Endometriosis – revisited

Puvithra Thanikachalam, S. Arunkumar, Sowbarnika Arunkumar, Radha Pandiyan, Pandiyan Natarajan
In: Journal of Reproductive Healthcare and Medicine · 2025 · vol. 6 , pp. 13 · doi:10.25259/jrhm_6_2025 · W4411665786
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This review discusses endometriosis pathophysiology, proposes menstruation as a biomarker for failed physiology, and questions the efficacy of endometriosis treatment for infertility.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

This paper is a literature-based debate on endometriosis, focusing on its basic pathophysiology, proposed etiologic hypotheses (including menstruation as a biomarker of failed physiology and a retrograde menstruation framework), and the controversy of whether infertility is a cause or consequence. It compiles epidemiologic estimates (e.g., laparoscopy- and histology-based incidence ranges) and discusses key uncertainties in diagnosis (including the lack of perfect diagnostic specificity) and natural history, noting that outcomes and mechanisms for pain/infertility are not clearly understood. It reviews positions from ESHRE and ASRM that medical and surgical interventions are not supported for improving fertility in most infertility contexts, with major explicit caveats including evidence limitations and the need for histological confirmation without fully ruling out disease when negative. This paper is centrally about endometriosis — it revisits hypotheses about causation and evaluates evidence for infertility-related medical and surgical management in endometriosis.

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Abstract

Although giant strides have been achieved in human reproductive sciences, with newer technologies and therapies, yet very little is known about many distressing problems like endometriosis. Endometriosis is still considered an enigma by many gynecologists and reproductive endocrinologists. Medical and surgical advances have emerged as possible solutions for this unrelenting malady in reproductive-aged women. We raised a debate if infertility is the cause or consequence of endometriosis. In this paper, we discuss the basic pathophysiology of endometriosis, while proposing a hypothesis that “Menstruation is a biomarker for failed physiology,” where repeated cycles of ovulation and non-conception exposes a woman to more retrograde menstruation. We have also questioned the value of medical and surgical treatment in infertility associated with endometriosis and have presented literature-based evidences to substantiate the points for and against the different views expressed about endometriosis. We conclude by stating that “it is wise to treat infertility and not waste time, hope, and money in trying to treat endometriosis, especially in women with infertility.”

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Condition tags

endometriosisinfertility

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last seen: 2026-06-10T17:14:06.276822+00:00
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