Endometriosis and Progesterone resistance

[Inge D]

Hi Dr. Briden, nice to see you have this forum! I have endometriosis since already 25 years and I'm also helping other endo patients with information and education. But I was wondering about progesterone resistance that you sometimes see popping up in articles... Here some questions about it...

Many studies talk about progesterone resistance that could occur in some endo patients. Would this mean that:
- if you would take bio identical progesterone, that is not a treatment as there is a resistance to progesterone?
- taking progestins (the pill) could be a solution because its composition is different from progesterone and receptors could be ok with progestin? or is this incorrect?
- if you would look at progesterone in blood results in those patients, there would be no or little result?

[Jeslyn]

If someone had progesterone resistance then their body does not respond properly to the hormone progesterone. This can occur with endometriosis.

Taking bioidentical progesterone may not be effective in women in this case, as the body may not respond to the hormone in the same way as it would in women without resistance.

Progestins (the synthetic hormones used in birth control pills) have a different chemical structure than progesterone. They can bind to the same receptors as progesterone, but may have different effects on the body. Progestins can help to alleviate the symptoms of endometriosis, so may be a better choice for those with progesterone resistance, but this would need to be determined on a case-by-case basis.

If a person has progesterone resistance, then their progesterone blood results would typically show normal to high levels of progesterone - because the body is unable to absorb it. But, this cannot be used to diagnose progesterone resistance. At the moment there is no specific test, so diagnosis is often made based on clinical symptoms and medical history.

[Lara]

The progesterone resistance of endometriosis is because endometriosis lesions have a reduced number of progesterone receptors compared to normal endometrial tissue. Neither progesterone nor progestins can entirely get around this problem, which is why the main treatment for endo is immune treatment, not hormonal treatment. Serum progesterone levels are usually normal with women with endometriosis.

[Inge D]

Thanks for your replies! as you mention, immunity treatment is more important than hormone treatment. In that regard, I found information that LDN or low dose naltrexone could be a possible treatment. Low dose could increase immunity and could act as a pain treatment. Is this correct and what are your thoughts about this?