus.
Aromatase Inhibitors Can Target Endometriosis Located Outside the Uterus
Aromatase inhibitors (AI’s) block the enzyme, aromatase, essential to estrogen production. Thus AI’s can target endometriosis cells anywhere in the body, be they on on nerves outside the uterus, the ovaries, or inside the uterine muscular wall (this type of endometriosis is called “adenomyosis” and is responsible for pain and heavy bleeding with menses).
Early studies indicate aromatase inhibitors have the potential to reduce or eliminate endometriosis for at least as long as Lupron, or even longer, with fewer side effects than either Lupron or total hysterectomy.
Endometrial ablation rids the uterus of abnormal endometrial cells
Global endometrial ablation (GEA) is a procedure to remove the uterine lining in order to treat abnormal uterine bleeding. It can be done in the office in a few minutes and requires no down-time from work. Global endometrial ablation has potential application to endometriosis.
In women with endometriosis who have severe menstrual cramps (dysmenorrhea) endometrial ablation can be used to remove the uterus lining, thus the abnormal cells within that lining. This can have immediate effects on heavy menstrual bleeding and pain.
Global ablation has the potential to reduce the load of abnormal cells in the endometrium, thus reducing the chances of these spreading outside the uterus. In reducing the abnormal cells, global ablation also has the potential to reduce prostaglandins and cytokines, molecules that contribute to pelvic pain.
Using AI’s alone, or in combination with GEA has promise to control endometriosis symptoms without need for surgery or incurring the side effects of Lupron.