Various Subtypes of Endometriosis and Cardiovascular Disease: Emerging Molecular Links and Clinical Implications: A Narrative Review

Endometriosis is associated with increased cardiovascular risk, but how its subtype heterogeneity informs this association remains unclear. This narrative review examines the biological characteristics of superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE) and their potential cardiovascular relevance. English-language literature identified through PubMed, Scopus, Google Scholar, and reference screening was synthesized across susceptibility factors, molecular and vascular alterations, and treatment exposures. Subtype-related findings highlight differences in anatomical location and tissue microenvironment, including peritoneal immune interactions in superficial lesions, intracystic iron accumulation and oxidative injury in OMA, and inflammatory and fibromuscular remodeling in deep lesions. These features provide a basis for investigating how lesion heterogeneity may relate to systemic lipid dysregulation, inflammation, endothelial dysfunction, and coagulation abnormalities. Ovarian function, surgical history, and hormonal regimens further inform interpretation of these relationships. By integrating phenotype and treatment exposure while distinguishing local findings from circulating biomarkers, vascular measurements, and clinical events, this review identifies evidence gaps linking biological heterogeneity to cardiovascular outcomes. Emerging subtype-related evidence supports further investigation but does not establish differences in cardiovascular event risk among SUP, OMA, and DIE. Prospective studies are needed to determine whether incorporating endometriosis subtype improves cardiovascular risk assessment beyond conventional factors. (Figure 1)