Estrogen is the hormone that makes women “women,” in its support of the female organs that support human life. It initiates the development of sex characteristics at puberty by stimulating the growth of endometrial and breast tissue. Every month it stimulates the growth of the follicle which releases the egg. It supports vaginal tissues and stores fat to support a woman who might become pregnant or nursing. Other growth-related processes attributed to estrogen are preventing bone loss and maintaining collagen in the skin and connective tissues. Estrogen also aids in the synthesis of neurotransmitters, especially serotonin and dopamine, and supports the transportation of glucose across the blood brain barrier.
While estrogen contributes to fertility and a woman’s monthly cycle, it can run amok when it goes unchecked by enough progesterone, the hormone that promotes differentiation. A common presentation of unbalanced estrogen is endometriosis. Endometriosis is the presence of endometrial-like tissue outside of the uterus, primarily located on the pelvic peritoneum, ovaries and rectovaginal septum. Endometriosis has a high association with adenoymyosis, endometrial tissues growing outside of the uterine wall; and fibroids, a benign tumor of muscular tissue in the wall of the uterus.
Endometriosis and its cousins adenomyosis and uterine fibroids, often difficult to tell apart, are the reasons that many women experience pelvic pain and bleeding, and make visits to their gynecologists. While only 6-10% of women of reproductive age experience endometriosis, 50-60% of the pelvic pain experienced by teenage girls is caused by endometriosis, and endometriosis is present in 50% of women with infertility.
Endometriosis is also associated with inflammation, in the form of elevated cytokines and homocysteine. These cytokine elevations put a woman at higher risk for autoimmune diseases such as Crohn’s and Ulcerative Colitis, Grave’s, Hashimoto’s, and Celiac disease. Amazingly, endometriosis lesions express aromatase and synthesize their own estradiol from testosterone, creating more estrogen and inflammation, and contributing to estrogen dominance! Endometriosis is also associated with an increased risk of ovarian endometrioid and clear-cell cancers, as well as other cancers such as non-Hodgkins lymphoma and melanoma.
In short, the estrogen dominance that leads to endometriosis breeds growth in the form of more endometriosis, more estrogen production and more inflammation, and may even contribute to the growth of cancer. The conventional treatment for endometriosis includes NSAIDS, GnRH agonists (Lupron), oral contraceptives, and surgery. Because progesterone tends to be decreased in women with endometriosis, progesterone supplementation can be a more natural alternative to pharmaceuticals. Progesterone can serve as an important component in breaking the cycle of estrogen dominance as it stabilizes and slows the cell growth associated with estrogen. Many women are desperate for a solution to their pain and will gladly start with a trial of progesterone.
Consider salivary hormone testing in your patients, as the Pg/E2 ratio can play an important role in determining a progesterone-based treatment plan for women with endometriosis at any age.
