Endometriosis as a risk factor for venous and arterial thromboembolism: A systematic review (2020-2025)

Research objective: Summarize evidence (2020–2025) on the association between endometriosis and venous/arterial thromboembolism, emphasizing deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and myocardial infarction, and evaluating how hormonal and surgical treatment affect thrombotic risk. Methodology: Narrative review of 2020–2025 literature on endometriosis as a systemic inflammatory disease and its links to thromboembolic outcomes. Focus includes proposed pathophysiology and the impact of therapeutic strategies on thrombosis risk. Main conclusions: Endometriosis is now seen as a systemic, chronically inflammatory condition linked to higher venous and arterial thromboembolic risk. Proposed mechanisms include oxidative stress, endothelial dysfunction, coagulation activation, and fibrinogen changes. Vascular compression and perioperative/postoperative hypercoagulability may add risk. Hormonal therapies may increase venous thromboembolism, especially with cardiovascular risk factors, while surgery may reduce long-term inflammation. Application/Originality: Supports clinician recognition of endometriosis as systemic when planning hormonal vs surgical management, especially in patients with added cardiovascular risk. Integrates 2020–2025 evidence linking endometriosis to both venous and arterial events and differentiates hormonal versus surgical effects on thrombotic risk.Endometriosis

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Abou-Ismail, M. Y., Citla Sridhar, D., & Nayak, L. (2020). Estrogen and thrombosis: A bench to bedside review. Thrombosis Research, 192, 40–51. https://doi.org/10.1016/j.thromres.2020.05.008 Al-Amer, O. M. (2022). The role of thrombin in haemostasis. Blood Coagulation & Fibrinolysis, 33(3), 145–148. https://doi.org/10.1097/MBC.0000000000001130 American College of Obstetricians and Gynecologists. (2021). Prevention of venous thromboembolism in gynecologic surgery: ACOG Practice Bulletin, Number 232. Obstetrics & Gynecology, 138(1), e1–e15. https://doi.org/10.1097/AOG.0000000000004445 Ansariniya, H., Yavari, A., Javaheri, A., & Zare, F. (2022). Oxidative stress-related effects on various aspects of endometriosis. American Journal of Reproductive Immunology, 88(3), Article e13593. https://doi.org/10.1111/aji.13593 Arsalan, H. M., Mumtaz, H., & Lagana, A. S. (2025). Biomarkers of endometriosis. 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