Urinary Profiles of the Endogenous Steroids in Pre-Menopausal Women with Uterine Leiomyoma / 대한불임학회지

ABSTRACT

Uterine leiomyoma is the most common solid pelvic tumor, occurring in 20~30% of women who are over 30 years of age1 and it accompanies with the symptoms such as uterine bleeding, dysmenorrhea, pain and the pressure on the urinary tract lead to blockage of the urinary tract. it some-times becomes a factor in sterility.2 Leiomyoma is a benign neoplasm that arises from uterine smooth muscle. it is hypothesized that leiomyoma originates from the somatic mutations in myometrial cells, resulting in progressive loss of growthregulation.3,4 Ovarian hormones are believed to stimulate the growth of leiomyoma because there is an increased incidence of leiomyoma after menarche and these tumors enlarge during pregnancy and regress after menopause. The growth of leiomyoma is variable among women with regular menstruation cycles and even among myoma nodules in the same uterus. One possible reason for this variation is thaovarian hormones, especially estrogen, stimulate individual myoma nodules by varying degree. 5 Therefore, therapeutic attempt based on over-come the state of hyperestrogenism have been tried. Treatment with competitive inhibitors of estrogen receptors (ER)6,7 or gonadotropin-releasing hor-mone agonist2,8,9 has been studied for those reasons. it was found that mean ER content was significantly greater in leiomyoma than in myometrium. 10~14 And ER content of the fibroid was reported to signifIcantly correlate wIth the myoma-shrinkage.15 But there were no consistent results as the concentration of estrogen in uterine leiomyoma.16,17 in this study, we determined the concentrations of urinary steroids, including estrogens as well as androgens, which are closely related to the estrogen biosynthesis, in premenopausal women with leiomyoma using Gas Chromatography-Mass Spectrometry (GC-MS). The urinary levels of the same endogenous steroids in age-matched healthy premenopausal women were also estimated by comparing urinary steroid levels between the two groups. From these results, we studied the effect of endogenous steroids and the metabolic changes in the leiomyoma, and we especially observed the difference in the estrogen level between the two groups to predict the role of estrogens in the prevention of and the therapy for leiomyoma