Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis


      To determine the relationship between steroid receptor expression and pain symptoms in endometriosis.




      University Hospital


      Women with endometriosis (N = 92).


      Tissue samples were obtained from patients with surgically diagnosed endometriosis.

      Main Outcome Measure(s)

      A tissue microarray (TMA) was generated from patients with endometriosis. Data were collected on the presence and severity of dysmenorrhea, deep dyspareunia, dyschezia, and nonmenstrual pain by use of a numerical rating scale (NRS) at the time of surgery and after 1 year. The intensity of receptor expression was evaluated through immunohistochemistry and measured according to an immunoreactive score (IRS). Clinical variables were correlated to IRS by multivariate logistic regression analysis.


      Estrogen receptor-α (ER-α), progesterone receptor (PR), androgen receptor (AR), and aromatase expression differed among study participants. ER-α expression was reduced by progestin therapy, whereas of expressions of PR, AR, and aromatase were unchanged. Higher ER-α expression increased the likelihood of moderate to severe dysmenorrhea and deep dyspareunia in women not receiving hormonal treatment. In women receiving progestin therapy, persistently higher ER-α expression was correlated with greater likelihood of deep dyspareunia, severe dyschezia, and endometriosis-associated pain persistence at 1 year.


      ER-α, PR, AR, and aromatase were all expressed in deep endometriosis. ER-α levels best correlated with severity of symptoms, which suggests that ER is a key driver of deep endometriosis. Progestin treatment was associated with a reduction of ER-α expression; however, failure of ER suppression by progestins was also a predictor of pain severity and recurrence at 1 year.
      El Receptor-α de Estrógenos con Inmunoreactividad Predice la Severidad de los Síntomas y la Recurrencia del Dolor en la Endometriosis Profunda


      Determinar la relación entre la expresión del receptor esteroideo y la sintomatología de dolor en endometriosis
      Diseño: Estudio transversal.


      Hospital Universitario.


      Mujeres con endometriosis (N=92).


      Se obtuvieron muestras de tejido de pacientes con endometriosis diagnosticadas quirúrgicamente.

      Medida(s) principal(es) de resultado

      Se generó un microarray tisular (TMA) a partir de pacientes con endometriosis. Los datos fueron recogidos según presencia y gravedad de dismenorrea, dispareunia profunda, disquecia y dolor no menstrual mediante el uso de una escala de calificación numérica (NRS) en el momento de la cirugía y después de 1 año. La intensidad de la expresión del receptor se evaluó mediante inmunohistoquímica y medido de acuerdo con una puntuación inmunorreactiva (IRS). Las variables clínicas se correlacionaron con el IRS por un análisis de regresión logística multivariable.


      El receptor de estrógeno-α (ER-α), el receptor de progesterona (PR), el receptor de andrógenos (AR) y la expresión de aromatasa difirieron entre las participantes del estudio. La expresión de ER-α se redujo con el tratamiento con progestágenos, mientras que la expresión de PR, AR y aromatasa no cambió. La mayor expresión de ER-α aumentó la probabilidad de dismenorrea moderada a severa y de dispareunia profunda en mujeres que no recibieron tratamiento hormonal. En mujeres que recibieron terapia con progestágenos, la expresión de persistentemente más alta de ER-α se correlacionó con una mayor probabilidad de dispareunia profunda, disquecia severa y persistencia del dolor asociado a la endometriosis al año.


      ER-α, PR, AR y aromatasa se expresaron en endometriosis profunda. Los niveles de ER-α se correlacionaron mejor con la gravedad de los síntomas, lo que sugiere que ER es un factor clave de la endometriosis profunda. El tratamiento con progestágenos se asoció con una reducción de la expresión de ER-α; sin embargo, el fracaso de la supresión de ER por las progestágenos también fue un predictor de la severidad y recurrencia del dolor al cabo de un año.

      Key Words

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