Could statins constitute a novel treatment for endometriosis? Systematic review of the literature

Endometriosis, defined as the presence of endometrial glands and/or stroma outside the uterine cavity, is an estrogen-dependent disease that affects about 10% of reproductive age women. Theories to explain the etiology of endometriosis abound. These include the alteration of epithelial cells on peritoneal surface, metaplasia of embryonic remnants of the mullerian ducts, immune system abnormalities, and the dissemination of endometrial cells through the circulation or lymphatic system, as well as retrograde menstruation, the hypothesis currently favored for the development of endometriosis. Angiogenesis, the development of new capillaries from pre-existing blood vessels, has been proposed as a key mechanism in the pathogenesis of endometriosis. Again from an etiological perspective, the formation of endometriotic implants requires ectopic fixation and proliferation of endometrial stroma and glands. The process of invasive insertion of endometriotic tissues involves the degradation of the extracellular matrix, and altered expression of matrix metalloproteinases (MMPs) in the eutopic and ectopic endometrium. Considering the antiproliferative, antiangiogenic, antioxidant, anti-inflammatory properties and matrix metalloproteinase activity inhibition of statins and the original studies addressing the possible mechanisms of action in endometriosis, the aim of this systematic review was to synthesize the research conducted to date in order to propose statins as possible and effective tools for controlling this disease.