Progesterone resistance worsens quality of life for women with endometriosis
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Key takeaways:
- Women with progesterone resistance report worse quality of life than those with endometriosis alone.
- Women with progesterone resistance also had higher mean dysmenorrhea and dyspareunia scores vs. those without.
NEW ORLEANS — Among women with endometriosis, those with progesterone resistance reported worse pain scores during menses and at the time of surgery for endometriosis compared with those without progesterone resistance.
“Little is known regarding the quality of life for this unique subset of endometriosis patients [with progesterone resistance],” Laura Courtright, MSN, RN, researcher in the department of obstetrics and gynecology at Johns Hopkins University School of Medicine, said during the presentation at the ASRM Scientific Congress & Expo.
Approximately one-third of patients with symptomatic endometriosis report no benefit from treatment with progestin therapy and may exhibit reduced or disrupted progesterone receptor signaling at the tissue level, Courtright said.
Courtright and colleagues conducted a prospective, observational study with 90 women (mean age, 33.16 years; 66% white) undergoing laparoscopic surgery; 67 had endometriosis diagnosed by visual inspection at surgery with histopathological confirmation. Of those, 37 had clinically expressed progesterone resistance. Participants provided quality of life data using the Endometriosis Health Profile questionnaire and reported their response to progestin therapy. Researchers defined clinically expressed progesterone resistance as the patient’s choice to move to a gonadotropin-releasing hormone agonist or undergo surgery after 3 months or longer of unsuccessful progestin therapy.
Of all participants, the average age at menarche was 12.4 years, and the average menstrual cycle duration was 28 days with an average of 6.4 bleeding days. Women with progesterone resistance had higher mean dysmenorrhea (9.1 vs. 7.9), dyspareunia during intercourse (6.3 vs. 5.1) and dyspareunia 24 hours after intercourse (5.8 vs. 4.4) scores on the Visual Analogue Scale (scale from 1-10; higher scores indicate worse pain) compared with women without progesterone resistance. Researchers observed higher average Endometriosis Health Profile questionnaire scores (scale from 1-100; higher scores indicate worse health-related quality of life) among women with progesterone resistance compared with those without progesterone resistance:
- pain (62.8 vs. 61.7);
- control and powerlessness (73.7 vs. 67.9);
- emotional well-being (55.9 vs. 53.6);
- social support (62.2 vs. 57.7); and
- self-image (68.1 vs. 54.5).
These data suggest a correlation between progesterone resistance and pain related to endometriosis, Courtright said.
“[For women with endometriosis] we can consider recommending surgery sooner rather than cycling through the various types of hormonal treatments, especially if we suspect that they are not effective,” Courtright said. “We can consider suggesting additional pain control methods to account for that stronger pain that they experience. Going forward, we want to know if clinically expressed progesterone resistance correlates with progesterone resistance observed at the tissue level, and we want to know what might be driving it.”