Vascularisation in Deep Endometriosis: A Systematic Review with Narrative Outcomes

Simon G. Powell, Priyanka Sharma, Samuel Masterson, James Wyatt, Ilyas Arshad, Shakil Ahmed, Gendie E. Lash, Michael Cross, Dharani K. Hapangama
Cells · 2023 · vol. 12(9) , pp. 1318 · doi:10.3390/cells12091318 · PMID:37174718 · W4372292085
review OA: gold CC0 ⤵ 12 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review found deep endometriosis lesions to be highly vascularized with increased VEGF-A and VEGFR-2, and noted progestin therapy reduced microvessel density.

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Abstract

Deep endometriosis (DE) is the most severe subtype of endometriosis, with the hallmark of lesions infiltrating adjacent tissue. Abnormal vascularisation has been implicated in contributing to endometriosis lesion development in general, and how vascularisation influences the pathogenesis of DE, in particular, is of interest. This systematic review followed the PRISMA guidelines to elucidate and examine the evidence for DE-specific vascularisation. A literature search was performed using MEDLINE, Embase, PubMed, Scopus, Cochrane CENTRAL Library and Europe PubMed Central databases. The databases were searched from inception to the 13 March 2023. A total of 15 studies with 1125 patients were included in the review. The DE lesions were highly vascularised, with a higher microvessel density (MVD) than other types of endometriotic lesions, eutopic endometrium from women with endometriosis and control tissue. Vascular endothelial growth factor, its major subtype (VEGF-A) and associated receptor (VEGFR-2) were significantly increased in the DE lesions compared to superficial endometriosis, eutopic endometrium and control tissue. Progestin therapy was associated with a significant decrease in the MVD of the DE lesions, explaining their therapeutic effect. This review comprehensively summarises the available literature, reporting abnormal vascularisation to be intimately related to the pathogenesis of DE and presents potentially preferential therapeutic targets for the medical management of DE.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Endometrium Endometrium Female Female Female Female Humans Humans Humans Humans Neovascularization, Pathologic Neovascularization, Pathologic

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