New Insights in Pathogenesis of Endometriosis

Abstract

Endometriosis is a gynecological disease characterized by the growth of endometrial glands and stroma outside the uterine cavity. The incidence of the disease is very high, there are currently no reliable early diagnostic tests, the therapies are only symptomatic and, consequently, the social impact of endometriosis is very important, also considering the related fertility problems. Despite this, the pathogenesis of endometriosis is still not fully defined. Retrograde menstruation and coelomic metaplasia are currently the most recognized pathogenetic hypotheses. Recent experimental evidences generated by our research group and by others have indicated an alteration of the fine-tuning of the female genital system developmental program during a critical window of time in the fetal life as the pathogenetic event prompting to the development of endometriosis later in life. Goal of this article is to present a revision of the recent literature about the different pathogenetic mechanisms proposed for endometriosis with particular emphasis on the embryologic theory. The possible clinical and pathological implications of these findings will be discussed.

The role of peroxisome proliferator-activated receptors in endometriosis

“…Laparoscopic excision and thermal destruction of endometrial lesions are the most widely spread surgical treatments when pharmacological therapy fails to work or the disease course is complicated ( 16 ). Both retrograde menstruation and coelomic metaplasia are the two most common pathogenetic hypotheses, but the exact pathophysiology of endometriosis development and progression are still not fully explored ( 17 , 18 ). The hematogenous/lymphatic spread theory, the embryogenetic theory, and the stem cell recruitment theory are additional pertinent hypotheses ( 17 ).…”

The PES1/FOXM1 heterodimer suppresses TCF21 and ERβ expression in ovarian endometriosis

“…Approximately 10% of women experience this pathogenesis of endometriosis remains elusive. 2 Current treatments for endometriosis include surgical and medical therapies. However, considering the unfavorable side effects of hormonal therapy 3 and the high recurrence rate following surgery, 4 it is necessary to explore the core molecular targets in endometriosis to precisely treat this condition.…”

“…The etiology of endometriosis is multifactorial, involving retrograde menstruation, hormonal imbalance, coelomic metaplasia, abnormal immune and inflammatory regulation, and epigenetic changes. Despite extensive research, the true pathogenesis of endometriosis remains elusive 2 . Current treatments for endometriosis include surgical and medical therapies.…”

Ovarian Stimulation for In Vitro Fertilization and Reproductive Outcome after Surgical Treatment of Endometriosis Compared with Tubal Factor Infertility

“…It is often a multifocal condition with a slow but progressive course in the absence of adequate management. Globally, the incidence of this pathology is approximately 10-15% in women of reproductive age, reaching up to 30-50% in patients with chronic pelvic pain or infertility [1][2][3].…”