Correlation of serum estradiol and progesterone levels with endometrial expression of estrogen receptor α in abnormal uterine bleeding endometrium cases in reproductive age group

Abstract

Aim: Abnormal uterine bleeding (AUB) is a common cause for gynecological referrals. Serum correlation of hormone levels along with study of expression of estrogen receptor (ER) and progesterone receptor (PR) in the endometrium of patients with AUB may be helpful in deciding treatment. Materials and methods: Forty AUB-endometrium (AUB-E) cases classified as per PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification were assessed. Endometrial biopsies were stained with hematoxylin and eosin (H&E) for histomorphological details and immunohistochemistry (IHC) for quantification of ERα and PR expression in AUB-E cases. Serum samples were obtained on the day of biopsy and examined for serum estrogen and serum progesterone levels. Unpaired Student’s t-test was used for statistical calculation and p = 0.05 value was taken as critical level of significance. Results: Serum estradiol was decreased in 10%, normal in 65%, and increased in 25% cases. Serum progesterone levels were decreased in 52.5%, normal in 30%, and increased in 17.5%. Correlation of ERα with serum estradiol levels showed an inverse relationship. The difference was statistically significant (p = 0.04). Conclusion: In AUB-E cases, a hyperestrogenic state may be due to true/relative increase in serum estradiol levels. Decreased serum estradiol levels present with changes of hyperestrogenism may be due to overexpression of ERα receptors. Both expressions of receptors in endometrium and serum hormone levels play a role in the final outcome of hyperestrogenic state. Therefore, patients with normal or decreased serum estradiol levels may be investigated for expression of ERα in endometrium for deciding the final treatment. Clinical significance: Patients with AUB-E with normal or decreased hormonal levels should be investigated for ERα in endometrial biopsy to decide optimal hormonal therapy.