Two medical conditions in women, endometriosis and fibroids, that are thought to be caused by the female hormone, estrogen, are now treated with estrogen.

During the menstrual cycle, the inner lining of the uterus thickens to receive a fertilized egg. If a woman does not become pregnant in that cycle, she sloughs off the inner lining of her uterus during menstruation. Endometriosis means that the inner lining of the uterus attaches to other parts of her body, such as her ovaries or the outside of her intestines or uterus and causes severe menstrual pain when she bleeds into her belly and vomiting. Usual treatment is nonsteroidal pills such as naprosyn. Fibroids are benign tumors of the muscular wall of the uterus that stick out or into the uterus. They can cause heavy bleeding and they can twist and cause pain. Thickening of the uterus in endometriosis and growth of fibroids are caused by brain hormones that regulate the ovaries, not the female hormone, estrogen (9). If doctors give drugs to stop a woman's body from making estrogen, her bones will weaken and break, but they can shrink fibroids and endometriosis by giving a drug called tibolone, that blocks the brain hormone and also strengthens bones (1). They can treat fibroids (2,3,4) and endometriosis (5,6,7) by giving drugs such as Lupron to stop her body from making estrogen and adding back estrogen and progesterone in birth control pills.

A study from the University of Iowa shows that as a woman approaches the menopause, most uterine fibroids disappear with no treatment.(10)

1) O Gregoriou, N Vitoratos, C Papadias, S Konidaris, D Costomenos, A Chryssikopoulos. Effect of tibolone on postmenopausal women with myomas. Maturitas 27: 2 (JUN 1997):187-191.

2) MY Dawood, J Ramos, FS Khandawood. Depot leuprolide acetate versus danazol for treatment of pelvic endometriosis: Changes in vertebral bone mass and serum estradiol and calcitonin. Fertility and Sterility 63: 6 (JUN 1995):1177-1183. Depot LA produced marked sustained hypoestrogenemia and significant bone loss with complete recovery 1 year after stopping treatment. Danazol maintained normoestrogenemia and increased bone mass with the gain maintained even 1 year after stopping therapy.

3) P Kiilholma, M Korhonen, R Tuimala, E Hagman, S Kivinen. Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis. Fertility and Sterility 64: 5 (NOV 1995):903-908.

4) DK Edmonds. Add-back therapy in the treatment of endometriosis: The European experience. British Journal of Obstetrics and Gynaecology 103: Suppl. 14 (OCT 1996):10-13.

5) LB Schwartz, S Lazer, M Mark, LE Nachtigall, C Horan, SR Goldstein. Does the use of postmenopausal hormone replacement therapy influence the size of uterine leiomyomata? A preliminary report. Menopause - the Journal of the North American Menopause Society 3: 1 (SPR 1996):38-43. HRT in post-menopausal women with uterine leiomyomas does not seem to significantly increase uterine or myoma size.

6) AJ Friedman, M Daly, M Juneaunorcross, R Gleason, MS Rein, M Leboff. Long-term medical therapy for leiomyomata uteri: A prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin 'add-back' for 2 years. Human Reproduction 9: 9 (SEP 1994):1618-1625.

7) Thomas. Add-back therapy for long-term use in dysfunctional uterine bleeding and uterine fibroids. British Journal of Obstetrics and Gynaecology. 103: Suppl. 14 (OCT 1996):18-21. The loss of bone mineral density was significantly diminished in a study using 25 mu g oestradiol patches combined with continuous medroxyprogesterone acetate (5 mg). Zoladex(TM) (goserelin acetate). the gonadomimetic tibolone totally prevented the loss of bone structure during GnRH agonist.

8) O Gregoriou, S Konidaris, N Vitoratos, C Papadias, i Papoulias, A Chryssicopoulos. Gonadotropin-releasing hormone analogue plus hormone replacement therapy for the treatment of endometriosis: A randomized controlled trial. International Journal of Fertility and Womens Medicine. 42: 6 (NOV-DEC 1997):406-411.

9) JN Lubianca, CM Gordon, MR Laufer. ''Add-back'' therapy for endometriosis in adolescents. Journal of Reproductive Medicine 43: 3 (MAR 1998):164-172.

10)Natural history of uterine polyps and leiomyomata. Obstetrics and Gynecology, 2002, Vol 100, Iss 1, pp 3-7. DJ DeWaay, CH Syrop, IE Nygaard, WA Davis, BJ VanVoorhis. Van Voorhis BJ, Univ Iowa Hosp & Clin, Dept Obstet & Gynecol, Div Reprod Endocrinol & Infertil, Coll Med, 200 Hawkins Dr, Iowa City,IA 52242 USA

Updated 9/2/02

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