Endometriosis-associated pain and adhesions — new pathogenetic aspects and therapeutic approach

Maria I. Yarmolinskaya, L.V. Adamyan
In: Russian Journal of Human Reproduction · 2023 · vol. 29(2) , pp. 93 · doi:10.17116/repro20232902193 · W4378175302
article OA: closed CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review explores the role of the immune system and fibrosis in endometriosis-associated pain and adhesions and evaluates the efficacy of a combined therapy for treating pain, infertility, and preventing adhesions.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper discusses endometriosis-associated pelvic pain and adhesion formation by synthesizing evidence on how chronic inflammation and reactive fibrosis translate into clinical symptoms. It highlights mechanisms involving activated platelets and macrophages (including M1-to-M2 transitions) that drive TGF-β1/Smad3 signaling, epithelial–mesenchymal transition, α-SMA–positive myofibroblast activity, and extracellular matrix collagen deposition, linking these processes to pain mediators such as IL-1β, IL-6, TNF-α, VEGF, MCP-1, and neurotrophic pathways involving BDNF and NGF. The major limitation stated in the text is that pathogenetic mechanisms are still fragmentary and require further clarification, with fibrosis also complicating histologic interpretation and potentially causing mismatches between preoperative diagnosis and pathology. Relevance to endometriosis: the paper is directly centered on endometriosis-associated pain, fibrosis, and adhesions, including described roles of inflammatory mediators and immune-platelet-macrophage pathways in endometriosis.

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Abstract

Endometriosis is a genetic determined disease defined as the presence of endometrium-like tissue outside of the uterine cavity. Although the etiology of endometriosis remains elusive, immunological dysfunction and hormone imbalance are considered to cause an estrogen-dependent chronic inflammation leading to fibrosis and adhesion formation. Thus, endometriosis pathogenesis is not still fully elucidated, this article describes the role of immune system in endometriosis-associated pelvic pain and adhesions. At the same time, the impact of fibrosis on disease progression as well as on pain and infertility is considered. Furthermore, the efficacy of combined therapy with use of bovhyaluronidase azoximer is evaluated for treatment of pain and infertility, and prevention of endometriosis-related adhesions.

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endometriosisinfertility

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