Reproductive steroids hold potential for treating endometriosis

Reproductive steroids are powerful hormones that play a key role in the growth and development of our bodies, especially during puberty. These natural chemicals, produced by the ovaries in women and the testes in men, shape physical changes such as breast development, muscle growth and fertility. Beyond these functions, reproductive steroids also influence overall health and well-being.

Dr Philippa Saunders, an expert in reproductive steroids, defines them as a group of essential hormones that regulate bodily changes. The most well-known among these are oestrogen, progesterone and testosterone. Oestrogen, primarily found in women, is responsible for breast development, the onset of menstrual cycles and preparing the body for pregnancy. Progesterone, also in women, thickens the uterine lining, making it ready for potential pregnancy.

On the other hand, testosterone, mainly found in men, is responsible for helping boys grow muscles, develop deeper voices and form other male characteristics. Although testosterone is present in women too, it works in much smaller amounts. Together, these hormones guide our bodies through crucial stages of growth and reproductive health.

“Reproductive steroids, particularly oestrogen and progesterone, play a central role in regulating the menstrual cycle and preparing the uterus for pregnancy,” explains Dr Saunders. In women with endometriosis, however, the endometrial tissue often exhibits ‘progesterone resistance.’ This means the cells do not respond effectively to progesterone, disrupting the natural balance of the menstrual cycle. As a result, the endometrial lining becomes less receptive to implantation, contributing to infertility. Kenyan women, especially those in rural areas, may face delays in diagnosis and treatment due to limited awareness and access to specialized care, exacerbating the challenges posed by progesterone resistance.

Endometriosis is a complex and often misunderstood condition affecting millions of women worldwide, including a growing number in Kenya. Characterised by the presence of endometrial-like tissue outside the uterus, this condition is associated with severe pain, heavy menstrual bleeding and infertility. There’s a profound influence from recent research of reproductive steroids on endometriosis that offers promising avenues for treatment.

Endometriosis is not a single disease but it’s a condition that consists of three subtypes, each with different risk factors. Ovarian endometriosis, which leads to lesions on the ovaries, is the most heritable. Deep endometriosis infiltrates farther into the pelvis and produces hard nodules. Peritoneal or superficial endometriosis consists of smaller lesions scattered along the pelvic lining.

A striking finding from Dr Saunders’ research is the ability of endometriosis lesions to produce their own steroids. These lesions (small patches of tissue similar to the lining of the uterus that grow outside of it) create a micro-environment, complete with immune cells, nerves and blood vessels, allowing them to sustain themselves independently of ovarian hormone production.

“This self-sufficiency can render traditional hormonal therapies less effective, leaving many women in Kenya reliant on limited treatment options or costly surgical interventions that are often inaccessible,” says Dr Saunders.

Dr Ezekiel Mecha, an endocrinologist, further explains, “these cells travel through the fallopian tubes and deposit in other areas like the intestines, peritoneum, lungs or even the brain. They respond to hormonal changes, so every month, when a woman menstruates, these cells also undergo changes, leading to inflammation and pain.”

The widespread nature of endometriosis makes it more than just a gynaecological issue; it is a systemic disease. Beyond the pelvis, it can affect the immune system, leading to widespread inflammation throughout the body. This chronic inflammation may contribute to various health problems, including an increased risk of cardiovascular diseases. Studies suggest that altered steroid signalling and immune responses in women with endometriosis could be key factors linking the condition to cardiovascular health concerns.

In addition to heart-related issues, endometriosis can also cause chronic pelvic pain, painful periods, infertility, digestive problems, urinary issues, fatigue and mental health challenges like anxiety and depression. In Kenya, cardiovascular health awareness is still developing, and addressing these risks in women with endometriosis requires urgent attention from healthcare providers.

A significant case published in The Standard’s Health and Science Magazine titled, ‘Why chronic menstrual pain is often misunderstood’ sheds light on the often overlooked complexity of endometriosis. Anne, a Kenyan woman, had been experiencing chest pains and breathlessness symptoms that seemed completely unrelated to her menstrual cycle. For years, doctors struggled to diagnose her condition, attributing her issues to various causes. It wasn’t until later that they discovered her collapsed lung was linked to endometriosis.

Although Anne had previously been diagnosed with endometriosis and undergone multiple surgeries, the connection to her lung problems went unnoticed for quite some time. Initially, her doctors questioned whether her symptoms were due to high-altitude activities or possible trauma. A chest x-ray revealed that her right lung was smaller than it should have been, leading to speculation about past injuries. However, Anne had no history of such experiences, leaving her confused and frustrated. The idea that her lung could collapse because of her endometriosis seemed far-fetched until further tests confirmed the rare and serious connection.

This revelation opened Anne’s eyes to how endometriosis can affect not just the reproductive organs, but other parts of the body as well. The tissue growth from endometriosis can spread to the diaphragm or even the lungs, causing severe complications like lung collapse. This rare condition, known as catamenial pneumothorax, is just one example of how the disease can manifest in unexpected ways.

Anne’s experience underscores the critical need for a more comprehensive approach to diagnosing endometriosis. Women who experience unexplained symptoms, even those unrelated to their menstrual cycle, should not hesitate to discuss their reproductive health with every doctor they visit. Chest pain or breathlessness, for example, may seem to be symptoms of something entirely different but could be linked to endometriosis affecting other organs. This highlights the importance of raising awareness and ensuring that endometriosis is thoroughly considered in all medical evaluations, especially in Kenya, where many women face misdiagnoses and years of suffering before receiving the right treatment.

Endometriosis has usually been seen as a problem just for the reproductive system, often treated by either a general doctor or a gynaecologist. But experts now know it affects the whole body, not just the reproductive organs. The way we separate health problems into different areas of medicine has made it hard to see how they are all connected.

Studies show that young women and teens with endometriosis are five times more likely to get irritable bowel syndrome. They are also at a higher risk between 20 to 80 per cent, depending on the study of problems like high blood pressure, stroke and heart disease. Women with endometriosis are also twice as likely to get rheumatoid arthritis and are more likely to have conditions like asthma, lupus and osteoarthritis. Many also deal with other issues like migraines, chronic back pain and fibromyalgia, a long-term pain disorder. This shows that we need a more complete way to diagnose and treat the condition.

According to the World Endometriosis Society (WES), painful endometriosis can affect the whole body, not just the pelvis. “Many physicians don’t recognise the symptoms, and it takes an average of eight years for sufferers to be diagnosed,” says Dr Mecha.

“In the last three to five years, this disorder has been completely redefined as a neuro-inflammatory condition that impacts the whole body. It isn’t just about a little bit of tissue stuck in the wrong place. Your whole body reacts,” says Dr Saunders.

Dr Mecha further explains, “Endometriosis depends on oestrogen, meaning it worsens during a woman’s reproductive years but usually improves after menopause when oestrogen levels drop.”

This explains why symptoms can change over time. Treatments often focus on lowering oestrogen levels, but new treatments are being explored.

One key component in endometriosis is transforming growth factor beta (TGF), a molecule that influences how reproductive steroids work. Transforming growth factor beta refers to a group of proteins that regulate cell growth and inflammation.

These proteins may influence how endometriosis develops and spreads. Researchers are exploring whether blocking these proteins could lead to new treatments for endometriosis.

Dr Mecha states, “Transforming growth factor beta helps induce menstruation by pushing out the inner wall of the endometrium. However, it also contributes to the spread of endometrial cells through the fallopian tubes, leading to their implantation in abnormal locations.” Because of its role in these processes, TGF is being studied as a potential target for new treatments.

Hormonal therapies remain a primary treatment for endometriosis, aiming to reduce pain and slow the growth of endometrial tissue outside the uterus. Common options include birth control pills, progestins, gonadotropin-releasing hormone (GnRH) agonists and aromatase inhibitors.

These medications suppress ovulation, thin the endometrial lining and reduce inflammation. However, they do not cure endometriosis and often come with side effects like mood changes, weight gain and decreased bone density.

Emerging non-hormonal therapies offer hope for managing endometriosis without the side effects of hormonal treatments. These include drugs targeting prostaglandins, which drive inflammation and antibody-based therapies focusing on immune factors like interleukin-8 (IL-8). Additionally, repurposed drugs such as dichloroacetate (DCA) are being studied for their potential to reduce pelvic inflammation. While these therapies hold promise, their high cost and reliance on advanced healthcare infrastructure pose challenges, especially in Kenya. Expanding access to these treatments will require investment in research, education and healthcare systems.

Understanding the role of reproductive steroids in this condition can help demystify its causes and guide better treatment choices, ensuring women receive care that targets the underlying hormonal and inflammatory processes rather than just managing symptoms.

In Kenya, awareness and diagnosis of endometriosis remain low. Many women endure years of misdiagnosis or ineffective treatment, often receiving only painkillers or hormonal contraceptives without addressing the root cause. Cultural stigma surrounding menstrual health further complicates the conversation, preventing many from seeking help.

There is a pressing need for public education campaigns, affordable diagnostic tools and specialized training for healthcare providers to improve the outlook for women with endometriosis.

Endometriosis has long been seen as just a reproductive health issue, primarily handled by general practitioners or gynaecologists. However, experts now understand that it affects the entire body.

As the understanding of endometriosis evolves, so must the approaches to diagnosis, treatment, and awareness. For Kenya, the journey involves tackling stigma, improving access to therapies, and training healthcare providers to recognize and treat this condition.

By integrating global advancements with local initiatives, Kenya can pave the way for better reproductive health outcomes. Expanding knowledge on reproductive steroids will shape future treatments and improve quality of life.