Reducing pain in endometriosis
21 March 2017
Endometriosis, a condition where endometrial cells develop in areas outside the uterus, is reported to affect around 1 in every 10 women. This extra-uterine tissue is influenced by cyclical fluctuations in estrogenic hormones, which causes the abnormal tissue to bleed into surrounding areas during menstruation. An inflammatory process is initiated as a result, leading to chronic pain, infertility and a range of other symptomology. At it’s worst, endometriosis is a severely debilitating condition. It impacts on quality of life to an enormous degree and according to the Australian Government, is estimated to cost over $5 million in lost productivity, in addition to around $2.5 million in direct healthcare costs.
Therapeutic interventions that reduce the level of estradiol can help in both the treatment of endometriosis and the reduction of associated pain. Currently, one treatment involves gonadotrophin releasing hormone (GnRH) agonists that are used together with estrogen and progestin to titrate circulating estradiol levels. Although this combination treatment may minimise the side effects typically associated with low estradiol including bone mineral density loss, estrogen use is associated with an increased risk of thrombosis, embolism and paradoxically, endometriosis progression.
Therefore, the development of a new class of therapeutics known as GnRH antagonists, could provide a hormonal monotherapy treatment option that offers additional benefits over current therapies. These antagonists preferentially bind to the GnRH receptor in the pituitary gland, inhibiting the production of luteinizing hormone and follicle-stimulating hormone. The inhibition of both reduces the amount of estradiol and progesterone produced by the ovaries, leading to a potential improvement in endometriosis symptoms. Ongoing monitoring and adjustment in GnRH antagonist dosing can then be implemented to highlight the optimal level of estradiol suppression needed to achieve a balance between individual efficacy, safety and tolerability.
Currently there are four GnRH antagonists in Phase II and III clinical trials with results to date suggesting that they are beneficial in reducing endometriosis-related dysmenorrhea. Additional studies should address the future role of GnRH antagonists in endometriosis, providing hope for the 176 million women worldwide that are directly impacted by this condition.
Emeritus Research is a dedicated Clinical Research Centre based in Melbourne, Australia. We conduct clinical trials from Phase Ib to Phase IV in a range of areas that encompass two therapeutic area pillars – inflammatory conditions and lifestyle diseases.