By the age of 75, an impressive 50% of men will experience an inguinal (groin) hernia—characterized by a bulge from soft tissue pushing through a weak point in the abdominal wall. While these hernias are common, the exact cause remains unclear, and the only known remedy is surgical intervention to mend the weakened area. Unfortunately, even after surgery, there’s a 10 to 15% chance of recurrence in men.
A recent study from Northwestern Medicine has introduced an innovative medication-based method that successfully reversed existing inguinal hernias in male mice, restoring their normal anatomy without the need for surgery. Even more encouraging, researchers took a closer look at human hernia tissues and discovered the same molecular markers found in the mouse models. In the U.S., over a million inguinal hernia repairs are carried out each year using general anesthesia.
“This is a groundbreaking study marking the first medical treatment for inguinal hernias,” stated Dr. Serdar Bulun, senior author and chair of the department of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “Our results strongly indicate that men may respond to this medication similarly to the male mice, suggesting that for high-risk surgical patients, medical treatment could eventually become an option.”
Additionally, the study identified a probable cause for inguinal hernias: the estrogen receptor-alpha (ESR1). This receptor plays a crucial role in stimulating the growth of certain connective tissue cells and the accumulation of fibrous tissue, contributing to the onset of inguinal hernias.
This research was published today, February 4, in the Journal of Clinical Investigation.
Study Overview:
The investigation was conducted in two parts: one involving modified male mouse models and another focusing on human tissue samples.
During the mouse study, researchers administered the anti-estrogen drug fulvestrant, which is approved for treating specific breast cancer types, to a humanized mouse model that simulates elevated estrogen levels seen in older men. By blocking ESR1 in the connective tissue cells, scientists could prevent muscle damage and hernia development. The use of fulvestrant helped to shrink large hernias and return the mice to a healthy anatomical state.
In the human tissue analysis, scientists performed two biopsies on each participant—one from the hernia area and another from a nearby healthy muscle. They found the same biological markers present in the mouse model. Further examination revealed that estrogen and ESR1 activate gene expressions linked to excessive tissue scarring, consistent with patterns observed in human hernia tissues.
“We believe that targeting estrogen/ESR1 could be a vital step in developing pharmaceutical treatments for inguinal hernias in men,” remarked Dr. Hong Zhao, corresponding author and research professor of obstetrics and gynecology (reproductive science in medicine) at Feinberg.
About Inguinal Hernias
While inguinal hernias can also occur in women, they are significantly less common (approximately one woman for every 34 men). More than 10% of elderly male patients experience recurrence after surgical repair attempts, which translates to around 100,000 elderly men annually, according to Bulun. Although these hernias often do not cause significant pain, there is a risk of severe health issues or even death if a bowel becomes trapped and strangulated by the hernia.
