Skip to content
naulon

No retraction, correction or concern found when last checked on Nov 2, 2026.

The Main Theories on the Pathogenesis of Endometriosis

Jelizaveta Lamceva, Romans Uljanovs, Ilze Strumfa

International Journal of Molecular Sciences · 2023 · Review · CC BY-NC

doi:10.3390/ijms24054254

Abstract

Endometriosis is a complex disease, which is defined by abnormal growth of endometrial tissue outside the uterus. It affects about 10% of women of reproductive age all over the world. Endometriosis causes symptoms that notably worsen patient’s well-being—such as severe pelvic pain, dysfunction of the organs of pelvic cavity, infertility and secondary mental issues. The diagnosis of endometriosis is quite often delayed because of nonspecific manifestations. Since the disease was defined, several different pathogenetic pathways have been considered, including retrograde menstruation, benign metastasis, immune dysregulation, coelomic metaplasia, hormonal disbalance, involvement of stem cells and alterations in epigenetic regulation, but the true pathogenesis of endometriosis remains poorly understood. The knowledge of the exact mechanism of the origin and progression of this disease is significant for the appropriate treatment. Therefore, this review reports the main pathogenetic theories of endometriosis based on current studies.

References 54

  1. 1.

    World Health Organization.

    Not in our library

  2. 2.

    Saunders P.T.K., Horne A.W. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell. 2021;184:2807-2824.

    Not in our library10.1016/j.cell.2021.04.041

  3. 3.
  4. 4.

    Ahn S.H., Singh V., Tayade C. Biomarkers in endometriosis: Challenges and opportunities. Fertil. Steril. 2017;107:523-532.

    Not in our library10.1016/j.fertnstert.2017.01.009

  5. 5.

    Horne A.W., Saunders P.T.K. SnapShot: Endometriosis. Cell. 2019;179:1677.

    Not in our library10.1016/j.cell.2019.11.033

  6. 6.

    Wang Y., Nicholes K., Shih I.M. The origin and pathogenesis of endometriosis. Annu. Rev. Pathol. 2020;15:71-95.

    Not in our library10.1146/annurev-pathmechdis-012419-032654

  7. 7.

    Yovich J.L., Rowlands P.K., Lingham S., Sillender M., Srinivasan S. Pathogenesis of endometriosis: Look no further than John Sampson. Reprod. Biomed. Online. 2020;40:7-11.

    Not in our library10.1016/j.rbmo.2019.10.007

  8. 8.

    Sampson J.A. The development of the implantation theory for the origin of peritoneal endometriosis. Am. J. Obstet. Gynecol. 1940;40:549-557.

    Not in our library10.1016/s0002-9378(40)91238-8

  9. 9.

    Nisolle M., Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil. Steril. 1997;68:585-596.

    Not in our library10.1016/s0015-0282(97)00191-x

  10. 10.

    Izumi G., Koga K., Takamura M., Makabe T., Satake E., Takeuchi A., Taguchi A., Urata Y., Fujii T., Osuga Y. Involvement of immune cells in the pathogenesis of endometriosis. J. Obstet. Gynaecol. Res. 2018;44:191-198.

    Not in our library10.1111/jog.13559

  11. 11.

    D’Hooghe T.M., Debrock S. Endometriosis, retrograde menstruation and peritoneal inflammation in women and in baboons. Hum. Reprod. Update. 2002;8:84-88.

    Not in our library10.1093/humupd/8.1.84

  12. 12.

    Signorile P.G., Viceconte R., Baldi A. New insights in pathogenesis of endometriosis. Front. Med. 2022;9:879015.

    Not in our library10.3389/fmed.2022.879015

  13. 13.

    Sampson J.A. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am. J. Pathol. 1927;3:93-110.

    Not in our library

  14. 14.

    Jerman L.F., Hey-Cunningham A.J. The role of the lymphatic system in endometriosis: A comprehensive review of the literature. Biol. Reprod. 2015;64:1-10.

    Not in our library10.1095/biolreprod.114.124313

  15. 15.
  16. 16.

    Parag D.J., Vijayanand K.M., Lakshmi K. Gastrointestinal deep infiltrative endometriosis with lymph node involvement. Indian J. Pathol. Microbiol. 2021;64:213-215.

    Not in our library10.4103/ijpm.ijpm_1022_19

  17. 17.

    Law Y.Y., Patel R., Yorke R., Bailey H.R., Van Eps J.L. A case of infiltrative cecal endometriosis with appendiceal obliteration and lymph node involvement. J. Surg. Case. Rep. 2020;2020:rjaa396.

    Not in our library10.1093/jscr/rjaa396

  18. 18.

    Takehara M., Ueda M., Yamashita Y., Terai Y., Hung Y.C., Ueki M. Vascular endothelial growth factor A and C gene expression in endometriosis. Hum. Pathol. 2004;35:1369-1375.

    Not in our library10.1016/j.humpath.2004.07.020

  19. 19.

    Keichel S., Barcena de Arellano M.L., Reichelt U., Riedlinger W.F., Schneider A., Köhler C., Mechsner S. Lymphangiogenesis in deep infiltrating endometriosis. Hum. Reprod. 2011;26:2713-2720.

    Not in our library10.1093/humrep/der230

  20. 20.

    Kapoor R., Stratopoulou C.A., Dolmans M.M. Pathogenesis of endometriosis: New insights into prospective therapies. Int. J. Mol. Sci. 2021;22:11700.

    Not in our library10.3390/ijms222111700

  21. 21.
  22. 22.

    Vallvé-Juanico J., Houshdaran S., Giudice L.C. The endometrial immune environment of women with endometriosis. Hum. Reprod. Update. 2019;25:565-592.

    Not in our library10.1093/humupd/dmz018

  23. 23.

    Berbic M., Schulke L., Markham R., Tokushige N., Russell P., Fraser I.S. Macrophage expression in endometrium of women with and without endometriosis. Hum. Reprod. 2009;24:325-332.

    Not in our library10.1093/humrep/den393

  24. 24.

    Wu M.H., Chuang P.C., Lin Y.J., Tsai S.J. Suppression of annexin A2 by prostaglandin E₂ impairs phagocytic ability of peritoneal macrophages in women with endometriosis. Hum. Reprod. 2013;28:1045-1053.

    Not in our library10.1093/humrep/det003

  25. 25.

    Bacci M., Capobianco A., Monno A., Cottone L., Di Puppo F., Camisa B., Mariani M., Brignole C., Ponzoni M., Ferrari S., et al. Macrophages are alternatively activated in patients with endometriosis and required for growth and vascularization of lesions in a mouse model of disease. Am. J. Pathol. 2009;175:547-556.

    Not in our library10.2353/ajpath.2009.081011

  26. 26.

    Takamura M., Koga K., Izumi G., Urata Y., Nagai M., Hasegawa A., Harada M., Hirata T., Hirota Y., Wada-Hiraike O., et al. Neutrophil depletion reduces endometriotic lesion formation in mice. Am. J. Reprod. Immunol. 2016;76:193-198.

    Not in our library10.1111/aji.12540

  27. 27.
  28. 28.

    Maridas D.E., Hey-Cunningham A.J., Ng C.H.M., Markham R., Fraser I.S., Berbic M. Peripheral and endometrial dendritic cell populations during the normal cycle and in the presence of endometriosis. J. Endometr. Pelvic Pain Disord. 2014;6:67-119.

    Not in our library10.5301/je.5000180

  29. 29.

    Rizner T.L. Estrogen metabolism and action in endometriosis. Mol. Cell. Endocrinol. 2009;307:8-18.

    Not in our library10.1016/j.mce.2009.03.022

  30. 30.

    Slabe N., Meden-Vrtovec H., Verdenik I., Kosir-Pogacnik R., Ihan A. Cytotoxic T-cells in peripheral blood in women with endometriosis. Geburtshilfe. Frauenheilkd. 2013;73:1042-1048.

    Not in our library10.1055/s-0033-1350702

  31. 31.

    Konrad L., Dietze R., Kudipudi P.K., Horné F., Meinhold-Heerlein I. Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis? Reproduction. 2019;158:R41-R47.

    Not in our library10.1530/rep-19-0106

  32. 32.

    Cho M.K., Kim C.H., Oh S.T. Endometriosis in a patient with Rokitansky-Kuster-Hauser syndrome. J. Obstet. Gynaecol. Res. 2009;35:994-996.

    Not in our library10.1111/j.1447-0756.2009.01025.x

  33. 33.

    Maruyama T., Yoshimura Y. Stem cell theory for the pathogenesis of endometriosis. Front. Biosci. 2012;4:2754-2763.

    Not in our library10.2741/e589

  34. 34.

    Gordts S., Koninckx P., Brosens I. Pathogenesis of deep endometriosis. Fertil. Steril. 2017;108:872-885.

    Not in our library10.1016/j.fertnstert.2017.08.036

  35. 35.

    Figueira P.G., Abrão M.S., Krikun G., Taylor H.S. Stem cells in endometrium and their role in the pathogenesis of endometriosis. Ann. N. Y. Acad Sci. 2011;1221:10-17.

    Not in our library10.1111/j.1749-6632.2011.05969.x

  36. 36.

    Djokovic D., Calhaz-Jorge C. Somatic stem cells and their dysfunction in endometriosis. Front. Surg. 2014;1:51.

    Not in our library10.3389/fsurg.2014.00051

  37. 37.
  38. 38.
  39. 39.

    Koukoura O., Sifakis S., Spandidos D.A. DNA methylation in endometriosis (Review). Mol. Med. Rep. 2016;13:2939-2948.

    Not in our library10.3892/mmr.2016.4925

  40. 40.

    Jiang L., Yan Y., Liu Z., Wang Y. Inflammation and endometriosis. Front. Biosci. 2016;21:941-948.

    Not in our library10.2741/4431

All 54 references

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.