What's new in endo & adenomyosis research

INTRODUCTION AND HYPOTHESIS: Pelvic floor dysfunctions are common in women with endometriosis. Currently available assessment tools are limited to isolated domains that do not allow for a comprehensive multidimensional evaluation. This study aimed to develop and perform a preliminary validation of a multidimensional composite index for pelvic floor dysfunction based on both subjective and objective measures in women with endometriosis. METHODS: Data were retrospectively analyzed from a previously established cohort of patients who received either medical or medical-surgical treatment for endometriosis. The PDCS comprises three domains (each transformed to a 0-100 scale): subjective anorectal dysfunction (Wexner constipation and incontinence scores), pelvic floor symptoms (PFDI-20), and objective anorectal function (manometric parameters). The score was calculated as the mean of the available domains and stratified into mild (0-33), moderate (34-66), and severe (67-100) dysfunction. Internal structure assessment was based on principal component analysis and Spearman correlations. Clinical validation was assessed by correlating with pain (EHP-30) and sexual function (FSFI). RESULTS: Twenty-nine patients with clinically relevant pelvic dysfunction were assessed [median PDCS 45.2 (IQR 33.3-60.6)]. Patients with a PDCS value of 0 were excluded from the validation analyses. There were no significant differences between treatment groups. PDCS correlated very well with PFDI-20, and moderately with the Wexner domain and manometric findings. The PDCS was significantly correlated with pain burden and sexual function. CONCLUSIONS: The PDCS is a preliminary, multidimensional composite index that integrates symptom burden and anorectal functional findings in women with endometriosis. In the clinical setting, the proposed severity categories should therefore be regarded as exploratory and require validation in larger prospective cohorts before translating the results into practice.

Endometriosis, a chronic health condition primarily associated with women, is not just a physical experience but is an invisible, gendered illness deeply intertwined with societal narratives that often overlook women's embodied knowledge. This research employs body-mapping as a visual, verbal, and symbolic methodology to foreground embodied experiences and explore how social perceptions shape women's lived realities of endometriosis. Through an interpretive phenomenological analysis of six body maps, this research reveals conforming bodies, which internalize societal stigmas, resulting in disconnection from self and others, and resisting bodies, who actively challenge and transform oppressive narratives. The integration of visual, symbolic, and verbal expressions in body-mapping offers a nuanced understanding of how participants with endometriosis navigate the intersection of chronic illness and societal expectations. Our findings highlight the necessity of acknowledging and valuing embodied knowledge, emphasizing the importance of reflecting critically on the social narratives that shape the experiences of gendered illnesses.

Ovarian endometrioma excision remains a double-edged intervention: it improves pelvic pain and ART access, yet bilateral or repeated stripping surgery is associated with measurable decline in anti-Müllerian hormone (AMH) and antral follicle count (AFC), a phenomenon conceptually framed by the author as surgical ovarian aging. Contemporary protocols address the surgical act itself but neglect the pre-operative metabolic window, the first 72 postoperative hours, and the neuro-motivational dimension of the 12-month fertility trajectory, where attrition from ART programs reaches 25–40%. Objective. To describe and standardize RENDO™ (Reproductive Endo-Neuro-Dynamic Optimization), a six-module integrated protocol — PREP, SURG, RECOVER, MIND, DRIVE, TRACK — spanning 4–8 weeks before surgery to 12 months after, combining anti-adhesion excisional technique, targeted nutraceutical matrices, polyvagal-informed psychosomatic stabilization, dopamine-based behavioral architecture, and a digital companion with composite outcome indices. Methods. Single-arm prospective implementation; eligibility per ICD-10 N80.1–N80.3 / ICD-11 GA10.Z–GA10.3; primary endpoint: relative AMH change at 3 months; secondary endpoints: AFC recovery ratio, Ovarian Shock Index (OSI) at post-op day 3, RENDO™ Score (0–100), RPS-SCORE dynamics, ART attrition rate. Conclusion. RENDO™ reframes post-endometrioma care from a passive convalescence model to an active, measurable, patient-facing recovery system.

Abstract Background Endometriosis is a chronic disease affecting millions of women worldwide, characterized by the presence of ectopic endometrial-like tissue. While the formation of neutrophil extracellular traps (NETs) has been linked to endometriosis progression, the underlying implicated molecular mechanisms remain poorly understood. Methods The presence of NETs was evaluated using immunofluorescence and the extent of fibrosis was assessed using Masson’s trichrome staining in patient endometriotic lesions ( n = 10) in comparison with the endometrium of healthy women ( n = 10). Human epithelial and stromal endometriotic cells were used to evaluate the fibrotic effect of NETs. The involvement of the signaling of sphingosine 1-phosphate (S1P) in the fibrotic effect of NETs was assessed by genetic and pharmacologic approaches. Conditioned media from endometriotic cells where S1P metabolism or export were modulated, were employed to evaluate their effect on neutrophil NETosis. The plasma levels of the NET marker (MPO) and S1P were measured in patients ( n = 30) and controls ( n = 20). Results Immunofluorescence and immunohistochemistry analysis of patient-derived lesions revealed a significant increase in NET markers and collagen deposition compared to controls. NET treatment induced epithelial-mesenchymal transition and fibrosis in endometriotic epithelial as well as stromal cells. Mechanistically, in endometriotic cells NETs modulated the S1P signaling axis by increasing the expression of sphingosine kinase-1 (SK1), one of the two isoforms responsible for S1P biosynthesis, the S1P transporter Spns2, and S1P 2 and S1P 3 receptors. Notably, the pro-fibrotic effect of NETs was abrogated when SK1 or Spns2 were specifically silenced. To add further layers of complexity, conditioned media from endometriotic cells where S1P metabolism or export were modulated, potently influenced neutrophil NETosis demonstrating that endometriotic cells stimulated neutrophils to release NETs via S1P, creating a pathological feedback loop. The relevance of the S1P/NET axis in endometriosis was supported by the positive correlation between S1P and MPO plasma levels in patients but not in healthy controls. Conclusions Our findings identify a novel S1P-driven bidirectional crosstalk between neutrophils and endometriotic cells that fuels the progression of fibrosis. These results highlight the S1P signaling pathway as a promising non-hormonal therapeutic target for the treatment of endometriosis since interfering with S1P metabolism and export could be extremely beneficial not only for counteracting fibrogenesis but also NETosis.

No direct evidence for how complication rates of excision procedures for abdominal wall endometriosis compare with other surgical interventions. Indirect evidence suggests complications from excision may be comparable or slightly higher than less invasive alternatives, but further studies are necessary.

Background Endometriosis is a chronic inflammatory disease linked to infertility. Coagulation-related processes may contribute to lesion persistence and pelvic remodeling, but the relevance of coagulation parameters in women with infertility undergoing surgical evaluation remains unclear. This study examined the association of plasma fibrinogen (FIB) with the presence and stage of endometriosis. Methods This retrospective cross-sectional study included 389 women with infertility undergoing combined hysteroscopy and laparoscopy. Endometriosis was surgically confirmed and staged using the revised American Society for Reproductive Medicine classification. Plasma FIB was analyzed continuously and by quartiles. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for overall and stage-specific endometriosis after adjustment for age, body mass index, education level, dysmenorrhea, and parity. Spline analyses explored potential nonlinearity. Activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and international normalized ratio (INR) were exploratory comparators. Sensitivity analyses considered reproductive, inflammatory, and coagulation-related variables. Results Among 389 women, 259 had endometriosis, including 186 with stage I–II and 73 with stage III–IV disease. Continuous FIB was not significantly associated with overall endometriosis (OR, 1.20; 95% CI, 0.76–1.91; P = 0.433). Compared with the first quartile, the third FIB quartile was associated with higher odds of overall endometriosis (OR, 2.37; 95% CI, 1.20–4.66; P = 0.012), with the largest estimate for stage III–IV disease (OR, 4.03; 95% CI, 1.56–10.43; P = 0.004). Q4 did not show a further increase, and trend tests were not significant. The adjusted spline increased across the lower-to-middle FIB range and then plateaued. The overall Q3 estimate remained elevated across sensitivity analyses, including the exploratory expanded model (OR, 2.27; 95% CI, 1.09–4.75). APTT, PT, TT, and INR showed no consistent associations. Conclusions Plasma FIB did not show a simple linear association with endometriosis. A higher estimate was observed in the intermediate FIB range and persisted across several adjusted analyses, particularly in stage III–IV disease. This quartile-specific pattern remains exploratory and does not define a clinical cutoff. Independent cohorts are needed to determine whether this pattern is reproducible and clinically informative.

Introduction Endometriosis is a chronic gynecological disease associated with pelvic pain, infertility, and reduced quality of life. Ovarian endometrioma is its most common manifestation. Although laparoscopic cystectomy is widely used, concerns regarding ovarian reserve have led to increasing interest in conservative approaches. Ultrasound-guided ethanol sclerotherapy (EST) has emerged as a minimally invasive alternative with potential benefits for symptom control and reproductive outcomes. The ESCOMA trial aims to evaluate the impact of EST compared with expectant management on quality of life in women with ovarian endometriomas. Methods and analysis ESCOMA is a prospective, multicentre, randomised controlled trial comparing ultrasound-guided ethanol sclerotherapy with expectant management. A total of 288 women with ovarian endometriomas will be randomised in a 1:1 ratio. The primary outcome is change in quality of life at 6 months, assessed using the Endometriosis Health Profile-5 (EHP-5). Secondary outcomes include pain reduction, changes in pain-related biomarkers, ovarian reserve markers, cyst size reduction, reproductive outcomes, adverse events and complications, diagnostic accuracy, and healthcare costs. Analyses will be performed according to both intention-to-treat and per-protocol principles. Ethics and dissemination The study was approved by the Clinical Research Ethics Committee of Hospital Universitari de Bellvitge (PR070/25). Written informed consent will be obtained from all participants. Clinical Trial Registration ClinicalTrials.gov , identifier NCT06955221.

Evidence on the complication rate of surgical excision for abdominal wall endometriosis is limited and varied, with rates affected by the type of endometriosis and patient-specific factors.

Introdução: A endometriose é uma condição multifatorial, marcada por manifestações que vão além da dor pélvica e da infertilidade. Além dos sintomas físicos, observa-se uma forte associação com prejuízos à saúde mental e à qualidade de vida das pacientes. Objetivo: Evidenciar como endometriose pode impactar na saúde mental das pacientes, elucidando também o papel da dor crônica nesse aspecto. Materiais e Métodos: Realizou-se uma revisão integrativa da literatura em bases de dados indexadas como PubMed MEDLINE, SCIELO, Ebscohost, Google Scholar e a Biblioteca Virtual de Saúde (BVS) utilizando os descritores "Endometriose", "Saúde Mental" e "Dor crônica". Foram selecionados artigos publicados entre 2017 e 2025, priorizando estudos clínicos, revisões sistemáticas e diretrizes internacionais, com dados analisados criticamente. Resultados e Discussão: Estima-se que até dois terços das mulheres com endometriose recebam, ao longo da vida, diagnósticos associados a transtornos mentais, principalmente ansiedade e depressão. A presença de dor pélvica crônica (DPC) intensifica significativamente esse impacto. Padrões cognitivos negativos, como o catastrofismo, e estratégias de enfrentamento passivas foram associados a maior intensidade dolorosa e pior desfecho psicológico. O diagnóstico tardio, o estigma social e a interferência nas atividades sociais e laborais agravam o sofrimento psíquico. A forma como a paciente interpreta e reage à sua condição tem papel determinante na evolução clínica. Conclusão: A endometriose compromete a saúde mental, especialmente quando acompanhada de DPC. Uma abordagem integrada, que considere tanto os aspectos físicos quanto os psicossociais da doença, é fundamental. Estudos longitudinais com grupos controle são necessários para aprofundar o entendimento dessas interações complexas.

Abstract Purpose To compare current endometriosis classification systems across clinically relevant domains and to identify which components may be used for a single internationally accepted classification. Methods A PubMed search was performed up to December 31, 2025, to identify publications on the revised American Society for Reproductive Medicine classification (rASRM) and endometriosis classifications introduced after 2000 (#Enzian, AAGL, EFI, UBESS, dPEI, Endo-Stage MRI, NMS-E, VNESS, FOATIaRVS, Chapron), excluding case reports. The full classification names as well as their abbreviations were used as search terms. The included systems were evaluated across pre-defined domains: descriptive anatomical mapping, pain, fertility, quality of life, surgical complexity, surgical duration, complication risk, non-invasive applicability, treatment guidance, disease progression, postoperative recurrence, and reproducibility. Results No currently available classification performed well across all domains. #Enzian provided the most comprehensive anatomical-descriptive framework. EFI remained the best-validated tool for predicting spontaneous conception after surgery. AAGL, UBESS, dPEI, and Endo-Stage MRI were most informative for operative complexity and surgical risk stratification. In contrast, correlations with pain, quality of life, disease progression, and treatment response were generally weak or inconsistent across systems. Evidence for recurrence prediction was limited, and reproducibility varied depending on the system and clinical setting. Conclusion Current endometriosis classifications remain purpose-specific and clinically fragmented. Rather than replacing one imperfect system with another, future progress will likely depend on a modular framework combining a robust anatomical-descriptive backbone with validated domain-specific overlays. Among existing systems, the modular #Enzian classification appears to offer the most promising structural basis for such further development.

Endometriosis is a chronic gynecological disease characterized by the growth of tissue similar to the lining of the uterus outside the uterine cavity. It is widespread among women of reproductive age, yet it remains one of the most frequently underdiagnosed pathologies. The primary symptom of the disease—severe and prolonged menstrual pain—is often confused with common dysmenorrhea, resulting in a delay of several years before an accurate diagnosis is made.

Introduction Endometriosis is a chronic, estrogen-dependent inflammatory disease defined by the presence of endometrial-like tissue outside the uterine cavity, most commonly on the pelvic peritoneum, ovaries, and rectovaginal septum [1]. It affects an estimated 10% of women and girls of reproductive age worldwide and is strongly associated with dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility [1,2]. Despite its high prevalence and substantial impact on quality of life and work productivity [3], endometriosis remains one of the most poorly and slowly diagnosed conditions in gynecology. Multiple international studies converge on a strikingly consistent finding: patients typically wait several years, often the better part of a decade, between the onset of symptoms and a confirmed diagnosis [3-8]. This delay is not attributable to any single cause but instead reflects an interlocking set of patient-level, clinician-level, and health-system-level barriers, compounded by the biological ambiguity of the disease itself. This review synthesizes the current evidence on the scope of diagnostic delay in endometriosis and examines the factors that make the condition so difficult to identify in a timely manner.

No direct evidence for differences in complication rates between excision and other surgical techniques for abdominal wall endometriosis was identified. Surgical decisions should be individualized, and more studies are needed to address this gap.

OBJECTIVE: To describe the anatomical distribution and laterality patterns of ovarian endometriosis (OE) and deep endometriosis (DE) using TVS and the #Enzian classification, and to evaluate the association between lesion location and the clinical symptoms. METHODS: Retrospective analysis of 394 consecutive women evaluated for suspected endometriosis at a specialized center. All underwent TVS by a single expert operator following the International Deep Endometriosis Analysis (IDEA) consensus protocol. Lesion distribution was classified using the #Enzian system. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: DE was identified in 33.5% of patients and OE in 35.8%. The most frequently affected deep compartment was the uterosacral ligament or pelvic sidewall (B compartment; 52.9%), followed by rectal involvement (C compartment; 31.0%). Laterality differed significantly among compartments: tubo-ovarian adhesions were predominantly bilateral (63.1%), uterosacral ligament lesions were predominantly unilateral (bilateral in only 7.9%), and OE showed an intermediate pattern (38.6%). Rectouterine pouch obliteration was strongly associated with combined OE and DE (PR, 9.14; 95% CI, 5.83-14.35). Symptoms were generally not predictive of lesion location, except for an inverse association between heavy menstrual bleeding and OE (PR, 0.57; 95% CI, 0.38-0.85). CONCLUSION: TVS with the #Enzian classification reveals distinct anatomical and laterality patterns among pelvic compartments. The strong association between combined OE and DE and rectouterine pouch obliteration supports systematic and comprehensive ultrasound evaluation (including the sliding sign) whenever an endometrioma is detected, as it may signal more advanced and surgically complex disease.

OBJECTIVE: To present our preliminary experience with laparoscopic discoid excision for bowel endometriosis using hand-sewn bowel closure, without a circular transanal stapler. METHODS: This retrospective cohort study was based on prospectively collected data from Surgical Endoscopy Units in university-affiliated hospitals. Patients had deep endometriotic nodules involving the bowel, measuring >3 and ≤5 cm, and were scheduled for deep bowel shaving but considered unsuitable for standardized stapled discoid excision. Bowel shaving was initially attempted in all cases, and the decision to proceed to discoid excision was made intraoperatively. After excision, bowel closure was performed laparoscopically with a two-layer hand-sewn repair using 2-0 polyglycolic acid sutures. RESULTS: Ten patients were included. Mean duration of manual bowel suturing was 22 minutes (range, 18-35). Intraoperative complications were minimal. Time to first flatus ranged from 2 to 5 postoperative days, and oral feeding was delayed until bowel function returned. One patient developed severe febrile morbidity, successfully managed with antibiotics and parenteral nutrition. Follow-up ranged from 18 to 60 months. No severe complications, including anastomotic leakage, fistula, or major functional sequelae, occurred. Pain symptoms and quality of life improved in all patients. One patient developed recurrent bowel endometriosis and underwent segmental resection. Among four patients wishing to conceive, two achieved pregnancies, one spontaneously and one after in vitro fertilization; both delivered by caesarean section. CONCLUSION: Laparoscopic discoid excision with hand-sewn bowel closure may be a feasible conservative alternative for selected patients with larger bowel endometriotic nodules, potentially avoiding segmental resection.

Endometriosis is a multifaceted disease, causing debilitating pelvic pain in some patients, while being completely asymptomatic in others. The pathophysiology of endometriosis pain is not well understood and poorly correlated to stage. We hypothesized that this clinical heterogeneity may be explained by examining differences in gene expression. We performed RNA sequencing of 27 formalin-fixed, paraffin-embedded peritoneal biopsies from 9 symptomatic (Sx) and 10 asymptomatic (ASx) subjects. 890 genes were differentially expressed between Sx and ASx samples. Of these, the most significant including genes involved inflammatory signaling (IL16, IL17RA, JAK3, SMPD3, RELT), cell adhesion (OLFML1, CDON, VCAN), and neuromodulation (SEMA6D, ADRA2C, SLC7A5). Gene Set Enrichment Analysis identified functional enrichment in 22 gene ontology (GO) pathways, of which 7 represented immunologic pathways. Weighted Gene Correlation Network Analysis (WGCNA) identified 11 co-expression modules significantly correlated with symptomaticity, including one module strongly enriched for immunologic/inflammatory functions. Of all molecules identified as associated with pain, IL16 expression also correlated with symptom severity when cases were stratified into mild vs. severe pain based on clinical criteria. These findings suggest that endometriotic lesions of symptomatic subjects are characterized by distinct molecular signatures, including altered expression of inflammatory pathways, highlighting potential mechanisms underlying symptom variability and identifying candidate pathways for future therapeutic interventions.

Fibrosis is a common pathological feature of inflammatory conditions across various organ systems, leading to a marked increase in matrix stiffness. The effects of substrate stiffness on benign epithelial cells in fibrotic microenvironments remain less well characterized compared with malignant cell types. We used an endometriotic epithelial cell line and polyacrylamide hydrogels with tunable stiffness to model mechanically driven single-cell and multicellular migration. We identified a biphasic relationship between substrate stiffness and epithelial migration, where substrates of intermediate stiffness best promoted cell speed, actin stress fiber formation, focal adhesion presentation, and spheroid expansion compared with the soft and very stiff gel substrates. Increasing cellular contractility on the soft substrate and decreasing contractility on the fibrotic stiffness substrate led to an increase and decrease in cell speed, respectively. These findings suggest a role for how fibrosis as a biomechanical state regulates epithelial cell migration during the pathogenesis of benign yet invasive conditions.

BACKGROUND: Chronic pelvic pain (CPP) is increasingly recognized as a disorder of altered central pain processing, providing a strong rationale for non-invasive brain stimulation (NIBS) as a therapeutic approach. However, use of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) for CPP remains uncertain. This systematic review aimed to evaluate the evidence for NIBS in CPP. METHODS: A comprehensive search of PubMed, Web of Science, Ovid MEDLINE, Embase, Scopus, and Cochrane CENTRAL was conducted till July 2026. Studies evaluating tDCS or rTMS in adults with CPP were included. Cochrane RoB-2 and ROBINS-I were used to assess methodological quality. Owing to a low number of studies, substantial clinical and methodological heterogeneity, a structured narrative approach was used. RESULTS: Fifteen studies involving 295 participants, of whom 264 completed the respective studies, met the inclusion criteria, including nine tDCS and six rTMS studies. Inter-rater agreement for data extraction was almost perfect (Cohen's kappa = 0.878). Considerable heterogeneity was observed across clinical conditions, protocols, comparator interventions, outcome measures, and follow-up durations. Most randomized controlled trials (RCT) were rated at high or some risk of bias. Across studies, tDCS demonstrated favorable effects in some conditions, although findings were inconsistent and benefits beyond the treatment period were not consistently demonstrated. Evidence for rTMS was more limited and heterogeneous. CONCLUSIONS: Current evidence is insufficient to support NIBS for routine CPP care because of methodological limitations, small samples, and substantial heterogeneity in stimulation protocols and populations. Well-designed RCT using standardized intervention protocols and outcome measures are needed. PROSPERO ID: CRD420251058830.

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Zhiqiang Wang,1 Jinwei Yang,1 Bo Yan,2 Guangmei Xie11Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu, 730050, People’s Republic of China; 2Clinical Laboratory, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu, 730050, People’s Republic of ChinaCorrespondence: Guangmei Xie, Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), No. 143 Qilihe North Street, Qilihe District, Lanzhou, Gansu, 730050, People’s Republic of China, Email [email protected]: In this narrative review, we summarize current evidence regarding the endometrium undergoes cyclic remodeling driven by estrogen (E2) and progesterone (P4) signaling, with precise coordination essential for receptivity and pregnancy establishment. GREB1, initially identified as an estrogen-responsive co-activator in breast cancer, plays a pivotal, context-dependent role in endometrial biology. In normal physiology, GREB1 predominantly supports progesterone signaling: it is directly induced by progesterone receptor (PR) and functions as a critical co-activator that reinforces PR-dependent transcription, enabling stromal decidualization, implantation window formation, and receptivity. Genetic deletion or silencing of GREB1 selectively impairs progesterone-driven responses while largely sparing estrogen-mediated proliferation. In pathological conditions such as endometriosis, the regulatory balance shifts dramatically. Estrogen dominance and progesterone resistance redirect GREB1 toward an ERα-centered feedforward loop, amplifying proliferative, invasive, and angiogenic gene programs that promote lesion persistence and progression. This bidirectional feedforward mechanism with steroid receptors explains GREB1’s opposing roles in health and disease. The findings position GREB1 as a promising biomarker of tissue-level progesterone responsiveness in infertility and as a selective therapeutic target for estrogen-driven endometrial disorders, potentially allowing disruption of pathological amplification while preserving physiological function. As a narrative review, this article synthesizes current knowledge while highlighting areas requiring further systematic investigation.Keywords: GREB1, endometrium, progesterone receptor, estrogen receptor, feedforward loop, decidualization, endometrial receptivity, endometriosis, progesterone resistance, steroid hormone co-regulator, implantation failure, context-dependent regulation

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Endometriosis is a chronic inflammatory and sex steroid hormone-dependent gynaecologic disease, characterised by endometrial cell proliferation outside the uterine cavity, often accompanied by fibrosis, progesterone resistance, and high recurrence despite hormonal and surgical interventions. Epithelial-mesenchymal transition (EMT) is important for establishment of lesions and invasiveness, but the upstream transcriptional regulators that integrate hormonal, inflammatory and epigenetic signals are incompletely defined. This review emphasises ZEB1 as a molecular integrator at the systems level in endometriosis pathogenesis. We reviewed evidence for selective upregulation of ZEB1 in ectopic lesions, where it inhibits epithelial adhesion molecules, stabilises mesenchymal differentiation and activates the attachment-invasion angiogenesis cascade required for lesion persistence. In addition to EMT, we discuss bidirectional crosstalk between ZEB1 and endocrine signalling, illustrating how oestrogen-mediated induction and suppression of progesterone receptor pathways converge to establish progesterone resistance. The review includes miR-200 family members, long non-coding RNAs and circular RNAs that strengthen ZEB1 expression through multilayered feedback mechanisms that perpetuate chronic inflammatory and pro-fibrotic microenvironments. Critically, it tackles translational complexity by incorporating the heterogeneity of lesions uncovered through single-cell and spatial transcriptomics, and by assessing the experimental models necessary to determine causal relevance. Additionally, it addresses the paradox of targeting ZEB1 therapeutically, considering its physiological function in endometrial regeneration and implantation. Understanding the oestrogen-ZEB1-TGF-β axis is critical for developing mechanism-based precision interventions for endometriosis.

A endometriose é uma doença inflamatória crônica, estrogênio-dependente, caracterizada pela presença de tecido semelhante ao endométrio fora da cavidade uterina e associada a dor pélvica, dismenorreia, dispareunia, infertilidade e prejuízo relevante da qualidade de vida. Esta revisão narrativa discute avanços no diagnóstico, manejo multimodal da dor, repercussões reprodutivas e estratégias de cuidado centrado na paciente, incluindo o papel complementar da nutrição. A evolução da ultrassonografia especializada e da ressonância magnética ampliou a possibilidade de diagnóstico clínico-radiológico, reduzindo a dependência da laparoscopia diagnóstica isolada. O tratamento deve ser individualizado conforme sintomas, desejo reprodutivo, extensão da doença, tratamentos prévios e preferências. Terapias hormonais, analgésicas, cirurgia e reprodução assistida permanecem pilares do manejo. Intervenções nutricionais são de interesse crescente, sobretudo por possíveis efeitos sobre inflamação, sintomas gastrointestinais e dor; contudo, a evidência ainda é heterogênea e não sustenta dietas restritivas universais nem substituição do tratamento médico. Revisões recentes de ensaios randomizados sugerem possível redução de dismenorreia com alguns compostos nutricionais, mas com risco de viés e heterogeneidade importantes. Conclui-se que o cuidado ideal é multidisciplinar, integrando ginecologia, reprodução humana, manejo da dor, saúde mental e, quando indicado, acompanhamento nutricional individualizado.

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In women, chronic pelvic pain (CPP) is recurrent or constant pain in the pelvis, lower abdominal region, and female organs that persists for longer than 6 months. Exercise has been effective for other chronic pain conditions and could potentially be effective for CPP. The objective was to evaluate if exercise is more effective than no intervention, minimal intervention or usual care for improving pain and quality of life (QOL) in the short, medium, and long-term in women of reproductive age with ongoing CPP of gynaecological or urological origin. Short-term pain was the primary endpoint. This was a systematic review with meta-analysis. Four databases were searched. Title/abstract, full-text screening, data extraction and risk of bias assessment were conducted by two independent authors. Risk of bias was measured using the Cochrane risk of bias 2.0 tool. For pain, scales were converted to a standardised 0 to 10 scale, with a smallest clinically worthwhile effect of 1.5 points. For QOL, scales were converted to a Standardised Mean difference (SMD). Random effects meta-analyses were used, and GRADE syntheses were performed. We identified 9319 records. Six studies ( n = 333) were included. All studies were high risk of bias. Two studies included yoga as an exercise modality, while the remaining used multiple exercise types. Comparators included advice, medication, or usual care. For pain, the evidence was very uncertain that exercise was better than the comparator and the effect was clinically worthwhile in the short- (MD: -2.74, 95%CI: -3.70 to -1.78, 4 studies) and long-term (MD: -3.38, 95%CI: -4.80 to -1.96, 2 studies). For QOL, the evidence was very uncertain that exercise was better than the comparator in the short- (SMD: 0.64, 95%CI: 0.08 to 1.19, 3 studies) and long-term (SMD: 1.12, 95%CI: 0.36 to 1.89, n = 31, 1 study). No studies investigated medium-term pain or QOL. The evidence was very uncertain for exercise on short-and long-term pain and QOL. Studies with low risk of bias are required to confirm these effects and to determine if any specific exercise modality is more effective. The protocol was pre-registered in Open Science Framework on May 31st, 2024 (https://doi.org/10.17605/OSF.IO/FA3CR).

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Endometriosis is a complex chronic inflammatory disease with an unclear etiology and limited treatment options, severely affecting the reproductive health and quality of life of many women. Histone deacetylases (HDACs), as key epigenetic regulatory molecules, play a significant role in the pathogenesis and progression of endometriosis. This article reviews the abnormal expression of HDACs in endometriosis and their molecular mechanisms in driving the disease by regulating processes such as cell proliferation, apoptosis, inflammation, and epithelial-mesenchymal transition (EMT). It also summarizes the therapeutic potential of histone deacetylase inhibitors (HDACis) such as Vorinostat, Romidepsin, and Butyrate demonstrated in preclinical studies, and analyzes the main challenges currently faced in clinical translation. Finally, this article discusses the challenges and future research directions for developing novel endometriosis therapies targeting HDACs, aiming to provide references for in-depth research and clinical translation in this field.

β-Glucuronidase (β-G, EC 3.2.1.31) reverses phase II glucuronidation, and microbial β-G at the gut-liver interface reactivates biliary and circulating conjugates, closing enterohepatic loops for drugs, estrogens, bile acids, and bilirubin. Human GUSB buries catalytic glutamates in a deep pocket, whereas bacterial glycoside hydrolase family 2 (GH2) enzymes expose an open gorge with mobile loops and, in a flavin mononucleotide (FMN)-binding subclass, an allosteric site (enabling > 104-fold selective inhibition). This review surveys biochemical, microbiological, and translational literature with quantitative emphasis, advancing four positions: β-G activity follows a homeostatic-to-pathological continuum; interindividual gus operon and estrobolome variation necessitates pharmacomicrobiomic stratification; the estrobolome links gut β-G to female endocrine and hepatic health (breast cancer, endometriosis, polycystic ovary syndrome (PCOS), and metabolic dysfunction-associated steatotic liver disease (MASLD); and β-G is both a target to inhibit and a tool to exploit (e.g., SN-38 antibody-drug conjugates). Selective inhibitors (entropy-driven competitive, covalent-allosteric, natural products) are chemically mature, but efficacy is gated by microbial phenotype, not chemistry. We analyze structural determinants of selectivity, four substrate classes dictating distinct therapeutic responses, diagnostic platforms spanning bulk chromogenic assays to activity-based protein profiling, and a broadening chemotype space. We argue that combining fecal β-G phenotyping with genotype-informed, mechanistically matched inhibition is the most realistic near-term path to clinical benefit, while warning against indiscriminate suppression that may disrupt barrier-protective β-G activity.

While biological and lifestyle determinants of reproductive health are well documented globally, comprehensive data integrating socio-demographic, lifestyle, and health correlates within a contemporary Polish context remain limited. This study aimed to estimate the prevalence and identify correlates of self-reported fertility problems among adults completing a 2024 online survey in Poland (the National Fertility Test). Of the 8,000 respondents surveyed, the analytical sample comprised 5,532 (3,316 women, 2,216 men) who had attempted to conceive. Sex-specific, age-adjusted, Holm-Bonferroni-corrected logistic regression assessed associations between socio-demographic, lifestyle, and health variables and fertility problems. Within the analytical sample, 28.9% of respondents reported fertility problems (36.6% of women and 17.4% of men). Among women, the strongest associations were observed for Fallopian tube obstruction (OR = 23.0), polycystic ovary syndrome (OR = 5.35) and endometriosis (OR = 2.82), whereas a history of prior pregnancy (OR = 0.26) and better self-rated mental health (OR = 0.76) were associated with lower odds. Among men, associations were limited to use of reproductive supplements (OR = 4.06), varicocele or epididymal cysts (OR = 3.08), and a history of sexually transmitted infection (OR = 4.60). In both sexes, associations with behaviours such as supplement use and specific conception strategies likely reflect reverse causation, marking active help-seeking rather than causal risk factors. Given the self-selected sampling method, these findings should not be interpreted as population-level prevalence estimates for Poland, but confirm established clinical correlates alongside distinct socio-demographic and lifestyle patterns, underscoring the need for targeted reproductive health education. Lay Summary This study examined the frequency of fertility struggles among 8,000 Polish adults through the 2024 National Fertility Test, a nationwide online survey. Among the 5,532 participants who had attempted to conceive, 28.9% reported such difficulties. Factors linked to these struggles differed by sex. ● For women: conditions such as Fallopian tube obstruction, polycystic ovary syndrome (PCOS), thyroid disease, or endometriosis were among the strongest factors; a history of prior pregnancy and better self-reported mental health were both linked to lower odds of reporting current problems. ● For men: varicocele or epididymal cysts, and a history of sexually transmitted infection were the clearest factors identified. Due to the self-selected online nature of this cohort, results likely reflect participation bias from people currently attempting to conceive. Overall, the study underscores significant reproductive challenges in Poland, highlighting a strong, critical need for better health education and support tailored specifically to the Polish public.

OBJECTIVE: Pregnant women with coronavirus disease 2019 (COVID-19) are more likely than nonpregnant women to require admission to an intensive care unit, and many may require antiviral therapy. Remdesivir, an antiviral drug used to treat COVID-19, may exert toxic effects on specific tissues and organs. Therefore, this study investigated the effects of remdesivir on endometrial tissue in pregnant female mice. METHODS: Thirty female Naval Medical Research Institute (NMRI) mice were divided into five groups. The control group received no treatment, and the sham group received the remdesivir solvent, dimethyl sulfoxide. The 2-, 4-, and 8-mg groups received the corresponding doses of remdesivir. Treatment continued for 10 days. After injection and mating, the presence of a vaginal plug was considered to indicate gestational day 1. On gestational day 4.5, uterine tissue damage, pinopode status, serum estradiol levels, and tissue expression of interleukin-6 and interleukin-1β were examined. RESULTS: Serum estradiol levels and interleukin-6 expression in endometrial tissue decreased in a dose-dependent manner after remdesivir treatment. Remdesivir treatment was also associated with fewer uterine pinopodes and histological evidence of endometrial tissue injury (p<0.05). CONCLUSION: In pregnant mice, remdesivir reduced serum estradiol levels, decreased the number of endometrial pinopodes, and suppressed interleukin-6 expression. These findings suggest that remdesivir may adversely affect the endometrium and potentially compromise implantation; however, direct functional validation is required.

Introdução: A doença inflamatória pélvica (DIP) constitui importante causa de morbidade ginecológica e reprodutiva, podendo resultar em infertilidade tubária, gestação ectópica, dor pélvica crônica e abscesso tubo-ovariano. Objetivo: Analisar as principais atualizações relacionadas à epidemiologia, etiologia, diagnóstico, tratamento, prevenção e complicações da doença inflamatória pélvica. Metodologia: Trata-se de uma revisão narrativa da literatura realizada nas bases SciELO e PubMed, incluindo estudos publicados entre 2016 e 2026, em português, inglês e espanhol. Foram identificadas 39 publicações na SciELO e 57 no PubMed. Após a aplicação dos critérios de elegibilidade, análise dos textos selecionados e exclusão de estudos não pertinentes, 28 estudos compuseram a amostra final. Resultados: O diagnóstico da DIP permanece predominantemente clínico, enquanto exames laboratoriais e de imagem apresentam papel complementar, sobretudo na investigação de complicações e diagnósticos diferenciais. Evidenciou-se etiologia polimicrobiana, com participação de Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, anaeróbios e microrganismos associados à vaginose bacteriana. O tratamento empírico precoce e de amplo espectro permanece fundamental, destacando-se a associação entre ceftriaxona, doxiciclina e metronidazol. O rastreamento de infecções sexualmente transmissíveis, o tratamento das parcerias e a prevenção de reinfecções são essenciais para reduzir recorrências e sequelas. Conclusão: O manejo da DIP exige elevada suspeição clínica, tratamento oportuno e acompanhamento adequado. Novos testes moleculares, biomarcadores e estratégias direcionadas à resistência antimicrobiana apresentam potencial para aprimorar o diagnóstico e individualizar a terapêutica.

Este trabalho vai além da simples descrição de problemas ou limitações. Seu propósito é contribuir para a construção de estratégias que fortaleçam a apicultura regional, promovendo a integração entre produtores, instituições de pesquisa, órgãos de assistência técnica e formuladores de políticas públicas. Ao apresentar um diagnóstico detalhado da realidade local e apontar caminhos para o aprimoramento da atividade, a pesquisa busca subsidiar ações capazes de ampliar a produtividade, fortalecer a organização social dos apicultores e garantir maior sustentabilidade ambiental e econômica ao setor. Assim, esta obra constitui uma importante fonte de conhecimento para pesquisadores, estudantes, extensionistas rurais, gestores públicos e demais profissionais interessados no desenvolvimento sustentável do semiárido brasileiro. Mais do que um estudo sobre produção de mel, trata-se de uma reflexão sobre a relação entre sociedade, meio ambiente e desenvolvimento, evidenciando como a apicultura pode atuar como instrumento de geração de renda, conservação ambiental e promoção da qualidade de vida das populações que vivem e produzem em uma das regiões mais desafiadoras do território nacional.

A endometriose é uma doença inflamatória crônica associada a sintomas gastrointestinais e psiquiátricos, que acomete mulheres em idade fértil, causando grande impacto na qualidade de vida. Este estudo teve como objetivo analisar a prevalência de sintomas intestinais e psiquiátricos em mulheres com endometriose. Trata-se de um estudo retrospectivo e descritivo, realizado a partir da análise de 225 prontuários de pacientes atendidas em uma clínica particular em Cascavel (PR), entre janeiro de 2022 e agosto de 2025. Foram avaliadas manifestações intestinais, sintomas neuropsiquiátricos e função evacuatória. Sintomas intestinais estiveram presentes em 95,6% das pacientes, com predomínio de estufamento, constipação e dor à evacuação. Sintomas ansiosos e depressivos coexistiram em 67,6% das pacientes. Os achados sugerem forte associação entre alterações intestinais, manifestações clínicas de dor crônica e sintomas neuropsiquiátricos, reforçando o caráter multifatorial da endometriose e a necessidade de abordagem interdisciplinar.

Introdução: A endometriose é uma doença inflamatória crônica caracterizada pela presença de tecido semelhante ao endométrio fora do útero, com repercussões importantes na vida da mulher e na fertilidade. Objetivo: Identificar os impactos da endometriose na fertilidade feminina, relacionar a infertilidade aos impactos psicológicos e descrever o papel do enfermeiro no acolhimento a essas mulheres. Metodologia: Revisão integrativa realizada nas bases LILACS e SciELO, com uso de descritores relacionados a endometriose, infertilidade, tratamento, fertilidade, enfermagem e diagnóstico. Resultados: Os estudos analisados apontaram redução da qualidade de vida associada à dor, com repercussões psicológicas, emocionais e sociais. A enfermagem participa da promoção da saúde, do acolhimento e da orientação às mulheres diagnosticadas. Conclusão: A revisão reúne informações sobre os impactos da endometriose na fertilidade feminina e destaca a importância da assistência de enfermagem.

This study sought to examine the function of hematological inflammatory markers in differentiating endometrioma from other benign ovarian cysts prior to surgery and in individuals with Douglas infiltration. The study was designed retrospectively and included 480 patients (321 endometrioma, 159 non-endometrioma) who were operated on for benign ovarian cysts at Mersin University Hospital between January 1, 2004, and March 1, 2024. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were analyzed as hematological inflammatory markers. Additionally, the indices were evaluated in patients with Douglas infiltration, and ROC analysis was conducted to determine their predictive power. The average age of patients with endometrioma did not show a significant difference compared to the average of patients with other benign ovarian cysts (39.0 vs. 40.0 years, p = 0.174). NLR, PLR, SII, and SIRI were significantly higher in the endometrioma group ( p < 0.001). SIRI had the highest value (0.894) in distinguishing endometrioma from other benign ovarian cysts. Douglas infiltration was found to be significantly high with SII, PIV, and PLR having AUCs of 0.580, 0.567, and 0.564, respectively. Hematological inflammatory markers, particularly SIRI, were found to be useful in distinguishing endometriomas from other benign ovarian cysts, and PLR was identified as a potential non-invasive biomarker when analyzing its predictive power in patients with Douglas infiltration.

Endometriosis is a chronic, heterogeneous gynaecological disorder characterised by the presence of endometrial-like tissue outside the uterine cavity and is associated with pain, infertility, and reduced quality of life. Emerging evidence suggests that dysregulation of the Hippo signalling pathway—a central regulator of cell proliferation, survival, mechanotransduction, and tissue homeostasis—may contribute to several pathogenic processes involved in endometriosis. This narrative review synthesises direct evidence from endometriosis studies and clearly identified mechanistic evidence from related disease models. Aberrant Hippo pathway activity and sustained activation of the transcriptional co-activator YAP1 have been linked to enhanced cellular proliferation, invasive behaviour, apoptosis resistance, altered autophagy, ferroptosis resistance, fibrosis, and progesterone resistance. Hippo signalling integrates mechanical, metabolic, inflammatory, and hormonal cues within the endometriotic microenvironment and interacts with other disease-relevant pathways, including the mechanistic target of rapamycin (mTOR), estrogen and progesterone signalling, epigenetic regulation, and immune modulation. Preclinical and experimental findings suggest that components of the Hippo pathway and its regulatory network may represent potential non-hormonal therapeutic targets. However, no Hippo pathway-targeting strategy has been clinically validated for endometriosis, and the physiological roles of YAP/TAZ in tissue homeostasis and regeneration require careful consideration. Further subtype-resolved mechanistic studies, robust preclinical validation, and clinical safety assessment are, therefore, required before these approaches can be translated into practice.

Inguinal endometriosis is a very rare extrapelvic form of endometriosis, estimated to occur in only 0.3–0.6% of women with endometriosis. It mostly affects the right round ligament running inside the inguinal canal. Its symptoms, an intermittent, cyclical right groin mass or pain, can very easily be confused with an inguinal hernia, which results in patients not being diagnosed on time or being operated on inappropriately. Here we present a 38-year-old female patient with repeated episodes of gradually worsening and relieving right inguinal pain, in whom ultrasound and magnetic resonance imaging (MRI) findings were highly suggestive of inguinal endometriosis. Laparoscopic excision of the lesion together with the involved round ligament segment was performed, and histopathological examination confirmed the diagnosis, rather than management as a simple hernia.

Background. Endometriosis is a chronic gynecological disease that is frequently associated with infertility in women of reproductive age. Ovarian endometriosis, particularly endometriomas, may affect ovarian tissue and follicular function and may therefore be associated with a reduction in ovarian reserve. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) are widely used markers for assessing ovarian reserve. According to current recommendations, transvaginal ultrasonography is an important imaging modality for the diagnosis and assessment of endometriosis, while a comprehensive evaluation of clinical and ultrasound parameters may provide a more accurate assessment of reproductive potential [1,2]. However, the relationship between the morphological characteristics of endometriomas, ovarian reserve markers, and Doppler-derived blood-flow parameters remains insufficiently characterized. Objective. To investigate the relationship between ovarian reserve parameters, including serum AMH levels and antral follicle count, and ultrasound-Doppler characteristics of the ovaries and endometrium in women with endometriosis-associated infertility, and to evaluate their potential role in assessing reproductive potential. Materials and Methods. The study is planned to include women of reproductive age with endometriosis-associated infertility. Clinical and anamnestic characteristics, the stage of endometriosis, the presence of ovarian endometrioma, its size and localization, and unilateral or bilateral ovarian involvement will be assessed. Ovarian reserve will be evaluated based on serum AMH levels and the number of antral follicles determined by transvaginal ultrasonography. Doppler assessment will include vascular resistance and blood-flow parameters, including the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV). Endometrial thickness and morphology, as well as endometrial and subendometrial vascularization, will also be evaluated. The obtained data will be analyzed using correlation and multivariable statistical methods. Expected Results. The study is expected to determine the relationships between endometrioma characteristics, ovarian reserve parameters, and ultrasound-Doppler findings. Particular attention will be given to the associations of AMH levels and AFC with endometrioma size, unilateral or bilateral localization, ovarian morphometric characteristics, and blood-flow parameters. A comprehensive assessment of these parameters may allow the identification of potential predictors of reduced reproductive potential and the development of criteria for stratifying patients according to reproductive risk. Conclusion. Comprehensive assessment of ovarian reserve, morphological characteristics of endometriomas, and ultrasound-Doppler parameters of the ovaries and endometrium may contribute to a more objective evaluation of reproductive potential in women with endometriosis-associated infertility. Identification of clinically relevant associations between these parameters may provide a basis for developing an individualized prognostic algorithm and optimizing reproductive management in this patient population.

Endometriosis is a chronic inflammatory disorder characterized by aberrant stromal-cell behavior, including enhanced invasion, resistance to apoptosis, and sustained cytokine production. Dysregulation of Wnt/β-catenin signaling has been linked to these pathological features, emphasizing its association with disease-related cellular phenotypes. Identifying non-hormonal approaches that selectively target endometriotic stromal cells remains an important research focus. In this study, primary endometriotic stromal cell cultures derived from ectopic lesions of women with ovarian endometrioma were compared with primary control endometrial stromal cell cultures from women without endometriosis. Vimentin and CK18 were evaluated in separate flow-cytometry tubes; therefore, the designation of these cultures as stromal cultures is operational and does not imply complete lineage purity. Cells were treated with Salinomycin, and MTT-derived viable-cell/metabolic activity, Matrigel invasion, cytokine secretion, and selected molecular markers related to Wnt/β-catenin signaling, cell-cycle regulation, invasion, and apoptosis were evaluated using MTT assays, Transwell assays, ELISA, and quantitative real-time PCR. Salinomycin induced a dose- and time-dependent reduction in MTT signal, with primary endometriotic cultures showing greater sensitivity than control cultures. At the selected experimental concentration, salinomycin reduced the viable-cell/metabolic signal and invasion in primary endometriotic stromal cell cultures and decreased IL-6 and IL-8 secretion. These phenotypic changes were accompanied by increased β-catenin phosphorylation at Ser45, reduced AXIN2, Cyclin D1, and MMP-9 expression, and increased Caspase-3 expression in ectopic cultures. Because MTT alone cannot distinguish reduced proliferation from cytotoxicity or altered metabolism, the findings are interpreted as viability-associated and proliferation-associated responses rather than direct proof of isolated growth arrest. These findings indicate that Salinomycin modulates disease-relevant features of primary endometriotic stromal cell cultures in association with Wnt/β-catenin pathway-related changes and support further mechanistic investigation of this experimental non-hormonal approach.

Background Microplastics (MPs) have recently been identified in multiple human biological matrices, including placenta, blood, breast milk, semen, and testicular tissue, raising concerns regarding their potential endocrine, inflammatory, and reproductive effects. Despite this rapidly expanding field, the ovarian follicular microenvironment remains largely understudied, and data on the direct presence of MPs in human follicular fluid (FF) are limited. Objective This pilot study aimed to qualitatively assess the presence and polymer composition of MPs in human FF obtained during in vitro fertilization (IVF) using a contamination-controlled workflow and confocal micro-Raman spectroscopy. Methods FF samples from 27 women undergoing IVF were processed under strict contamination-control conditions. Organic material was digested using 10% potassium hydroxide (KOH), followed by vacuum filtration through 1.6 µm glass-fiber filters. Filters were screened by optical microscopy, and suspected particles were analyzed using 532 nm confocal micro-Raman spectroscopy and matched against validated polymer spectral libraries. Procedural blanks were included in each analytical batch. Results MPs were detected in 22 of 27 FF samples (81.5%). Positive samples contained between one and three particles. Identified polymers included polypropylene (PP; most frequent), polyethylene (PE), polyamide (PA), polystyrene (PS), and polyethylene terephthalate (PET). No MPs were detected in procedural blanks. Conclusions MPs were detectable in the majority of FF samples under contamination-controlled conditions. While the clinical implications remain unclear, these findings support the presence of MPs within the ovarian microenvironment and highlight the need for larger, standardized, and mechanistic studies.

Background. Endometriosis is a common chronic gynecological disease among women of reproductive age and is frequently associated with impaired reproductive function and infertility. The clinical manifestations and extent of pelvic organ involvement vary considerably among patients, necessitating a differentiated approach to the assessment of reproductive potential. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) are important parameters for evaluating ovarian reserve. Modern transvaginal ultrasonography enables not only the detection of structural changes associated with endometriosis but also the assessment of morphological and hemodynamic characteristics of the pelvic organs.

(No abstract on file for this paper.)

BACKGROUND: Uterine adenomyosis involves the growth of endometrial gland and stroma within the uterine musculature. Patients with uterine adenomyosis experience heavy painful periods, deep dyspareunia and subfertility, reducing their overall quality of life. Hysterectomy is usually the recommended treatment for such patients. Whilst uterine artery embolization (UAE) offers a suitable, fertility-preserving alternative, for patients who have not completed their families, its impacts on pregnancy outcomes have not yet been explored or studied in women with pure adenomyosis. OBJECTIVE: The objective of the current study was to assess pregnancy and live birth rates in women with pure adenomyosis, treated with UAE. SEARCH STRATEGY: A comprehensive systematic review of the published literature, in Pubmed, Embase, Cochrane, Google Scholar, Scopus and ClinicalTrials.gov, was performed from January 2000 until January 2025. SELECTION CRITERIA: All the published and unpublished literature in English language, describing pregnancy outcome after uterine artery embolization for pure uterine adenomyosis, were eligible for inclusion in the study. DATA COLLECTION AND ANALYSIS: Data about preconception characteristics, pregnancy, obstetrics and neonatal outcomes were extracted and analyzed according to the study design source and pregnancy viability. MAIN RESULTS: We identified nine papers, with a total cohort of 578 patients, of which 208 desiring fertility. Women were aged 18-52, with a mean follow up of 46.3 months after UAE. We concluded a pregnancy rate of 41.20% (n = 28) and a live birth rate of 95.70% (n = 23) in this cohort. Of these, seven studies reported obstetric and/or neonatal complications, including preterm, premature rupture of membranes, hemorrhage during delivery, low birth weight and neonatal deaths. CONCLUSION: The current study showed that the pregnancy rates after uterine artery embolization are comparable to assisted conception clinical success rates for women with uterine adenomyosis, but with markedly higher live birth rates. UAE provides a foundation for further studies and research, directly assessing pregnancy outcomes and indirectly assessing the fertility potential in women with pure adenomyosis, with the potential to influence uterine adenomyosis treatment guidelines. Our research provides a foundation on which healthcare professionals can effectively counsel and treat fertility preserving women with pure uterine adenomyosis.

Chronic pelvic pain is one of the most disabling manifestations of endometriosis and is frequently associated with impaired quality of life, bladder dysfunction, and sexual dysfunction. Pelvic floor muscle (PFM) dysfunction may contribute to a potential contributor to symptom persistence; however, objective evidence regarding its role in women with endometriosis is limited. To examine and compare pelvic floor muscle (PFM) function, assessed using vaginal manometry, together with patient-reported measures of pelvic pain, pelvic floor symptoms in women with and without endometriosis. Secondary aims were to explore preliminary between-group differences and examine the associations between PFM function and symptom severity. In this pilot cross-sectional case–control study, 31 women aged 18–45 years were recruited. One participant was excluded from the control group, resulting in a final sample of ; 30 participants, including 15 women with medically confirmed endometriosis and 15 controls. Participants completed the Pelvic Pain Impact Questionnaire (PPIQ), Numeric Rating Scale (NRS) for pain, and Australian Pelvic Floor Questionnaire (APFQ). Pelvic floor muscle function was assessed using intravaginal manometry, including measures of resting pressure, maximal voluntary contraction (MVC), and the number of rapid contractions performed within 30 seconds. Group differences were examined using univariate analyses and analyses of covariance controlling for age, body mass index, and vaginal delivery history. Spearman correlations were calculated to investigate associations between PFM function and patient-reported outcomes. Women with endometriosis reported significantly higher average and maximal pain intensity, greater pelvic pain-related disability, and more severe bladder and sexual symptoms than controls (all p < 0.05). They also demonstrated significantly higher vaginal resting pressure and lower MVC values. After adjustment for covariates, significant group differences remained for pain outcomes, pelvic pain impact, bladder and sexual function, total APFQ score, and resting PFM tone (p < 0.05). MVC was moderately associated with bladder symptoms (ρ = −0.384, p = 0.036), sexual function (ρ = −0.470, p = 0.009), and overall pelvic floor symptom burden (ρ = −0.435, p = 0.016). No significant associations were observed between PFM parameters and pelvic pain-related disability. Women with endometriosis showed higher symptom burden and differences in selected pelvic floor muscle parameters compared with controls without a diagnosed gynaecological disorder. These exploratory findings warrant confirmation in prospective studies with larger sample sizes. ClinicalTrials.gov Identifier: NCT07713108 (01.07.2026)

A endometriose é uma doença ginecológica crônica e inflamatória que pode provocar dor pélvica, dismenorreia, dispareunia, sintomas gastrointestinais, infertilidade e prejuízos à qualidade de vida. Considerando a participação da inflamação e do estresse oxidativo em sua fisiopatologia, a alimentação tem sido investigada como estratégia complementar ao tratamento. Este estudo teve como objetivo analisar a influência da alimentação no manejo dos sintomas da endometriose e na qualidade de vida das mulheres acometidas. Foi realizada uma revisão integrativa da literatura, de caráter descritivo e abordagem qualitativa. A busca contemplou artigos publicados entre 2021 e 2026, disponíveis nas bases PubMed/MEDLINE, Biblioteca Virtual em Saúde, SciELO e Google Acadêmico. Foram incluídos estudos que investigaram padrões alimentares, dietas, nutrientes, suplementos ou compostos bioativos relacionados às manifestações clínicas da doença. Os resultados indicaram possíveis benefícios da dieta mediterrânea sobre a dor e o estresse oxidativo, da dieta com baixo teor de FODMAP sobre os sintomas gastrointestinais e de determinados nutrientes e antioxidantes sobre marcadores inflamatórios e oxidativos. Entretanto, as evidências referentes à suplementação e às dietas restritivas apresentaram resultados heterogêneos. Conclui-se que a alimentação pode contribuir para o manejo de manifestações específicas e para a melhoria da qualidade de vida, mas ainda não existe uma estratégia nutricional única aplicável a todas as mulheres. Assim, as intervenções alimentares devem ser individualizadas, orientadas por nutricionista e utilizadas de forma complementar ao tratamento médico.

Endometriosis is a chronic and often debilitating condition whose symptoms extend beyond pelvic pain to include fatigue, gastrointestinal and urinary complaints, menstrual irregularities, and reduced work capacity. These symptoms are typically framed within medical or occupational health discourse, yet little attention has been paid to how they are socially interpreted within workplace relationships. Drawing on the workplace bullying literature alongside qualitative research on the lived experience of endometriosis, this conceptual review proposes that endometriosis-related symptoms are minimized through two interconnected mechanisms: symptom fragmentation, in which the disease’s varied and cyclical presentations are perceived as unrelated complaints rather than expressions of one chronic illness, and identity pathologization, in which the resulting pattern of absence and reduced capacity is reattributed to the worker’s character rather than her condition. The review further situates these mechanisms within the broader literature on women-to-women workplace bullying and examines how humor may function as a socially deniable vehicle for mistreatment. Three anonymized vignettes drawn from clinical practice illustrate each mechanism in isolation and in combination, tracing the self-reinforcing loop through which fragmentation and pathologization sustain one another over time. Practical implications are offered for occupational health practice, managerial training, anti-bullying policy, and clinical care. The aim is not to psychologize endometriosis, but to contextualize suffering that currently falls between medical, organizational, and psychological frameworks—and to prevent the gradual transformation of illness into stigma and of symptoms into moral judgment.

Endometriosis is a chronic estrogen-dependent inflammatory disorder affecting approximately 10% of women of reproductive age. It remains a major contributor to chronic pelvic pain, infertility, and reduced quality of life. Despite considerable advances in elucidating its genetic, hormonal, and immunological basis, current therapeutic strategies frequently provide incomplete symptom relief, may be associated with adverse effects, and fail to prevent disease recurrence. Therefore, increasing attention has been directed toward modifiable environmental factors, particularly nutrition, as supplementary strategies for disease management. This review comprehensively examines the evidence connecting dietary patterns and bioactive food components with the immunopathogenesis of endometriosis. It explores the potential role of nutrition in modulating key biological processes involved in endometriosis pathophysiology and progression, including immune dysregulation, chronic inflammation, oxidative stress, angiogenesis, estrogen metabolism, and gut microbiota imbalance. Particular emphasis is placed on the Mediterranean diet and selected dietary components, such as omega-3 fatty acids, vitamin D, resveratrol, epigallocatechin-3-gallate, and probiotics, as well as dietary interventions like low-FODMAP and gluten-free diets. The findings are discussed in relation to mechanistic evidence and emerging observations. Substantial clinical data supporting specific dietary interventions are scarce, and most dietary guidelines are based on preliminary research. Future investigations that incorporate nutritional interventions alongside immune profiling, microbiome analysis, and multi-omics technologies may facilitate the development of individualized nutritional strategies as adjuncts within the framework of precision medicine for women affected by endometriosis.

Endometriosis profoundly impairs sexual function in women. Despite evidence supporting motivational interviewing (MI) and pelvic floor muscle training (PFMT) separately, no study has directly compared these two approaches on sexual function in endometriosis. This trial compared the effectiveness of MI versus PFMT on sexual function in women with endometriosis. This parallel-group, active-controlled randomized trial was conducted at Baghaeipour Clinic, Yazd, Iran (October 2024 – April 2025). Sixty women with endometriosis (30 per group) were randomly assigned to six weekly 90‑minute sessions of MI or PFMT delivered virtually. Both groups received routine care including lubricant gel. Sexual function was measured using the Female Sexual Function Index (FSFI) at baseline (T0), immediately post‑intervention (week 6, T1), and two months after intervention completion (week 14, T2). Data were analyzed using independent t‑tests, Chi‑square tests, and repeated‑measures ANOVA. Fifty‑four participants (27 per group) completed the study. Both groups were homogeneous at baseline. In the MI group, mean FSFI scores improved from baseline to T1 (17.82 ± 6.80 to 22.07 ± 7.41, p < 0.001) and to T2 (26.10 ± 3.35, p < 0.001), with sustained improvement from T1 to T2 (p < 0.001). In the PFMT group, scores improved from baseline to T1 (17.07 ± 6.04 to 23.43 ± 5.28, p < 0.001) and to T2 (24.30 ± 5.62, p 0.05). Time had a significant effect (p < 0.001), but neither group (p = 0.880) nor time‑group interaction (p = 0.418) was significant. Both motivational interviewing and pelvic floor muscle training were associated with improved sexual function in women with endometriosis. No statistically significant difference was observed between the interventions. Both approaches offer non-invasive, complementary options for managing endometriosis-related sexual dysfunction, though further large-scale research is needed to confirm these findings and establish comparative long-term efficacy. This research was registered in the Iranian Registry of Clinical Trials (IRCT20240623062218N1) on 2024-09-14. Endometriosis can negatively affect sexual health and quality of life. This study compared two non-drug approaches, motivational interviewing (MI) and pelvic floor muscle training (PFMT), to improve sexual function in women with endometriosis. Sixty women were randomly assigned to receive six weekly online sessions of either MI or PFMT. Sexual function was assessed at baseline, immediately after the six-week intervention, and at the two-month follow-up. Fifty-four women completed the study. Sexual function improved significantly over time in both groups. However, there was no significant difference between the two interventions, and neither approach was shown to be superior. These findings suggest that both MI and PFMT may be feasible and useful complementary approaches for managing sexual dysfunction related to endometriosis. Larger studies with longer follow-up and appropriate control groups are needed to confirm these findings.

Endometriosis is a chronic, estrogen-dependent inflammatory condition that is marked by the growth of lesions outside the uterus, along with angiogenesis, fibrosis, immune dysregulation, and pain sensitization. There is now growing evidence that receptor tyrosine kinase (RTK) signaling networks are central to these processes, integrating proliferative, angiogenic, inflammatory, endocrine, and microenvironmental signals. This review summarizes the roles of six major RTK axes in endometriosis and evaluates their receptor-specific mechanisms, therapeutic relevance, and modulation by representative phytochemicals. An English-language literature search of PubMed was conducted with no publication date restrictions using combinations and variations of the following keywords: phytochemicals, endometriosis, EGFR, VEGFR, IGF1R, PDGFR, FGFR, MET, curcumin, resveratrol, epigallocatechin gallate (EGCG), quercetin, naringenin, berberine, apigenin, luteolin, genistein, and baicalein. Additional search terms related to receptor signaling mechanisms, downstream pathways, cellular phenotypes, and therapeutic relevance were also incorporated to ensure comprehensive coverage of the literature. The RTK signaling pathways control stromal activation, lesion survival, angiogenic support, extracellular matrix remodeling, neuroimmune sensitization, and malignant progression. Of the six RTK axes examined, EGFR, VEGFR, and IGF1R have the strongest mechanistic and pharmacological support, whereas PDGFR, FGFR, and MET remain biologically plausible targets. Even though phytochemicals do not consistently act as receptor-selective RTK inhibitors, evidence shows they reduce RTK-centred signaling networks by targeting common downstream hubs. As a result of their effects at the network level, the phytochemicals may help to suppress lesion proliferation, angiogenesis, invasion, fibrosis, inflammation, oxidative stress, and pain sensitization. Endometriosis should be viewed as an RTK-centered network disease rather than a single-pathway disorder. In this context, phytochemicals act as modulators that attenuate signaling hubs, offering a mechanistically aligned strategy for a disease driven by redundancy and microenvironmental crosstalk.

ABSTRACT Key Content High‐quality ultrasound has been proven to be highly accurate in diagnosing ovarian endometriomas and deep endometriosis. Despite strong evidence supporting routine use of ultrasound, there is currently still heavy reliance on magnetic resonance imaging (MRI) and laparoscopy for endometriosis diagnosis in the United Kingdom. While MRI remains a valuable tool in endometriosis diagnosis due to its multiplanar imaging capability and operator‐independence, overreliance without integrating ultrasound can contribute to diagnostic delays and increased healthcare costs. Adoption of high‐quality ultrasound could better streamline endometriosis care and improve patient experience by reducing diagnostic delays, facilitating wider use of medical treatment, reducing costs, and avoiding invasive tests. Learning Objectives Understand how high‐quality ultrasound differs from standard ultrasound in evaluating deep endometriosis. Understand the diagnostic accuracy of ultrasound for different subtypes of endometriosis. Understand the current limitations of ultrasound in endometriosis diagnosis and recognise strategies to address them. Ethical Issues An overfocus on endometriosis as a cause for pelvic pain can lead to other gynaecological and non‐gynaecological causes being overlooked. This can delay appropriate treatment and prolong suffering. High‐quality ultrasound for endometriosis is currently not equally available across centres in the United Kingdom as it requires specialised training and expertise. Unequal access raises concerns about health inequalities in timely diagnosis and treatment depending on geographic location or socio‐economic status.

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Background: Endometriosis affects approximately 6–10% of women of reproductive age—an estimate that varies substantially with the diagnostic standard applied—and is increasingly recognized as a systemic inflammatory disease. Growing evidence implicates shared immunological pathways between endometriosis and autoimmune thyroid disease, yet large-scale real-world evidence from standardized multi-site data remains limited. We evaluated the association between endometriosis and newly recorded autoimmune thyroid disease using federated Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) data from 12 Korean hospitals. Methods: We conducted a propensity score (PS)-matched cohort study using OMOP-CDM version 5.3 data from 12 Korean tertiary academic medical centers. Women aged 18–60 years with a first recorded endometriosis diagnosis were matched 1:1 to controls without endometriosis on age, calendar year, hypertension, and selected Charlson comorbidity index components. Site-specific Cox proportional hazards models, fitted to patient-level records locally at each institution, estimated hazard ratios (HRs) for newly recorded autoimmune thyroid disease, defined as Hashimoto’s thyroiditis or Graves’ disease. Pooled estimates were derived using DerSimonian–Laird random-effects meta-analysis; leave-one-out meta-analysis, meta-regression on site-specific follow-up ratio, and an E-value were used to assess robustness. Results: After 1:1 PS matching, 71,619 women with endometriosis and 71,619 matched controls were included. Mean follow-up was 2693 days in the endometriosis group and 1677 days in the control group. A directionally positive but statistically inconclusive association was observed between endometriosis and autoimmune thyroid disease (pooled HR 1.22, 95% CI 0.97–1.53; p = 0.090; I2 = 38.2%). Seven of twelve sites reported HRs above 1.0, including two sites reaching individual statistical significance: AUMC (HR 1.38, p = 0.030) and KHUH (HR 2.69, p < 0.001). The pooled HR remained above 1.0 in all 12 leave-one-out iterations (range 1.17–1.31); omission of KHUH reduced I2 to 6.6%. Site-specific follow-up imbalance was not associated with the site-specific log HR (meta-regression p = 0.887). The E-value for the point estimate was 1.74. Conclusions: In this multi-site OMOP-CDM analysis, endometriosis showed a directionally positive but statistically inconclusive association with newly recorded autoimmune thyroid disease. The confidence interval is compatible with both no association and a clinically meaningful increase in risk, and the findings are hypothesis-generating rather than confirmatory. They do not support any change in the clinical evaluation of women with endometriosis. Further validation is warranted using standardized outcome definitions, thyroid autoantibody measurements, and thyroid function tests.

BACKGROUND: The impact of inflammatory bowel disease (IBD) on embryo chromosomal competence during in vitro fertilization (IVF) remains poorly defined. This study aimed to evaluate embryo euploidy rates among patients with IBD undergoing IVF with preimplantation genetic testing for aneuploidy (PGT-A), compared with patients without IBD. METHODS: This retrospective cohort study was conducted at an urban, academic reproductive medicine center. A total of 43 patients with IBD (Crohn's disease or ulcerative colitis) and 129 matched controls without IBD who underwent IVF with PGT-A between 2011 and 2022 were included. Patients with endometriosis, severe male factor infertility, prior chemotherapy or radiation exposure, or chromosomal translocations were excluded. All patients underwent controlled ovarian hyperstimulation, oocyte retrieval, intracytoplasmic sperm injection, and trophectoderm biopsy with PGT-A using next-generation sequencing. The primary outcome was euploid blastocyst rate. Secondary outcomes included oocyte yield, oocyte maturity and fertilization rates, blastulation rate, and rates of aneuploid and mosaic embryos. RESULTS: Euploid blastocyst rates were identical between patients with and without IBD (47.5% vs. 47.5%, P=0.99), with no significant differences in aneuploid or mosaic embryo rates. Patients with IBD had significantly higher total and mature oocyte yields despite comparable baseline ovarian reserve parameters. No differences were observed in oocyte maturity, fertilization, or blastulation rates. Results remained unchanged after multivariate adjustment. CONCLUSIONS: In this cohort, patients with IBD undergoing IVF with PGT-A had euploid blastocyst rates similar to those without IBD, suggesting no clear impact on embryo chromosomal competence. However, given the retrospective design and small sample size, these findings should be interpreted with caution, and a modest effect cannot be excluded. Overall, the results provide some clinical reassurance and support ART as a reasonable option for patients with IBD, while underscoring the need for prospective studies to further evaluate disease-related factors.