Hormonal treatment of endometriosis in adolescents and young adults: consequences on bone density

Abstract

Endometriosis is a chronic disorder characterized by the finding of “endometrium-like” tissue and glands outside the uterus. It is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis is mainly an estrogen-dependent disorder, therefore current hormonal therapies aim to counteract the biological effect of estrogens, reducing cell proliferation, neuroinflammation and pain In adolescents and young adults, in particular, treatment aims to reduce pain, prevent the development of endometrial implants, and preserve fertility.
Estrogens are main regulators of bone physiology, and hormonal therapies may therefore affect bone remodeling, both during adolescence and aging. Peak bone mineral accrual may be a concern in patients receiving long-term, low-estrogen hormonal treatment, such as for endometriosis. Here, we review crucial estrogen-related mechanisms associated with bone remodeling in adolescents and young adults and their potential role in long-term hormonal treatment of endometriosis. Early diagnosis of endometriosis is crucial, but early hormonal administration may expose young patients to bone fragility later in life.