The Main Theories on the Pathogenesis of Endometriosis Original paper

What Was Reviewed?

This review explored the primary theories underlying the pathogenesis of endometriosis, a chronic gynecological disorder characterized by the growth of endometrial-like tissue outside the uterus. The review evaluated various mechanisms, including retrograde menstruation, immune dysregulation, coelomic metaplasia, hormonal imbalance, and epigenetic regulation. Additionally, it considered the role of stem cells and environmental factors in disease onset and progression. The synthesis of these theories aimed to illuminate the multifactorial origins of the disease and its systemic implications.

Who Was Reviewed?

The review included a broad analysis of scientific literature, focusing on research involving women with endometriosis, animal models (notably baboons and mice), and cell-based experiments. Integrating data from diverse biological contexts provided a comprehensive overview of the disease’s potential mechanisms.

What Were the Most Important Findings?

The review highlighted that endometriosis likely results from an interplay of multiple pathogenic pathways. Immune dysregulation was a central focus, with macrophages, T cells, and dendritic cells contributing to chronic inflammation, suppressed apoptosis, and lesion growth. Hormonal imbalances, particularly estrogen dominance and progesterone resistance, were identified as pivotal in driving lesion persistence and infertility. Epigenetic changes, such as DNA methylation and micro-RNA dysregulation, emerged as significant contributors to disease progression, influencing inflammation, angiogenesis, and cellular proliferation.

This review did not address key microbial associations in endometriosis, but immune-modulated inflammation and altered hormonal environments suggest indirect links to microbiome perturbations. For example, increased inflammatory cytokines (e.g., TNF-α and IL-6) and VEGF in endometriotic lesions may influence local microbial dynamics.

What Are the Greatest Implications of This Review?

Understanding the multifactorial nature of endometriosis provides a foundation for developing targeted therapeutic strategies. The review underscores the need for integrative approaches combining hormonal regulation, immune modulation, and potential epigenetic therapies. Additionally, exploring microbiome interactions in this context may reveal novel interventions, particularly in immune-regulated inflammation and hormonal imbalances.