Bridging The Gap: Why Circulating microRNAs Have Yet to Become Clinical Biomarkers for Endometriosis

Endometriosis is a chronic inflammatory disorder in which endometrial-like tissue grows outside the uterus, leading to pelvic pain, infertility, and diagnostic delays due to the current reliance on invasive laparoscopy. Although imaging and hormonal assays offer limited accuracy in diagnosing the disease, circulating microRNAs (miRNAs) in arterial blood have emerged as a promising alternative method as noninvasive biomarkers because they regulate gene expression, reflect inflammatory and angiogenic pathways, and remain stable in circulation. I propose investigating miRNAs such as miR-17-5p, miR-451a, and the let-7 family because of their direct involvement in the regulation of processes such as cell proliferation, immune modulation, and endometrial tissue remodeling which are mechanisms directly implicated in endometriosis pathogenesis. Research on miRNA-based diagnostics has shown strong preliminary accuracy but inconsistent reproducibility due to small cohorts, limited diversity, and lack of standardized extraction or normalization protocols. Clinical translation has further stalled because of logistical and regulatory barriers that restrict large-scale validation and approval. This research examines how methodological standardization, computational modeling, and multicenter collaboration may bridge this gap by improving data reliability and diagnostic precision. Refining miRNA profiling could revolutionize noninvasive diagnostics for endometriosis by reducing time to diagnosis significantly and enabling personalized care based on different molecular signatures. However, because miRNA-based diagnostics remain in early developmental stages, longitudinal studies and global standardization efforts are needed to establish reproducibility, gain regulatory confidence, and real-world clinical feasibility.