MEDizzy - A 35-year-old woman presents with infertility. She has had

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Female Genital Tract

A 35-year-old woman presents with infertility. She has had dysmenorrhea, dyspareunia, and pelvic pain on defecation for 4 years. Laparoscopic examination reveals red-blue nodules on the surface of the uterus and extensive adhesions between ovaries and the fallopian tubes. Histologic examination of a biopsy from one of the nodules shows hyperplastic endometrial glands and hemorrhage in the stroma. Molecular analysis of the biopsy material reveals hypomethylation of the promoter regions of the genes that encode steroidogenic factor 1 and estrogen receptor beta. There are no mutations in the PTEN, KRAS, and MLH1 genes. Which of the following is an appropriate treatment modality in this case?

ExplanationIn 30% to 40% of cases, endometriosis presents with infertility, menstrual irregularities, and pelvic pain. The presence of endometrial tissue in the nodules confirms this diagnosis. The glands in the nodules are hyperplastic but show no evidence of malignancy; in addition, all the genes implicated in endometrial cancer are normal. Hypomethylation of the two genes, NR5A1 (steroidogenic factor 1) and ESR2 (estrogen receptor beta) is found in endometriosis. These lead to overproduction of prostaglandins and estrogens. Aromatase inhibitors are used to suppress estrogen production. Lesions of endometriosis are not neoplastic and chemotherapy or major surgery with organ removal is not indicated.