Koninckx Philippe R, Ussia Anastasia, Adamyan Leila, Wattiez Arnaud, Vigano Paola
Departments of Obstetrics and Gynecology, Katholieke University Leuven, 3000 Leuven, Belgium.
Departments of Obstetrics and Gynecology, University of Oxford, Oxford OX1 2JD, UK.
J Clin Med. 2025 Oct 12;14(20):7196. doi: 10.3390/jcm14207196.
: The aim of this study was to review the importance of peritoneal fluid steroid hormone concentrations to understand the mechanism of hormonal medical treatment of endometriosis-associated pain. : The study included a PubMed search and a pilot trial in 8 adolescents. : Oral contraceptives (OCs) were designed to inhibit ovulation in all women, and doses are much higher than the mean ovulation-inhibiting dose. Therefore, in most women, half a dose and in some women, even less is sufficient to inhibit ovulation. The inhibition of ovarian function and ovulation decreases estrogen and progesterone concentrations in plasma and peritoneal fluid. Surprisingly, the effect on peritoneal fluid steroid hormone concentrations has not been considered to explain the impact on endometriosis-associated pain. The lowering of the high estrogen concentrations in peritoneal fluid is sufficient to explain the pain decrease in superficial and ovarian endometriosis. A direct progesterone effect is unlikely, given the high progesterone concentrations in the peritoneal fluid of ovulatory women. In 8 adolescents, half an OC dose resulted in an apparently similar pain relief as a full dose (personal observation). The decrease in ovarian and superficial pelvic endometriosis-associated pain with OCs can be explained by lowering the intra-ovarian and the high estrogen concentrations in peritoneal fluid after ovulation. A direct progesterone effect is unlikely. Since OCs are severely overdosed in most women, half a dose is sufficient in most with fewer side effects, permitting individualization of therapy in women not requiring contraception. Understanding peritoneal fluid also explains that hormone replacement therapy is not contraindicated in most women with a history of endometriosis. Since the mechanisms of medical therapy of endometriosis-associated pain and the prevention of progression might be different, the growth of lesions must be monitored during treatment.
本研究的目的是回顾腹膜液甾体激素浓度的重要性，以了解激素治疗子宫内膜异位症相关性疼痛的机制。本研究包括一次PubMed检索和一项针对8名青少年的试点试验。口服避孕药（OCs）旨在抑制所有女性排卵，其剂量远高于平均排卵抑制剂量。因此，在大多数女性中，半量剂量，在一些女性中甚至更少的剂量就足以抑制排卵。卵巢功能和排卵的抑制会降低血浆和腹膜液中雌激素和孕酮的浓度。令人惊讶的是，对腹膜液甾体激素浓度的影响尚未被考虑用于解释对子宫内膜异位症相关性疼痛的影响。腹膜液中高雌激素浓度的降低足以解释浅表性和卵巢性子宫内膜异位症疼痛的减轻。鉴于排卵女性腹膜液中孕酮浓度较高，直接的孕酮作用不太可能。在8名青少年中，半量OCs剂量产生的疼痛缓解效果明显与全量相似（个人观察）。OCs导致卵巢性和浅表性盆腔子宫内膜异位症相关性疼痛减轻，这可以通过降低排卵后卵巢内和腹膜液中的高雌激素浓度来解释。直接的孕酮作用不太可能。由于大多数女性使用的OCs剂量严重过量，大多数情况下半量剂量就足够了，且副作用较少，这使得在不需要避孕的女性中可以实现个体化治疗。了解腹膜液情况还能解释，激素替代疗法对大多数有子宫内膜异位症病史的女性并非禁忌。由于子宫内膜异位症相关性疼痛的药物治疗机制和预防病情进展的机制可能不同，因此在治疗期间必须监测病变的生长情况。
