What's new in endo & adenomyosis research

Abstract Background Progressive fibrosis of ectopic lesions is a major pathological feature of endometriosis, contributing to treatment resistance and disease recurrence. However, the mechanisms driving this fibrotic process remain incompletely understood. Methods A murine model of endometriosis was established by transplanting endometrial tissue fragments into the peritoneal cavity of C57BL/6 mice. Macrophage-derived migrasomes were isolated from cultured RAW264.7 cells, characterized by scanning electron microscopy and Western blot, and administered intraperitoneally to endometriosis-bearing mice. Fibrotic changes were assessed by histology, immunofluorescence, and Western blot analysis of signaling pathways and epithelial-mesenchymal transition (EMT) markers. Cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA). Results Exogenously administered macrophage-derived migrasomes accumulated at ectopic lesion sites and markedly aggravated fibrotic remodeling. Migrasome-treated lesions exhibited cyst-wall thickening, increased stromal cellularity, and extensive collagen deposition. At the molecular level, migrasome treatment was associated with activation of the transforming growth factor-beta (TGF-β)/Smad pathway in ectopic lesions, as indicated by increased phosphorylation of Smad2 and Smad3 without significant changes in total Smad2/3 levels. This was accompanied by increased α-smooth muscle actin and vimentin expression together with reduced cytokeratin 18 (CK18) and E-cadherin expression, consistent with EMT-like phenotypic reprogramming. In parallel, TGF-β1 and VEGF levels were elevated, whereas MMP9 was reduced, collectively supporting a pro-fibrotic microenvironment. Conclusions These findings identify macrophage-derived migrasomes as previously unrecognized promoters of fibrotic remodeling in endometriosis and support a role for migrasome-associated signaling in lesion progression. This work provides new insight into the pathogenesis of endometriosis-associated fibrosis and highlights migrasomes as a potential target for future anti-fibrotic intervention.

Objetivo: Sintetizar e analisar criticamente as evidências científicas disponíveis sobre o impacto do tratamento cirúrgico laparoscópico na qualidade de vida de mulheres com endometriose profunda. Métodos: Trata-se de uma revisão integrativa da literatura, estruturada pela estratégia PICO: "Em mulheres com endometriose profunda, qual é o impacto do tratamento cirúrgico sobre a qualidade de vida em comparação à condição pré-operatória ou a parâmetros comparativos de referência?". A busca foi realizada em 9 de agosto de 2026 nas bases PubMed/MEDLINE e LILACS (via BVS), combinando descritores DeCS/MeSH (Endometriose, Procedimentos Cirúrgicos Operatórios, Procedimentos Cirúrgicos Ginecológicos, Laparoscopia e Qualidade de Vida) e termos livres pelos operadores booleanos AND e OR. Foram incluídos estudos clínicos primários publicados entre 2016 e 2026, em português, inglês ou espanhol, em acesso aberto, que avaliaram a qualidade de vida após tratamento cirúrgico por meio de instrumentos validados. O processo de seleção seguiu o fluxograma PRISMA 2020, dispensando apreciação pelo sistema CEP/CONEP por utilizar dados secundários de domínio público. Resultados: Foram incluídos 19 estudos clínicos primários (15 estudos longitudinais pré e pós-operatórios, somando 1.891 pacientes operadas únicas, e quatro estudos transversais analíticos pós-operatórios, somando 484 pacientes operadas), totalizando 2.375 pacientes operadas únicas (2.877 participantes totais ao se incluírem 502 mulheres de grupos controles saudáveis e comparativos sob manejo clínico). Os instrumentos validados mais utilizados foram o Endometriosis Health Profile (EHP-30/EHP-5, em 12 estudos; 63,2%), o Short Form Health Survey (SF-36/SF-12, em cinco estudos; 26,3%) e o Female Sexual Function Index (FSFI, em quatro estudos; 21,1%). Todos os 15 estudos longitudinais (100%) demonstraram melhora pós-operatória significativa nos domínios de dor corporal, capacidade funcional e dispareunia em seguimentos de um mês a quatro anos. Também foi observada redução nos escores de ansiedade e depressão, embora a recuperação dos domínios emocionais, de autoimagem, de suporte social e de desejo sexual tenha se mostrado menos uniforme, sendo negativamente influenciada por múltiplas cirurgias prévias, preocupação com a fertilidade, disfunções intestinais pós-operatórias (como a síndrome da ressecção anterior baixa) e uso de terapia hormonal adjuvante. Conclusão: O tratamento cirúrgico da endometriose profunda promove melhora significativa na qualidade de vida, com maior magnitude e consistência sobre os desfechos álgicos, funcionais e de dor sexual, exigindo indicação individualizada, preservação funcional nervosa e acompanhamento multidisciplinar para o manejo de demandas psicossociais e funcionais persistentes.

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Background Stromal heterogeneity, regulated-cell-death-associated stress, and chronic inflammation contribute to endometriosis, but their relationships within specific stromal populations remain incompletely understood. This study integrated clinical characterization with single-cell and spatial transcriptomics to investigate a TCF21-associated stromal death–inflammation signature. Methods A retrospective cohort of 150 patients with histopathologically confirmed endometriosis was characterized clinically. Public single-cell datasets (GSE179640 and GSE213216) were analyzed to identify stromal populations, reconstruct transcriptional trajectories, evaluate death-associated and inflammatory programs, and infer intercellular communication. Spatial transcriptomic analysis assessed TCF21-associated expression patterns in endometriotic lesions. Multiplex immunofluorescence, RT-qPCR, TCF21 silencing, EdU incorporation, Transwell assays, and three-dimensional spheroid culture were used for experimental evaluation. Results Single-cell analysis identified 13 major cell classes and a fib-TCF21-associated stromal state characterized by TCF21, NEXN, IFI44L, WNT2B, and SPRR2F. Cell-death-associated and inflammatory transcriptional programs varied across stromal states, with fib-TCF21 exhibiting selective rather than uniformly elevated program activity. Independent single-cell analysis identified a related but anatomically heterogeneous stromal expression pattern. Spatial transcriptomics demonstrated localized TCF21 expression and heterogeneous distributions of stromal, stress-associated, and inflammatory programs. Tissue immunofluorescence supported stromal-associated TCF21 expression, while lesion-derived ihESCs exhibited higher basal TCF21 expression than the eutopic stromal-cell model. TCF21 silencing was associated with reduced EdU incorporation, Transwell membrane traversal, and three-dimensional spheroid growth. Conclusion Integration of clinical, single-cell, spatial, and experimental findings identifies a TCF21-associated stromal transcriptional signature linked to heterogeneous death-related stress and inflammatory programs in endometriosis. These findings support further investigation of TCF21-associated stromal biology and its potential relevance to molecularly targeted interventions.

A endometriose profunda constitui uma condição ginecológica crônica e complexa, cujo potencial álgico e inflamatório impacta significativamente a qualidade de vida das mulheres, repercutindo nas dimensões física, emocional e psicossocial. Diante disso, este estudo objetiva analisar os impactos da endometriose profunda na qualidade de vida de uma paciente, considerando seu itinerário clínico, os desafios cotidianos e as estratégias de enfrentamento (coping) adotadas. Trata-se de uma pesquisa de abordagem qualitativa, de caráter descritivo e exploratório, operacionalizada por meio do método de relato de caso. A coleta de dados foi realizada por meio de entrevista semiestruturada, fundamentada em um roteiro flexível composto por perguntas abertas. O estudo analisa as repercussões da dor crônica, as limitações funcionais e os agravos emocionais vivenciados, além de compreender os mecanismos de adaptação desenvolvidos pela participante. Os achados contribuem para a ampliação do conhecimento científico acerca da temática, reiterando a importância do cuidado integral e humanizado no âmbito da saúde da mulher.

A endometriose é uma doença ginecológica crônica e inflamatória frequentemente associada à dor pélvica, podendo comprometer a qualidade de vida e apresentar repercussões funcionais e psicossociais. Diante da persistência dos sintomas e da necessidade de estratégias complementares, torna-se relevante investigar a atuação da fisioterapia no manejo da dor pélvica crônica associada à endometriose. Esta pesquisa, portanto, trata-se de uma revisão integrativa da literatura, de abordagem qualitativa e descritiva. A busca foi realizada nas bases PubMed, Biblioteca Virtual em Saúde (BVS), SciELO e PEDro, considerando estudos publicados entre 2022 e 2026, disponíveis integralmente e gratuitamente, nos idiomas português, inglês e espanhol. Foram incluídos estudos sobre intervenções fisioterapêuticas e dor pélvica em mulheres com endometriose. Foram identificados 42 estudos, dos quais cinco foram incluídos. Os achados demonstraram resultados promissores da fisioterapia na redução da dor pélvica, dispareunia e sensibilização pélvica, além de possíveis benefícios sobre a qualidade de vida. Destacaram-se fisioterapia do assoalho pélvico, terapia manual, exercícios terapêuticos, hidroterapia, massagem, eletroterapia e educação em saúde. Entretanto, a heterogeneidade dos protocolos, o tamanho reduzido das amostras e a ausência de acompanhamento prolongado dificultaram a definição de uma abordagem fisioterapêutica padronizada. A Fisioterapia apresenta resultados favoráveis no manejo da dor pélvica crônica associada à endometriose, com efeitos variáveis conforme a intervenção e o desfecho, reforçando a necessidade de abordagens individualizadas e de novos estudos com maior rigor metodológico.

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Durante a adolescência, ocorrem diversas mudanças no desenvolvimento do indivíduo, envolvendo aspectos físicos, emocionais e sociais, e para muitas jovens se inicia o ciclo menstrual. Embora a menstruação seja um processo fisiológico natural, a presença de dor intensa pode indicar condições patológicas, como a endometriose, que consiste em uma condição inflamatória crônica na qual células semelhantes às do endométrio estão presentes em outras regiões do organismo, podendo provocar dor e outros sintomas. Apesar de ser mais diagnosticada em mulheres adultas, evidências apontam que os primeiros sintomas da endometriose frequentemente se manifestam ainda na adolescência, sendo comumente confundidos com cólicas menstruais consideradas “normais”. Este estudo tem como objetivo analisar os desafios e as dificuldades no diagnóstico da endometriose em adolescentes e seus impactos na qualidade de vida. A pesquisa consiste em uma revisão integrativa da literatura, de caráter descritivo e exploratório, realizada por meio da consulta às bases PubMed, SciELO, LILACS, Science.gov e Biblioteca Virtual em Saúde, considerando estudos publicados entre 2012 e 2026. Os resultados evidenciam que a normalização da dor menstrual, o tabu relacionado à menstruação, a tendência de considerar a dor menstrual algo normal e os desafios para reconhecer a doença ainda em sua fase inicial e a insuficiente capacitação dos profissionais de saúde contribuem para o atraso diagnóstico. Observou-se que o diagnóstico tardio está associado a prejuízos no desempenho escolar, nas relações sociais e no bem-estar psicológico das adolescentes, além de favorecer a progressão da doença. Conclui-se que a detecção precoce da endometriose na adolescência é fundamental para a redução do sofrimento físico e emocional, sendo necessárias ações educativas, capacitação profissional, ampliação de práticas de cuidado integral, acolhedor e humanizado.

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A adenomiose causa dismenorreia, sangramento uterino aumentado e infertilidade, e a escolha entre tratamento medicamentoso, procedimentos que preservam o útero e cirurgia carece de critérios consolidados. Esta revisão integrativa analisou as evidências publicadas entre 2021 e 2026 sobre eficácia, segurança e seleção de pacientes nas abordagens terapêuticas da adenomiose, com ênfase nos critérios para intervenção cirúrgica. A busca foi feita em 4 de novembro de 2026 no PubMed/MEDLINE, na LILACS e na SciELO, com relato orientado pelo PRISMA 2020 e nível de evidência segundo Melnyk e Fineout-Overholt. Dos 198 registros identificados, 44 estudos foram incluídos: 24 revisões sistemáticas, 10 ensaios clínicos randomizados e 10 estudos observacionais. A mifepristona reduziu a dor em 6,63 pontos na escala visual analógica, contra 0,95 com placebo, e o dienogeste superou o sistema intrauterino de levonorgestrel no alívio da dor em parte dos estudos. A ablação por ultrassom focalizado obteve remissão da dismenorreia em 79% dos casos, com recorrência de 20%. Em metanálise de estudos de braço único, a recorrência foi de 12,6% após adenomiomectomia, 29,5% após embolização e 10,0% após ablação térmica, e o estudo QUESTA não demonstrou não inferioridade da embolização frente à histerectomia. Critérios explícitos de escolha (idade, paridade, subtipo, espessura miometrial ou tamanho do útero) foram descritos em um único estudo, sem validação. Nenhum estudo primário brasileiro foi incluído. Os dados são compatíveis com escolha individualizada, mas vêm sobretudo de estudos de curto prazo e de centros asiáticos.

Polycystic ovary syndrome (PCOS) and endometriosis are prevalent gynecological disorders associated with chronic inflammation, oxidative stress, hormonal dysregulation, and impaired fertility. Current treatments primarily focus on symptom management and may be limited by adverse effects and disease recurrence. Extracellular vesicles (EVs) are promising cell-free therapeutic and diagnostic platforms that transport bioactive cargo, including microRNAs, proteins, and lipids. This review explores the therapeutic and diagnostic potential of human-, animal-, and plant-derived EVs in PCOS and endometriosis, distinguishing direct evidence from disease-specific models from indirect evidence obtained in other experimental conditions. Mesenchymal stem cell-derived EVs exhibit anti-inflammatory, antioxidant, antifibrotic, and regenerative effects in preclinical models, while plant-derived EVs from ginger, aloe, garlic, grapefruit, rice, pomegranate, and tomato demonstrate diverse biological activities with varying relevance to these disorders. Notably, ginger-derived EVs have shown beneficial effects in experimental endometriosis models by reducing inflammation, angiogenesis, and cellular invasion while promoting apoptosis. Findings from other disease models provide indirect support for potential mechanisms but do not establish therapeutic efficacy in PCOS or endometriosis. EVs may also serve as biomarkers for disease diagnosis and monitoring. This review discusses EV isolation, characterization, proposed mechanisms, preclinical evidence, and translational challenges. Future research should prioritize disease-specific mechanistic studies, standardized EV isolation and characterization, rigorous evaluation of biodistribution and safety, and well-designed clinical trials to establish diagnostic utility and therapeutic efficacy. Although EV-based approaches hold promise, further validation is essential before clinical application.

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Adolescent girls are vulnerable to reproductive health disorders, including endometriosis and Polycystic Ovary Syndrome (PCOS), while knowledge of early detection remains limited. The “SHE CARE (Sehat dan Cerdas Reproduksi Remaja)” program was conducted at SMP Negeri 6 Yogyakarta to improve students’ knowledge through interactive education using print and digital media. The activity involved 40 female students using a pre-test and post-test design. The mean knowledge score increased from 50.0 to 81.7, an increase of 31.7 points (63.5%), with 39 participants (97.5%) showing improved scores. After the intervention, 72.5% of participants had good knowledge, with none remaining in the poor category. The SHE CARE program was associated with improved knowledge and awareness of early detection of reproductive health disorders among adolescent girls.

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Evidence suggests that endometriosis influences how women perceive their bodies and sense of self. However, less is known across other pelvic pain conditions. This reflexive analysis of 12 semi-structured interviews from women with pelvic pain in Australia explored the interrelationships among pelvic pain, body image, and sense of identity. Three themes were developed: “the devil within me: the experience of pelvic pain”; “the camouflage that hides me: curating and concealing the pain”; and “the resilience that (re)defines me: surviving the pain”. Findings highlight how pelvic pain simultaneously undermines and redefines women’s relationships with their body and sense of self.

Background: Umbilical endometriosis is a rare form of extra pelvic endometriosis accounting for less than 1% of all endometriosis cases. It commonly presents with cyclical pain, swelling and bleeding from the umbilicus, often leading to delayed diagnosis because of its resemblance to other umbilical pathologies. This report describes a rare case of primary umbilical endometriosis with concurrent paraumbilical hernia, highlighting diagnostic challenges and management considerations. Case Presentation: A 27-year-old multiparous woman presented with a 6-month history of cyclical umbilical bleeding and severe pain associated with menstruation. Physical examination revealed a firm, tender, dark-brown umbilical nodule measuring approximately 2 × 2 cm. Ultrasonography demonstrated a mixed echogenic lesion in the umbilical region suggestive of endometriosis. Laboratory investigations, including serum CA-125, were within normal limits. Based on the clinical and radiological findings, a diagnosis of primary umbilical endometriosis with concurrent paraumbilical hernia was made. The patient was planned for surgical excision with hernioplasty followed by histopathological evaluation. Conclusion: Primary umbilical endometriosis should be considered in reproductive aged women presenting with cyclical umbilical symptoms, particularly bleeding and pain associated with menstruation. Early clinical suspicion and surgical management are essential for definitive diagnosis and prevention of recurrence. Chatt Maa Shi Hosp Med Coll J; Vol.25 (2); July 2026; Page 116-119

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AIMS: Oxidative stress (OS) is implicated in the pathogenesis of female reproductive disorders and may contribute to infertility. This study evaluated serum OS-related biomarkers and their diagnostic potential in women with different causes of infertility. MATERIALS AND METHODS: In this case-control study, 300 women were enrolled, including 250 infertile women with diminished ovarian reserve (DOR), polycystic ovary syndrome (PCOS), tubal factor infertility (TF), endometriosis (EM), or unexplained infertility (UI), and 50 fertile controls. Serum total antioxidant capacity (TAC), superoxide dismutase (SOD) activity, iron (Fe), copper (Cu), and reproductive hormone concentrations were measured. Correlation and receiver operating characteristic (ROC) curve analyses were performed. RESULTS: Compared with fertile controls, infertile women had significantly lower serum TAC levels (p < 0.001) and higher Fe concentrations (p < 0.001). SOD activity and Cu concentrations were also significantly higher among infertile women (p < 0.05). ROC curve analysis showed the best diagnostic performance of TAC to distinguish all subgroups of infertility from fertile controls. Serum Fe levels were negatively and significantly correlated with the levels of TAC. CONCLUSION: An imbalance between oxidative and antioxidative systems is associated with female infertility. TAC demonstrated the highest discriminative ability and may represent a useful noninvasive biomarker of infertility-associated OS.

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BACKGROUND: Adenomyosis is a prevalent gynaecological disorder whose pathogenesis remains incompletely understood. Congenital Müllerian anomalies provide an informative in vivo model, since obstructive and non-obstructive variants impose spatially defined alterations of intrauterine pressure, myometrial architecture, and contractility. OBJECTIVES: To characterise adenomyosis localisation across Müllerian anomaly subtypes, assess concomitant endometriosis prevalence, and examine their topographic concordance with sites of uterine obstruction. SEARCH STRATEGY: PubMed/MEDLINE, Embase and Scopus were searched from inception to October 2025 using MeSH/Emtree and free-text terms for adenomyosis and congenital Müllerian anomalies, without date restrictions. SELECTION CRITERIA: Original case reports, case series, and observational studies in English explicitly describing the diagnostic modalities used for both conditions. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened and extracted data; methodological quality was assessed with the Joanna Briggs Institute tools. Data were synthesised descriptively by malformation subtype, with case-by-case laterality analysis where individual patient-level data were available. MAIN RESULTS: Forty-two studies (135 patients) were included. Unicornuate uterus predominated (102/135, 75.6%). Among patients with directly reported localisation and a non-communicating functional rudimentary horn, adenomyosis involved the rudimentary horn in 10/12 cases (83.3%). In Robert's uterus, adenomyosis was ipsilateral to the blind hemicavity in 3/3 evaluable cases (100%). In Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, adenomyosis occurred in remnants lacking functional endometrium in 10/15 patients (66.7%). Concomitant endometriosis (43/134 evaluable patients, 32.1%) was most frequent in obstructive anomalies (Herlyn-Werner-Wunderlich syndrome (HWW) 3/5, 60.0%; Robert's uterus 2/4, 50.0%) and least frequent in septate uterus (0/2, 0%) and MRKH (2/15, 13.3%), localising ipsilateral to the obstruction in 9/10 (90.0%) reported obstructive cases. CONCLUSIONS: Adenomyosis preferentially involved structurally abnormal or obstructed uterine compartments. The endometriosis gradient was compatible with impaired menstrual efflux as a shared mechanical determinant. These findings derive from a low-quality evidence base and should therefore be regarded as hypothesis-generating. Prospective confirmation is required, although these findings may support increased clinical awareness in women with Müllerian anomalies, particularly obstructive variants.

Endometriosis may influence pregnancy beyond its established association with infertility by affecting placentation, gestational duration, maternal health, and neonatal outcomes.This systematic review and meta-analysis aimed to determine whether endometriosis is associated with adverse maternal, fetal, and neonatal complications.PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2026, using controlled vocabulary and free-text terms related to endometriosis and pregnancy outcomes.Comparative observational studies involving pregnant women with and without endometriosis were included.Two reviewers independently screened studies, extracted adjusted effect estimates, and assessed risk of bias using Risk of Bias in Non-randomized Studies-of Exposures (ROBINS-E).Random-effects meta-analysis was performed when at least three clinically comparable studies provided extractable data; the remaining outcomes were synthesized narratively.Ten studies were included.Women with endometriosis had significantly higher odds of placenta previa (pooled OR 2.98, 95% CI 2.00-4.45;I²=34.5%) and a higher risk of preterm birth (pooled adjusted OR/RR sensitivity estimate 1.24, 95% CI 1.14-1.36;I²=10.2%).Narrative findings also suggested increased frequencies of hypertensive disorders, hemorrhage, cesarean delivery, fetal growth abnormalities, stillbirth, neonatal intensive care admission, and respiratory morbidity, although consistency varied.Endometriosis is associated with clinically important obstetric and neonatal risks, particularly placenta previa and preterm birth, supporting individualized antenatal surveillance and delivery planning.

BACKGROUND: To evaluate SONAZOID real-time four-dimensional hysterosalpingography (4D-HyCoSy) for assessing fallopian tube patency in endometriosis (EM)-induced infertility. METHODS: A retrospective study of 100 patients (200 fallopian tubes) underwent SONAZOID 4D-HyCoSy. Patients were divided into six groups based on varying degrees of tubal patency or obstruction. A liquid injection machine was employed to record the peak pressure for contrast agent injection, and the corresponding pain score of the patients was noted. Contrast agent reflux and quantitative range were observed in each group. Hysteroscopy combined with laparoscopy was considered the gold standard. RESULTS: The diagnostic accuracy of 4D-HyCoSy was 95.23% (20/21) compared to laparoscopy. Peak pressure and pain scores were significantly higher in patients with bilateral obstruction than in the other groups (p  0.8), indicating clinically meaningful differences. CONCLUSION: 4D-HyCoSy, combined with quantitative indicators like intrauterine peak pressure, pain score, and contrast reflux, provides an effective and objective assessment of tubal patency in EM-induced infertility, thereby offering a valuable imaging reference for clinical evaluation of tubal status.

A endometriose é uma doença crônica, inflamatória e estrogênio-dependente que acomete cerca de 10% das mulheres em idade reprodutiva, sendo a dor sua manifestação mais incapacitante. A alimentação vem sendo investigada como fator modificável capaz de influenciar mecanismos inflamatórios envolvidos na gênese e na manutenção dessa dor. Este estudo teve como objetivo investigar a efetividade da adoção de padrões alimentares anti-inflamatórios na redução da intensidade e da frequência da dor em mulheres com endometriose. Trata-se de uma revisão narrativa da literatura, de abordagem qualitativa, realizada nas bases PubMed/MEDLINE, SciELO e Google Scholar, com seleção conforme critérios de inclusão e exclusão previamente definidos. Foram analisados estudos observacionais, um estudo prospectivo com grupo controle, uma revisão sistemática, uma metanálise de ensaios clínicos randomizados e um ensaio clínico randomizado cruzado, publicados entre 2022 e 2026, que indicam associação entre padrões alimentares de menor potencial inflamatório e menor intensidade dolorosa, mensurada principalmente pela Escala Visual Analógica. O consumo elevado de carnes vermelhas e de ácidos graxos saturados e trans mostrou-se associado a maior risco e intensidade de sintomas, enquanto dietas ricas em fibras, antioxidantes, laticínios totais e a dieta Low FODMAP associaram-se a efeito protetor, com respostas mais consistentes para sintomas gastrointestinais e dismenorreia do que para dor pélvica crônica. Observou-se, contudo, heterogeneidade metodológica relevante entre os estudos analisados. Conclui-se que a alimentação anti-inflamatória apresenta potencial como estratégia adjuvante no manejo da dor associada à endometriose, mas o número ainda reduzido de ensaios clínicos randomizados limita conclusões causais definitivas, reforçando a necessidade de investigações futuras mais padronizadas.

Background and aim: Endometrial cancer is a rising gynecological malignancy, particularly in low- and middle-income countries including Sudan. The study aimed to assess the relationship between clinical presentation, risk factor and the type of endometrial cancer, in Sudanese ladies.Methods: This is a descriptive hospital based prospective study conducted at gynecology department of Omdurman Maternity Hospital (March to September 2022). The study sample was 120 women fulfilled inclusion criteria of the study. Data was collected using a questionnaire filled with the women after taking informed consent.Results: The histopathological types of endometrial cancer were serous carcinoma 69(57.5%), endometrial adenocarcinoma 33(27.5%) and endometrial adenocarcinoma with squamous differentiation 18(15%). The clinical presentations of endometrial cancer were postmenopausal bleeding 37(30.9%), abdominal pain and mass 27(22.5%), irregular menstruation 20(16.7%), pelvic pain 10(8.3%), abnormal vaginal discharge 10(8.3%), intra menstrual bleeding 9(7.5%) and heavy menstrual bleeding 7(5.8%). The clinical presentations that significantly associated with the common type (serous carcinoma was postmenopausal bleeding, and that significantly associated with adenocarcinoma with differentiation was abdominal pain mass (P value < 0.05). risk factors of endometrial cancer were nulliparity 56(46.7%), polycystic ovary syndrome 30(25%), hormonal replacement therapy 27(22.5%), contraceptive use 22(20.8%), infertility 24(20%), endometritis 22(18.3%), pelvic inflammatory disease 21(17.5%), obesity 19(15.8%), age above 50 years 18(15%) and family history of cancers 10(8.3%). The risk factors that significantly associated with serous carcinoma were age above 50 years, nulliparity and endometritis, and that associated with adenocarcinoma with squamous differentiation were polycystic ovary syndrome and pelvic inflammatory disease (P value < 0.05).Conclusion: The study concluded that the histopathological types of endometrial cancer were serous carcinoma, endometrial adenocarcinoma and endometrial adenocarcinoma with squamous differentiation, which were significantly associated with clinical presentations such as postmenopausal bleeding, and age above 50 years, nulliparity and endometritis, polycystic ovary syndrome and pelvic inflammatory disease. hysterectomy. Keywords: Endometrial cancer, Gynecological malignancy.

Objetivo: Sintetizar as evidências científicas sobre como a endometriose compromete o sucesso reprodutivo, analisando os atrasos nos marcos de desenvolvimento embrionário (morfocinética), a redução das taxas de implantação em ciclos de fertilização in vitro (FIV) e a influência de fatores sistêmicos, como a qualidade do sono e a receptividade endometrial. Metodologia: Trata-se de uma revisão sistemática conduzida conforme as diretrizes PRISMA e MOOSE, utilizando a estratégia PECO para a formulação da questão de pesquisa. Foram incluídos estudos observacionais publicados entre 2016 e 2023, após busca nas bases de dados especificadas na metodologia. A qualidade metodológica dos estudos incluídos foi avaliada por meio da Escala de Newcastle-Ottawa (NOS). Resultados: Foram selecionados 9 estudos de alta qualidade, totalizando uma amostra superior a 1.100 mulheres com endometriose e 2.300 controles. A análise morfocinética via time-lapse revelou que embriões de pacientes com a patologia exibem atrasos cronológicos significativos em marcos cruciais, como a extrusão do segundo corpo polar (tPB2), clivagens intermediárias (t5 a t8) e a progressão para blastocisto expandido, que foi cerca de 2 horas superior no grupo exposto. Observou-se também uma taxa de multinucleação elevada (50,0% vs. 44,5% no controle). Embora as taxas de fertilização e nascidos vivos em ciclos autólogos tenham permanecido comparáveis, houve uma redução estatisticamente relevante na taxa de implantação (OR 0,85; IC 95%: 0,74–0,97) e na taxa de nascidos vivos em modelos de doação de óvulos (OR 0,89), sugerindo um comprometimento da receptividade endometrial. Adicionalmente, identificou-se uma deterioração severa na qualidade do sono nessas pacientes (PSQI médio de 10,6 vs. 7,1; p < 0,001), correlacionada à dor pélvica crônica. Conclusão: A endometriose exerce um impacto deletério e multifatorial na função reprodutiva, fundamentado em uma tríplice falha que envolve a competência embrionária, a receptividade uterina e a homeostase sistêmica. Os resultados reforçam a necessidade de protocolos de Reprodução Assistida personalizados e de um manejo clínico multidisciplinar que integre estratégias de higiene do sono e controle da dor para otimizar os desfechos gestacionais.

Rectal endometriosis may be similar to gastrointestinal stromal tumors (GIST), especially in women without typical gynecological or cyclical gastrointestinal symptoms. A 45-year-old female patient had an eight-year history of rectal defecation difficulty and increased defecation frequency, but no dysmenorrhea or increased menstrual flow. Colonoscopy revealed a smooth protruding lesion on the rectal surface, and endoscopic ultrasound showed a heterogeneous lesion within the muscular layer, with intact surface mucosa, suggesting the possibility of GIST. A laparoscopic anterior resection was performed. Postoperative histopathology showed ectopic endometrial glands and stroma, combined with positive estrogen and progesterone receptors and expression of CD10 in the stroma, confirming rectal endometriosis. The patient’s symptoms improved significantly and recovered well. Subsequently, this study reviewed 12 reported cases, and the results showed that intestinal endometriosis and gastrointestinal tumors have overlapping diagnoses in terms of diagnosis. Even without periodic symptoms, the possibility of rectal endometriosis should be considered for women with rectal submucosal lesions. A comprehensive assessment of clinical history, pelvic anatomical relationship, imaging examinations, and histological evaluation should be conducted to establish the diagnosis and guide treatment.

A endometriose é uma doença ginecológica crônica que impacta a qualidade de vida das mulheres e apresenta frequente atraso no diagnóstico (Giudice, 2010). Nesse contexto, a percepção de risco e o comportamento de saúde podem influenciar o reconhecimento dos sintomas e a busca por atendimento. O estudo analisou essa relação em mulheres universitárias, com base nas evidências disponíveis na literatura. Objetivo: analisar a relação entre percepção de risco e comportamento de saúde relacionado à endometriose em mulheres universitárias. Método: Foi realizada uma revisão integrativa da literatura, de caráter descritivo e abordagem qualitativa. A busca dos estudos foi realizada nas bases de dados eletrônicas PubMed/MEDLINE, SciELO e LILACS, utilizando descritores relacionados à endometriose, percepção de risco e comportamento de saúde em mulheres universitárias. A análise dos dados foi realizada de forma descritiva e interpretativa. Considerações finais: A literatura analisada aponta que a normalização da dor menstrual, as dificuldades no reconhecimento dos sintomas e as barreiras de acesso aos serviços de saúde podem contribuir para o atraso na investigação da endometriose. Nesse cenário, ações de educação em saúde e conscientização no ambiente universitário são relevantes para ampliar o conhecimento sobre a doença e incentivar a busca por avaliação profissional diante de sintomas sugestivos.

Abstract Background To investigate the expression pattern of LINC00702 in endometriosis and explore its regulatory role and molecular mechanism in endometrial stromal cells (ESCs). Methods Eutopic and ectopic tissues from 84 endometriosis patients and normal tissues from 72 controls were collected. Primary normal endometrial stromal cells (NESCs) and ectopic endometrial stromal cells (EcESCs) were isolated and cultured. LINC00702, miR-103a-3p, and FGF2 expression were detected by RT-qPCR. Cell proliferation, apoptosis, migration, and invasion were assessed by CCK-8, flow cytometry, and Transwell assays. Subcellular localization, dual-luciferase reporter assays, and rescue experiments were performed to validate the LINC00702/miR-103a-3p/FGF2 regulatory axis. Results LINC00702 was upregulated in ectopic endometrial tissues and EcESCs. Overexpression of LINC00702 enhanced the proliferative, anti‑apoptotic, migratory, and invasive phenotypes of NESCs, while silencing LINC00702 reversed these phenotypes in EcESCs. miR-103a-3p was downregulated in endometriosis and could reverse the regulatory effect of LINC00702 on ESCs. FGF2 was a direct target of miR-103a-3p, which was highly expressed in endometriosis and positively correlated with LINC00702. FGF2 knockdown reversed the effect of LINC00702 overexpression on NESCs, while FGF2 overexpression rescued the inhibitory effect of LINC00702 silencing on EcESCs. Conclusion LINC00702 promotes proliferative, anti‑apoptotic, migratory, and invasive phenotypes of ESCs in endometriosis through the LINC00702/miR-103a-3p/FGF2 ceRNA regulatory axis, providing potential therapeutic targets for endometriosis treatment.

A endometriose é uma doença ginecológica inflamatória crônica que pode comprometer a saúde e a qualidade de vida das mulheres. Nesse contexto, a N-acetilcisteína (NAC) apresenta potencial como terapia complementar devido às suas propriedades antioxidantes e anti-inflamatórias. Este estudo teve como objetivo analisar as evidências científicas sobre o uso da NAC como terapia complementar no tratamento da endometriose, considerando seus possíveis efeitos sobre os sintomas e a fertilidade. Trata-se de uma revisão integrativa da literatura, de caráter descritivo, realizada nas bases de dados Biblioteca Virtual em Saúde (BVS) e PubMed, utilizando os descritores “Acetylcysteine” e “Endometriosis”, combinados pelo operador booleano AND. Foram selecionados 15 artigos publicados entre 2021 e 2026, nos idiomas inglês e português. Os resultados apontaram possíveis benefícios da NAC na redução da dor relacionada à endometriose, do tamanho dos endometriomas ovarianos e da necessidade de medicamentos analgésicos. Também foram identificados resultados promissores relacionados à fertilidade e à modulação do estresse oxidativo e da inflamação. Entretanto, as evidências apresentaram inconsistências, especialmente quanto aos desfechos reprodutivos e à recorrência dos endometriomas. Conclui-se que a NAC apresenta potencial terapêutico complementar, embora sejam necessários estudos clínicos mais robustos para estabelecer sua eficácia e segurança.

(No abstract on file for this paper.)

(No abstract on file for this paper.)

Deep endometriosis (DE) poses diagnostic and surgical challenges. We evaluated transvaginal sonography (TVS) performed according to the International Deep Endometriosis Analysis (IDEA) protocol, and the Ultrasound-Based Endometriosis Staging System (UBESS), against laparoscopic findings and surgical complexity. This prospective pilot study enrolled 33 women with suspected DE scheduled for operative laparoscopy at a tertiary referral centre in India. A single experienced radiologist performed IDEA-based TVS and assigned a UBESS stage preoperatively; laparoscopy was the reference standard. Diagnostic accuracy was calculated from 2 × 2 contingency tables with exact 95% confidence intervals (CIs); for UBESS, Stage III (high surgical complexity) was the positive outcome. At laparoscopy, 16 women (48.5%) had UBESS Stage III and 17 (51.5%) Stage II disease; none had Stage I. TVS-derived UBESS correctly classified 13/16 Stage III and 17/17 Stage II cases (sensitivity 81.3%, 95% CI 54.4–96.0%; specificity 100%, 80.5–100%; accuracy 90.9%, 75.7–98.1%); three Stage III cases were under-staged. All laparoscopically confirmed endometriomas were correctly identified by TVS (right 30/30, 95% CI 88.4–100%; left 29/29, 88.1–100%), although specificity rested on only 3–4 endometrioma-negative patients. Sensitivity was 85.7% (18/21; 63.7–97.0%) for pouch of Douglas (POD) obliteration and 81.3–84.2% for ovarian immobility, with no false-positive findings. In this small single-centre cohort, IDEA-based TVS identified endometriomas and POD obliteration with few errors, and UBESS under-staged 3 of 16 high-complexity cases without over-staging any case. Wide CIs, absence of Stage I disease and an expert single-operator setting preclude definitive conclusions; validation in larger multicentre cohorts is required.

Background: Endometriosis (EM) is a benign gynecological disorder characterized by the hyperproliferation of endometrial cells outside the uterus. This abnormal proliferation followed by neoangiogenesis leads to the formation of EM lesions, which often require surgical removal. Contemporary pharmacological treatment of EM involves hormonal therapies, which are frequently accompanied by adverse effects and a high rate of symptom recurrence following cessation of treatment. Consequently, the development of innovative pharmaceuticals is crucial for the effective management of EM. Small interfering RNA (siRNA) therapeutics are evolving from a niche modality into a major pharmaceutical platform applicable for the therapy of inherited and multifactorial diseases. However, a major obstacle hindering broader clinical use is the challenge of delivering siRNA to tissues beyond the liver. Peptide-based nanoparticles mediating siRNA delivery hold potential to overcome this limitation through receptor targeting and by shielding excessive positive charges. Methods: In the current study, we developed ternary polyplexes composed of anti-VEGFA siRNA, a cationic arginine-rich polymer, and an anionic glutamate-rich polymer modified with a cyclic RGD (cRGD) moiety for αVβ3-integrin binding. The polyplexes were characterized physicochemically, and their toxicity and GFP marker gene silencing properties were studied in vitro. Anti-angiogenic effects were evaluated in vivo using a surgically induced EM model in female Wistar rats. Results: A significant reduction in the volume of modeled EM lesions, along with decreased VEGFA gene expression and apparent reduction in endothelial marker CD34 immunostaining in representative sections, was observed following intralesional administration of anti-VEGFA siRNA-loaded peptide-based nanoparticles decorated with the cRGD ligand, compared to control ligand-free nanoparticles. Conclusions: The results provide evidence that electrostatically stabilized siRNA-peptide nanoparticles can exert anti-angiogenic effects in EM lesions following intralesional administration, warranting further investigation of their targeting properties, safety, and therapeutic potential.

(No abstract on file for this paper.)

Lạc nội mạc tử cung (LNMTC) là bệnh lý viêm mạn tính ảnh hưởng đáng kể đến sức khỏe sinh sản và chấtlượng cuộc sống. Nghiên cứu này được thực hiện nhằm mô tả kiến thức, thái độ, năng lực nhận diện lâmsàng ở sinh viên nữ y khoa. Nghiên cứu mô tả cắt ngang được thực hiện trên 284 sinh viên nữ hệ bác sĩy khoa Trường Đại học Y Hà Nội từ tháng 1 đến tháng 6 năm 2026 bằng bộ câu hỏi tự điền gồm thông tinchung, kiến thức, thái độ và tình huống lâm sàng. Có 79,2% sinh viên chưa từng nghe hoặc chỉ nghe sơqua về LNMTC, với điểm tự đánh giá hiểu biết trung bình 3,92 ± 1,87/10. Đau bụng kinh trong 6 tháng gầnđây được ghi nhận ở 73,8% sinh viên nhưng chỉ 7,2% từng đi khám. Tỷ lệ sinh viên có kiến thức cao, trungbình và thấp lần lượt là 46,8%, 28,2% và 25,0%. Điểm thái độ trung bình là 3,75 ± 0,47/5 và tỷ lệ trả lờiđúng các tình huống lâm sàng trung bình là 79,1%. Điểm kiến thức cao hơn ở sinh viên lâm sàng và nhómđã hoàn thành thực hành Sản phụ khoa, với p < 0,001. Không ghi nhận khác biệt có ý nghĩa về điểm tháiđộ. Kết quả cho thấy nhận thức về LNMTC còn hạn chế, đặc biệt ở nhóm chưa trải qua đào tạo lâm sàngSản phụ khoa, cho thấy cần tăng cường nội dung đào tạo về bệnh lý này.

A endometriose é uma doença inflamatória crônica que pode causar dor pélvica, infertilidade e comprometimento da qualidade de vida, sendo frequentemente associada ao atraso diagnóstico. Nesse contexto, os métodos não invasivos têm ganhado destaque como alternativas para ampliar a identificação e a caracterização da doença. O presente estudo teve como objetivo analisar os avanços no diagnóstico não invasivo da endometriose, com ênfase nos métodos de imagem, nos biomarcadores e nas tecnologias emergentes. Foi proposta uma revisão integrativa da literatura, com busca em bases de dados científicas e seleção de estudos relacionados à acurácia diagnóstica e ao potencial clínico dessas estratégias. Os resultados indicam que a ultrassonografia transvaginal especializada e a ressonância magnética apresentam utilidade na identificação de endometriomas e no mapeamento da endometriose profunda. Entretanto, a acurácia depende da localização da doença, da experiência do examinador e das características dos protocolos utilizados, e resultados negativos não excluem todas as formas de endometriose. Biomarcadores moleculares, microRNAs circulantes, análise do efluente menstrual e ferramentas de inteligência artificial demonstram perspectivas promissoras, embora ainda existam limitações relacionadas à padronização e à validação clínica. Conclui-se que os métodos não invasivos representam avanços relevantes para o diagnóstico da endometriose, mas novas pesquisas prospectivas são necessárias para estabelecer sua aplicabilidade clínica e contribuir para a redução do atraso diagnóstico.

UNLABELLED: Adenomyosis (ADS) is a common gynecological disorder characterized by dysmenorrhea, menorrhagia, and infertility, which markedly impair women's quality of life. Repeated cyclic bleeding of ectopic endometrial lesions may sustain local inflammation and tissue remodeling, leading to a "menstruation-inflammation-fibrosis" cycle. This study aimed to establish a mouse model that mimics this process and to evaluate the effect of estrogen-progesterone (EP) sequential exposure on uterine fibrosis in adenomyosis. METHODS: A tamoxifen-induced mouse model of adenomyosis was established, followed by EP sequential exposure to induce a menstruation-like process. Histological staining and immunohistochemistry were performed to evaluate lesion formation, inflammatory responses, and fibrosis-related changes in uterine tissues. RESULTS: EP sequential exposure successfully induced menstruation-like changes in the uterus of mice with adenomyosis. Compared with controls, mice exposed to sequential EP showed more prominent endometrial breakdown, inflammatory responses, and fibrotic remodeling. Collagen deposition and the expression of fibrosis-associated markers, including α-SMA, were increased in uterine lesions, indicating aggravated fibrosis. CONCLUSION: EP sequential exposure promotes fibrosis in adenomyosis lesions in mice and may serve as a useful model for investigating the "menstruation-inflammation-fibrosis" cycle in adenomyosis.

BACKGROUND: While minimally invasive surgery is the current surgical standard of care for excision of deep endometriosis of the bowel, there is little literature evaluating patient-reported outcome measures following a multidisciplinary, robotic approach. OBJECTIVE: This study aimed to assess the functional outcomes of robotic surgery for patients undergoing resection of deep endometriosis involving the bowel. DESIGN: Retrospective cohort review. SETTINGS: A single academic tertiary institution. PATIENTS: Patients with endometriosis of the bowel undergoing multidisciplinary resection between January 1, 2018, and October 1, 2023. MAIN OUTCOME MEASURES: A survey assessing functional outcomes on a Numeric Rating Scale preoperatively and at multiple points postoperatively. RESULTS: Of 92 eligible patients, 41 completed a preoperative survey and at least one postoperative survey. Among these 41 patients, overall pain improved postoperatively from 5.3 ± 2.7 (Numeric Rating Scale) to a nadir of 1.6 ± 1.9 at 6 months and 2.3 ± 3.0 at 12 months (p < 0.001). Preoperative pain at ovulation (mean 4.2 Numeric Rating Scale ± 3.7), pre-period pain (4.9 ± 3.5), period pain (5.7 ± 3.6) and post-period pain (3.3 ± 3.3) all decreased to a mean of 1 at 12 months postoperatively (p < 0.001). The proportion of patients reporting pain impacting work decreased from 88% preoperatively to <40% postoperatively (p < 0.001). The proportion of patients happy with their bowel function increased from 39% preoperatively to 63.2% at 1 month, 80.0% at 6 months, and 69.2% at 12 months postoperatively (p = 0.014). LIMITATIONS: Only 31.7% of patients responded to their 12-month survey, tertiary care center, low diversity in patient demographics, retrospective design. CONCLUSION: In this cohort of patients undergoing multi-disciplinary robotic excision for advanced endometriosis involving the bowel, patients reported significantly improved pain and quality of life measures. See Video Abstract.

BACKGROUND: Endometriosis affects approximately 10% of women of reproductive age with a mean diagnostic delay of 7-10 years. Image-guided procedures show increasingly promising results as minimally invasive alternatives to excision. OBJECTIVE: Structured overview of image-guided minimally invasive treatment options for endometriosis with focus on percutaneous cryoablation. RESULTS: Percutaneous cryoablation demonstrates the strongest evidence for extraperitoneal and intramuscular lesions and represents a valid minimally invasive alternative to excision. Three institutional cases illustrate technique and outcomes. Ethanol sclerotherapy is established for ovarian endometriomas. High-intensity focused ultrasound (HIFU) shows promising results for abdominal wall disease; radiofrequency ablation (RFA) and microwave ablation are investigational. CONCLUSION: Interventional radiology offers a growing therapeutic spectrum. Prospective randomized trials are needed for guideline integration.

Preserving ovarian reserve while minimising recurrence remains a major challenge in endometrioma surgery. Conventional bipolar excision may cause thermal injury to the ovarian cortex and impair fertility potential. We conducted a pilot feasibility study of a technical modification of laparoscopic cystectomy using an S-shaped incision at the ovarian hilum with cold dissection to reduce thermal exposure and cortical damage. Twelve patients underwent cystectomy with this approach, and all procedures were completed without intraoperative complications. Postoperative evaluation included serum anti-Müllerian hormone (AMH), antral follicle count (AFC), pain score, CA-125, and sonographic assessment. Early postoperative findings were compatible with short-term technical feasibility and safety in this small initial series. The observed postoperative changes in ovarian reserve markers and symptoms provide preliminary data to inform future comparative studies with longer follow-up.

The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely used for adenomyosis, but expulsion and displacement may compromise treatment. We estimated their study-reported cumulative proportions and compared fixed or modified placement with conventional placement. PubMed, Embase, Web of Science Core Collection, CENTRAL, and Scopus were searched from inception to July 2026. Random-effects models pooled proportions and risk ratios (RRs) with 95% confidence intervals (CIs). Follow-up subgroups, common-time-point sensitivity analyses, and a binomial generalized linear mixed model (GLMM) were examined. Certainty of evidence was assessed using GRADE. 30 studies reporting 3,536 participants overall were included. Across 24 studies (2,443 participants), the pooled cumulative proportion of reported expulsion was 7.3% (95% CI, 3.7%–11.7%), with substantial heterogeneity (I² = 89.55%) and a 95% prediction interval of 0.0%–34.7%. Proportions were 2.8% (95% CI, 0.8%–5.6%) and 13.6% (95% CI, 6.9%–22.0%) in studies with nominal follow-up of ≤ 12 and > 12 months, respectively ( P = 0.004 for the subgroup difference). Separate analyses at exact 6- and 12-month endpoints yielded approximately 3% and 4%, respectively, in different sets of studies. The GLMM estimate for reported expulsion was 5.8% (95% CI, 3.1%–10.4%). Across seven studies (329 participants), the pooled reported-displacement proportion was 0.8% (95% CI, 0.0%–2.5%). Exploratory comparisons associated fixed or modified placement with less reported expulsion (two nonrandomized studies; RR, 0.12; 95% CI, 0.03–0.49) and fewer displacement-or-expulsion composite events (one randomized and one nonrandomized study; RR, 0.28; 95% CI, 0.15–0.54). Certainty was very low for the graded outcomes; no single GRADE rating was assigned to the mixed-design pooled composite estimate. Study-reported LNG-IUS expulsion and displacement occur in women with adenomyosis, but heterogeneity in follow-up, outcome definitions, and ascertainment, together with very low-certainty evidence, limits interpretation. The low reported frequency of displacement may underestimate positional abnormalities because asymptomatic cases can be missed without systematic imaging. Exploratory comparisons do not establish a clinical benefit of fixed or modified placement or support its routine use.

Background/Objectives: Endometriosis often follows a prolonged diagnostic pathway and raises uncertainty about fertility. This study explored how women experienced diagnostic delay, fertility anxiety, healthcare encounters, and coping. Methods: In a qualitative descriptive study, 18 women were recruited from the gynecology outpatient clinic of a private hospital in Istanbul, Türkiye. All reported a previous physician diagnosis of endometriosis and an interval of at least two years between symptom onset and diagnosis. Individual semi-structured interviews were audio-recorded, transcribed, and analyzed with a collaboratively developed thematic codebook. Results: Participants’ mean age was 30.3 ± 4.8 years, and their mean self-reported diagnostic interval was 7.9 ± 3.6 years. Five themes addressed experiences of diagnostic delay; the meaning and consequences of diagnosis; fertility anxiety and reproductive decisions; healthcare experiences and expectations; and social support and coping. Women described the normalization of severe pain, dismissive or fragmented care, and the need to persist in seeking answers. Diagnosis validated symptoms but also brought the perceived costs of lost time into focus. Some participants described concerns about future fertility before attempting conception, while others discussed anxiety during pregnancy attempts; these concerns shaped treatment choices, relationships, and future plans. Participants described anxiety about ovarian reserve, unsuccessful fertility treatment, and pressure around marriage or motherhood; they sought clearer explanations and continuity of care. Conclusions: In this sample, diagnostic delay and fertility anxiety were intertwined with social expectations and healthcare experiences. Timely recognition of disabling symptoms, individualized fertility information, validating communication, and coordinated care may address needs across the endometriosis pathway.

Adenomyosis is a benign uterine condition characterized by the presence of endometrial glands and stroma within the myometrium. “A substantial proportion of patients may be asymptomatic, but the rest may present with heavy menstrual bleeding, pelvic pain, or infertility. Heavy menstrual bleeding is the most common symptom. Adenomyosis is distinct from endometriosis (the presence of endometrial glands outside of the uterus), but the two conditions often occur simultaneously. Risk factors for developing adenomyosis include increasing age, parity, and history of uterine procedures. Most patients are diagnosed from 40 to 50 years of age, but younger patients with infertility are increasingly being diagnosed with adenomyosis as imaging modalities improve. Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. Treatment of adenomyosis typically starts with hormonal menstrual suppression. Levonorgestrel-releasing intrauterine systems have shown some effectiveness. Patients with adenomyosis may ultimately have a hysterectomy if symptoms are not controlled with medical therapy.

Background/Objectives: Berberine is increasingly promoted through social media and endometriosis-related websites as a non-hormonal supplement, although its disease-specific evidence remains unclear. This PRISMA-compliant systematic review evaluated experimental and clinical evidence for berberine in endometriosis and adenomyosis. Methods: PubMed/MEDLINE, EBSCOhost, BASE, CNKI Overseas, CENTRAL, and Google Scholar were searched from inception to 3 August 2026, supplemented by targeted manual searches. Clinical studies and experimental studies using endometriosis- or adenomyosis-related cellular or animal models were eligible. Purified berberine formed the primary evidence set. Chemically characterized multi-alkaloid preparations containing berberine were analyzed separately. Risk of bias was assessed with SYRCLE for animal studies and a predefined domain-based appraisal for in vitro studies. A structured qualitative assessment examined confidence in the synthesized findings. Contextual evidence from outside endometriosis and adenomyosis concerning steroid signaling, gut microbiota, microbial metabolites, and GLP-1 was discussed separately. Results: Six preclinical studies were included: three on endometriosis and three on adenomyosis, comprising four in vitro and two animal studies. Five investigated purified berberine and one a protoberberine-rich multi-alkaloid fraction. No clinical study was identified. Berberine reduced cell proliferation or viability and, where directly assessed, migration and invasion. It also reduced inflammatory and angiogenesis-related signaling, and, in an adenomyosis mouse model, myometrial infiltration and hyperalgesia. Reduced proliferation or viability recurred in all four cellular studies, with lower IL-6 and VEGF reported across cellular and animal adenomyosis models. Reported molecular effects involved NF-κB, STAT3, TLR4-associated signaling, VEGF, MMPs, TRPV1, COX-2, miR-429, and lncRNA H19. Gut microbiota modulation, short-chain fatty acids, intestinal barrier function, estrogen metabolism, GPER1, and GLP-1/GLP1R signaling remain plausible indirect routes that have not been demonstrated in disease-specific berberine studies. Conclusions: Berberine shows disease-relevant activity across a small and heterogeneous preclinical evidence base. Clinical efficacy, clinically achievable exposure, reproductive safety, and microbiota- or hormone-mediated effects remain unestablished.

OBJECTIVE: To evaluate perioperative morbidity, factors associated with postoperative complications and documented recurrence after one-stage laparoscopic resection for multicompartment deep endometriosis. DESIGN: Retrospective multicentre cohort study. SETTING: Two tertiary referral centres specialised in endometriosis surgery (Bern, Switzerland; Budapest, Hungary). POPULATION: A total of 299 consecutive patients with pathologically confirmed deep endometriosis undergoing one-stage laparoscopic resection between January 2017 and December 2025. INTERVENTIONS: One-stage laparoscopic resection of multicompartment deep endometriosis. MEASUREMENTS AND MAIN RESULTS: Clinically relevant postoperative complications were defined as Clavien-Dindo Grade ≥ II. Multivariable logistic regression assessed associated factors. Recurrence-free survival was evaluated using Kaplan-Meier analysis in patients with an available recurrence time or censoring time. Postoperative complications occurred in 36/299 patients (12.0%), including 35/299 (11.7%) with Grade ≥ II complications and 14/299 (4.7%) with Grade ≥ IIIb complications. Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant complications (adjusted odds ratio 1.51 per additional involved compartment, 95% confidence interval 1.04-2.18). Documented recurrence occurred in 43/299 patients (14.4%) and 26/299 (8.7%) underwent reoperation for recurrence. Follow-up duration was available for 231/299 patients (77.3%). Recurrence-free survival did not differ significantly according to bowel (log-rank p = 0.431) or bladder surgical technique (p = 0.116). CONCLUSION: Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant postoperative complications following one-stage surgery for multicompartment deep endometriosis, suggesting that overall anatomical disease extent may better reflect surgical complexity than involvement of a single anatomical site. These findings support the role of anatomical disease extent in preoperative counselling and individualised surgical planning.

Adenomyosis is a chronic, oestrogen-responsive uterine disorder characterised by endometrial glands and stroma within the myometrium. It is commonly associated with dysmenorrhoea, heavy menstrual bleeding, chronic pelvic pain, subfertility, and impaired quality of life. Increasing demand for uterine preservation has stimulated interest in image-guided thermal therapies as alternatives to hysterectomy. Microwave Ablation (MWA) produces rapid dielectric heating and coagulative necrosis within targeted adenomyotic tissue while aiming to preserve the endometrial cavity, serosal surface, and unaffected myometrium. The present narrative review summarises the biophysical basis, patient selection, imaging requirements, procedural principles, clinical outcomes, reproductive evidence, safety considerations, and comparative position of MWA. Published cohorts report substantial reductions in pain, bleeding, symptom-severity scores, and uterine or lesion volume. In a 36-patient study of posterior-wall adenomyosis, complete relief of dysmenorrhoea and menorrhagia at 12 months was reported in 81.3% and 69.6% of evaluable patients, respectively, with an 11.1% recurrence rate and no major complications. However, fertility evidence remains limited: MWA-specific pregnancy and live-birth rates cannot yet be estimated reliably, and pooled reproductive outcomes for imageguided thermal ablation combine several modalities. Uterine rupture after MWA has not been quantified and remains an unresolved obstetric safety question. MWA is therefore a promising uterus-preserving option for carefully selected patients, but standardised eligibility criteria, energy-delivery protocols, outcome definitions, and prospective long-term reproductive studies are required before it can be considered an established fertility-restoring treatment.

Endometriosis affects ~ 10% of reproductive-age women yet its impact extends far beyond pelvic pain: accumulating epidemiologic and mechanistic data implicate endometriosis in systemic immunovascular dysfunction and elevated risk of arterial and venous thrombotic events. Current clinical paradigms treat reproductive disease, endocrine therapy, and thromboembolism as separate domains, overlooking how chronic lesion-level inflammation, iron-driven oxidative stress, and endothelial metabolic reprogramming interact with coagulation and immune effectors to determine embolic risk. Here we synthesize evidence that repetitive hemorrhage and iron overload prime endothelium and immune cells for a pro-coagulant state, that platelet–leukocyte crosstalk and neutrophil extracellular traps stabilize and protect thrombi from lysis, and that abrupt estrogen withdrawal (e.g., GnRH agonist therapy) may serve as a biologically meaningful second hit within a proposed mechanistic model, potentially promoting vascular destabilization in susceptible individuals. We propose the immunothrombotic continuum as a conceptual mechanistic framework, a systems-level framework in which inflammatory, redox, metabolic, and endocrine axes converge to produce emergent thrombotic vulnerability. This model prioritizes biomarker-guided phenotyping, dynamic surveillance during hormonal therapy, and mechanism-targeted prophylaxis, a translational roadmap for precision cardio-reproductive medicine aimed at preventing clinically meaningful embolic outcomes. Not applicable. Immunothrombotic continuum: Conceptualizes thrombotic risk as an emergent property of interacting inflammatory, redox, metabolic, and endocrine networks rather than isolated factors. Endothelial reprogramming as a therapeutic target: Highlights the endothelium as a dynamic integrator of chronic inflammation, iron-driven oxidative stress, and hormonal perturbation, enabling mechanism-guided interventions. Second-hit vulnerability framework: Frames abrupt estrogen withdrawal or endocrine therapy as a biologically significant “second hit” that unmasks pre-existing vascular priming, refining risk prediction. Personalized surveillance thresholds: Advocates adaptive biomarker trajectories, not single static values, to trigger therapy modification or prophylactic intervention. Cross-disease relevance: Positions lessons from endometriosis to inform thrombotic risk in autoimmune, chronic inflammatory, and reproductive-endocrine disorders with systemic vascular impact. Roadmap for precision cardio-reproductive medicine: Integrates mechanistic insights with biomarker-guided phenotyping and dynamic intervention strategies, defining a translational pipeline from molecular understanding to patient-tailored prophylaxis.

Endometriosis is a chronic inflammatory disease characterized by endometrial-like tissue growing outside the uterus. Increasing evidence suggests that innate immune pathways contribute to disease initiation, progression, and symptom development. Pattern-recognition receptors, including Toll-like receptors (TLRs), as well as their soluble counterparts (sTLRs), pathogen-associated molecular patterns (PAMPs), damage-associated molecular patterns (DAMPs), and related soluble decoy receptors may influence inflammatory signaling within the peritoneal environment. Although numerous studies have examined individual biomarkers, no comprehensive narrative synthesis has critically evaluated the biological rationale, mechanistic evidence, and biomarker potential of soluble innate immune receptors and their ligands in endometriosis. This review aims to address this gap.

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OBJECTIVE: Recent observational studies have identified an association between the anxious/worrier trait and endometriosis. However, the causal nature of this relationship remains unclear. METHODS: Summary statistics from genome-wide association studies were used to identify independent genetic variants associated with the anxious/worrier trait, which served as instrumental variables in a two-sample Mendelian randomization (MR) study. Causal estimates for the effect of emotional factors on endometriosis risk were obtained using inverse variance weighting, MR-Egger regression, and weighted median methods. Reverse MR analysis was then used to assess the impact of endometriosis on emotional indicators. Sensitivity analyses included the MR-Egger intercept test, leave-one-out analysis, and Cochran's Q test, which were used to detect potential pleiotropy and heterogeneity. RESULTS: The inverse variance weighted analysis indicated that the anxious/worrier trait significantly elevated the risk of developing endometriosis (odds ratio 3.84; 95% confidence interval 1.42-10.41, P = 0.008). The results of the reverse MR analysis did not indicate a significant causal effect of endometriosis on emotional indicators (P > 0.05). CONCLUSION: This study provides genetic evidence for a causal relationship between emotional factors (anxious/worrier trait) and endometriosis. However, the specific biological pathways involved warrant further investigation.

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