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The aim of this study is to review the current literature associating endometriosis with iron and to discuss the potential causes and consequences of iron overload in the pelvic cavity. Indeed, iron is essential for all living organisms. However, excess iron can result in toxicity and is associated with pathological disorders. In endometriosis patients, iron overload has been demonstrated in the different components of the peritoneal cavity (peritoneal fluid, endometriotic lesions, peritoneum and macrophages). Animal models allow us to gather essential information on the origin, metabolism and effect of iron overload in endometriosis, which may originate from erythrocytes carried into the pelvic cavity mainly by retrograde menstruation. Peritoneal macrophages play an important role in the degradation of these erythrocytes and in subsequent peritoneal iron metabolism. Iron overload could affect a wide range of mechanisms involved in endometriosis development, such as oxidative stress or lesion proliferation. In conclusion, excess iron accumulation can result in toxicity and may be one of the factors contributing to the development of endometriosis. Treatment with an iron chelator could thus be beneficial in endometriosis patients to prevent iron overload in the pelvic cavity, thereby diminishing its deleterious effect.

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background: Increased peritoneal eicosanoid concentrations have been reported in endometriosis patients and might be important in disease-associated pain and inflammation. Here, we evaluated the expression of key biosynthetic and catabolic enzymes involved in this abnormal eicosanoid production in peritoneal macrophages and endometriotic lesions.methods: Peritoneal macrophages, endometriotic lesions and matched eutopic endometrium were collected from endometriosis patients (n ¼ 40). Peritoneal macrophages and eutopic endometrium samples were also collected from disease-free women (n ¼ 25). Expression of type IIA secretory phospholipase A 2 (sPLA 2 -IIA), cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), 15-hydroxyprostaglandin dehydrogenase (15-PGDH) and 5-lipoxygenase (5-LO) was quantified by real-time PCR, and these five key enzymes were localized by immunohistochemistry.results: sPLA 2 -IIA, COX-2 and mPGES-1 mRNA was significantly increased in peritoneal macrophages of endometriosis patients compared with controls (P ¼ 0.006, P ¼ 0.016 and P ¼ 0.025, respectively). In endometriosis patients, sPLA 2 -IIA, mPGES-1 and 15-PGDH mRNA was significantly enhanced in peritoneal lesions compared with matched eutopic endometrium (P , 0.001, P , 0.001 and P ¼ 0.005, respectively). In eutopic endometrium, a significant decrease in 15-PGDH mRNA was found in the endometriosis group compared with controls (P ¼ 0.023). Finally, sPLA 2 -IIA, COX-2, mPGES-1 and 15-PGDH immunostaining was found mainly in endometrial glands, whereas 5-LO was distributed throughout the glands and stroma. conclusions: Our study highlights an imbalance between eicosanoid biosynthesis and degradation in endometriosis patients. Both peritoneal macrophages and endometriotic lesions may be involved. Research into new molecules inhibiting biosynthetic enzymes (such as sPLA 2 -IIA and mPGES-1) and/or activating catabolic enzymes (such as 15-PGDH) may prove to be a major field of investigation in the development of targeted medical therapies.

The purpose of this study was to analyze complication and recurrence rates after deep endometriotic nodule surgery. A total of 3,298 cases of deep endometriotic nodules were analyzed. The shaving technique was used, avoiding bowel resection. Laparoscopic nodule resection was performed successfully in all cases. Major complications included: (1) rectal perforation in 42 cases (1.3 %), (2) ureteral retention (<5 days) in 21 cases (0.64 %), (3) ureteral injury in 10 cases (0.3 %), and (4) fecal peritonitis in 1 case (0.04 %). This complication rate is much lower than that observed after bowel resection. In the same period, bowel resection was only required in 1.1 % (n 037) of cases. Histology revealed circumscribed nodular aggregates of smooth muscle, endometrial glands, and scanty endometrial stroma. Lesions were found to be invaded by nerve fibers. Endometriosis is not cancer and does not require the same treatment approach. In young women, conservative surgery using the shaving technique means preservation of organs, nerves, and the vascular blood supply. The shaving technique yields low complication and recurrence rates and should be considered the first line in surgical approach in the case of deep endometriotic lesions.

Unlike previous studies, we observed no aromatase protein in any of the endometriosis types, and barely detectable aromatase mRNA expression, suggesting that locally produced aromatase (within endometriotic lesions) may be less implicated in endometriosis development than previously postulated. Potential factors responsible for these discrepancies are discussed.

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