What's new in endo & adenomyosis research

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Uterine leiomyoma is the most common benign gynecological tumor and is influenced by various individual, environmental, and inflammatory factors. Residential environmental characteristics and the Platelet-to-Lymphocyte Ratio (PLR) have been proposed as potential factors associated with leiomyoma occurrence. This study aimed to analyze the association between residential factors and PLR with the occurrence of uterine leiomyoma. This study used an observational analytic design with a case-control approach. The study included 256 histopathological medical records from 2020-2023, consisting of 185 patients with uterine leiomyoma as the case group and 71 patients with adenomyosis as the control group. Residential characteristics were classified into urban and rural areas based on the Central Bureau of Statistics (BPS) classification. PLR was calculated by dividing the absolute platelet count by the absolute lymphocyte count, with a cut-off value of 216.86 based on the 75th percentile. Bivariate analysis was performed using the Chi-Square test or Fisher’s Exact Test. Ethical clearance from the Health Research Ethics Committee of PKU Muhammadiyah Hospital, Surakarta, under number 08/KEPK/RS.PKU/IX/2025. Most respondents in both groups lived in urban areas, accounting for 93.51% of the leiomyoma group and 91.55% of the adenomyosis group. No significant association was found between residential area and uterine leiomyoma occurrence (p=0.590). Similarly, PLR was not significantly associated with uterine leiomyoma occurrence (p=0.878). Residential factors and PLR were not significantly associated with the occurrence of uterine leiomyoma in this study.

This study was conducted to determine the effect of Endometriosis Nursing Care Program (ENCP), developed in line with Health Promotion Model for women with endometriosis, on women's quality of life and healthy lifestyle behaviours. This prospective, single-centre, randomized controlled trial was conducted with 46 women diagnosed with endometriosis who applied to the Endometriosis Outpatient Clinic of a training research hospital. Women with an Endometriosis Health Profile Questionnaire-5 (EHP-5) score ≥ 22 indicating reduced quality of life were included. Participants were randomly assigned to an intervention group (n = 23) receiving Endometriosis Nursing Care Program (ENCP) or a control group (n = 23) receiving routine care. The ENCP consisted of two individual 60-min sessions delivered two weeks apart. The primary outcome was change in quality of life measured by EHP-5. Secondary outcomes included healthy lifestyle behaviours measured by Health Promoting Lifestyle Profile II (HPLP-II). Data were analysed using parametric or non-parametric statistical tests, as appropriate. Statistical significance was set at p < 0.05. Forty-six women completed the study (23 intervention, 23 control). The mean EHP-5 score in the intervention group decreased significantly from 61.8 ± 11.4 to 32.1 ± 18.7; Cohen's d = − 1.71, p 0.05). HPLP-II total scores significantly increased in the ENCP group (132.04 ± 19.81 vs 164.17 ± 18.83; Cohen's d = 1.58, p < 0.001). ENCP significantly improved quality of life in women with endometriosis and resulted in increased scores on healthy lifestyle behaviours. Structured nursing interventions may play an important role in comprehensive endometriosis care. Trial registration NCT05402943 Date of registration: 02.06.2022. https://clinicaltrials.gov/study/NCT05402943?term=NCT05402943&rank=1 .

Endometriosis-associated infertility is a heterogeneous syndrome in which distorted pelvic anatomy interacts with immune dysregulation, iron-dependent oxidative injury, altered follicular and peritoneal environments, and endometrial receptivity. Objective: To critically integrate mechanistic and clinical evidence and examine whether real-world analytics can improve decisions without overstating the validity of candidate biomarkers. Methods: This integrative narrative review prioritizes the 2022 ESHRE endometriosis guideline, recent systematic reviews, randomized trials, and regulatory guidance on real -world evidence and responsible artificial intelligence.

Analysis code, small input files and every derived table and figure that backs a number in the manuscript “The reported strength of the endometriosis–adenomyosis association is a function of diagnostic definition: a bidirectional Mendelian randomization and endpoint-nesting analysis”.Contents. scripts/ (Python 3.12 and R 4.6, portable paths via the PAPER_BASE environment variable), data/gwas/ (instrument panels, the FinnGen release-12 endpoint manifest, and archived Risteys endpoint pages), fetch/ (download scripts for every public input, with checksums), results/ (all derived tables) and figures/.Inputs. FinnGen release-12 genome-wide association summary statistics for four N14_* endpoints (public mirror, no authorisation needed); FinnGen Risteys release-12 endpoint definitions and individual-level-derived CodeWAS co-occurrence counts; and, for the external replication in Section 3.10, the summary statistics deposited by Koller and colleagues (Nature Genetics 2026;58(5):1051–1061, Zenodo doi:10.5281/zenodo.18983492, CC BY-NC 4.0, non-commercial scientific use only — their raw files are not redistributed here, only statistics derived from them).The second file, verification_package_paperA.zip, is a self-contained verification package. It has three tiers, each of which runs independently. Tier 1 recomputes 42 headline numbers from the archived result tables in seconds and independently re-derives the Wilson intervals. Tier 2 rebuilds the LD-independent instrument panel from the four official FinnGen release-12 summary-statistics files. Tier 3 recomputes the full sensitivity battery — inverse-variance weighted with random effects, MR-Egger with its intercept, weighted median, Cochran's Q and leave-one-out — for all six exposure–outcome pairings and prints a line-by-line comparison against the values reported in the manuscript. Every tier compares each intermediate product against the archived baseline and prints any divergence rather than passing over it. The package README, the data-sources note, every script and every comparison table are in English.No individual-level data are included or were accessed. Every input is public summary statistics or a published aggregate count.Two cautions for anyone reusing the Section 3.10 outputs. (1) Koller's deposit carries no per-allele effect estimates, so effects were reconstructed on a standardised scale while FinnGen effects are log-odds; a ratio mixing the two is on neither scale and is not an odds ratio — those rows are interpretable for direction and heterogeneity only. (2) The coefficients in A29_koller_internal_mr.csv are in standard-deviation units of liability and must not be exponentiated. Both points are also stated in the manuscript and in README.md.Software attribution. The analysis scripts were drafted with the assistance of the ClawsGO Science Agent (ClawsGO Science Harness), a large language model-based research assistant, under the authors' direction. The authors designed the study, chose the endpoints, instruments and analyses, directed each iteration, reviewed and edited all content, and take full responsibility for the content of the publication.

OBJECTIVES: To compare structured and free-text MRI reporting in terms of objective report quality and surgeon ratings of perceived clinical utility in suspected deep pelvic endometriosis. MATERIALS AND METHODS: In this single-center randomized reader study, 20 radiology residents were assigned to free-text or structured reporting. Five residents became unavailable before report generation and provided no outcome data. The remaining 15 readers completed the same 22 pelvic MRI examinations, generating 330 reports: 154 free-text and 176 structured reports. Reports were compared with an imaging reference standard established by two pelvic radiologists through independent review and consensus adjudication. The primary endpoint was clinically weighted completeness. Secondary endpoints included unweighted completeness, explicit negative discrepancies relative to the expert imaging reference, positive findings unsupported by the expert imaging reference, and reporting time. Objective outcomes were analyzed using mixed-effects models or Poisson generalized estimating equations. In an exploratory paired assessment, two expert gynecologic surgeons evaluated 44 reports, comprising one free-text and one structured report for each MRI examination. RESULTS: Structured reporting was associated with an 8.1%-point increase in completeness compared with free-text reporting (95% CI, 4.1-12.1; p < 0.001) and a 5.6%-point increase in clinically weighted completeness (95% CI, 1.3-10.0; p = 0.011). Reporting time was 4.52 min longer with structured reporting (95% CI, 3.05-5.99; p < 0.001). Structured reporting was also associated with more explicit negative discrepancies relative to the expert imaging reference (rate ratio, 2.94; 95% CI, 1.73-4.98; p < 0.001). These discrepancies were mainly explicit compartment-based negative statements. In the exploratory surgeon assessment, structured reports received higher ratings for perceived completeness, usefulness for clinical decision-making, and adequacy to clinical needs, whereas clarity ratings were similar between formats. CONCLUSION: Structured MRI reporting was associated with higher objective completeness and, in an exploratory assessment, higher surgeon ratings for several dimensions of perceived clinical utility. These findings should be balanced against longer reporting time and more explicit negative discrepancies relative to the expert imaging reference.

Endometriosis is a chronic inflammatory gynecologic disorder associated with pelvic pain, infertility, and systemic metabolic alterations [1]. Despite growing recognition of metabolic involvement in disease pathophysiology, the combined role of metabolic and demographic factors remains incompletely defined. This study aimed to evaluate complementary associations of body mass index (BMI), lipid profiles, and race/ethnicity with recorded endometriosis diagnosis using the All of Us Research Program database. In this retrospective observational analysis, participants aged 18–45 years with a recorded endometriosis diagnosis were compared with participants without a recorded diagnosis using propensity score–based methods. BMI differences were assessed using Welch t-tests stratified by race, and racial associations were evaluated using chi-square testing and multivariable logistic regression. Lipid analyses — including HDL, LDL, total cholesterol, and triglycerides — utilized matched regression models and inverse probability of treatment weighting (IPTW) sensitivity analyses adjusted for age and BMI. Endometriosis cases had modestly lower BMI than controls in the matched-design analysis (mean difference, − 1.19 kg/m²; 95% CI, − 1.97 to − 0.41; P =0.003), although formal interaction testing indicated heterogeneity across race/ethnicity (P for interaction=0.020). Race/ethnicity was associated with recorded endometriosis diagnosis, with Asian and Hispanic or Latino participants demonstrating lower odds than White participants. In the primary matched lipid analyses, triglycerides were higher among cases in the adjusted model, whereas HDL, LDL, and total cholesterol differences were not statistically significant. IPTW sensitivity analyses yielded directionally similar estimates and statistically significant differences across all four lipid outcomes. Race/ethnicity, BMI, and lipid measures were associated with recorded endometriosis diagnosis in this EHR-based population, although the direction of BMI differences varied across demographic subgroups and lipid findings differed in statistical significance across analytic approaches. Because socioeconomic factors, healthcare access, treatment exposures, fasting status, and temporality were not fully characterized, these associations should not be interpreted as causal. Prospective studies incorporating longitudinal metabolic measurements and more comprehensive clinical and social covariates are warranted.

A endometriose é uma doença ginecológica benigna, crônica e dependente de estrogênio, associada a dor pélvica, dismenorreia, dispareunia e infertilidade, com impacto significativo na qualidade de vida de mulheres em idade reprodutiva. O manejo é predominantemente hormonal, e a gestrinona — modulador seletivo do receptor de progesterona com ação antiprogesterônica, antiestrogênica e androgênica — promove atrofia do tecido endometrial ectópico pela supressão do eixo hipotálamo-hipófise-ovariano. Objetivou-se analisar as evidências disponíveis sobre a eficácia e a segurança da gestrinona no tratamento da endometriose. Trata-se de revisão integrativa nas bases PubMed, BVS e SciELO, com os descritores "endometriosis" e "gestrinone" associados a termos de eficácia e segurança. Incluíram-se estudos (2016–2026) com mulheres tratadas com gestrinona. A seleção por dois revisores independentes resultou em 10 artigos incluídos de 37 identificados. Os estudos demonstraram eficácia relevante no controle da dor pélvica, dismenorreia e dispareunia. Em ensaio pós-laparoscópico, a gestrinona apresentou menor taxa de recorrência (5%) em comparação à mifepristona (8,33%) e ao grupo controle (23,33%). A revisão Cochrane indicou perfil ósseo mais favorável da gestrinona frente aos análogos de GnRH, embora com baixa certeza de evidência. Em contrapartida, revisão sistemática apontou alta frequência de eventos adversos, como acne/seborreia (42,7%), amenorreia (41,4%) e redução da libido (26,5%), sendo os efeitos androgênicos os principais causadores de descontinuação. Comparações diretas com dienogeste, didrogesterona e análogos de GnRH não mostraram vantagem inequívoca, e a diretriz da ESHRE não a inclui como primeira linha. A gestrinona apresenta eficácia analgésica relevante e comparável a outras terapias hormonais. Contudo, os efeitos adversos androgênicos e a qualidade limitada dos estudos restringem a definição de um perfil de segurança consistente. São necessários estudos prospectivos e randomizados para estabelecer com maior precisão seus benefícios e riscos no manejo da doença.

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Objectives: This bibliometric analysis systematically evaluated the research landscape, emerging trends, and key focus areas in adenomyosis to guide future research directions. Design: Performance analysis combined with scientific mapping of global adenomyosis research literature. Data sources: Web of Science Core Collection (1980–2024). Data extraction and synthesis: Articles were manually screened. Bibliometrix (R 4.3.0), VOSviewer, and CiteSpace analyzed productivity, collaboration, citation patterns, and research trends. Derived data and analysis scripts are deposited in the Open Science Framework (OSF) under a citable DOI. Results: Among 3100 included publications, China led output (752, 24.26%, full-counted), followed by the United States (414, 13.35%), Japan (350, 11.29%), Italy (215, 6.94%), and South Korea (128, 4.13%). In the 2 adenomyosis-specific corpora, however, the United States ranked first. The US had the highest citations and international collaboration, though international co-authorship among top-producing countries remained low (16.14%). Leading institutions were Fudan University (89), Shandong University (52), and University of Tokyo (49). Top journals by volume: Fertility and Sterility, Human Reproduction, and Journal of Minimally Invasive Gynecology. Research focus shifted from hysterectomy and uterine artery embolization toward high-intensity focused ultrasound (HIFU), and from endothelial nitric oxide synthase/induced adenomyosis toward ectopic endometrium. Eight keyword clusters emerged; the 4 largest (#0 EMT, #1 HIFU, #2 endometrial cancer, #3 pregnancy outcomes) form the present focus. Burst analysis identified “consensus” (2020–2024), “pathogenesis” (2022–2024), and “pregnancy outcome” (2022–2024) as recent and currently active hotspots. Conclusions: Current adenomyosis research centers on ectopic endometrium and EMT in pathogenesis, fertility outcomes, long-term efficacy of HIFU and fertility-sparing surgery, links to endometrial cancer, and adverse pregnancy outcomes. Beyond deepening pathogenesis and pregnancy-outcome research, key future directions include enhancing international collaboration and developing internationally agreed, evidence-based standardized terminology, diagnostic criteria, and classification systems for adenomyosis.

Pigs are increasingly used as models of human diseases, largely because their anatomy, physiology, and genetics more closely resemble those of humans. Given its relatively high prevalence and incompletely understood pathogenesis, endometriosis is an important condition to model in a large-animal model. This protocol describes the laparoscopic induction of endometriosis in a preclinical swine model via autologous transplantation of endometrial tissue into the peritoneal cavity. Endometrial fragments are isolated shortly after standing estrus, minced into uniform pieces, and optionally labeled ex vivo with fluorescein isothiocyanate (FITC) dye-doped silica nanoparticles to enable fluorescent identification of ectopic lesions. The labeled or unlabeled tissue fragments are reintroduced into the abdominal cavity under sterile surgical conditions. The procedure is then followed by longitudinal monitoring and laparoscopic retrieval of endometriotic lesions. Development and application of a laparoscopic approach that is less invasive than cavity-breaching surgery enables multiple procedures to be performed in the same experimental animal. This large-animal model provides a reproducible, translational platform for studying endometriosis pathophysiology, imaging approaches, and therapeutic interventions.

Endometriosis (EM) is a common chronic gynecological disorder in women of reproductive age, yet its pathogenesis remains unclear, and current therapeutic options are limited by significant side effects. Endometriosis itself increases the risk of premature ovarian failure. Long-term lack of standardized treatment may accelerate the decline of ovarian function and prematurely trigger the aging process of the reproductive system. Reliable animal models are therefore essential for investigating disease mechanisms and evaluating novel treatments. This study presents a detailed protocol for establishing an endometriosis model in Sprague‑Dawley (SD) rats via autologous endometrial transplantation, and evaluates the therapeutic efficacy of the FDA‑approved gonadotropin‑releasing hormone (GnRH) antagonist Elagolix. The method involved excising uterine tissue, isolating endometrial fragments, and suturing them onto the peritoneal wall. At 21 days post‑surgery, ectopic lesions with typical cystic morphology had successfully formed in 18 out of 20 rats (90% success rate). Following model validation, Elagolix administration (100 mg/kg daily, oral gavage for 4 weeks) significantly reduced final lesion volume compared with the model group (inhibition rate: 86.7%), decreased serum levels of follicle‑stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2), and suppressed peritoneal cytokine levels, including tumor necrosis factor‑α (TNF‑α), vascular endothelial growth factor (VEGF), and interleukin‑6 (IL‑6). Histopathological examination revealed glandular atrophy, reduced epithelial proliferation, and diminished inflammatory infiltration in Elagolix‑treated lesions. The model demonstrated several advantages, including operational simplicity, high stability, and avoidance of immune rejection. The pharmacological response to GnRH antagonism in this model demonstrated biological activity consistent with the known mechanism of Elagolix, although pain-related and behavioral outcomes were not evaluated. Collectively, this model provides a standardized and reliable platform for mechanistic studies and preclinical drug efficacy assessment in endometriosis.

Background Fusobacterium nucleatum , an oral-associated bacterium implicated in several extraoral diseases, has recently been proposed as a potential contributor to endometriosis through microbial translocation, inflammation, and fibrosis. However, the consistency and clinical significance of this association remain uncertain. This systematic review evaluated the human and experimental evidence linking F. nucleatum with endometriosis and assessed the plausibility of a proposed oral microbe-host axis. Methods PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were searched from inception through August 31, 2026, following PRISMA 2020 guidelines. Human and animal studies reporting F. nucleatum or historically related F. nucleatum -complex taxa in relation to endometriosis were included. Risk of bias was assessed using a prespecified adapted ROBINS-I framework for human observational studies and SYRCLE for animal studies. Owing to substantial heterogeneity in anatomical compartments, detection methods, and outcomes, meta-analysis was not appropriate and findings were synthesized qualitatively. Results Four human studies encompassing 384 participants at the study level were included, although analysis-specific denominators varied. Direct tissue evidence came from two studies and was conflicting: Muraoka et al. reported Fusobacterium positivity in 64.3% of endometrial samples from women with endometriosis versus 7.1% of controls in a 42-versus-42 tissue subset, whereas Graciano-España et al. found no significant case-control difference in F. nucleatum abundance among 55 cases and 37 controls. Indirect microbiome studies reported oral Fusobacterium enrichment in moderate/severe endometriosis and vaginal F. animalis depletion in chronic pelvic pain with endometriosis. All human studies were judged at serious overall risk of bias, and certainty of evidence was very low. Experimental evidence suggesting TGF-β-mediated lesion growth and fibrosis derived principally from one translational study and lacked independent replication. Conclusions Current evidence supports biological plausibility but not a consistent or causal association between F. nucleatum and endometriosis. Direct tissue evidence is limited to two conflicting studies, while non-tissue microbiome findings are indirect. Standardized contamination-controlled sampling, paired anatomical-site sampling, strain-level analyses, and longitudinal studies are required before microbial translocation, temporality, causality, or antimicrobial treatment can be established. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261337885 .

Chronic pelvic pain (CPP) is defined as the persistent or recurrent pain in the pelvic region lasting for six months or longer. It is a heterogeneous and multifactorial condition, with endometriosis representing one of its major gynecological causes. However, diagnosing endometriosis as the root cause of CPP remains challenging due to its variable presentation and limitations in current non-invasive detection methods. Although the reproductive microbiome has been proposed as a promising tool to distinguish endometriosis-associated CPP from other CPP etiologies, clinically validated microbial biomarkers have not yet been established. In this study, we investigated whether the taxonomic and predicted functional diversity of the vaginal and rectal microbiomes could differentiate CPP patients with endometriosis (CPP Endo) from those without endometriosis (CPP Only) using a 16S rRNA sequencing dataset. Microbial diversity did not distinguish CPP Endo from CPP Only at either body site as there was a lack of disease-associated separation. Furthermore, our core microbiome analysis only identified one amplicon sequence variant (ASV) that was unique to the core rectal or vaginal microbiome of CPP Endo patients, and we failed to identify indicator species by Indicator Species Analysis (ISA) that could reliably distinguish CPP Endo. Although there were many differentially enriched taxa found by DESeq and predicted functional pathways found by PICRUSt2 between CPP Endo and CPP Only patients at both body sites, many of these features were also observed in healthy controls, suggesting an overall lack of CPP Endo specific microbial signatures. Consistent with these findings, our random forest model trained on microbial taxon abundance was unable to accurately predict CPP Endo status. Together, our data show that the community-level composition and function of the microbiome of CPP patients with endometriosis did not differ from CPP patients without endometriosis despite small differences in predicted functional profiles. These findings suggest that microbial dysbiosis may not be a reliable diagnostic indicator for endometriosis-associated CPP.

BACKGROUND: Adenomyosis is increasingly diagnosed noninvasively using transvaginal ultrasound, but the relationship between the cumulative number of standardized sonographic features and clinical severity remains incompletely understood, particularly in African populations. This study aimed to characterize adenomyosis phenotypes according to the revised Morphological Uterus Sonographic Assessment (MUSA) definitions and to evaluate the association between cumulative MUSA feature count and clinical severity. MATERIALS AND METHODS: We conducted a multicenter cross-sectional observational analytical study based on retrospective review of routinely acquired clinical data and ultrasound images from three institutions in Kinshasa, Democratic Republic of the Congo. The source ultrasound examinations were performed as part of routine clinical care between January 2023 and June 16, 2026. Among 2,743 women who had undergone gynecologic ultrasonography, 211 with sonographically diagnosed adenomyosis were included. Nine revised MUSA features were assessed. The primary exposure was cumulative MUSA feature count analyzed as a continuous variable. Multivariable logistic regression models were adjusted for age, body mass index, parity, previous cesarean delivery, recorded concomitant endometriosis, uterine fibroids, and study center. RESULTS: The median cumulative MUSA feature count was 5 (interquartile range: 4-6). Severe chronic pelvic pain was present in 60 women (28.4%). Each additional MUSA feature was associated with increased odds of severe chronic pelvic pain (adjusted odds ratio (aOR): 1.65; 95% confidence interval (CI): 1.26-2.18; p<0.001). When direct and indirect feature counts were entered simultaneously, the indirect feature count remained associated with severe chronic pelvic pain (aOR: 1.89; 95% CI: 1.32-2.70; p<0.001), whereas the direct feature count was not statistically significant (aOR: 1.42; 95% CI: 0.97-2.07; p=0.068). Cumulative feature count was not significantly associated with severe dysmenorrhea (aOR: 1.26; 95% CI: 0.97-1.63; p=0.083) or infertility (aOR: 1.09; 95% CI: 0.87-1.38; p=0.448). CONCLUSIONS: A higher cumulative MUSA feature count was associated with severe chronic pelvic pain, with the association mainly driven by indirect sonographic features. Cumulative MUSA feature count should be considered an exploratory phenotypic measure rather than a validated severity score. Prospective external validation using standardized image acquisition and independent blinded readers is warranted.

Endometriosis is a major health problem affecting about 190 million reproductive-aged women. There is no definite cure for endometriosis; however, there are many medical and surgical options for relieving the severity of the disease and improving the quality of life for these women. This study aims to examine the relationship between illness perception and health-related quality of life (HRQoL) among women who have been diagnosed with endometriosis, as well as examining the role of pain self-efficacy as a mediator between these two variables. A cross-sectional design was employed with 300 participants. Data were collected using a structured, self-administered questionnaire that included sociodemographic and clinical characteristics, the Brief Illness Perception Questionnaire, the Pain Self-Efficacy Questionnaire, and the Health-Related Quality of Life: Endometriosis Health Profile-30 (EHP-30). Data were analyzed using. Data were analyzed using SPSS version 27 and SmartPLS 4.0. Partial Least Squares Structural Equation Modeling (PLS-SEM) with bootstrapping (5000 resamples) was also conducted to test both direct and mediating effects. Statistical significance was set at p < .05. The mean age of participants was 30.0 ± 5.5 years. The majority were predominantly married and attained a bachelor’s education, with a marked symptom burden. Two-thirds of participants were overweight and obese. It was found that 28.7% had Stage III endometriosis, and over 80% reported moderate-to-severe pelvic pain. Both Illness perceptions and pain self-efficacy were at moderate levels, while HRQoL impairment was substantial, especially in pain and emotional domains as well. More negative illness perceptions were significantly associated with worse HRQoL (r = 0.458, p < .001) and lower pain self-efficacy (r = − 0.474, p < .001), whereas higher pain self-efficacy was associated with better HRQoL (r = − 0.542, p < .001). In regression analysis, illness perceptions and pain self-efficacy together explained 34.6% of the variance in HRQoL, with pain self-efficacy demonstrating the stronger independent association. This study demonstrated that illness perceptions and pain self-efficacy are related factors that influence HRQoL in endometriosis patients. Negative illness perceptions were found to be associated with HRQoL, and increased levels of pain self-efficacy were found to be related to HRQoL. Pain self-efficacy also partially mediated the relationship between illness perceptions and HRQoL.

Background: Endometriosis affects approximately 190 million women globally; however, despite this, epidemiological data on endometriosis from Africa remain scarce. Understanding regional disease patterns, histopathological characteristics, and anatomical distribution is essential for improving diagnostic accuracy and clinical management. Methods: A retrospective cross-sectional study was conducted using archival data from the Department of Anatomical Pathology at the Dr George Mukhari Academic Laboratory, Ga-Rankuwa, South Africa, from 01 January 2012 to 31 December 2021. Histopathologically confirmed cases of endometriosis were identified using SNOMED codes. Demographic and clinical data were analysed using Stata 14, with Chi-square and Fisher’s exact tests to assess associations (p < 0.05). Results: Of 93 804 female specimens examined, 156 cases of endometriosis were confirmed (histopathological diagnostic frequency = 0.166%). The mean age at diagnosis was 36.97 years. The most common histopathological pattern (60.3%) demonstrated all three classic features. The ovary was the most frequently affected site (36.5%). Synchronous involvement at multiple sites occurred in 9.6% of cases, predominantly affecting the adnexa. Endometriotic cysts were identified in 28.8% of patients. Cervical endometriosis was associated with older age (≥ 50 years), although based on a small number of cases (p = 0.008). Associated lesions were identified in 24.4% of the cases. Conclusion: These findings contribute to the limited epidemiological data on endometriosis in Africa and emphasise the need for heightened clinical awareness, particularly for extrauterine manifestations that may present diagnostic challenges. Contribution: This study contributes to the limited South African data by providing detailed insights into the histopathological diagnostic frequency, anatomical distribution and histopathological patterns, enhancing understanding of disease patterns.

Endometriosis affects approximately one in 10 women and people assigned female at birth of reproductive age, yet diagnosis is still delayed by years, historically because confirmation required laparoscopy. This review synthesizes which non-invasive tools-expert ultrasound and magnetic resonance imaging (MRI), molecular and microRNA (miRNA) biomarkers, and artificial intelligence (AI)-are ready for clinical use and which have so far been evaluated only in research settings and proposes a pragmatic clinical pathway. This is a narrative review and not a systematic review. Major guidelines now endorse a clinical and imaging-based diagnosis without mandatory laparoscopy. Expert transvaginal ultrasound and MRI identify ovarian endometrioma and deep endometriosis with high specificity and map disease for surgery, but a normal scan does not exclude endometriosis because superficial peritoneal endometriosis remains largely invisible. No blood, urinary, or endometrial biomarker meets criteria for clinical use; circulating miRNA panels have failed independent validation, and a salivary miRNA signature still needs independent, lower-prevalence validation. Radiomics and AI remain investigational pending external validation, calibration, and demonstrated clinical utility. Non-invasive diagnosis is best framed not as one replacement test but as a multimodal, staged pathway in which each tool is used according to how far its evidence has progressed, which shortens diagnostic delay, targets specialist care, and interprets a negative scan safely.

Endometriosis is a chronic estrogen-dependent inflammatory disease affecting about 10% of women of reproductive age. Pharmacotherapy and surgery form the basis of treatment, but emerging evidence points towards the potential role of diet as an adjunct. The paper presents the pathophysiological basis of nutritional intervention in endometriosis, including chronic inflammation, oxidative stress and disturbances in estrogen metabolism related to the functioning of the intestinal microbiota and the estrobolome. The nutritional model based on an anti-inflammatory diet rich in omega-3 fatty acids, cruciferous vegetables and fiber, as opposed to routine elimination of food, as well as the need to individualize the recommendations depending on the patient's clinical phenotype, was discussed. Evidence on supplementation with selected compounds with potential anti-inflammatory and antioxidant effects and the role of probiotics and prebiotics in supporting intestinal and vaginal microbiota were also presented. The paper emphasizes that diet therapy should be treated as a supportive intervention, not as a causal treatment of endometriosis.

Urinary tract endometriosis is rare, and ureteral involvement is particularly insidious due to its asymptomatic nature. The absence of symptoms can lead to ureteral stricture, hydronephrosis, chronic kidney disease up to end-stage renal failure, and irreversible loss of kidney function. Diagnosis requires imaging methods to assess the degree of obstruction, while treatment involves surgical release of the ureter from endometriotic infiltrates to preserve organ function. Our observation illustrates the difficulty of establishing the etiology of a retroperitoneal tumor-like infiltrate leading to ureteral obstruction and hydronephrosis, as well as the need for differential diagnosis of endometriosis with other infiltrative processes.

Under the broader concept of magnetic induction (MI), in which magnetic fields are used to induce a current in conductors, magnetic induction heating (MIH) is known in oncotherapy for tumour ablation in what is called magnetic hyperthermia. However, a multitude of wider applications of MIH are beginning to shape opportunities at the interface of materials fabrication. This includes organic and inorganic synthesis, a comprehensive spectrum of biomedical needs, sensing, diagnostics, industrial processing, sustainable technologies, power generation and locomotion. A comparative analysis of reported MI studies is given grouped by application type, providing insight into the different materials employed and temperatures achieved. While MIH is predominantly based on magnetic materials that dissipate energy through hysteresis and Néel/Brownian relaxation losses, electrically conductive materials can also generate heat via eddy-current-induced Joule heating, although they remain relatively underexplored in biomedical applications. We examine the field parameters, the set-ups used and experimental configurations to provide a clear overview of the current landscape. In chemistry these applications will interest researchers in areas such as materials synthesis, electrocatalysis and sustainable chemistry. In the biomedical landscape, we explore studies from neuropathology to endometriosis and ocular disease, and even dental applications. Thus, we enable both specialists and researchers from adjacent fields to contribute with fresh perspectives. This review examines MIH through a new lens, highlighting underrepresented and recent developments and identifying promising directions to accelerate progress across different areas of science.

Gynecologic diseases, including infectious disorders, endocrine-related conditions, gynecologic malignancies, and pregnancy complications, are clinically diverse yet frequently share features of hormonal imbalance, microbial dysbiosis, and dysregulated inflammation. Current research has largely examined these processes separately, limiting integrated understanding of their potential interactions. This review synthesizes current evidence and proposes a hormone-microbiota-neutrophil extracellular trap (NET) framework as a conceptual tool for understanding common and disease-specific mechanisms across gynecologic disorders. We first summarize the core molecular basis of NET formation, with emphasis on peptidylarginine deiminase 4 as a candidate regulatory node. We then examine the effects of sex hormones on NET regulation, the role of the microbiota in shaping mucosal immune responses, and potential mechanistic links between microbial products, extracellular matrix components, and NET dysregulation. Evidence is further integrated across representative infectious, endocrine-related, malignant, and pregnancy-associated conditions, including pelvic inflammatory disease, bacterial vaginosis, endometriosis, polycystic ovary syndrome, ovarian, cervical, and endometrial cancers, and preeclampsia. The available literature indicates that hormone-dependent immune modulation, pathogen- or microbiota-associated inflammatory signaling, and NET-related tissue injury may converge in multiple gynecologic settings, although the strength of evidence differs substantially across specific pathways and diseases. Direct support is strongest for selected hormone-NET effects in defined experimental or pregnancy-associated settings and for pathogen/microbial product-NET interactions in infectious contexts, whereas the complete hormone-microbiota-NET framework and the proposed glycosaminoglycan-peptidylarginine deiminase 4 (GAG-PAD4) bridge remain insufficiently validated. Overall, this review provides an evidence-based integrative framework for organizing current knowledge, identifying mechanistic gaps, and informing future biomarker development, patient stratification, and translational research in gynecologic disease.

This prospective observational cohort study mainly focuses on the clinical significance of preoperative central sensitization status assessed by the Central Sensitization Inventory (CSI) in endometriosis patients. The core purpose is to explore whether different preoperative CSI levels can distinguish the etiology of postoperative pain recurrence. Higher preoperative CSI is hypothesized to indicate that postoperative recurrent pain is mainly derived from central sensitization rather than peripheral organic lesions. This study also aims to verify the predictive effect of preoperative CSI on postoperative pain recurrence and further explore its moderating effect on patients’ response to neuromodulation therapy. CSI will be measured before surgery and re-tested during postoperative follow-up to observe dynamic changes of central sensitization.

Summary Pelvic venous disorder (PeVD) is an under‐recognised cause of chronic pelvic pain (CPP). Routine pelvic ultrasound rarely includes assessment of the pelvic veins, despite being well positioned to identify features of PeVD. A limited venous assessment can be incorporated into a routine pelvic ultrasound, analogous to varicocele assessment in men. Adnexal vein size alone is an unreliable indicator of disease; Doppler‐confirmed reflux is essential for diagnosis. Transvaginal Doppler ultrasound (TVDUS) is emerging as a clinically meaningful and efficient tool for assessing pelvic venous function. Integrating pelvic venous assessment into routine pelvic scanning may improve diagnostic recognition, support timely referral and enhance patient outcomes.

Background and Aim: Endometriosis may impair oocyte competence and calcium-mediated activation, limiting fertilization after ICSI. This study evaluated whether calcium ionophore-assisted oocyte activation (AOA) associated with improved fertilization and embryological outcomes in women with endometriosis undergoing fresh ICSI cycles. Patients and Methods: This prospective observational cohort included 108 women with endometriosis-associated infertility at Cairo University Hospital. Fifty-four underwent ICSI followed by calcium ionophore AOA using GM508 Cult-Active, and 54 underwent standard ICSI. The primary outcome was fertilization rate. Secondary outcomes included normal fertilization, cleavage, blastocyst formation, high-quality embryos, implantation, and clinical pregnancy. Results: AOA significantly increased normally fertilized oocytes (3.41 ± 0.92 vs 2.87 ± 0.80; p=0.003) and fertilization rate (75.99 ± 12.79% vs 59.10 ± 15.94%; p<0.001). It also improved cleaved embryos, blastocyst number, blastocyst formation rate, and high-quality embryos. Adjusted analysis confirmed higher normal fertilization (adjusted OR 2.34, 95% CI 1.80–3.05), blastocyst formation (adjusted OR 1.40, 95% CI 1.08–1.82), and high-quality embryo production (adjusted IRR 1.43, 95% CI 1.28–1.60). Clinical pregnancy was higher but not significant (33.3% vs 24.1%; p=0.288). Conclusion: Calcium ionophore AOA was associated with higher fertilization and embryo-development outcomes in selected endometriosis ICSI cycles but did not significantly improve implantation or clinical pregnancy. Because allocation was non-randomized, residual indication bias cannot be excluded. These findings apply mainly to young women with surgically confirmed endometriosis, acceptable ovarian reserve, normal semen parameters, and fresh ICSI cycles, and require confirmation in larger randomized trials assessing pregnancy and live birth.

Background Many Canadians experience prolonged pain, uncertainty, and stigma before receiving an endometriosis diagnosis, with delays averaging 11 years from symptom onset. Endometriosis, defined by the presence of endometrial-like tissue outside the uterine cavity, impacts 10% of Canadian women and approximately 9% of transgender men. Existing screening measures are limited because they often focus on advanced disease and were developed outside Canada.Aims The aim of this study is to revise the ENDOPAIN-4D screening measure to match a Canadian young adult (age 18–25) population.Methods Using a participatory approach, the study involved four phases: an initial Delphi consensus survey with Canadian endometriosis experts; a virtual working meeting with a purposively selected subgroup; a second Delphi survey with working group members to refine proposed changes and reach consensus; and a third Delphi to collect final feedback. Participants included people with lived and living experience of endometriosis, gynecologists, pain medicine specialists focused on chronic pelvic pain, primary care providers, and other healthcare professionals involved in endometriosis care.Results Sixty-five experts participated in the first Delphi round. Five major themes were identified: conceptual appropriateness of domains, question clarity, response option clarity, item redundancy, and simplification for a Canadian young adult audience. Fifteen experts participated in the working meeting and second Delphi round, where they refined item wording, clarified core concepts, and finalized items for the revised screening measure.Conclusions This study adapted the ENDOPAIN-4D for Canadian young adults, resulting in a 22-item, five-domain screening measure called Screening for Early Endometriosis Detection (SEED).

Abstract STUDY QUESTION What evidence-based strategies are used in the treatment of endometriosis-associated symptoms in adolescents and young adults? SUMMARY ANSWER The use of hormonal therapies and surgery was associated with improvements in pain symptoms in most studies; however, the certainty of evidence was very low, meaning that the true impact of these treatments remain uncertain. WHAT IS KNOWN ALREADY Endometriosis is a chronic condition estimated to affect one in ten women, with symptoms commonly present during adolescence. Current management strategies for endometriosis include analgesia, hormonal suppression and surgery, as well as non-pharmacological measures. STUDY DESIGN, SIZE, DURATION This is a systematic review of the literature. Six databases (CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, MEDLINE, PsychInfo and Web of Science Core Collection) were searched from inception to May 2026. Search terms were related to endometriosis combined with terms regarding management and the adolescent age group. PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible studies included participants aged under 24 years with endometriosis, and reported on outcomes in the management of endometriosis-associated symptoms. Only studies with full texts or data available in English were included. Screening and data extraction were performed independently and in duplicate by two authors. Key outcomes included pain, quality of life, recurrence and side effects. Data were reported narratively. Risk of bias was assessed according to study design (ROB2, NOS and JBI tools) and quality of evidence with the GRADE system. MAIN RESULTS AND THE ROLE OF CHANCE The search identified 14,376 records, of which 333 full texts were assessed for eligibility, and 23 studies, with a combined total of 1,561 participants, were included. There were two randomised controlled trials, one single arm open label interventional study, eleven cohort studies, and nine case series. Five studies investigated hormonal treatments, one other study assessed other pharmacological treatments, sixteen studies assessed surgical management with or without hormonal treatment, and one study investigated non-pharmacological treatments. Most studies reported improvements in pain symptoms, however there was heterogeneity in study design, length of follow up, and outcome measures. LIMITATIONS, REASONS FOR CAUTION There is limited evidence in this age group. Most studies had a moderate risk of bias, and the certainty of evidence was very low. WIDER IMPLICATIONS OF THE FINDINGS The very low certainty of evidence limits the ability to draw inferences from the data. More high-quality research is essential to understand the effectiveness of current treatments and identify how they should be tailored for this age group. FUNDING No specific external or departmental funding was received for this systematic review. DISCLOSURES CB declares research grants from US DoD, NIH, EU Horizon 2020, Bayer AG, Aspira Ltd, Exeltis Ltd, Proteomics Inc, and Serac Healthcare Ltd, and consulting fees from Gedeon Richter, Theramex, Gesynta, and Roche, (all paid to institution). CB is Chair of the ESHRE Endometriosis Guideline Group and a member of the NICE Endometriosis Guideline Group (unpaid). SAM declares research grants (paid to institution) from AbbVie and the Marriot Family Foundations, received honoraria from the University of Kansas Medical Center and received travel support from LIDEA Registry, Taiwan Endometriosis Society, SEUD, Japan Endometriosis Society, NASEM, Endometriosis Foundation of America, Gedeon Richter, WES, New York Academy of Sciences, and Asian Conference on Endometriosis. SAM is Field Chief Editor for Frontiers in Reproductive Health (personal fee) and is an advisory board member for the LIDEA Registry (personal fee) and has unpaid roles with Human Reproduction Statistical Advisory Board and the NextGen Jane Advisory Board, the Society for Women’s Health Research, WERF, WES, ASRM, and ESHRE. KV reports research grants from the NIHR, NIH, UKRI, Medical Research Foundation, and EU IMI-2, consulting fees from Gesynta and Reckitts, and speakers’ fees from Reckitts, Organon, Gedeon Richter, and Eli Lilly (all payments to institution). KV is a member of the Medical Advisory Panel of Endometriosis UK (unpaid). KTZ declares research grants from the Gates Foundation, US DoD, NIH, EU Horizon 2020, Bayer AG, Aspira Ltd, Exeltis Ltd, Proteomics Inc, and Serac Healthcare Ltd and consulting fees from Apikal Ltd, Gedeon Richter, Roche, and LIDEA, (all paid to institution), and speaker’s fees (paid to institution) from Rathlin Therapeutics and Camber Collective/Gates Foundation, received travel support for ESHRE 2025, SEUD 2024, EEC 2024, and LIDEA 2023, and is named on patent WO2024115891A1 relating to chronic pelvic pain treatment (NRG3), which is unrelated to the present manuscript. KTZ is a board member of the World Endometriosis Foundation (unpaid). UB, LM, GB, CS, EE and PM declare no conflict of interest. Some of the above companies manufacture treatments discussed in this review. REGISTRATION NUMBER CRD420251018467

A endometriose é uma doença crônica inflamatória e estrogênio dependente caracterizada pela presença de epitélio e/ou estroma semelhante ao endométrio fora do endométrio ou miométrio, geralmente associado ao processo inflamatório. O objetivo deste artigo foi analisar a influência da nutrição no manejo da endometriose, investigando seus impactos sobre os processos inflamatórios, a modulação dos sintomas dolorosos e a possível relação com a qualidade de vida das pacientes. Trata-se de uma revisão integrativa da literatura realizada entre janeiro e março de 2026, nas bases MEDLINE/PubMed, LILACS, SciELO e ScienceDirect. Foram incluídos artigos científicos originais e revisões sistemáticas (2021–2026). Cinco estudos compuseram o corpus final de análise que defendem a terapia nutricional personalizada como uma abordagem complementar ao tratamento clínico-cirúrgico convencional.

Both gut microbiota dysbiosis and altered pelvic immune microenvironment have been linked to endometriosis (EM), but the metabolites connecting the two remain undefined. Combining 16S rDNA sequencing with non-targeted metabolomics in a murine EM model, we found altered gut microbiota composition alongside a marked rise in peritoneal lysophosphatidylcholine (LysoPC(16:0)), linked to the microbiota shift by correlation analysis and fecal transplantation. LysoPC(16:0) promoted M2 macrophage polarization through peroxisome proliferator-activated receptor gamma (PPARγ), an effect observed in two mouse strains. Clodronate-mediated macrophage depletion blocked LysoPC(16:0)-driven lesion growth. LysoPC(16:0) further induced PPARγ-dependent IL-10 transcription, and IL-10 neutralization in vivo reduced lesion weight. Conditioned medium from LysoPC(16:0)-stimulated THP-1 macrophages promoted migration of primary endometrial stromal cells from patients with EM, an effect reversed by GW9662 or IL-10 neutralization. Together, these results outline a gut microbiota-LysoPC(16:0)-PPARγ-M2–IL-10 axis in EM pathogenesis, a mechanistic and therapeutic target for future clinical study.

Objective To assess the diagnostic accuracy of machine learning (ML) and deep learning (DL) models for endometriosis. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251231469). Databases were searched through November 24, 2025. Twenty-two eligible studies were included. Risk of bias was assessed using QUADAS-2. Pooled analysis was conducted in Stata 18.0. Results Pooled sensitivity was 0.90 (95% CI 0.86–0.93), specificity 0.75 (95% CI 0.64–0.84), and SROC-AUC 0.92 (95% CI 0.89–0.94). A positive prediction increased disease probability from 10% to 29%, whereas a negative prediction reduced it to 1%. Multicenter design and DL were associated with lower sensitivity. Results were robust. Conclusions ML/DL models demonstrate high diagnostic performance and are promising for non-invasive auxiliary diagnosis. Large multicenter prospective studies and multimodal models are needed to enable clinical translation. Systematic Review Registration : https://www.crd.york.ac.uk/PROSPERO/view/CRD420251231469 , identifier CRD420251231469

Objetivo: Sintetizar indicações e resultados clínicos da cirurgia laparoscópica na endometriose. Método: Revisão integrativa de 2021 a 2026, com 31 documentos. Resultados: A excisão do endometrioma pode reduzir recidiva e reoperação em relação à ablação (certeza baixa), mas o hormônio antimülleriano caiu após ambas. Na doença intestinal, técnicas conservadoras associaram-se a menos complicações graves. A supressão hormonal pós-operatória associou-se a menor recidiva. A via robótica não superou a convencional. Conclusão: A cirurgia laparoscópica é opção individualizada; a técnica deve equilibrar controle da doença e reserva ovariana.

Introdução: A endometriose profunda é uma forma grave de endometriose, que pode comprometer significativamente a qualidade de vida da mulher. Objetivo: O artigo visa relatar o caso de uma paciente portadora de endometriose profunda, que apresentou um pólipo endometrial, e logo após evidenciou um câncer (CA) de colo uterino. Método: as informações foram obtidas por meio de revisão de prontuário, registro fotográfico dos métodos diagnósticos e revisão de literatura. Resultados: o caso relatado busca trazer uma discussão sobre a endometriose. Conclusão: Logo este relato evidencia a importância da anamnese, do exame físico e dos exames complementares para o diagnóstico preciso e a definição da conduta terapêutica. A abordagem adequada possibilita melhores desfechos clínicos e contribui para a melhoria da qualidade de vida da paciente.

(No abstract on file for this paper.)

BACKGROUND: Thoracic endometriosis syndrome (TES) is the most common extrapelvic manifestation of endometriosis, yet its classification, diagnosis, and treatment remain debated. Thoracic endometriosis syndrome has recently been proposed to be categorized into 3 types: pleural, bronchopulmonary, and diaphragmatic. OBJECTIVES: Our study aims to propose a 3-step approach - computed tomography (CT) imaging, careful intraoperative assessment, and targeted pathology - to enhance the diagnostic process and optimize the management of TES-related pneumothorax. MATERIAL AND METHODS: We retrospectively analyzed 3 cases of recurrent right-sided catamenial pneumothorax in female patients with a history of pelvic endometriosis, managed surgically at the Department of Thoracic Surgery, Medical University of Gdansk, between 2021 and 2024. All included patients underwent video-assisted thoracoscopic surgery (VATS), with comprehensive preoperative CT imaging, intraoperative lesion mapping, and postoperative histopathological examination, improving diagnostic accuracy in TES, with a possible impact on therapeutic results. RESULTS: Chest CT is essential for detecting bullous lesions, aiding in intraoperative identification and surgical treatment. Immunohistochemistry (IHC), assessing estrogen receptor (ER) and CD10 for stromal identification, improves pathological accuracy. CONCLUSIONS: This study underlines the diagnostic value of integrating imaging, intraoperative assessment, and targeted histopathology, as well as clear communication between surgeons, radiologists, and pathologists to ensure accurate diagnosis and an improved therapeutic process for patients in clinical practice.

INTRODUCTION: Gestrinone is an androgenic progestin derived from 19-nortestosterone, in use for four decades in endometriosis and other estrogen-dependent conditions. It has largely disappeared from contemporary progestin taxonomies and is sometimes described as an anabolic-androgenic steroid. This review examines its pharmacology and the evidence for its use. AREAS COVERED: Narrative review without a prespecified protocol, based on searches of PubMed, trial registries and regulatory sources, without date or language limits. It integrates chemistry and multireceptor pharmacology, pharmacokinetics, comparative efficacy against danazol, gonadotropin-releasing hormone (GnRH) agonists and other progestins, and safety, by indication, route and formulation. EXPERT OPINION: Gestrinone was active in every controlled setting tested, and the direct comparisons against danazol and a GnRH agonist detected no difference in the principal pain outcomes, in trials too small to establish equivalence; no direct comparison with dienogest exists. Its hallmark is an androgenic-metabolic signature, and its androgenic effects are not consistently milder than those of danazol. Skeletal findings varied between studies and doses and do not establish long-term protection or the absence of a need for add-back therapy. Priorities are formulation-specific exposure data and contemporary comparisons.

Аденомиозда эндометрийга ўхшаш безлар ва строма миометрий ичида жойлашади; эндометриозда эса эндометрийга ўхшаш тўқима бачадондан ташқари соҳаларда аниқланади. Улар бир беморда бирга учраши мумкин, лекин ташхислаш ва анатомик тавсифлаш жиҳатидан мустақил ҳолатлардир [1,2]. Ҳомила тушишидан кейинги қабулда фақат аввалги акушерлик ҳодисасига эътибор қаратиш ҳайз оғриғи, кўп қон кетиши ва сурункали чаноқ оғриғи каби белгиларни етарлича баҳоламасликка олиб келиши мумкин.

Endometriosis is a chronic, estrogen-dependent systemic disease that significantly impairs women's quality of life and remains a major therapeutic challenge due to frequent symptom recurrence and the limitations of currently available treatments. This review aimed to summarize current evidence regarding the efficacy, safety, and clinical role of oral gonadotropin-releasing hormone (GnRH) antagonists in the management of endometriosis-associated pain. A literature search was conducted using the PubMed and Cochrane Library databases with the terms “endometriosis,” “GnRH antagonists,” “elagolix,” “relugolix,” and “linzagolix.” Relevant prospective and retrospective studies, systematic reviews, meta-analyses, and landmark publications providing essential background on the pathophysiology of endometriosis and the mechanism of action of GnRH antagonists were included. Current evidence indicates that oral GnRH antagonists provide rapid, reversible, and dose-dependent suppression of ovarian estrogen production without the initial flare effect observed with GnRH agonists. Clinical trials have demonstrated significant reductions in dysmenorrhea, non-menstrual pelvic pain, and dyspareunia, accompanied by improvements in health-related quality of life and reductions in analgesic use. The availability of different dosing strategies and add-back therapy enables individualized treatment while minimizing hypoestrogenic adverse effects, including bone mineral density loss. Despite their favorable efficacy and safety profile, treatment remains limited by high costs, the need for long-term monitoring, and the lack of direct comparisons with standard hormonal therapies. Oral GnRH antagonists represent an important advancement in the pharmacological management of endometriosis and offer a promising option for long-term individualized treatment, particularly in women with persistent symptoms or resistance to conventional hormonal therapy.

Introdução: A endometriose é uma doença ginecológica crônica associada a manifestações como dismenorreia, dor pélvica crônica e dispareunia, capazes de repercutir significativamente sobre a funcionalidade, as atividades cotidianas e a qualidade de vida das mulheres. Além das repercussões físicas, a condição pode estar relacionada a alterações emocionais, psicossociais e sexuais, tornando relevante a investigação de abordagens conservadoras, incluindo fisioterapia, atividade física e exercícios. Objetivo: Analisar, em dois eixos complementares, as evidências disponíveis sobre a endometriose: (1) suas repercussões sobre a dor, a função física, a funcionalidade, a qualidade de vida, a saúde mental e a função sexual; e (2) os efeitos das intervenções conservadoras, incluindo fisioterapia, atividade física, exercício e intervenções psicológicas, sobre esses desfechos. Essa organização permite distinguir a síntese das repercussões associadas à doença da análise dos efeitos das estratégias de manejo investigadas. Métodos: Trata-se de uma revisão integrativa da literatura, composta exclusivamente por revisões sistemáticas, com ou sem meta-análise. A busca foi realizada nas bases PubMed/MEDLINE, SciELO e Biblioteca Virtual em Saúde (BVS), desenvolvida com o objetivo de reunir, analisar e sintetizar as evidências científicas disponíveis acerca das repercussões da endometriose sobre a funcionalidade e a qualidade de vida das mulheres, considerando os desfechos relacionados à dor, função física, saúde mental e função sexual, bem como as estratégias conservadoras investigadas para o manejo dessas repercussões. Resultados: Inicialmente, foram identificados 120 registros; após a remoção de duplicatas e aplicação dos critérios de elegibilidade, 12 estudos constituíram a amostra final. Os estudos incluídos identificaram associações entre a endometriose e diferentes repercussões, incluindo dor pélvica, comprometimento da função física e da qualidade de vida, além de alterações relacionadas à saúde mental e à função sexual, embora a magnitude e a consistência desses achados tenham variado entre os estudos e os desfechos avaliados. As evidências sobre fisioterapia, atividade física e exercícios indicaram efeitos predominantemente favoráveis sobre a redução da dor associada à endometriose, sendo esse o desfecho com maior convergência entre as revisões. Também foram observados resultados positivos sobre qualidade de vida, função física e bem-estar emocional; contudo, esses efeitos apresentaram menor consistência, em razão da heterogeneidade das intervenções, dos protocolos, das populações e das medidas de desfecho, o que limita a definição da magnitude dos benefícios e impede estabelecer superioridade entre modalidades específicas. Também foram identificadas associações entre a doença e ansiedade, depressão, estresse, catastrofização da dor, alterações na regulação emocional, dispareunia e comprometimento da função sexual. Os achados reforçam o caráter multidimensional da endometriose e indicam a importância de uma abordagem individualizada e interdisciplinar. Entretanto, a heterogeneidade dos estudos quanto às intervenções e aos desfechos avaliados limita a definição de protocolos terapêuticos padronizados. Conclusão: A endometriose e a dor pélvica crônica apresentam repercussões relevantes sobre diferentes dimensões da vida das mulheres, incluindo funcionalidade, qualidade de vida, saúde emocional e sexualidade. A fisioterapia, a atividade física e os exercícios constituem estratégias conservadoras investigadas principalmente para o manejo da dor e das limitações funcionais. Contudo, são necessários novos estudos primários, com maior rigor metodológico e protocolos padronizados, para determinar com maior precisão os efeitos das diferentes intervenções e fortalecer sua aplicação na assistência às mulheres com endometriose.