Endometriosis y Dolor Pélvico Crónico en Mujeres Mexicanas: Análisis de Susceptibilidad Biopsicosocial, Farmacogenómica y Evidencia Terapéutica

Endometriosis and Chronic Pelvic Pain (CPP) constitute a public health crisis in Mexico, affecting 10% of reproductive-age women and resulting in a 20% CPP prevalence in the 20-to-40 age range. This estrogen-dependent pathology is governed by a multifactorial polygenic model, characterized by molecular progesterone resistance in the lesions, the contribution of metabolic dysfunction (high BMI), and oxidative stress. The Mestizo ancestry of the Mexican population introduces a key genetic factor, modulating inflammation and disease progression through unique allelic variants (IL8, IL1β, DUOX1). The associated CPP often evolves into a nociplastic phenotype due to central sensitization, a mechanism that explains persistent pain even after lesion elimination. This necessitates a biopsychosocial approach that incorporates anxiety and depression management, and pelvic floor physical therapy. The review of therapeutic evidence reveals low certainty (GRADE Very Low) for many first-line interventions, including NSAIDs and surgery. Although hormonal therapy is the cornerstone, its efficacy is limited by tissue resistance and pharmacogenomic variability. Translational research in Mexico is essential, focusing on: a) the determination of Cytochrome P450 (CYP) polymorphisms to optimize hormonal dosing, and b) the validation of biomarkers (e.g., glycodelin) to predict progesterone resistance, enabling phenotypic stratification and precision medicine. El presente análisis se fundamenta en una revisión narrativa y crítica de la literatura científica y documentaldisponible sobre la endometriosis y el dolor pélvico crónico (DPC) en el contexto de la población femenina mexicana.