Endometriosis and Müllerian Anomalies: A Review

Purpose of Review Müllerian anomalies are recognized as a significant risk factor for the development of endometriosis. The purpose of this review is to synthesize current evidence on the association between Müllerian anomalies and endometriosis and to present our clinical experience with diagnosis and management strategies in these complex cases. Recent Findings Recent meta-analysis data demonstrate that 47% of patients with obstructive müllerian anomalies develop endometriosis, compared to 19% with non-obstructive anomalies and 21% without anomalies. While surgical correction of obstructive anomalies is often associated with symptom improvement, the degree of endometriosis regression postoperatively remains variable. Some studies report complete resolution of symptoms and endometriotic lesions, while others document persistent disease. Summary Müllerian anomalies, particularly obstructive variants, are strongly associated with an increased risk of endometriosis, likely due to the pathophysiological mechanism of retrograde menstruation. Clinical management requires a thorough understanding of the müllerian anomaly type, and further evidence is needed to determine if concurrent endometriosis treatment during corrective surgery is beneficial. Similar content being viewed by others Data Availability No datasets were generated or analysed during the current study.

Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244–56. Piriyev E, Römer T. Coincidence of uterine malformations and endometriosis: a clinically relevant problem? Arch Gynecol Obstet. 2020;302(5):1237–41. Pitot MA, Bookwalter CA, Dudiak KM. Müllerian duct anomalies coincident with endometriosis: a review. Abdom Radiol. 2020;45(6):1723–40. Bhamidipaty-Pelosi S, Kyei-Barffour I, Volpert M, O’Neill N, Grimshaw A, Eriksson L, et al. Müllerian anomalies and endometriosis: associations and phenotypic variations. Reprod Biol Endocrinol. 2024;22(1):157. Pfeifer SM, Attaran M, Goldstein J, Lindheim SR, Petrozza JC, Rackow BW, et al. ASRM müllerian anomalies classification 2021. Fertil Steril. 2021;116(5):1238–52. Bortoletto P, Romanski PA, Pfeifer SM. Müllerian anomalies: presentation, diagnosis, and counseling. Obstet Gynecol. 2024;143(3):369–77. Patel V, Gomez-Lobo V. Obstructive anomalies of the gynecologic tract. Curr Opin Obstet Gynecol. 2016;28(5):339–44. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223–36. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod Oxf Engl. 2014;29(3):400–12. Treatment of pelvic. Pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927–35. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12. Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet. 2021;304(1):143–55. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268–79. Vercellini P, Salmeri N, Somigliana E, Piccini M, Caprara F, Viganò P, et al. Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis. Hum Reprod. 2024;39(7):1460–70. Takahashi N, Harada M, Kanatani M, Wada-Hiraike O, Hirota Y, Osuga Y. The association between endometriosis and obstructive müllerian anomalies. Biomedicines. 2024. https://doi.org/10.3390/biomedicines12030651 LaMonica R, Pinto J, Luciano D, Lyapis A, Luciano A. Incidence of septate uterus in reproductive-aged women with and without endometriosis. J Minim Invasive Gynecol. 2016;23(4):610–3. Kapczuk K, Zajączkowska W, Madziar K, Kędzia W. Endometriosis in adolescents with obstructive anomalies of the reproductive tract. J Clin Med. 2023. https://doi.org/10.3390/jcm12052007 Song X, Zhu L, Ding J, Xu T, Lang J. Clinical characteristics of congenital cervical atresia and associated endometriosis among 96 patients. Int J Gynaecol Obstet. 2016;134(3):252–5. Tong J, Zhu L, Chen N, Lang J. Endometriosis in association with Herlyn-Werner-Wunderlich syndrome. Fertil Steril. 2014;102(3):790–4. Dreisler E, Stampe Sørensen S. Müllerian duct anomalies diagnosed by saline contrast sonohysterography: prevalence in a general population. Fertil Steril. 2014;102(2):525–9. Konrad L, Dietze R, Kudipudi PK, Horné F, Meinhold-Heerlein I. Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis? Reprod Camb Engl. 2019;158(2):R41–7. Sanfilippo JS, Wakim NG, Schikler KN. Endometriosis in association with uterine anomaly. Am J Obstet Gynecol. 1986;154(1):39–43. Silveira SA, Laufer MR. Persistence of endometriosis after correction of an obstructed reproductive tract anomaly. J Pediatr Adolesc Gynecol. 2013;26(4):e93-94. Author information Authors and Affiliations Contributions C.W. and J.S. wrote the main manuscript text. Corresponding author Ethics declarations Competing interests J.S. receives royalties from UpToDate. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Jessica Y. Shim is an author for UpToDate. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Wentworth, C.J., Shim, J.Y. Endometriosis and Müllerian Anomalies: A Review. Curr Obstet Gynecol Rep 14, 42 (2025). https://doi.org/10.1007/s13669-025-00443-z Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s13669-025-00443-z