Medicine:Endometriosis

From HandWiki

Endometriosis is a disease in which tissue similar to the lining of the womb grows elsewhere in the body.[1] It occurs in humans and a limited number of other mammals that have a menstruation cycle, notably primates.[2] The tissue most often grows on or around the ovaries and fallopian tubes, on the outside surface of the womb, or the tissues surrounding the womb and the ovaries.[3] It can also grow on other organs in the pelvic region like the bowels, stomach or bladder.[4] Rarely, it can also occur in other parts of the body.[3]

Symptoms can be very different from person to person, varying in range and intensity. About 25% of individuals have no symptoms,[5] while for some it can be a debilitating disease.[6] Common symptoms include pelvic pain, heavy and painful periods, pain with bowel movements, painful urination, pain during sexual intercourse, and infertility.[5][7] Nearly half of those affected have chronic pelvic pain, while 70% feel pain during menstruation.[5] Up to half of affected individuals are infertile.[5] Besides physical symptoms, endometriosis can affect a person's mental health and social life.[8]

Diagnosis is usually based on symptoms and medical imaging;[3] however, a definitive diagnosis is made through laparoscopy (keyhole surgery).[3] Other causes of similar symptoms include pelvic inflammatory disease, irritable bowel syndrome, interstitial cystitis, and fibromyalgia.[5] Endometriosis is often misdiagnosed and many patients report being incorrectly told their symptoms are trivial or normal.[8] Patients with endometriosis see an average of seven physicians before receiving a correct diagnosis.[9]

Worldwide, around 10% of the female population of reproductive age (190 million women) are affected by endometriosis.[10] Asian women are more likely than White women to be diagnosed with endometriosis.[11][12] The exact cause of endometriosis is not known. Possible causes include problems with menstrual period flow, genetic factors, hormones, and problems with the immune system.[3] Endometriosis is associated with elevated levels of the female sex hormone estrogen, as well as estrogen receptor sensitivity.[13]

While there is no cure for endometriosis, several treatments may improve symptoms.[5] This includes pain medication, hormonal treatments or surgery. The recommended pain medication is usually a non-steroidal anti-inflammatory drug (NSAID), such as naproxen. Taking the birth control pill continuously or using a hormonal IUD (coil) is another first-line treatment. Other types of hormonal treatment can be tried if the pill or IUD are not effective.[14] Surgical removal of endometriosis may be used to treat those whose symptoms are not manageable with other treatments, or to treat infertility.[15]


Signs and symptoms

Pain and infertility are common symptoms, although 20–25% of affected women are asymptomatic.[5] The presence of pain symptoms is associated with the type of endometrial lesions, as 50% of women with typical (peritoneal) lesions, 10% of women with cystic ovarian lesions, and 5% of women with deep endometriosis do not have pain.[16]

Pelvic pain

A major symptom of endometriosis is recurring pelvic pain. The pain can range from mild to severe cramping or stabbing pain that occurs on both sides of the pelvis, in the lower back and rectal area, and even down the legs. The amount of pain a person feels correlates weakly with the extent or stage (1 through 4) of endometriosis, with some individuals having little or no pain despite having extensive endometriosis or endometriosis with scarring, while others may have severe pain even though they have only a few small areas of endometriosis.[17] The most severe pain is typically associated with menstruation. Pain can also start a week before a menstrual period, during, and even a week after a menstrual period, or it can be constant. The pain can be debilitating and result in emotional stress.[18] Symptoms of endometriosis-related pain may include:

  • Dysmenorrhea (64%)[19] – painful, sometimes disabling cramps during the menstrual period; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
  • Chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
  • Dyspareunia – painful sexual intercourse
  • Painful urination during period[20]
  • Mittelschmerz – pain associated with ovulation[21]

Compared with patients with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of their insides being pulled down.[22] Individual pain areas and intensity appear to be unrelated to the surgical diagnosis, and the area of pain is unrelated to the area of endometriosis.[22]

Infertility

Main article: Biology:Endometriosis and infertility

About a third of women with infertility have endometriosis.[5] Among those with endometriosis, about 40% are infertile.[5] The pathogenesis of infertility varies by disease stage: in early-stage disease, it is hypothesised to result from an inflammatory response that impairs various aspects of conception, whereas in later stages, distorted pelvic anatomy and adhesions contribute to impaired fertilisation.[23] Endometriosis can lead to ovarian cysts (endometriomas), adhesions, and damage to the fallopian tubes or ovaries, all of which can interfere with ovulation and fertilization.

Other

Bowel endometriosis may include symptoms like diarrhea, constipation, tenesmus, dyschezia, and, rarely, rectal bleeding. Other symptoms include chronic fatigue, nausea and vomiting, migraines, low-grade fevers, heavy (44%) and/or irregular periods (60%), and hypoglycemia.[19][24][20] Endometriosis is associated with certain types of cancers, notably some types of ovarian cancer,[25] non-Hodgkin's lymphoma and brain cancer.[26] Endometriosis is however unrelated to endometrial cancer.[27]

Rarely, endometriosis can cause endometrium-like tissue to be found in other parts of the body. Thoracic endometriosis occurs when endometrium-like tissue implants in the lungs or pleura. Manifestations of this include coughing up blood, a collapsed lung, or bleeding into the pleural space.[11][28] Endometriosis may also affect the nearby colon, which in rare situations may progress to partial obstruction, requiring emergency surgery.[29]

Stress may be a contributing factor or a consequence of endometriosis.[30]

Complications

Physical health

Ovarian endometriosis may complicate pregnancy through decidualization, abscess formation, and/or rupture.[31] Women with endometriosis also face a significantly increased risk of experiencing ante- and postpartum hemorrhage[32] as well as a 170% increased risk of severe pre-eclampsia[33] during pregnancy. Endometriosis can also impact a woman's fetus or neonate, increasing the risks for congenital malformations, preterm delivery, and higher neonatal death rates.[33]

Thoracic endometriosis can be associated with recurrent thoracic endometriosis syndrome which manifests during menstrual periods. It includes catamenial pneumothorax in 73% of women, catamenial hemothorax in 14%, catamenial hemoptysis in 7%, and pulmonary nodules in 6%.[34][35] Sciatic endometriosis, also called catamenial or cyclical sciatica, is a rare form where endometriosis affects the sciatic nerve. Diagnosis is usually confirmed through MRI or CT-myelography.[36]

A 20-year study involving 12,000 women with endometriosis found that individuals under 40 are three times more likely to develop heart problems compared to their healthy peers.[37]

Endometriosis increases the risk of developing ovarian and thyroid cancers compared to women without the condition, and slightly increases the risk of breast cancer.[38]

The mortality rates associated with endometriosis are low, with unadjusted and age-standardized death rates of 0.1 and 0.0 per 100,000, respectively.[39]

Mental health

"Endometriosis is associated with an elevated risk of developing depression and anxiety disorders".[40] Studies suggest this is partially due to the pelvic pain experienced by endometriosis patients.

"It has been demonstrated that pelvic pain has significant negative effects on women's mental health and quality of life; in particular, women who suffer from pelvic pain report high levels of anxiety and depression, loss of working ability, limitations in social activities and a poor quality of life" [41]

Mental health concerns like depression and anxiety can also result due to poor diagnostic procedures related to cultural norms where women's concerns are devalued or ignored, especially by medical professionals.[42][43]

Risk factors

Genetics

Endometriosis is a heritable condition influenced by both genetic and environmental factors,[44] a genetic disorder of polygenic/multifactorial inheritance[45] acquired via affected genes from either a person's father or mother. For example, children or siblings of women with endometriosis are at higher risk of developing endometriosis themselves; low progesterone levels may be genetic, and may contribute to a hormone imbalance.[46] Individuals with an affected first-degree relative have an approximate six-fold increase incidence of endometriosis.[47]

Inheritance is significant but not the sole risk factor for endometriosis. Studies attribute 50% of the risk to genetics, the other 50% to environmental factors.[48] It has been proposed that endometriosis may result from multiple mutations within target genes, in a mechanism similar to the development of cancer.[44] In this case, the mutations may be either somatic or heritable.[44]

A 2019 genome-wide association study (GWAS) review enumerated 36 genes with mutations associated with endometriosis development.[49] Nine chromosome loci were robustly replicated:[50][51][52][53]

Chromosome Gene/cytoband Gene Product Function
1 WNT4/1p36.12 Wingless-type MMTV integration site family member 4 Vital for the development of the female reproductive organs
2 GREB1/2p25.1 Growth regulation by estrogen in breast cancer 1/Fibronectin 1 Early response gene in the estrogen regulation pathway/Cell adhesion and migration processes
2 ETAA1/2p14 (ETAA1 Activator Of ATR Kinase) is a protein-coding gene. Diseases associated with ETAA1 include Adult Lymphoma and Restless Legs Syndrome
2 IL1A/2q13 Interleukin 1 alpha (IL-1α) is encoded by the IL1A gene. Interleukin 1 alpha (IL-1α) is encoded by the IL1A gene.
4 KDR/4q12 KDR is the human gene encoding kinase insert domain receptor, also known as vascular endothelial growth factor receptor 2 (VEGFR-2) Primary mediator of VEGF-induced endothelial proliferation, survival, migration, tubular morphogenesis and sprouting[54]
6 ID4/6p22.3 Inhibitor of DNA binding 4 Ovarian oncogene, biological function unknown
7 7p15.2 Transcription factors Influence transcriptional regulation of uterine development
9 CDKN2BAS/9p21.3 Cyclin-dependent kinase inhibitor 2B antisense RNA Regulation of tumour suppressor genes
12 VEZT/12q22 Vezatin, an adherens junction transmembrane protein Tumor suppressor gene

There are many findings of altered gene expression and epigenetics, but both of these can also be a secondary result of, for example, environmental factors and altered metabolism. Examples of altered gene expression include that of miRNAs.[44]

Environmental toxins

Some factors associated with endometriosis include:

  • Prolonged exposure to naturally synthesized estrogen; for example, from late menopause[55] or early menarche[56][57]
  • Obstruction of menstrual outflow; for example, in Müllerian anomalies[55]

Potential toxins:

  • Dioxins - Several studies have investigated the potential link between exposure to dioxins and endometriosis, but evidence is equivocal, and potential mechanisms are poorly understood.[58] A 2004 review of studies of dioxin and endometriosis concluded that "the human data supporting the dioxin-endometriosis association are scanty and conflicting",[59] and a 2009 follow-up review also found that there was "insufficient evidence" in support of a link between dioxin exposure and developing endometriosis.[60]
  • Endocrine-disrupting chemicals (EDCs)- A wider class of hormonally active agents, to which dioxin belongs, consists of both natural and manmade compounds, e.g., bisphenols, phthalates, pesticides (chlorpyrifos, hexachlorobenzene) and polychlorinated biphenyls (PCBs).[61] Dietary uptake represents a significant source of EDC exposure via consumption of food, water and beverages, but exposure can also occur through ingestion of EDC dust and inhalation of its gases or particles in the air.[61] Most EDCs are lipophilic, allowing them to bioaccumulate in adipose tissue (body fat) and increase in concentration.[62] Bisphenol A (BPA), bisphenol S (BPS), phthalates, pesticides and PCBs all have a suspected linkage to endometriosis,[61] though have not been definitively proven as being causative.[62]

Autoimmune and autoinflammatory conditions

Endometriosis patients show a significantly increased risk of autoimmune, autoinflammatory, and mixed-pattern psoriatic diseases, with two studies in 2025 pointing to the connection. One of the studies suggested that the chances of receiving a diagnosis of at least one of the autoimmune conditions for those with endometriosis was around twice that of a control cohort. The linked conditions include rheumatoid arthritis, multiple sclerosis, coeliac disease, osteoarthritis, and psoriasis. This reinforces the view that there is a genetic correlation between endometriosis and osteoarthritis, rheumatoid arthritis, and multiple sclerosis (MS), and a potential causal link to rheumatoid arthritis. The work suggests a shared biological basis between endometriosis on one side, and autoimmune and autoinflammatory diseases, on the other. This suggests that certain autoimmunne treatment pathways could be repurposed to provided alternative therapy options for those with endometriosis.[63][64][65]

Mechanism

File:Characteristics of endometriosis.webp
Six characteristics of endometriosis: estrogen dependency, retrograde menstruation, angiogenesis, local inflammation, oxidative stress and stem cells

While the exact cause of endometriosis remains unknown, many theories have been presented to understand and explain its development. These concepts do not necessarily exclude each other. The pathophysiology of endometriosis is likely to be multifactorial and to involve an interplay between several factors.[44]

Formation

The main theories for the formation of the ectopic endometrium-like tissue include retrograde menstruation, Müllerianosis, coelomic metaplasia, vascular dissemination of stem cells, and surgical transplantation, which were postulated as early as 1870. Each is further described below.[11][66][67]

Retrograde menstruation theory

During menstruation, some menstrual blood, tissue, and fluid can flow backward through the fallopian tubes into the pelvic area (the peritoneal cavity). This backward flow (called retrograde menstruation) is thought to be the main reason why endometriosis develops inside the pelvic cavity. However, this explanation alone is not enough, because almost all women have some backward flow of menstrual fluid, but only some of them develop endometriosis.[68]

Evidence in support of the theory are based on retrospective epidemiological studies that an association with endometrial implants attached to the peritoneal cavity, which would develop into endometrial lesions and retrograde menstruation; and the fact that animals like rodents and non-human primates whose endometrium is not shed during the estrous cycle don't produce naturally endometriosis contrary to animals that have a natural menstrual cycle like rhesus monkeys and baboons.[69]

Retrograde menstruation alone is not able to explain all instances of endometriosis, and additional factors such as genetics, immunology, stem cell migration, and coelomic metaplasia (see "Other theories" on this page) are needed to account for disseminated disease and why many individuals with retrograde menstruation are not diagnosed with endometriosis. In addition, endometriosis has shown up in people who have never experienced menstruation including men, female fetuses, and prepubescent girls.[70] Further theoretical additions are needed to complement the retrograde menstruation theory to explain why cases of endometriosis show up in the brain[71] and lungs.[72]

Researchers are investigating the possibility that the immune system may be unable to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest in studying the relationship of endometriosis to autoimmune disease, allergic reactions, and the impact of toxic materials.[73][74]

Endometriotic lesions differ in their biochemistry, hormonal response, immunology, and inflammatory response compared to the endometrium.[11][75] This is likely because the cells that give rise to endometriosis are a side population of cells.[44] Similarly, there are changes in, for example, the mesothelium of the peritoneum in people with endometriosis, such as loss of tight junctions. It is unknown if these are causes or effects of the disorder.[76]

In rare cases, when an imperforate hymen persists to menarche, menstrual outflow can be obstructed, leading to retention of blood within the vagina and uterus (hematocolpos/hematometra) and, in some cases, into the Fallopian tubes. Symptoms (e.g., pelvic or abdominal pain) may be nonspecific, contributing to delayed recognition. Prolonged obstruction can produce retrograde menstruation, a mechanism widely discussed in reviews of endometriosis pathogenesis.[77][78][79]

Other theories

  • Stem cells: Endometriosis may arise from stem cells from bone marrow and potentially other sources. In particular, this theory explains endometriosis found in areas remote from the pelvis, such as the brain or lungs.[67] Stem cells may be from local cells such as the peritoneum (see coelomic metaplasia below) or cells disseminated in the bloodstream (see vascular dissemination below) such as those from the bone marrow.[66][67][80]
  • Vascular dissemination: Vascular dissemination is a 1927 theory that has been revived with new studies of bone marrow stem cells involved in pathogenesis.[67][80]
  • Müllerianosis: A theory supported by foetal autopsy is that cells with the potential to become endometrial, which are laid down in tracts during embryonic development called the female reproductive (Müllerian) tract, as it migrates downward at 8–10 weeks of embryonic life, could become dislocated from the migrating uterus and act like seeds or stem cells.[66][81]
  • Coelomic metaplasia: Coelomic cells which are the common ancestor of endometrial and peritoneal cells may undergo metaplasia (transformation) from one type of cell to the other, perhaps triggered by inflammation.[66][82]
  • Vasculogenesis: Up to 37% of the microvascular endothelium of ectopic endometrial tissue originates from endothelial progenitor cells, which result in de novo formation of microvessels by the process of vasculogenesis rather than the conventional process of angiogenesis.[83][clarification needed]
  • Neural growth: An increased expression of new nerve fibres is found in endometriosis, but does not fully explain the formation of ectopic endometriotic tissue and is not definitely correlated with the amount of perceived pain.[84][clarification needed]
  • Autoimmune: Graves disease is an autoimmune disease characterized by hyperthyroidism, goiter, ophthalmopathy, and dermopathy. People with endometriosis had higher rates of Graves' disease. One of these potential links between Graves disease and endometriosis is autoimmunity.[85][86]
  • Oxidative stress: Influx of iron is associated with the local destruction of the peritoneal mesothelium, leading to the adhesion of ectopic endometriotic cells.[87] Peritoneal iron overload has been suggested to be caused by the destruction of erythrocytes, which contain the iron-binding protein hemoglobin, or a deficiency in the peritoneal iron metabolism system.[87] Oxidative stress activity and reactive oxygen species (ROS) (such as superoxide anions and peroxide levels) are reported to be higher than normal in people with endometriosis.[87] Oxidative stress and the presence of excess ROS can damage tissue and induce rapid cellular division.[87] Mechanistically, there are several cellular pathways by which oxidative stress may lead to or may induce proliferation of endometriotic lesions, including the mitogen activated protein (MAP) kinase pathway and the extracellular signal-related kinase (ERK) pathway.[87] Activation of both of the MAP and ERK pathways lead to increased levels of c-Fos and c-Jun, which are proto-oncogenes that are associated with high-grade lesions.[87]
  • Microbiome: Some studies have reported differences in gut microbial composition in individuals with endometriosis compared to healthy controls. These findings have led to suggestions that alterations in the gut microbiome may contribute to the pathophysiology of endometriosis, though further research is needed to clarify this relationship.[88]

Pain

There are multiple causes of pain. Endometriosis lesions react to hormonal stimulation and may "bleed" during menstruation. The blood accumulates locally if not cleared shortly by the immune, circulatory, and lymphatic systems. This accumulation can lead to swelling, which triggers inflammation via cytokines, resulting in pain. Another source of pain is organ dislocation that arises from adhesion binding internal organs together. The ovaries, the uterus, the oviducts, the peritoneum, and the bladder can all be bound together. Pain triggered in this way can last throughout the menstrual cycle, not just during menstrual periods.[89]

Additionally, endometriotic lesions can develop an independent nerve supply, creating a direct and two-way interaction between lesions and the central nervous system. This interaction can produce a variety of individual differences in pain that, in some cases, become independent of the disease itself.[17] Nerve fibers and blood vessels are thought to grow into endometriosis lesions by a process known as neuroangiogenesis.[90]

Localization

Most often, endometriosis is found on the:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place (ligaments)
  • Outer surface of the uterus[3]

Less common pelvic sites are:

Rectovaginal or bowel endometriosis affects approximately 5-12% of those with endometriosis and can cause severe pain with bowel movements.[91] Deep infiltrating endometriosis (DIE) has been defined as the presence of endometrial glands and stroma infiltrating more than 5 mm in the subperitoneal tissue. The prevalence of DIE is estimated to be 1 to 2% in women of reproductive age. Deep endometriosis typically presents as a single nodule in the vesicouterine fold or the lower 20 cm of the bowel. Deep endometriosis can be associated with severe pain. However, it can be present without severe levels of pain.[92]

Extrapelvic endometriosis

Rarely, endometriosis appears in extrapelvic parts of the body, such as the lungs, brain, and skin.[3][35] Risk factors for scar endometriosis include previous abdominal surgeries, such as a hysterotomy or cesarean section, or ectopic pregnancies, salpingostomy, puerperal sterilization, laparoscopy, amniocentesis, appendectomy, episiotomy, vaginal hysterectomies, and hernia repair.[93][94][95]

Less commonly, lesions can be found on the diaphragm or lungs. Diaphragmatic endometriosis is rare, almost always on the right hemidiaphragm, and may cause the cyclic pain of the right scapula (shoulder) or cervical area (neck) during a menstrual period.[96] Pulmonary endometriosis can be associated with a thoracic endometriosis syndrome that can include catamenial (occurs during menstruation) pneumothorax seen in 73% of women with the syndrome, catamenial hemothorax in 14%, catamenial hemoptysis in 7%, and pulmonary nodules in 6%.[35]

Diagnosis

A health history and a physical examination can lead the health care practitioner to suspect endometriosis. Symptoms in combination with ultrasound or MRI imaging can lead to a presumed diagnosis of endometriosis. The gold standard for definite diagnosis is via surgery and a biopsy, but there is a shift away from requiring surgical confirmation before starting treatment to prevent delays.[97] Patients in the UK have an average delay in diagnosis of 8 years and in Norway of 6.7 years.[98] A third of women had consulted their GP six or more times before being diagnosed.[98]

Endometriosis can be classified into four different stages. The American Society of Reproductive Medicine's scale, revised in 1996, gives higher scores to deep, thick lesions or intrusions on the ovaries and dense, enveloping adhesions on the ovaries or fallopian tubes.[99]

As for deep infiltrating endometriosis, TVUS, TRUS, and MRI are the techniques of choice for non-invasive diagnosis with a high sensitivity and specificity.[100]

Physical examination

A trauma-informed framework is recommended for a physical examination, where the health practioner validates pain and fosters trust. The examination focuses on assessing both general symptoms and those linked to deep endometriosis or endometriosis outside the pelvis. Ris factors are also reviewed. The physical examination can include an abdominal exam, a single digit exam of the vagina and pelvic floor, a bimanual exam and examination with a speculum.[97]

Ultrasound

Transvaginal ultrasonography showing a 67 x 40 mm endometrioma as distinguished from other types of ovarian cysts by a somewhat grainy and not completely anechoic content

Vaginal ultrasound can be used to diagnose endometriosis or to localize an endometrioma before surgery.[101] This can be used to identify the spread of disease in individuals with well-established clinical suspicion of endometriosis.[101] Vaginal ultrasound is inexpensive, easily accessible, has no contraindications, and requires no preparation.[101] By extending the ultrasound assessment into the posterior and anterior pelvic compartments, a sonographer can evaluate structural mobility and look for deep infiltrating endometriotic nodules.[102] Better sonographic detection of deep infiltrating endometriosis could reduce the number of diagnostic laparoscopies, as well as guide disease management and enhance patient quality of life.[102]

Ultrasounds cannot be used to exclude a diagnosis of endometriosis.[103] If a transvaginal ultrasound is not suitable or declined, an alternative is an ultrasound via the lower abdomen.[104]

Magnetic resonance imaging

Trichromatic color MRI of ovarian cysts. The bottom right cyst is endometriosis (a chocolate cyst).

MRI is another means of detecting lesions in a non-invasive manner.[105] MRI is not widely used due to its cost and limited availability.[105] It can reliably detect endometriomas and deep infiltrating endemetriosis. It is sometimes used for planning surgery, for instance if an ultrasound is unclear, or for diagnosis if a transvaginal ultrasound is not appropriate or is declined. The field of view is larger in an MRI compared to an ultrasound, which allows a larger part of the bowel to be assessed.[106]

Laparoscopy

Laparoscopic image of endometriotic lesions at the peritoneum of the pelvic wall

Laparoscopy, a surgical procedure where a camera is used to look inside the abdominal cavity, is the only way to accurately diagnose the extent and severity of pelvic/abdominal endometriosis.[105] Laparoscopy is not an applicable test for extrapelvic sites such as umbilicus, hernia sacs, abdominal wall, lung, or kidneys.[105]

Laparoscopy permits lesion visualization unless the lesion is visible externally (e.g., an endometriotic nodule in the vagina) or is extra-abdominal.[105] If the growths (lesions) are not visible, a biopsy must be taken to determine the diagnosis.[107] Surgery for diagnosis also allows for surgical treatment of endometriosis at the same time.

During a laparoscopic procedure, lesions can appear dark blue, powder-burn black, red, white, yellow, brown, or non-pigmented. Lesions vary in size.[108] Some within the pelvic walls may not be visible, as the normal-appearing peritoneum of infertile women reveals endometriosis on biopsy in 6–13% of cases.[109] Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas.[108] Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as endometriomas or "chocolate cysts"; "chocolate" because they contain a thick brownish fluid, mostly old blood.[108]

Frequently, during diagnostic laparoscopy, no lesions are found in individuals with chronic pelvic pain, a symptom common to other disorders including adenomyosis, pelvic adhesions, pelvic inflammatory disease, congenital anomalies of the reproductive tract, and ovarian or tubal masses.[110]

Stages and categories

Endometriosis can be classified as stage I–IV by the revised American Society of Reproductive Medicine (ASRM) staging system.[99][111] The scale uses a point system that assesses lesions and adhesions in the pelvic organs. It is important to note that staging assesses physical disease only, not the level of pain or infertility.[112] A person with Stage I endometriosis may have a little disease and severe pain, while a person with Stage IV endometriosis may have severe disease and no pain or vice versa. The various stages are summarized by:

Stage I (Minimal)

Findings restricted to only superficial lesions and possibly a few filmy adhesions.

Stage II (Mild)

In addition, some deep lesions are present in the cul-de-sac.

Stage III (Moderate)

As above, plus the presence of endometriomas on the ovary and more adhesions.

Stage IV (Severe)

As above, plus large endometriomas and extensive adhesions. Implants and adhesions may be found beyond the uterus. Large ovarian cysts are common.

Endometrial lesions can be differentiated into three types depending on their physiopathology and localisation. The three types are superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE).[113]

The American Society of Reproductive Medicine (ASRM) also has a system for classifying endometriosis into 4 or 5 stages using a point-based scoring metric, while the Endometriosis Foundation of America, has a system with 4 stages based on the location and type of endometriomas.[114][115][116]

Histopathology

For a histopathological diagnosis, at least two of the following three criteria should be present:[117]

  • Endometrial type stroma
  • Endometrial epithelium with glands
  • Evidence of chronic hemorrhage, mainly hemosiderin deposits

Immunohistochemistry is useful in diagnosing endometriosis as stromal cells have the surface antigen CD10, allowing the pathologist to identify and confirm the presence of endometrial stromal cells. This method has a higher rate of accuracy than traditional H&E staining, as H&E staining may miss up to 60% of cases in lower stages of the disease by presenting as false negatives.[118]

Pain quantification

The most common pain scale for quantification of endometriosis-related pain is the visual analogue scale (VAS); VAS and numerical rating scale (NRS) were the best adapted pain scales for pain measurement in endometriosis. For research purposes, and more detailed pain measurement in clinical practice, VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia, and non-menstrual chronic pelvic pain), combined with the clinical global impression (CGI) and a quality of life scale, are used.[119]

Prevention

Limited evidence indicates that the use of combined oral contraceptives is associated with a reduced risk of endometriosis, as is regular exercise and the avoidance of alcohol and caffeine.[3] There is little known information on preventing endometriosis.[120]

Management

While there is no cure for endometriosis, there are treatments for pain and endometriosis-associated infertility. Pain can be treated with hormones, painkillers, or, in severe cases, surgery.[121] The goal of management is to provide pain relief, to restrict the progression of the process, and to restore or preserve fertility where needed.[11]

Treatment with medication for pain management can be initiated based on the presence of symptoms, examination, and ultrasound findings that rule out other potential causes.[122] The UK National Institute for Health and Care Excellence recommends starting initial medication for those with suspected endometriosis, at the same time as referral for investigations such as ultrasound.[123]

In general, the diagnosis of endometriosis is confirmed during surgery, at whih time removal can be performed. Further steps depend on circumstances: someone without infertility can manage symptoms with pain medication and hormonal medication that suppresses the natural cycle, while an infertile individual may be treated expectantly after surgery, with fertility medication, or with in vitro fertilisation (IVF).

A 2020 Cochrane systematic review found that for all types of endometriosis, "it is uncertain whether laparoscopic surgery improves overall pain compared to diagnostic laparoscopy".[124]

Hormonal medications

See also: Chemistry:High-dose estrogen
  • Hormonal birth control pills: combined estrogren-progestin birth control pills are a first-line treatment. The recommendation is to use the pills continuously to stop periods.[97] A 2018 Cochrane systematic review found that there is insufficient evidence to make a judgement on the effectiveness of the combined oral contraceptive pill compared with placebo or other medical treatment for managing pain associated with endometriosis partly because of lack of included studies for data analysis (only two for COCP vs placebo).[125]
  • Progestin-only hormonal suppression (progestogen) is another first-line therapy. It come in different forms and includes the hormonal coil (intrauterine device), the oral dienogest, an injection of medroxyprogesterone acetate every three months or an implant under the skin.[97] Dienogest, which may better than injections,[126] is not available on its own in the US.[97] Oral progestins likely reduce overall pain and period pain compared to placebo, and may also help with pelvic pain. It is unclear how well they work compared to other hormonal therapies.[126]
  • Gonadotropin-releasing hormone (GnRH) modulators are second-line treatments: These drugs include GnRH agonists such as leuprorelin, and GnRH antagonists such as elagolix and decrease estrogen levels.[97] GnRH agonists mimic the effects of menopause, and seem more effective than placebo or oral progestin at reducing pain.[127] They come with side effects of hot flashes and decreased bone density. GnRHs can be prescribed with hormonal 'add-back' therapy or with calcium-regulating agents to reduce the amount of bone loss.[97][127]
  • Aromatase inhibitors are third-line treatments and block estrogen production throughout the body. Examples of aromatase inhibitors include anastrozole and letrozole. Common side effects are hot flashes, night sweats and functional cysts.[97][128] In premenopausal women, these should be taken with other hormones (such as the combined pill) to prevent ovarian stimulation and to prevent menopause symptoms. They can be a option for post-menopausal women who still have endometriosis symptoms, as their action is not limited to suppressing estrogen from ovaries. Evidence is limited.[97]
  • Progesterone receptor modulators like mifepristone and gestrinone have the potential (based on only one randomized controlled trial each) to be used as a treatment to manage pain caused by endometriosis.[129]

Other medicines

  • Pentoxifylline, an immunomodulating agent, has been theorized to improve pain as well as improve pregnancy rates in individuals with endometriosis. There is not enough evidence to support the effectiveness or safety of either of these uses.[130]
  • NSAIDs are anti-inflammatory medications commonly used for endometriosis patients despite unproven efficacy and unintended adverse effects.[131]

Surgery

Based on strong evidence, experts recommend that surgery be performed laparoscopically (through keyhole surgery) rather than open.[107] Treatment consists of the ablation or excision of the endometriosis, electrocoagulation,[132] lysis of adhesions, resection of endometriomas, and restoration of normal pelvic anatomy as much as is possible.[107][133] When laparoscopic surgery is used, small instruments are inserted through the incisions to remove the endometriosis tissue and adhesions. Because the incisions are tiny, there will only be small scars on the skin after the procedure, and most individuals recover from surgery quickly and have a reduced risk of adhesions.[134] Many endometriosis specialists believe that excision is the ideal surgical method to treat endometriosis.[135] A 2017 literature review found that excision improved some outcomes over ablation.[136] In the United States, some specialists trained in excision for endometriosis do not accept health insurance because insurance companies do not reimburse the higher costs of this procedure over ablation.[137]

As for deep endometriosis, a segmental resection or shaving of nodules is effective but is associated with an increased rate of complications, of which about 4.6% are major.[138]

Historically, a hysterectomy (removal of the uterus) was thought to be a cure for endometriosis in individuals who do not wish to conceive. Removal of the uterus may be beneficial as part of the treatment if the uterus itself is affected by adenomyosis. However, this should only be done in combination with the removal of the endometriosis by excision. If endometriosis is not also removed at the time of hysterectomy, pain may persist.[107] A study of hysterectomy patients found that those with endometriosis did not use less pain medication three years after the procedure.[139]

Presacral neurectomy may be performed where the nerves to the uterus are cut. However, this technique is not usually used due to the high incidence of associated complications, including presacral hematoma and irreversible problems with urination and constipation.[107]

Recurrence

The underlying process that causes endometriosis may not cease after a surgical or medical intervention. Even though surgery can improve symptoms, the resurgence of pain is common.[140] A study has shown that dysmenorrhea recurs at a rate of 30 percent within a year following laparoscopic surgery. Resurgence of lesions tends to appear in the same location if the lesions were not completely removed during surgery. It has been shown that laser ablation resulted in higher and earlier recurrence rates when compared with endometrioma cystectomy, and recurrence after repetitive laparoscopy was similar to that after the first surgery. Endometriosis has a 10% recurrence rate after hysterectomy and bilateral salpingo-oophorectomy.[141]

Endometriosis recurrence following conservative surgery is estimated as 21.5% at 2 years and 40–50% at 5 years.[142]

Risks and safety of pelvic surgery

The risk of developing complications following surgery depends on the type of lesion that has undergone surgery.[132] 55% to 100% of individuals develop adhesions following pelvic surgery,[143] which can result in infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery. Trehan's temporary ovarian suspension, a technique in which the ovaries are suspended for a week after surgery, may be used to reduce the incidence of adhesions after endometriosis surgery.[144][145] Removal of cysts on the ovary without removing the ovary is a safe procedure.[132]

Comparison of interventions

A 2021 meta-analysis found that GnRH analogs and combined hormonal contraceptives were the best treatment for reducing dyspareunia and menstrual and non-menstrual pelvic pain.[146] A 2018 Swedish systematic review found several studies but a general lack of scientific evidence for most treatments.[101] There was only one study of sufficient quality and relevance comparing the effect of surgery and non-surgery.[147] Cohort studies indicate that surgery is effective in decreasing pain.[147] Most complications occurred in cases of low intestinal anastomosis, while the risk of fistula occurred in cases of combined abdominal or vaginal surgery, and urinary tract problems were common in intestinal surgery.[147] The evidence was found to be insufficient regarding surgical intervention.[147]

The advantages of physical therapy techniques are decreased cost, absence of major side effects, it does not interfere with fertility, and a near-universal increase in sexual function.[148] Disadvantages are that there are no large or long-term studies of its use for treating pain or infertility related to endometriosis.[148]

Treatment of infertility

Main article: Biology:Endometriosis and infertility

Infertility can be treated with medication (controlled ovarian hyperstimulation), IVF or surgery.[149]

In terms of surgery, endometriomas can be cut out (a cystectomy), or drained and destroyed (ablation). The ablation technique may be better able to preserve the number of remaining viable eggs (the ovarian reserve), compared to cutting out the endometrioma.[150] Surgery attempts to remove endometrium-like tissue[11] and preserve the ovaries without damaging normal tissue.[151] Receiving hormonal suppression therapy after surgery might be positive regarding endometriosis recurrence and pregnancy.[152] In vitro fertilization (IVF) procedures are effective in improving fertility in many individuals with endometriosis.[5]

During fertility treatment, the ultralong pretreatment with GnRH-agonist has a higher chance of resulting in pregnancy for individuals with endometriosis compared to the short pretreatment.[101]

Epidemiology

Determining how many people have endometriosis is challenging because a definitive diagnosis requires surgical visualization through laparoscopic surgery.[153] Criteria that are commonly used to establish a diagnosis include pelvic pain, infertility, surgical assessment, and in some cases, magnetic resonance imaging. An ultrasound can identify large clumps of tissue as potential endometriosis lesions and ovarian cysts, but it is not effective for all patients, especially in cases with smaller, superficial lesions.[154]

Ethnic differences in endometriosis have been observed. The condition is more common in women of East Asian and Southeast Asian descent than in White women.[11]

Estimates of prevalance vary. One source estimates that between 6 and 10% of the general female population have endometriosis.[5] Another estimates that between 2 and 11% of asymptomatic women are affected.[11] In addition, 11% of women in a general population have undiagnosed endometriosis that can be seen on magnetic resonance imaging (MRI).[155][153] Globally, around 176 girls and women are effected, with roughly 22 million having a diagnosis confirmed surgically as of 2021.[156]

Endometriosis is most common in those in their thirties and forties; however, it can begin in girls as early as eight years old.[3][157] It results in few deaths with unadjusted and age-standardized death rates of 0.1 and 0.0 per 100,000.[39] Endometriosis was first determined to be a separate condition in the 1920s.[158] Before that time, endometriosis and adenomyosis were considered together.[158]

It chiefly affects adults from premenarche to postmenopause, regardless of race or ethnicity or whether or not they have had children, and is estimated to affect over 190 million women in their reproductive years.[159] Incidences of endometriosis have occurred in postmenopausal individuals,[160] and in less common cases, individuals may have had endometriosis symptoms before they even reach menarche.[161][162]

The rate of recurrence of endometriosis is estimated to be 40-50% for adults over five years.[163] The rate of recurrence has been shown to increase with time from surgery and is not associated with the stage of the disease, initial site, surgical method used, or post-surgical treatment.[163]

History

Endometriosis was first discovered microscopically by Karl von Rokitansky in 1860,[164] although the earliest antecedents may have stemmed from concepts published almost 4,000 years ago.[165] The Hippocratic Corpus outlines symptoms similar to endometriosis, including uterine ulcers, adhesions, and infertility.[165] Historically, women with these symptoms were treated with leeches, straitjackets, bloodletting, chemical douches, genital mutilation, pregnancy (as a form of treatment), hanging upside down, surgical intervention, and even killing due to suspicion of demonic possession.[165] Hippocratic doctors recognized and treated chronic pelvic pain as a true organic disorder 2,500 years ago, but during the Middle Ages, there was a shift into believing that women with pelvic pain were mad, immoral, imagining the pain, or simply misbehaving.[165] The symptoms of inexplicable chronic pelvic pain were often attributed to imagined madness, female weakness, promiscuity, or hysteria.[165] The historical diagnosis of hysteria, which was thought to be a psychological disease, may have indeed been endometriosis in many cases.[165] The idea that chronic pelvic pain was related to mental illness influenced modern attitudes regarding individuals with endometriosis, leading to delays in correct diagnosis and indifference to the patients' true pain throughout the 20th and into the 21st century.[165]

Hippocratic doctors believed that delaying childbearing could trigger diseases of the uterus, which caused endometriosis-like symptoms. Women with dysmenorrhea were encouraged to marry and have children at a young age.[165] The fact that Hippocratics were recommending changes in marriage practices due to an endometriosis-like illness implies that this disease was likely common.[165]

The theory of retrograde menstruation as a cause of endometriosis was first proposed by John A. Sampson.[66][166]

The early treatment of endometriosis was surgical and included oophorectomy (removal of the ovaries) and hysterectomy (removal of the uterus).[167] In the 1940s, the only available hormonal therapies for endometriosis were high-dose testosterone and high-dose estrogen therapy.[168] High-dose estrogen therapy with diethylstilbestrol for endometriosis was first reported by Karnaky in 1948 and was the main pharmacological treatment for the condition in the early 1950s.[169][170][171] Pseudopregnancy (high-dose estrogen–progestogen therapy) for endometriosis was first described by Kistner in the late 1950s.[169][170] Pseudopregnancy, as well as progestogen monotherapy, dominated the treatment of endometriosis in the 1960s and 1970s.[171] These agents, although efficacious, were associated with intolerable side effects. Danazol was first described for endometriosis in 1971 and became the main therapy in the 1970s and 1980s.[169][170][171] In the 1980s, GnRH agonists gained prominence for the treatment of endometriosis and by the 1990s had become the most widely used therapy.[170][171] Oral GnRH antagonists such as elagolix were introduced for the treatment of endometriosis in 2018.[172]

Society and culture

Public figures

Several public figures have spoken about their experience with endometriosis, including:

Economic burden

The economic burden of endometriosis is widespread and multifaceted.[215] Endometriosis is a chronic disease that has direct and indirect costs, which include loss of work days, direct costs of treatment, symptom management, and treatment of other associated conditions such as depression or chronic pain.[215] One factor that seems to be associated with especially high costs is the delay between the onset of symptoms and diagnosis.

Costs vary greatly between countries.[216] Two factors that contribute to the economic burden include healthcare costs and losses in productivity. A Swedish study of 400 endometriosis patients found "Absence from work was reported by 32% of the women, while 36% reported reduced time at work because of endometriosis".[217] An additional cross sectional study with Puerto Rican women, "found that endometriosis-related and coexisting symptoms disrupted all aspects of women's daily lives, including physical limitations that affected doing household chores and paid employment. The majority of women (85%) experienced a decrease in the quality of their work; 20% reported being unable to work because of pain, and over two-thirds of the sample continued to work despite their pain."[218] A study published in the UK in 2025 found that after women received a diagnosis of endometriosis in an English NHS hospital their earnings were on average £56 per month less in the four to five years after diagnosis than they were in the two years before. There was also a reduction in the proportion of women in employment.[219]

Medical culture

There are many barriers that those affected face in receiving a diagnosis and treatment for endometriosis. Some of these include outdated standards for laparoscopic evaluation, stigma about discussing menstruation and sex, lack of understanding of the disease, primary-care physicians' lack of knowledge, and assumptions about typical menstrual pain.[220] On average, those later diagnosed with endometriosis waited 2.3 years after the onset of symptoms before seeking treatment, and nearly three-quarters of women receive a misdiagnosis before endometriosis.[221] Self-help groups say practitioners delay making the diagnosis, often because they do not consider it a possibility. There is a typical delay of 7–12 years from symptom onset in affected individuals to professional diagnosis.[222] There is a general lack of knowledge about endometriosis among primary care physicians. Half of the general health care providers surveyed in a 2013 study could not name three symptoms of endometriosis.[223] Healthcare providers are also likely to dismiss described symptoms as normal menstruation.[224] Younger patients may also feel uncomfortable discussing symptoms with a physician.[224]

Race and ethnicity

Race and ethnicity may impact how endometriosis affects one's life. Endometriosis is less thoroughly studied among Black people, and the research that has been done is outdated.[225][226] Cultural differences among ethnic groups also contribute to attitudes toward and treatment of endometriosis, especially in Hispanic or Latino communities. A study done in Puerto Rico in 2020 found that health care and interactions with friends and family related to discussing endometriosis were affected by stigma.[227] The most common finding was a referral to those expressing pain related to endometriosis as "changuería" or "changas", terms used in Puerto Rico to describe pointless whining and complaining, often directed at children.[227]

Stigma

The existing stigma surrounding women's health, specifically endometriosis, can lead to patients not seeking diagnoses, lower quality of healthcare, increased barriers to care and treatment, and negative reception from members of society.[228] Additionally, menstrual stigma significantly contributes to the broader issue of endometriosis stigma, creating an interconnected challenge that extends beyond reproductive health.[229][230] Widespread awareness campaigns, developments, and implementations aimed at multilevel anti-stigma organizational and structural changes, as well as more qualitative studies of the endometriosis stigma, help to overcome the harm of the phenomenon.[231]

Research directions

A priority area of research is the search for endometriosis biomarkers, which can help with earlier diagnoses.[232] Studies have examined potential biomarkers such as microRNAs, glycoproteins, and immune markers in blood, menstrual and urine samples, but none have shown the high accurarcy needed for clinical use yet. CA-125, a tumor marker, has been studied extensively. It is elevated in endometriosis, but also in many other conditions, and cannot be used on its own. MicroRNAs might be most promosing, but the high diversity in expression makes them a challenging target.[233]

Preliminary research on mouse models showed that monoclonal antibodies, as well as inhibitors of MyD88 downstream signaling pathway, can reduce lesion volume. Thanks to that, clinical trials are being done on using a monoclonal antibody directed against IL-33 and using anakinra, an IL-1 receptor antagonist.[234]

Taking contraceptive pills or getting long-acting progestogen injections seems to be equally effective for preventing recurring pain after endometriosis surgery. Compared to taking the pill, progestogen might result in a reduced risk of needing further treatments or surgery.[140][235]

Clinical trials are exploring the potential benefits of cannabinoid extracts, dichloroacetic acid, and curcuma capsules.[234]

References

  1. ↑ "About endometriosis". Eunice Kennedy Shriver National Institute for Child Health and Human Development. 21 February 2020. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo. 
  2. ↑ . The European Society of Human Reproduction and Embryology"The non-human primate model of endometriosis: research and implications for fecundity". Molecular Human Reproduction 15 (10): 577–586. 24 July 2009. October 2009. doi:10.1093/molehr/gap057. PMID 19633013. PMC 2744471. https://academic.oup.com/molehr/article-abstract/15/10/577/1090283?redirectedFrom=fulltext. 
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 "Endometriosis". 13 February 2017. https://www.womenshealth.gov/a-z-topics/endometriosis. 
  4. ↑ "Endometriosis". https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis. 
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 "Endometriosis and infertility". Journal of Assisted Reproduction and Genetics 27 (8): 441–7. August 2010. doi:10.1007/s10815-010-9436-1. PMID 20574791. 
  6. ↑ "What is endometriosis?". https://www.endometriosis-uk.org/what-endometriosis. 
  7. ↑ "Endometriosis Is More Than Just 'Painful Periods'" (in en). https://www.yalemedicine.org/news/endometriosis-is-more-than-painful-periods. 
  8. ↑ 8.0 8.1 "The social and psychological impact of endometriosis on women's lives: a critical narrative review". Human Reproduction Update 19 (6): 625–39. 1 November 2013. doi:10.1093/humupd/dmt027. PMID 23884896. 
  9. ↑ "Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries". Fertility and Sterility 96 (2): 366–373.e8. August 2011. doi:10.1016/j.fertnstert.2011.05.090. PMID 21718982. 
  10. ↑ "Endometriosis" (in en). https://www.who.int/news-room/fact-sheets/detail/endometriosis. 
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 "Endometriosis". The New England Journal of Medicine 382 (13): 1244–1256. March 2020. doi:10.1056/NEJMra1810764. PMID 32212520. 
  12. ↑ "Endometriosis as a highly relevant yet neglected gynecologic condition in Asian women". Endocrine Connections 12 (11): e230169. November 2023. doi:10.1530/EC-23-0169. PMID 37676242.  "Compared with Caucasian women, Asian women are more likely to be diagnosed with endometriosis (odds ratio (OR) 1.63, 95% CI 1.03–2.58) (14). Filipinos, Indians, Japanese, and Koreans are among the top Asian ethnicities who are more likely to have endometriosis than Caucasian women (17)."
  13. ↑ "Estrogen Receptors and Endometriosis". International Journal of Molecular Sciences (MDPI AG) 21 (8): 2815. April 2020. doi:10.3390/ijms21082815. PMID 32316608. ""These mechanisms might act in unison to cause endometriosis, but the main trophic factor in endometriosis is estrogen and estrogen exposure plays a crucial role in the development of the disease via estrogen receptors (ERs) [1]."". 
  14. ↑ Solnik & Sanders 2025, p. 14-15.
  15. ↑ "Endometriosis". 24 October 2025. https://www.womenshealth.gov/a-z-topics/endometriosis. 
  16. ↑ "Endometriosis Can Cause Pain at a Distance". Journal of Obstetrics and Gynaecology Canada (Elsevier BV) 43 (9): 1035–1036. September 2021. doi:10.1016/j.jogc.2021.06.002. PMID 34481578. 
  17. ↑ 17.0 17.1 "Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications". Human Reproduction Update 17 (3): 327–46. 2011. doi:10.1093/humupd/dmq050. PMID 21106492. 
  18. ↑ "Are aromatase inhibitors effective in endometriosis treatment?". Expert Opinion on Investigational Drugs 20 (7): 917–31. July 2011. doi:10.1517/13543784.2011.581226. PMID 21529311. 
  19. ↑ 19.0 19.1 "Ovarian endometrioma - a possible finding in adolescent girls and young women: a mini-review". Journal of Ovarian Research 12 (1). November 2019. doi:10.1186/s13048-019-0582-5. PMID 31699129. 50px Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License .
  20. ↑ 20.0 20.1 "What are the symptoms of endometriosis?". https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms. 
  21. ↑ "Endometriosis: an overview of Cochrane Reviews". The Cochrane Database of Systematic Reviews 2014 (3). March 2014. doi:10.1002/14651858.cd009590.pub2. PMID 24610050. 
  22. ↑ 22.0 22.1 "Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain". Fertility and Sterility 94 (1): 20–7. June 2010. doi:10.1016/j.fertnstert.2009.01.164. PMID 19342028. 
  23. ↑ "Treatment of infertility in women with endometriosis". https://www.uptodate.com/contents/treatment-of-infertility-in-women-with-endometriosis. 
  24. ↑ "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World Journal of Gastroenterology 20 (42): 15616–23. November 2014. doi:10.3748/wjg.v20.i42.15616. PMID 25400445. 
  25. ↑ "Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies". The Lancet. Oncology 13 (4): 385–94. April 2012. doi:10.1016/S1470-2045(11)70404-1. PMID 22361336. 
  26. ↑ "[Women with endometriosis: are they different from others?]" (in fr). Gynécologie, Obstétrique & Fertilité 33 (4): 239–46. April 2005. doi:10.1016/j.gyobfe.2005.03.010. PMID 15894210. 
  27. ↑ "Gynecological conditions and the risk of endometrial cancer". Gynecologic Oncology 123 (3): 537–41. December 2011. doi:10.1016/j.ygyno.2011.08.022. PMID 21925719. 
  28. ↑ "Thoracic endometriosis syndrome: CT and MRI features". Clinical Radiology 69 (3): 323–330. March 2014. doi:10.1016/j.crad.2013.10.014. PMID 24331768. 
  29. ↑ "Unusual case of acute large bowel obstruction: endometriosis mimicking sigmoid malignancy". ANZ Journal of Surgery 89 (11): E542–E543. November 2019. doi:10.1111/ans.14869. PMID 30277298. 
  30. ↑ "Is Stress a Cause or a Consequence of Endometriosis?". Reproductive Sciences 27 (1): 39–45. January 2020. doi:10.1007/s43032-019-00053-0. PMID 32046437. 
  31. ↑ "A retrospective analysis of ovarian endometriosis during pregnancy". Fertility and Sterility 94 (1): 78–84. June 2010. doi:10.1016/j.fertnstert.2009.02.092. PMID 19356751. 
  32. ↑ "ESHRE2015: Endometriosis associated with a greater risk of complications in pregnancy". European Society of Human Reproduction and Embryology. 2015. https://endometriosis.org/news/congress-highlights/eshre2015-endometriosis-associated-with-a-greater-risk-of-complications-in-pregnancy/#:~:text=After%20adjustments%20for%20age%20and%20previous%20pregnancy%2C%20results,three%20times%20higher%20for%20ectopic%20pregnancy%20%28OR%202.7%29. 
  33. ↑ 33.0 33.1 "Endometriosis increases the risk of obstetrical and neonatal complications". Acta Obstetricia et Gynecologica Scandinavica 96 (6): 751–760. June 2017. doi:10.1111/aogs.13111. PMID 28181672. 
  34. ↑ "Catamenial pneumothorax". Journal of Thoracic Disease 6 (Suppl 4): S448-60. October 2014. doi:10.3978/j.issn.2072-1439.2014.08.49. PMID 25337402. 
  35. ↑ 35.0 35.1 35.2 "Thoracic endometriosis presenting as a catamenial hemothorax with discordant video-assisted thoracoscopic surgery". Radiology Case Reports 15 (9): 1419–1422. September 2020. doi:10.1016/j.radcr.2020.05.064. PMID 32642009. 
  36. ↑ "Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition". Journal of Endometriosis and Pelvic Pain Disorders (SAGE Publications) 13 (1): 3–9. 11 November 2020. doi:10.1177/2284026520970813. ISSN 2284-0265. 
  37. ↑ "Women with endometriosis show higher risk for heart disease". BMJ 353. April 2016. doi:10.1136/bmj.i1851. PMID 27036948. 
  38. ↑ "Endometriosis and cancer: a systematic review and meta-analysis". Human Reproduction Update (Oxford University Press (OUP)) 27 (2): 393–420. February 2021. doi:10.1093/humupd/dmaa045. PMID 33202017. 
  39. ↑ 39.0 39.1 "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet 388 (10053): 1545–1602. October 2016. doi:10.1016/S0140-6736(16)31678-6. PMID 27733282. 
  40. ↑ "Health-related quality of life in women with endometriosis: a systematic review". Journal of Ovarian Research 5 (1). October 2012. doi:10.1186/1757-2215-5-29. PMID 23078813. 
  41. ↑ "A psychological profile of endometriosis patients in comparison to patients with pelvic pain of other origins". Journal of Psychosomatic Research 37 (2): 111–116. February 1993. doi:10.1016/0022-3999(93)90077-S. PMID 8463987. 
  42. ↑ Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. (1 November 2013). "The social and psychological impact of endometriosis on women's lives: a critical narrative review". Human Reproduction Update. 19 (6): 625–39. doi:10.1093/humupd/dmt027. hdl:2086/8845. PMID 23884896.
  43. ↑ Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. (August 2011). "Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries". Fertility and Sterility. 96 (2): 366–373.e8. doi:10.1016/j.fertnstert.2011.05.090. PMC 3679489. PMID 21718982.
  44. ↑ 44.0 44.1 44.2 44.3 44.4 44.5 "Contemporary genetic technologies and female reproduction". Human Reproduction Update 17 (6): 829–47. 2011. doi:10.1093/humupd/dmr033. PMID 21896560. 
  45. ↑ "Genetics of endometriosis: heritability and candidate genes". Best Practice & Research. Clinical Obstetrics & Gynaecology 18 (2): 219–232. April 2004. doi:10.1016/j.bpobgyn.2004.01.004. PMID 15157639. 
  46. ↑ Kapoor D, Davila W (2005). Endometriosis, eMedicine.
  47. ↑ "Endometriosis". Lancet 364 (9447): 1789–1799. 2004. doi:10.1016/S0140-6736(04)17403-5. PMID 15541453. 
  48. ↑ "Should Genetics Now Be Considered the Pre-eminent Etiologic Factor in Endometriosis?". Journal of Minimally Invasive Gynecology 27 (2): 280–286. February 2020. doi:10.1016/j.jmig.2019.10.020. PMID 31683028. 
  49. ↑ "Defining the genetic profile of endometriosis". Experimental and Therapeutic Medicine 17 (5): 3267–3281. May 2019. doi:10.3892/etm.2019.7346. PMID 30988702. 
  50. ↑ "Genetic variants underlying risk of endometriosis: insights from meta-analysis of eight genome-wide association and replication datasets". Human Reproduction Update 20 (5): 702–716. September 2014. doi:10.1093/humupd/dmu015. PMID 24676469. 
  51. ↑ "MUC16 mucin 16, cell surface associated [Homo sapiens (human) - Gene - NCBI"]. https://www.ncbi.nlm.nih.gov/gene/94025. 
  52. ↑ "FN1 fibronectin 1 [Homo sapiens (human) - Gene - NCBI"]. https://www.ncbi.nlm.nih.gov/gene/2335. 
  53. ↑ "Meta-analysis identifies five novel loci associated with endometriosis highlighting key genes involved in hormone metabolism". Nature Communications (Springer Science and Business Media LLC) 8 (1). May 2017. doi:10.1038/ncomms15539. PMID 28537267. Bibcode: 2017NatCo...815539S. 
  54. ↑ "GeneCards®: The Human Gene Database". Weizmann Institute of Science. https://www.genecards.org/cgi-bin/carddisp.pl?gene=KDR&keywords=kdr. 
  55. ↑ 55.0 55.1 "Clinical practice. Endometriosis". The New England Journal of Medicine 362 (25): 2389–98. June 2010. doi:10.1056/NEJMcp1000274. PMID 20573927. 
  56. ↑ "Early menstrual characteristics associated with subsequent diagnosis of endometriosis". American Journal of Obstetrics and Gynecology 202 (6): 534.e1–6. June 2010. doi:10.1016/j.ajog.2009.10.857. PMID 20022587. http://hdl.cqu.edu.au/10018/58278. 
  57. ↑ "Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies". Fertility and Sterility 98 (3): 702–712.e6. September 2012. doi:10.1016/j.fertnstert.2012.05.035. PMID 22728052. 
  58. ↑ "The link between environmental toxicant exposure and endometriosis". Frontiers in Bioscience 13 (13): 1578–93. January 2008. doi:10.2741/2782. PMID 17981650. 
  59. ↑ "The link between exposure to dioxin and endometriosis: a critical reappraisal of primate data". Gynecologic and Obstetric Investigation 57 (3): 157–73. 2004. doi:10.1159/000076374. PMID 14739528. 
  60. ↑ "Reassessing the evidence for the link between dioxin and endometriosis: from molecular biology to clinical epidemiology". Molecular Human Reproduction 15 (10): 609–24. October 2009. doi:10.1093/molehr/gap075. PMID 19744969. 
  61. ↑ 61.0 61.1 61.2 "Endocrine-Disrupting Chemicals and Disease Endpoints". International Journal of Molecular Sciences 24 (6): 5342. March 2023. doi:10.3390/ijms24065342. PMID 36982431. 
  62. ↑ 62.0 62.1 "Environmental Endocrine Disruptors and Endometriosis". Advances in Anatomy, Embryology, and Cell Biology. Advances in Anatomy, Embryology and Cell Biology. 232. 2020. pp. 57–78. doi:10.1007/978-3-030-51856-1_4. ISBN 978-3-030-51855-4. 
  63. ↑ Clark, Lauren (22 September 2025). "A deeper understanding of endometriosis is suggesting new treatments". New Scientist (London: New Scientist Ltd) (3562). 27 September 2025. ISSN 0262-4079. https://www.newscientist.com/article/2496240-a-deeper-understanding-of-endometriosis-is-suggesting-new-treatments/. Retrieved 29 September 2025. 
  64. ↑ . The International Endometriosis Genome Consortium and the 23andMe Research Team"The phenotypic and genetic association between endometriosis and immunological diseases". Human Reproduction 40 (6): 1195–1209. April 2025. doi:10.1093/humrep/deaf062. PMID 40262193. PMC 12127507. https://academic.oup.com/humrep/article/40/6/1195/8117905?login=false. 
  65. ↑ "Endometriosis and autoimmunity: a large-scale case-control study of endometriosis and 10 distinct autoimmune diseases". npj Women's Health 3 (1). 18 June 2025. doi:10.1038/s44294-025-00086-8. PMID 40547362. 
  66. ↑ 66.0 66.1 66.2 66.3 66.4 "Theories on the pathogenesis of endometriosis". Human Reproduction 11 (Suppl 3): 53–65. November 1996. doi:10.1093/humrep/11.suppl_3.53. PMID 9147102. 
  67. ↑ 67.0 67.1 67.2 67.3 "The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis". Seminars in Reproductive Medicine 33 (5): 333–40. September 2015. doi:10.1055/s-0035-1564609. PMID 26375413. 
  68. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Horne2022
  69. ↑ "Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology". Journal of Translational Medicine (Springer Science and Business Media LLC) 18 (1). August 2020. doi:10.1186/s12967-020-02471-0. PMID 32787880. 
  70. ↑ Pašalić, Elma; Tambuwala, Murtaza M.; Hromić-Jahjefendić, Altijana (2023). "Endometriosis: Classification, pathophysiology, and treatment options". Pathology - Research and Practice 251. doi:10.1016/j.prp.2023.154847. ISSN 0344-0338. https://www.sciencedirect.com/science/article/pii/S0344033823005484. 
  71. ↑ "Cerebral endometriosis. Case report". Journal of Neurosurgery 66 (4): 609–10. April 1987. doi:10.3171/jns.1987.66.4.0609. PMID 3559727. 
  72. ↑ "Catamenial hemoptysis due to bronchial endometriosis". The New England Journal of Medicine 266 (16): 805–8. April 1962. doi:10.1056/nejm196204192661604. PMID 14493132. 
  73. ↑ "Is endometriosis an autoimmune disease?". Obstetrics and Gynecology 70 (1): 115–22. July 1987. PMID 3110710. 
  74. ↑ "Role of estrogens in inflammatory response: expression of estrogen receptors in peritoneal fluid macrophages from endometriosis". Annals of the New York Academy of Sciences 1069 (1): 263–7. June 2006. doi:10.1196/annals.1351.024. PMID 16855153. Bibcode: 2006NYASA1069..263C. 
  75. ↑ "Was Sampson wrong?". Fertility and Sterility 78 (4): 686–93. October 2002. doi:10.1016/S0015-0282(02)03329-0. PMID 12372441. 
  76. ↑ "The role of the peritoneum in the pathogenesis of endometriosis". Human Reproduction Update 19 (5): 558–69. 2013. doi:10.1093/humupd/dmt024. PMID 23720497. 
  77. ↑ Lee KH, Hong JS, Jung HJ, et al. "Imperforate Hymen: A Comprehensive Systematic Review." J Clin Med. 2019;8(1):56.
  78. ↑ Bulun SE, Yilmaz BD, Sison C, et al. "Endometriosis caused by retrograde menstruation." Fertil Steril. 2022;118(4):713–732.
  79. ↑ Lamceva J, Popovska S, Jovanovska V, et al. "The Main Theories on the Pathogenesis of Endometriosis." Biomedicines. 2023;11(3):776.
  80. ↑ 80.0 80.1 "Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity". Am J Obstet Gynecol 14 (4): 422–469. 1927. doi:10.1016/S0002-9378(15)30003-X. 
  81. ↑ "Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer". Journal of Experimental & Clinical Cancer Research 28 (1). April 2009. doi:10.1186/1756-9966-28-49. PMID 19358700. 
  82. ↑ "Diagnosis and treatment of endometriosis". American Family Physician (American Academy of Family Physicians) 60 (6): 1753–62, 1767–8. October 1999. PMID 10537390. http://www.aafp.org/afp/991015ap/1753.html. Retrieved 26 July 2011. 
  83. ↑ "Vasculogenesis: a new piece of the endometriosis puzzle". Human Reproduction Update 17 (5): 628–36. 2011. doi:10.1093/humupd/dmr023. PMID 21586449. 
  84. ↑ "Peripheral changes in endometriosis-associated pain". Human Reproduction Update 20 (5): 717–36. 2014. doi:10.1093/humupd/dmu021. PMID 24859987. 
  85. ↑ "Graves Disease Is Associated With Endometriosis: A 3-Year Population-Based Cross-Sectional Study". Medicine 95 (10). March 2016. doi:10.1097/MD.0000000000002975. PMID 26962803. 
  86. ↑ "Endometriosis". Lancet 364 (9447): 1789–99. 2004. doi:10.1016/S0140-6736(04)17403-5. PMID 15541453. 
  87. ↑ 87.0 87.1 87.2 87.3 87.4 87.5 "Oxidative Stress and Endometriosis: A Systematic Review of the Literature". Oxidative Medicine and Cellular Longevity 2017. 2017. doi:10.1155/2017/7265238. PMID 29057034. 
  88. ↑ Torraco, Astrid; Di Nicolantonio, Sara; Cardisciani, Martina; Ortu, Eleonora; Pietropaoli, Davide; Altamura, Serena; Del Pinto, Rita (2025-05-14). "Meta-Analysis of 16S rRNA Sequencing Reveals Altered Fecal but Not Vaginal Microbial Composition and Function in Women with Endometriosis" (in en). Medicina 61 (5): 888. doi:10.3390/medicina61050888. ISSN 1648-9144. PMID 40428846. 
  89. ↑ The Encyclopedia of Natural Medicine (3rd ed.). New York, NY: Simon and Schuster. 2012. 
  90. ↑ "Endometriosis: the role of neuroangiogenesis". Annual Review of Physiology 73: 163–82. 2011. doi:10.1146/annurev-physiol-012110-142158. PMID 21054165. 
  91. ↑ "Endometriosis of the bowel". Obstetrics and Gynecology 69 (5): 727–30. May 1987. PMID 3574800. 
  92. ↑ "Ultrasound diagnosis of endometriosis and adenomyosis: State of the art". Best Practice & Research. Clinical Obstetrics & Gynaecology 51: 16–24. August 2018. doi:10.1016/j.bpobgyn.2018.01.013. PMID 29506961. https://lirias.kuleuven.be/handle/123456789/621035. 
  93. ↑ "Abdominal wall endometriomas". Digestive Diseases and Sciences 47 (2): 456–461. February 2002. doi:10.1023/a:1013711314870. PMID 11855568. 
  94. ↑ "Needle tract endometriosis: an unusual complication of amniocentesis". Obstetrics and Gynecology 54 (6): 753–755. December 1979. PMID 160025. 
  95. ↑ "Surgical scar endometrioma". Surgery, Gynecology & Obstetrics 177 (3): 243–246. September 1993. PMID 8356497. 
  96. ↑ "Extrapelvic Endometriosis: A Systematic Review". Journal of Minimally Invasive Gynecology 27 (2): 373–389. February 2020. doi:10.1016/j.jmig.2019.10.004. PMID 31618674. 
  97. ↑ 97.0 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 As-Sanie, Sawsan; Mackenzie, Scott C.; Morrison, Leigh; Schrepf, Andrew; Zondervan, Krina T.; Horne, Andrew W.; Missmer, Stacey A. (2025). "Endometriosis" (in en). JAMA 334 (1): 64. doi:10.1001/jama.2025.2975. ISSN 0098-7484. https://jamanetwork.com/journals/jama/article-abstract/2833561. 
  98. ↑ 98.0 98.1 "Management of endometriosis in general practice: the pathway to diagnosis". The British Journal of General Practice 57 (539): 470–6. June 2007. PMID 17550672. 
  99. ↑ 99.0 99.1 American Society For Reproductive (May 1997). "Revised American Society for Reproductive Medicine classification of endometriosis: 1996". Fertility and Sterility 67 (5): 817–21. doi:10.1016/S0015-0282(97)81391-X. PMID 9130884. 
  100. ↑ "Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta-analysis of diagnostic accuracy studies". Experimental and Therapeutic Medicine (Spandidos Publications) 20 (4): 3208–3220. October 2020. doi:10.3892/etm.2020.9043. PMID 32855690. 
  101. ↑ 101.0 101.1 101.2 101.3 101.4 "Endometriosis – Diagnosis, treatment and patient experiences". Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). 4 May 2018. https://www.sbu.se/en/publications/sbu-assesses/endometriosis--diagnosis-treatment-and-patient-experiences/. 
  102. ↑ 102.0 102.1 "A step-by-step guide to sonographic evaluation of deep infiltrating endometriosis". Sonography 5 (2): 67–75. June 2018. doi:10.1002/sono.12149. 
  103. ↑ Solnik & Sanders 2025, p. 94.
  104. ↑ Solnik & Sanders 2025, p. 93.
  105. ↑ 105.0 105.1 105.2 105.3 105.4 "Imaging modalities for the non-invasive diagnosis of endometriosis". The Cochrane Database of Systematic Reviews 2016 (2). February 2016. doi:10.1002/14651858.cd009591.pub2. PMID 26919512. 
  106. ↑ Quesada, Juan; Härmä, Kirsi; Reid, Shannon; Rao, Tanushree; Lo, Glen; Yang, Natalie; Karia, Sonal; Lee, Emmeline et al. (2023). "Endometriosis: A multimodal imaging review" (in English). European Journal of Radiology 158. doi:10.1016/j.ejrad.2022.110610. ISSN 0720-048X. PMID 36502625. https://www.ejradiology.com/article/S0720-048X(22)00460-0/fulltext. 
  107. ↑ 107.0 107.1 107.2 107.3 107.4 "Consensus on current management of endometriosis". Human Reproduction 28 (6): 1552–68. June 2013. doi:10.1093/humrep/det050. PMID 23528916. 
  108. ↑ 108.0 108.1 108.2 "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol 53 (2): 413–9. June 2010. doi:10.1097/GRF.0b013e3181db7ce8. PMID 20436318. 
  109. ↑ "Histologic study of peritoneal endometriosis in infertile women". Fertility and Sterility 53 (6): 984–8. June 1990. doi:10.1016/s0015-0282(16)53571-7. PMID 2351237. 
  110. ↑ Practice Committee of the American Society for Reproductive Medicine (April 2014). "Treatment of pelvic pain associated with endometriosis: a committee opinion". Fertility and Sterility 101 (4): 927–35. doi:10.1016/j.fertnstert.2014.02.012. PMID 24630080. 
  111. ↑ Crump, Jessica; Suker, Adriana; White, Louise (2024). "Endometriosis: A review of recent evidence and guidelines". Australian Journal of General Practice 53 (1-2): 11–18. doi:10.31128/AJGP/04-23-6805. https://www1.racgp.org.au/ajgp/2024/january-february/endometriosis. 
  112. ↑ "Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients". Human Reproduction 22 (1): 266–71. January 2007. doi:10.1093/humrep/del339. PMID 16936305. 
  113. ↑ "Three Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art". Journal of Clinical Medicine 12 (3): 994. 2023. doi:10.3390/jcm12030994. PMID 36769642. 
  114. ↑ "Endometriosis Stages: Understanding the Different Stages of Endometriosis". 15 July 2025. https://www.endofound.org/stages-of-endometriosis. 
  115. ↑ "Stages of Endometriosis". Seckin Endometriosis Center. 20 May 2020. https://drseckin.com/stages-of-endometriosis/. 
  116. ↑ "Endometriosis Stages » Stages I - IV Explained". https://www.advancedgynaecologymelbourne.com.au/endometriosis/stages. 
  117. ↑ "Ovary - nontumor - Nonneoplastic cysts / other - Endometriosis". November 2023. http://www.pathologyoutlines.com/topic/ovarynontumorendometriosis.html. 
  118. ↑ "The Clinical Utility Of CD10 Immunohistochemical Staining In The Diagnosis Of Endometriosis.". 10th World Congress of Endometriosis. Melbourne, Australia.. http://www.rfay.com.au/docs/cd10poster.pdf. Retrieved 18 July 2013. 
  119. ↑ "Systematic review of endometriosis pain assessment: how to choose a scale?". Human Reproduction Update 21 (1): 136–52. 2014. doi:10.1093/humupd/dmu046. PMID 25180023. 
  120. ↑ "Endometriosis" (in en). https://www.who.int/news-room/fact-sheets/detail/endometriosis. 
  121. ↑ "What are the treatments for endometriosis?" (in en). 2020-02-21. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment. 
  122. ↑ "Update on pharmacologic treatment for endometriosis- related pain". 7 June 2020. https://www.npwomenshealthcare.com/update-on-pharmacologic-treatment-for-endometriosis-related-pain/. 
  123. ↑ NICE 2024, pp. 11–12.
  124. ↑ "Laparoscopic surgery for endometriosis". The Cochrane Database of Systematic Reviews (Wiley) 2020 (10). October 2020. doi:10.1002/14651858.cd011031.pub3. PMID 33095458. 
  125. ↑ "Oral contraceptives for pain associated with endometriosis". The Cochrane Database of Systematic Reviews (Wiley) 2018 (5). May 2018. doi:10.1002/14651858.cd001019.pub3. PMID 29786828. 
  126. ↑ 126.0 126.1 Chen, Innie; Kives, Sari; Zakhari, Andrew; Nguyen, Dong Bach; Goldberg, Hanna R; Choudhry, Abdul J; Le, Ai-Lien; Kowalczewski, Emilie et al. (2025). Cochrane Central Editorial Service. ed. "Progestagens for pain symptoms associated with endometriosis" (in en). Cochrane Database of Systematic Reviews 2025 (10). doi:10.1002/14651858.CD002122.pub3. http://doi.wiley.com/10.1002/14651858.CD002122.pub3. 
  127. ↑ 127.0 127.1 Veth, Veerle B; van de Kar, Majorie MA; Duffy, James MN; van Wely, Madelon; Mijatovic, Velja; Maas, Jacques WM (2023). Cochrane Gynaecology and Fertility Group. ed. "Gonadotropin-releasing hormone analogues for endometriosis" (in en). Cochrane Database of Systematic Reviews 2023 (6). doi:10.1002/14651858.CD014788.pub2. http://doi.wiley.com/10.1002/14651858.CD014788.pub2. 
  128. ↑ "Aromatase inhibitors for the treatment of endometriosis: a systematic review about efficacy, safety and early clinical development". Expert Opinion on Investigational Drugs (Informa UK Limited) 29 (12): 1377–1388. December 2020. doi:10.1080/13543784.2020.1842356. PMID 33096011. 
  129. ↑ "Progesterone receptor modulators for endometriosis". The Cochrane Database of Systematic Reviews (Wiley) 2017 (7). July 2017. doi:10.1002/14651858.cd009881.pub2. PMID 28742263. 
  130. ↑ "Pentoxifylline for the treatment of endometriosis-associated pain and infertility". The Cochrane Database of Systematic Reviews 2021 (8). August 2021. doi:10.1002/14651858.CD007677.pub4. PMID 34431079. 
  131. ↑ "Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis". The Cochrane Database of Systematic Reviews 1 (1). January 2017. doi:10.1002/14651858.CD004753.pub4. PMID 28114727. 
  132. ↑ 132.0 132.1 132.2 "Endometriosis: pathogenesis and treatment". Nature Reviews. Endocrinology (Springer Science and Business Media LLC) 10 (5): 261–75. May 2014. doi:10.1038/nrendo.2013.255. PMID 24366116. 
  133. ↑ Clinical Gynecologic Endocrinology and Infertility (6th ed.). Lippincott Willimas Wilkins. 1999. p. 1057. ISBN 0-683-30379-1. 
  134. ↑ "Endometriosis and Infertility: Can Surgery Help?". American Society for Reproductive Medicine. 2008. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endometriosis_infertility.pdf. 
  135. ↑ "UNC Center for Endometriosis". https://www.med.unc.edu/obgyn/migs/our-services/unc-center-for-endometriosis/. 
  136. ↑ "Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis". Journal of Minimally Invasive Gynecology 24 (5): 747–756. 2017. doi:10.1016/j.jmig.2017.04.008. PMID 28456617. 
  137. ↑ "Endometriosis, a painful and often overlooked disease, gets attention in a new film". NPR. 16 July 2023. https://www.npr.org/sections/health-shots/2023/07/16/1186533247/endometriosis-a-painful-and-often-overlooked-disease-gets-attention-in-a-new-fil. 
  138. ↑ "ESHRE guideline: management of women with endometriosis". Human Reproduction (Oxford University Press (OUP)) 29 (3): 400–12. March 2014. doi:10.1093/humrep/det457. PMID 24435778. 
  139. ↑ Brunes, M, Altman, D, Pålsson, M, Söderberg, MW, Ek, M. Impact of hysterectomy on analgesic, psychoactive and neuroactive drug use in women with endometriosis: nationwide cohort study. BJOG 2021; 128: 846– 855. [1]
  140. ↑ 140.0 140.1 "Endometriosis, fibroids and heavy periods: long-term research supports treatment decisions". NIHR Evidence (National Institute for Health and Care Research). 2024-12-04. doi:10.3310/nihrevidence_64953. https://evidence.nihr.ac.uk/collection/endometriosis-fibroids-and-heavy-periods-long-term-research-supports-treatment-decisions/. 
  141. ↑ "Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature". J Turk Ger Gynecol Assoc 14 (2): 98–103. 2013. doi:10.5152/jtgga.2013.52385. PMID 24592083. 
  142. ↑ "Recurrence of endometriosis and its control". Human Reproduction Update 15 (4): 441–61. 2009. doi:10.1093/humupd/dmp007. PMID 19279046. 
  143. ↑ "Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management". Digestive Surgery 18 (4): 260–73. 2001. doi:10.1159/000050149. PMID 11528133. 
  144. ↑ "Temporary ovarian suspension". Gynaecological Endoscopy 11 (1): 309–314. 2002. doi:10.1046/j.1365-2508.2002.00520.x. 
  145. ↑ "Temporary ovarian suspension at laparoscopy for prevention of adhesions". The Journal of the American Association of Gynecologic Laparoscopists 9 (1): 98–102. February 2002. doi:10.1016/S1074-3804(05)60114-4. PMID 11821616. 
  146. ↑ "Medical therapy options for endometriosis-related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials". Journal of Gynecology Obstetrics and Human Reproduction (Elsevier BV) 50 (1). January 2021. doi:10.1016/j.jogoh.2020.101798. PMID 32479894. 
  147. ↑ 147.0 147.1 147.2 147.3 "Endometrios – diagnostik, behandling och bemötande" (in sv). Statens beredning för medicinsk och social utvärdering (SBU); Swedish Agency for Health Technology Assessment and Assessment of Social Services. 4 May 2018. p. 121. https://www.sbu.se/sv/publikationer/SBU-utvarderar/endometrios--diagnostik-behandling-och-bemotande/. 
  148. ↑ 148.0 148.1 [non-primary source needed] "Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual physical therapy: Results from two independent studies". Journal of Endometriosis and Pelvic Pain Disorders 3 (4): 188–196. 2011. doi:10.5301/JE.2012.9088. PMC 6154826. http://www.j-endometriosis.com/article/decreasing-dyspareunia-and-dysmenorrhea-in-women-with-endometriosis-via-a-manual-physical-therapy--results-from-two-independent-studies-je-11-0029. 
  149. ↑ Solnik & Sanders 2025, p. 28-29.
  150. ↑ NICE 2024, pp. 18–19.
  151. ↑ "Diagnosis and treatment of endometriosis". American Family Physician 60 (6): 1753–62, 1767–8. October 1999. PMID 10537390. http://www.aafp.org/afp/1999/1015/p1753.html. 
  152. ↑ "Pre- and postsurgical medical therapy for endometriosis surgery". The Cochrane Database of Systematic Reviews 11 (12). November 2020. doi:10.1002/14651858.CD003678.pub3. PMID 33206374. 
  153. ↑ 153.0 153.1 "Risk for and consequences of endometriosis: A critical epidemiologic review". Best Practice & Research. Clinical Obstetrics & Gynaecology 51: 1–15. August 2018. doi:10.1016/j.bpobgyn.2018.06.001. PMID 30017581. https://ora.ox.ac.uk/objects/uuid:39cf959c-3942-4d04-b99f-7be23c31217f. Retrieved 23 August 2020. 
  154. ↑ "Endometriosis Ultrasound: Procedure, Diagnosis, & Follow Up". https://my.clevelandclinic.org/health/diagnostics/21814-endometriosis-ultrasound. 
  155. ↑ "Incidence of endometriosis by study population and diagnostic method: the ENDO study". Fertil. Steril. 96 (2): 360–5. August 2011. doi:10.1016/j.fertnstert.2011.05.087. PMID 21719000. 
  156. ↑ Li, Ruijie; Zhang, Ling; Liu, Yi (2025-06-07). "Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021". Reproductive Biology and Endocrinology 23 (1): 88. doi:10.1186/s12958-025-01421-z. ISSN 1477-7827. PMID 40483411. 
  157. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Mc2013
  158. ↑ 158.0 158.1 Endometriosis: Science and Practice. John Wiley & Sons. 2012. p. 3. ISBN 978-1-4443-9849-6. https://books.google.com/books?id=Wu0gfwFUfz8C&pg=PA3. 
  159. ↑ "The emerging use of aromatase inhibitors for endometriosis treatment". Reproductive Biology and Endocrinology 9: 87. June 2011. doi:10.1186/1477-7827-9-87. PMID 21693036. 
  160. ↑ "Aromatase in aging women". Seminars in Reproductive Endocrinology 17 (4): 349–58. 1999. doi:10.1055/s-2007-1016244. PMID 10851574. 
  161. ↑ "Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and pedagogy". Journal of Pediatric and Adolescent Gynecology 16 (6): 337–47. December 2003. doi:10.1016/j.jpag.2003.09.008. PMID 14642954. 
  162. ↑ "Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly". Fertility and Sterility 83 (3): 758–60. March 2005. doi:10.1016/j.fertnstert.2004.08.025. PMID 15749511. 
  163. ↑ 163.0 163.1 "Recurrence of endometriosis and its control". Human Reproduction Update 15 (4): 441–61. 11 March 2009. doi:10.1093/humupd/dmp007. PMID 19279046. 
  164. ↑ A history of endometriosis. London: Springer. 2011. pp. 13–38. doi:10.1007/978-0-85729-585-9. ISBN 978-0-85729-585-9. 
  165. ↑ 165.0 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 "Endometriosis: ancient disease, ancient treatments". Fertility and Sterility 98 (6 Suppl): S1-62. December 2012. doi:10.1016/j.fertnstert.2012.08.001. PMID 23084567. 
  166. ↑ "Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation". Am. J. Pathol. 3 (2): 93–110.43. March 1927. PMID 19969738. 
  167. ↑ "Endometriosis—Its Significance". Ann. Surg. 114 (5): 866–74. November 1941. doi:10.1097/00000658-194111000-00007. PMID 17857917. 
  168. ↑ "Hormonal therapy of endometriosis". Infertility and Reproductive Medicine Clinics of North America 3 (1): 187–200. January 1992. "The hormonal therapy of endometriosis continues to evolve. In the 1940s and 1950s, high-dose testosterone and diethylstilbestrol regimens were the only hormonal agents available in the treatment of endometriosis. These agents, although efficacious, were associated with intolerable side effects. The current armamentarium of hormonal GnRH analogues, danazol, and synthetic progestins is efficacious and has fewer side effects.". 
  169. ↑ 169.0 169.1 169.2 Infertility: Diagnosis and Management. Springer Science & Business Media. 6 December 2012. pp. 261–. ISBN 978-1-4613-8265-2. https://books.google.com/books?id=D4_TBwAAQBAJ&pg=PA261. 
  170. ↑ 170.0 170.1 170.2 170.3 Gynecologic Endocrinology. Springer Science & Business Media. 11 November 2013. pp. 387–. ISBN 978-1-4613-2157-6. https://books.google.com/books?id=9vv2BwAAQBAJ&pg=PA387. 
  171. ↑ 171.0 171.1 171.2 171.3 Kistner's Gynecology: Principles and Practice. Mosby. 1995. p. 263. ISBN 978-0-8151-7479-0. https://books.google.com/books?id=WAdtAAAAMAAJ. 
  172. ↑ "A comprehensive review of hormonal and biological therapies for endometriosis: latest developments". Expert Opin Biol Ther 19 (4): 343–360. April 2019. doi:10.1080/14712598.2019.1581761. PMID 30763525. 
  173. ↑ "Irish songwriter Ruth Anne opens up on her debilitating fight with endometriosis". 31 March 2021. https://www.irishmirror.ie/showbiz/irish-songwriter-ruthanne-opens-up-23831453. 
  174. ↑ "Endometriosis showed me we need better ways to talk about women's pain | Emma Barnett". 22 October 2020. https://www.theguardian.com/commentisfree/2020/oct/22/endometriosis-women-pain-diagnosis-report-mps. 
  175. ↑ "'Nearly broke me' Spice Girls' Emma Bunton describes struggling to conceive with endometriosis". Her.ie. 11 May 2020. https://www.her.ie/entertainment/nearly-broke-spice-girls-emma-bunton-describes-struggling-conceive-endometriosis-491098. 
  176. ↑ "Alexa Chung Reveals Her Battle With Endometriosis—And Taps Into an Empowering Online Community". 18 July 2019. https://www.vogue.com/article/alexa-chung-endometriosis-battle-instagram-community. 
  177. ↑ "Champions Corner: Collins unleashes the best tennis of her career after life-changing surgery". https://www.wtatennis.com/news/2211449/champions-corner-collins-unleashes-the-best-tennis-of-her-career-after-life-changing-surgery. 
  178. ↑ "Watch: Olivia Culpo Shares Emotional Details of Her Endometriosis Journey". Sports Illustrated. https://lifestyle.si.com/wellness/olivia-culpo-shares-endometriosis-journey. 
  179. ↑ "Lena Dunham Gives Health Update Following Battle with Endometriosis". https://people.com/celebrity/lena-dunham-gives-health-update-following-battle-with-endometriosis/. 
  180. ↑ "Congresswoman Abby Finkenauer Opens Up About Her Struggle With Endometriosis". 5 March 2020. https://www.glamour.com/story/abby-finkenauer-endometriosis-caucus. 
  181. ↑ "EXCLUSIVE: Bethenny Frankel in Tears Over Recent Health Scare: 'I Really Tried to Hold It All Together'". 22 June 2016. https://www.etonline.com/news/191621_bethenny_frankel_tears_over_recent_health_scare_i_really_tried_to_hold_it_all_together. 
  182. ↑ "Blossom Ball 2009 – Whoopi Goldberg". Endometriosis Foundation of America. 27 November 2007. https://www.endofound.org/blossom-ball-2009-whoopi-goldberg/. 
  183. ↑ "Radio presenter Mel Greig's shocking photo shows reality of living with endometriosis". News.com.au. 28 March 2018. https://www.news.com.au/lifestyle/health/health-problems/radio-presenter-mel-greigs-shocking-photo-shows-reality-of-living-with-endometriosis/news-story/4638a8c8899928d4ebb8dfd82ef820a7. 
  184. ↑ "Halsey undergoes surgery to treat endometriosis". Billboard. 7 January 2017. https://www.billboard.com/articles/news/7647866/halsey-surgery-endometriosis/. Retrieved 27 November 2018. 
  185. ↑ "Emma Hayes: Chelsea manager has emergency hysterectomy because of endometriosis". BBC. 13 October 2022. https://www.bbc.co.uk/sport/football/63246126. 
  186. ↑ "Julianne Hough opens up about endometriosis: 'I just thought it was normal'". Today. 9 September 2017. https://www.today.com/health/julianne-hough-endometriosis-i-just-thought-it-was-normal-t116059. 
  187. ↑ "Julianne Hough Won't Let Endometriosis Stop Her From Having a Family With Brooks Laich: "We've Discussed Options"" (in en). 23 April 2018. https://www.endofound.org/julianne-hough-wont-let-endometriosis-stop-her-from-having-a-family-with-brooks-laich-weve-discussed. 
  188. ↑ "Julianne Hough Opens Up About Her Struggle with Endometriosis" (in en). 24 March 2017. https://people.com/health/julianne-hough-endometriosis/. 
  189. ↑ "Endometriosis: The pain sucks, but so does just getting a diagnosis". Hack on Triple J. 14 August 2018. https://www.abc.net.au/triplej/programs/hack/pain-of-endometriosis-sucks-but-so-does-just-getting-a-diagnosis/10119888/. 
  190. ↑ "On International Women's Day, Bindi Irwin reveals 10-year struggle with endometriosis". 8 March 2023. https://www.abc.net.au/news/2023-03-08/bindi-irwin-reveals-struggle-with-endometriosis/102066858. 
  191. ↑ "Why Jaime King Decided It Was Time to Talk About Her Years-Long Fertility Struggle". 24 April 2022. https://www.eonline.com/news/1327944/why-jaime-king-decided-it-was-time-to-talk-about-her-years-long-fertility-struggle. 
  192. ↑ "Padma Lakshmi shares her struggle with endometriosis". Redbook. 17 October 2011. https://www.youtube.com/watch?v=Gfixp0jUjKg. 
  193. ↑ "'80s Pop". The New York Times. 30 November 2012. ISSN 0362-4331. https://www.nytimes.com/2012/12/02/books/review/cyndi-lauper-a-memoir.html. 
  194. ↑ "No Kidding: Jillian Michaels is Not "Doing That" to Her Body". 7 February 2011. https://www.bitchmedia.org/post/no-kidding-jillian-michaels-is-not-doing-that-to-her-body. 
  195. ↑ "Monica's Second Surgery For Her Endometriosis Was 'Very Hard' And She 'Ended Up Having Multiple Blood Transfusions'". 9 June 2021. https://madamenoire.com/1230703/monica-endometriosis-2/. 
  196. ↑ "Marilyn Monroe's battle with endometriosis is often ignored – but it's a vital part of her story". 28 September 2022. https://www.cosmopolitan.com/uk/body/health/a41419168/marilyn-monroe-endometriosis/. 
  197. ↑ "Tia Mowry Releases a Cookbook for Women With Endometrosis". 14 June 2017. https://endometriosisnews.com/2017/06/14/tia-mowry-introduces-cookbook-for-women-with-endometriosis/. 
  198. ↑ "Sinead O'Connor tells of illness hell: "I'm in a bad way"". 19 August 2015. https://vipmagazine.ie/sinead-oconnor-tells-of-illness-hell/. 
  199. ↑ "12 celebrities who have opened up about having endometriosis". https://www.insider.com/celebrities-with-endometriosis-2019-3. 
  200. ↑ Shultz, Cara Lynn (19 November 2024). "Florence Pugh Says It Was a 'Mind-Boggling Realization' to Learn She Had to Freeze Her Eggs at 27". https://people.com/florence-pugh-froze-eggs-27-pcos-endometriosis-she-md-podcast-8746962. 
  201. ↑ "Daisy Ridley opened up about her struggle with endometriosis". Cosmopolitan. 12 June 2016. http://www.cosmopolitan.co.uk/entertainment/news/a43962/daisy-ridley-opened-up-about-her-struggle-with-endomitriosis/. 
  202. ↑ "Emma Roberts shares how her undiagnosed endometriosis affected her pregnancy journey". Self. Condé Nast. 11 November 2020. https://www.self.com/story/emma-roberts-endometriosis-pregnancy/. 
  203. ↑ "EFA2011: Susan Sarandon speaks up about endometriosis". Endometriosis.org. https://endometriosis.org/news/congress-highlights/susan-sarandon-speaks-up-about-endometriosis/. 
  204. ↑ "Amy Schumer 'feeling good' after endometriosis surgery and liposuction". 20 January 2022. https://independenttribune.com/entertainment/amy-schumer-feeling-good-after-endometriosis-surgery-and-liposuction/video_b81d1935-b96d-5726-999a-83464d9cb89b.html. 
  205. ↑ "'General Hospital': Kirsten Storms opens up about return – The TV Guy – Orlando Sentinel". 25 December 2012. http://blogs.orlandosentinel.com/entertainment_tv_tvblog/2012/08/general-hospital-kirsten-storms-opens-up-about-return.html. 
  206. ↑ "Gabrielle Union says she probably can't get pregnant because of adenomyosis. What exactly is that?". https://www.usatoday.com/story/life/allthemoms/2018/08/15/gabrielle-union-explains-infertility-type-endometriosis-called-adenomyosis/999052002/. 
  207. ↑ "Another victim of the 'Dancing With The Stars' curse" (in en-US). https://www.dispatch.com/story/news/2008/10/30/another-victim-dancing-with-stars/24005782007/. 
  208. ↑ "Lacey Schwimmer is Also Sick" (in en). 30 October 2008. https://www.tvfanatic.com/2008/10/lacey-schwimmer-is-also-sick/. 
  209. ↑ "Lena Dunham, Julianne Hough and More Who've Opened Up About Endometriosis Battles: "You Don't Have to Ignore Pain"". 23 March 2017. https://www.eonline.com/news/838260/lena-dunham-julianne-hough-and-more-who-ve-opened-up-about-endometriosis-battles-you-don-t-have-to-ignore-pain. 
  210. ↑ "Chrissy Teigen says endometriosis surgery was 'a toughie' but better than 'the pain of endo'". People. 5 February 2021. https://people.com/health/chrissy-teigen-endometriosis-surgery-better-than-pain/. 
  211. ↑ "Yellow Wiggle Emma Watkins opens up about the agony of endometriosis". PerthNow. 16 March 2019. https://www.perthnow.com.au/entertainment/yellow-wiggle-emma-watkins-opens-up-about-the-agony-of-endometriosis-ng-b881137647z. 
  212. ↑ "Mae Whitman: 'Endometriosis Is Like Being Shot With a Cannonball in the Stomach'". 21 May 2020. https://www.glamour.com/story/mae-whitman-on-navigating-a-hollywood-career-while-battling-endometriosis. 
  213. ↑ "Jessica Williams on the 'Debilitating' Symptom That Led to Her Endometriosis Diagnosis". 12 April 2022. https://www.self.com/story/jessica-williams-endometriosis. 
  214. ↑ "Leah Williamson, captain of the Lionesses, is our January cover star". Hearst UK. 27 December 2022. https://www.womenshealthmag.com/uk/health/a42306525/leah-williamson-january-2023/. 
  215. ↑ 215.0 215.1 "Economic burden of endometriosis". Fertility and Sterility 86 (6): 1561–72. December 2006. doi:10.1016/j.fertnstert.2006.06.015. PMID 17056043. 
  216. ↑ "Economic Burden of Endometriosis: A Systematic Review". Ann Reprod Med Treat 2 (2m): 1015. 2017. 
  217. ↑ "Healthcare Consumption and Cost Estimates Concerning Swedish Women with Endometriosis" (in english). Gynecologic and Obstetric Investigation 85 (3): 237–244. 2020. doi:10.1159/000507326. PMID 32248191. 
  218. ↑ "The Effect of Endometriosis Symptoms on Absenteeism and Presenteeism in the Workplace and at Home". Journal of Managed Care & Specialty Pharmacy 23 (7): 745–754. July 2017. doi:10.18553/jmcp.2017.23.7.745. PMID 28650252. 
  219. ↑ Snowdon, Catherine (5 February 2025). "Women with endometriosis earn less, research shows". BBC. https://www.bbc.co.uk/news/articles/c0k5rp87nzlo. 
  220. ↑ "Assessing research gaps and unmet needs in endometriosis". American Journal of Obstetrics and Gynecology 221 (2): 86–94. August 2019. doi:10.1016/j.ajog.2019.02.033. PMID 30790565. 
  221. ↑ "Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences". Human Reproduction 27 (12): 3412–6. December 2012. doi:10.1093/humrep/des316. PMID 22990516. 
  222. ↑ "Test d'auto-évaluation du JOGC". Journal of Obstetrics and Gynaecology Canada 25 (12): 1046–1051. December 2003. doi:10.1016/s1701-2163(16)30350-4. ISSN 1701-2163. 
  223. ↑ "[General practitioners and the challenge of endometriosis screening and care: results of a survey]". Gynécologie, Obstétrique & Fertilité 41 (6): 372–80. June 2013. doi:10.1016/j.gyobfe.2012.02.024. PMID 22521982. 
  224. ↑ 224.0 224.1 "Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women". Human Reproduction 18 (4): 756–9. April 2003. doi:10.1093/humrep/deg136. PMID 12660267. 
  225. ↑ "Endometriosis in the African American woman—racially, a different entity?". Gynecological Surgery 9: 59–62. 24 June 2011. doi:10.1007/s10397-011-0685-5. 
  226. ↑ "Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites". Proceedings of the National Academy of Sciences of the United States of America 113 (16): 4296–301. April 2016. doi:10.1073/pnas.1516047113. PMID 27044069. Bibcode: 2016PNAS..113.4296H. 
  227. ↑ 227.0 227.1 ""Es que tú eres una changa": stigma experiences among Latina women living with endometriosis". Journal of Psychosomatic Obstetrics and Gynaecology 42 (1): 67–74. March 2021. doi:10.1080/0167482X.2020.1822807. PMID 32964770. 
  228. ↑ "Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay". International Journal of Environmental Research and Public Health 18 (15): 8210. August 2021. doi:10.3390/ijerph18158210. PMID 34360501. 
  229. ↑ "Stigma and mental health in endometriosis". European Journal of Obstetrics & Gynecology and Reproductive Biology (Elsevier BV) 19. September 2023. doi:10.1016/j.eurox.2023.100228. PMID 37654520. 
  230. ↑ "Period Stigma and the Unacknowledged System of Oppression" (in en). 27 May 2022. https://digitaleducation.stanford.edu/period-stigma-and-unacknowledged-system-oppression. 
  231. ↑ "Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay". International Journal of Environmental Research and Public Health 18 (15): 8210. August 2021. doi:10.3390/ijerph18158210. PMID 34360501. 
  232. ↑ Pant, Anuja; Moar, Kareena; K. Arora, Taruna; Maurya, Pawan Kumar (2023). "Biomarkers of endometriosis". Clinica Chimica Acta 549. doi:10.1016/j.cca.2023.117563. ISSN 0009-8981. https://www.sciencedirect.com/science/article/pii/S0009898123003650. 
  233. ↑ Agostinis, C.; Battista, N.; Costanzo, M. (2021). "The Search for Biomarkers in Endometriosis: a Long and Windy Road". Reproductive Sciences 28 (10): 2751–2766. doi:10.1007/s43032-021-00668-2. 
  234. ↑ 234.0 234.1 "Endometriosis: Etiology, pathobiology, and therapeutic prospects". Cell (Elsevier BV) 184 (11): 2807–2824. May 2021. doi:10.1016/j.cell.2021.04.041. PMID 34048704. 
  235. ↑ Cooper, Kevin G; Bhattacharya, Siladitya; Daniels, Jane P; Cheed, Versha; Gennard, Laura; Leighton, Lisa; Pirie, Danielle; Melyda, Melyda et al. (September 2024). "Preventing recurrence of endometriosis-related pain by means of long-acting progestogen therapy: the PRE-EMPT RCT" (in en). Health Technology Assessment 28 (55): 1–77. doi:10.3310/SQWY6998. ISSN 2046-4924. PMID 39259620. PMC 11417646. https://www.journalslibrary.nihr.ac.uk/hta/SQWY6998. Retrieved 13 January 2025. 

Cited sources

Template:SweGov

Classification
External resources



Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Endometriosis&oldid=4171164"