Pathogenesis of endometriosis: Interaction between Endocrine and inflammatory pathways

Best Pract Res Clin Obstet Gynaecol. 2018 Jul:50:50-60. doi: 10.1016/j.bpobgyn.2018.01.006. Epub 2018 Feb 14.


Despite an estimated prevalence of 11% in women and plausible historical descriptions dating back to the 17th century, the etiology of endometriosis remains poorly understood. Classical theories of the histological origins of endometriosis are reviewed below. Clinical presentations are variable, and signs and symptoms do not correlate well with the extent of disease. In this summary, we have attempted to synthesize the growing evidence that hormonal and immune factors conspire to activate a local inflammatory microenvironment that encourages endometriosis to persist and elaborate mediators of its two cardinal symptoms: pain and infertility. Surprisingly, in the search for novel therapeutics for medical treatment of endometriosis, some compounds appear to have dual pharmacological functions, simultaneously modifying the endocrine and immune system facets of this complex gynecologic syndrome. We predict that these lead drugs will provide more therapeutic choices for patients in the future.

Keywords: Endometriosis; Estrogen; GnRH (gonadotropin-releasing hormone); Progesterone; SERM (selective estrogen receptor modulator).

Publication types

  • Review

MeSH terms

  • Endocrine System / immunology
  • Endocrine System / physiopathology*
  • Endometriosis / complications
  • Endometriosis / immunology
  • Endometriosis / pathology*
  • Female
  • Humans
  • Immune System / immunology
  • Immune System / physiopathology*
  • Infertility, Female / etiology
  • Inflammation / immunology
  • Inflammation / physiopathology
  • Pelvic Pain / etiology