Estrogen receptor-β, Estrogen receptor-α, and progesterone resistance in endometriosis

Serdar E. Bulun, You Hong Cheng, Mary Ellen Pavone, Qing Xue, Erkut Attar, Elena Trukhacheva, Hideki Tokunaga, Hiroki Utsunomiya, Ping Yin, Xia Luo, Zhihong Lin, Gonca Imir, Stephen Thung, Emily J. Su, J. Julie Kim

Research output: Contribution to journalReview articlepeer-review

181 Citations (Scopus)


Loss of progesterone signaling in the endometrium may be a causal factor in the development of endometriosis, and progesterone resistance is commonly observed in women with this disease. In endometriotic stromal cells, the levels of progesterone receptor (PR), particularly the PR-B isoform, are significantly decreased, leading to a loss of paracrine signaling. PR deficiency likely underlies the development of progesterone resistance in women with endometriosis who no longer respond to progestin therapy. Here we review the complex epigenetic and transcriptional mechanisms leading to PR deficiency. The initial event may involve deficient methylation of the estrogen receptor (ER) promoter resulting in pathologic overexpression of ER in endometriotic stromal cells. We speculate that alterations in the relative levels of ERβ and ERα in endometrial tissue dictate E2-regulated PR expression, such that a decreased ERα-ERβ ratio may result in suppression of PR. In this review, we propose a molecular model that may be responsible for changes in ERβ and ERα leading to PR loss and progesterone resistance in endometriosis.

Original languageEnglish
Pages (from-to)36-43
Number of pages8
JournalSeminars in Reproductive Medicine
Issue number1
Publication statusPublished - 2010


  • DNA methylation
  • ER-α
  • ER-β
  • Epigenetic
  • Gene regulation
  • PR
  • Progesterone resistance
  • Promoter
  • Transcription

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Reproductive Medicine
  • Endocrinology
  • Obstetrics and Gynaecology
  • Physiology (medical)


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