Endometriosis as a cause of chronic pain and deterioration of women's quality of life - etiology, symptoms and treatment method
DOI:
https://doi.org/10.12775/QS.2025.42.60549Keywords
endometriosis, chronic pelvic pain, inflammation, women, laparoscopyAbstract
Introduction, purpose
Endometriosis is a chronic inflammatory condition that primarily affects pelvic tissues, including the ovaries, and is the most common cause of chronic pelvic pain, significantly impacting the quality of life of women of reproductive age. It is currently estimated that up to 10% of women may be affected by this condition. However, diagnosing endometriosis is challenging and often delayed due to frequent misdiagnoses as well as the relatively common occurrence of asymptomatic cases. Several factors may contribute to the development of endometriosis, including anatomical, genetic, and immunological factors. Additionally, it is believed that diet and lifestyle may influence the course of the disease. It is important to remember that beyond reducing overall quality of life and causing chronic pain, endometriosis may also contribute to the development of depressive and anxiety disorders, making it an interdisciplinary health issue.
Materials and methods
A systematic literature review was conducted using the PubMed database to explore the current state of knowledge regarding endometriosis, with particular focus on its etiological factors, clinical manifestations, and treatment options.
Conclusions
Endometriosis remains a mystery and a challenge for modern medicine. There are various theories explaining the etiology of endometriosis; however, none of them is universal, nor do they fully account for the development of the disease in every case. In addition to medications and invasive treatment methods, one must not forget the beneficial impact of a proper diet and an active lifestyle on the progression of the disease and the alleviation of its burdensome symptoms. Patients struggling with this condition should be provided with comprehensive, interdisciplinary medical care.
References
[1] Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-279. doi:10.1056/NEJMra0804690
[2] Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261-275. doi:10.1038/nrendo.2013.255
[3] Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002
[4] Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. doi:10.1056/NEJMra1810764
[5] Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021;22(19):10554. Published 2021 Sep 29. doi:10.3390/ijms221910554
[6] Cohen Ben-Meir L, Soriano D, Zajicek M, et al. The Association Between Gastrointestinal Symptoms and Transvaginal Ultrasound Findings in Women Referred for Endometriosis Evaluation: A Prospective Pilot Study. Zusammenhang zwischen gastrointestinalen Symptomen und Befunden im transvaginalen Ultraschall bei Frauen mit Endometriose-Diagnostik: Eine prospektive Pilotstudie. Ultraschall Med. 2022;43(5):e81-e89. doi:10.1055/a-1300-1887
[7] Chen LC, Hsu JW, Huang KL, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J Affect Disord. 2016;190:282-285. doi:10.1016/j.jad.2015.10.030
[8] Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3):511-519. doi:10.1016/j.fertnstert.2012.06.029
[9] Yovich JL, Rowlands PK, Lingham S, Sillender M, Srinivasan S. Pathogenesis of endometriosis: Look no further than John Sampson. Reprod Biomed Online. 2020;40(1):7-11. doi:10.1016/j.rbmo.2019.10.007
[10] Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68(4):585-596. doi:10.1016/s0015-0282(97)00191-x
[11] Izumi G, Koga K, Takamura M, et al. Involvement of immune cells in the pathogenesis of endometriosis. J Obstet Gynaecol Res. 2018;44(2):191-198. doi:10.1111/jog.13559
[12] Sampson JA. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol. 1927;3(2):93-110.43.
[13] Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod. 2015;92(3):64. doi:10.1095/biolreprod.114.124313
[14] Konrad L, Dietze R, Kudipudi PK, Horné F, Meinhold-Heerlein I. Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis?. Reproduction. 2019;158(2):R41-R47. doi:10.1530/REP-19-0106
[15] Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):411-440. doi:10.1016/s0889-8545(05)70311-9
[16] Signorile PG, Viceconte R, Baldi A. New Insights in Pathogenesis of Endometriosis. Front Med (Lausanne). 2022;9:879015. Published 2022 Apr 28. doi:10.3389/fmed.2022.879015
[17] Maruyama T, Yoshimura Y. Stem cell theory for the pathogenesis of endometriosis. Front Biosci (Elite Ed). 2012;4(8):2754-2763. Published 2012 Jun 1. doi:10.2741/e589
[18] Gordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril. 2017;108(6):872-885.e1. doi:10.1016/j.fertnstert.2017.08.036
[19] Figueira PG, Abrão MS, Krikun G, Taylor HS. Stem cells in endometrium and their role in the pathogenesis of endometriosis [published correction appears in Ann N Y Acad Sci. 2011 May;1226(1):52. Taylor, Hugh [corrected to Taylor, Hugh S]]. Ann N Y Acad Sci. 2011;1221(1):10-17. doi:10.1111/j.1749-6632.2011.05969.x
[20] Djokovic D, Calhaz-Jorge C. Somatic stem cells and their dysfunction in endometriosis. Front Surg. 2015;1:51. Published 2015 Jan 6. doi:10.3389/fsurg.2014.00051
[21] Wang Y, Nicholes K, Shih IM. The Origin and Pathogenesis of Endometriosis. Annu Rev Pathol. 2020;15:71-95. doi:10.1146/annurev-pathmechdis-012419-032654
[22] Wu MY, Ho HN. The role of cytokines in endometriosis. Am J Reprod Immunol. 2003;49(5):285-296. doi:10.1034/j.1600-0897.2003.01207.x
[23] Szyllo K, Tchorzewski H, Banasik M, Glowacka E, Lewkowicz P, Kamer-Bartosinska A. The involvement of T lymphocytes in the pathogenesis of endometriotic tissues overgrowth in women with endometriosis. Mediators Inflamm. 2003;12(3):131-138. doi:10.1080/0962935031000134842
[24] Hadfield RM, Mardon HJ, Barlow DH, Kennedy SH. Endometriosis in monozygotic twins. Fertil Steril. 1997;68(5):941-942. doi:10.1016/s0015-0282(97)00359-2
[25] Fraga MF, Ballestar E, Paz MF, et al. Epigenetic differences arise during the lifetime of monozygotic twins. Proc Natl Acad Sci U S A. 2005;102(30):10604-10609. doi:10.1073/pnas.0500398102
[26] Treloar SA, Wicks J, Nyholt DR, et al. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet. 2005;77(3):365-376. doi:10.1086/432960
[27] Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet--what is the evidence?. Eur J Obstet Gynecol Reprod Biol. 2007;132(2):140-147. doi:10.1016/j.ejogrb.2006.12.006
[28] Parazzini F, Chiaffarino F, Surace M, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755-1759. doi:10.1093/humrep/deh395
[29] Raja MHR, Farooqui N, Zuberi N, et al. Endometriosis, infertility and MicroRNA's: A review. J Gynecol Obstet Hum Reprod. 2021;50(9):102157. doi:10.1016/j.jogoh.2021.102157
[30] Coiplet E, Courbiere B, Agostini A, Boubli L, Bretelle F, Netter A. Endometriosis and environmental factors: A critical review. J Gynecol Obstet Hum Reprod. 2022;51(7):102418. doi:10.1016/j.jogoh.2022.102418
[31] Broi MGD, Ferriani RA, Navarro PA. Ethiopathogenic mechanisms of endometriosis-related infertility. JBRA Assist Reprod. 2019;23(3):273-280. Published 2019 Aug 22. doi:10.5935/1518-0557.20190029
[32] Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. Published 2018 Jul 19. doi:10.1038/s41572-018-0008-5
[33] Falcone, Tommaso MD; Flyckt, Rebecca MD. Clinical Management of Endometriosis. Obstetrics & Gynecology 131(3):p 557-571, March 2018. | DOI: 10.1097/AOG.0000000000002469
[34] Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-682. doi:10.1038/s41574-019-0245-z
[35] Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261-275. doi:10.1038/nrendo.2013.255
[36] Ferrero S, Barra F, Leone Roberti Maggiore U. Current and Emerging Therapeutics for the Management of Endometriosis. Drugs. 2018;78(10):995-1012. doi:10.1007/s40265-018-0928-0
[37] Kiesel L, Sourouni M. Diagnosis of endometriosis in the 21st century. Climacteric. 2019;22(3):296-302. doi:10.1080/13697137.2019.1578743
[38] Bulun SE, Yilmaz BD, Sison C, et al. Endometriosis. Endocr Rev. 2019;40(4):1048-1079. doi:10.1210/er.2018-00242
[39] Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018;131(3):557-571. doi:10.1097/AOG.0000000000002469
[40] Harada T, Taniguchi F, Onishi K, et al. Obstetrical Complications in Women with Endometriosis: A Cohort Study in Japan. PLoS One. 2016;11(12):e0168476. Published 2016 Dec 22. doi:10.1371/journal.pone.0168476
[41] Zhao Y, Luan X, Wang Y. Letrozole combined with oral contraceptives versus oral contraceptives alone in the treatment of endometriosis-related pain symptoms: a pilot study. Gynecol Endocrinol. 2021;37(1):51-55. doi:10.1080/09513590.2020.1807502
[42] Taylor HS, Giudice LC, Lessey BA, et al. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 2017;377(1):28-40. doi:10.1056/NEJMoa1700089
[43] Harlev A, Gupta S, Agarwal A. Targeting oxidative stress to treat endometriosis. Expert Opin Ther Targets. 2015;19(11):1447-1464. doi:10.1517/14728222.2015.1077226
[44] Miller JE, Ahn SH, Marks RM, et al. IL-17A Modulates Peritoneal Macrophage Recruitment and M2 Polarization in Endometriosis. Front Immunol. 2020;11:108. Published 2020 Feb 14. doi:10.3389/fimmu.2020.00108
[45] Nagayasu M, Imanaka S, Kimura M, Maruyama S, Kobayashi H. Nonhormonal Treatment for Endometriosis Focusing on Redox Imbalance. Gynecol Obstet Invest. 2021;86(1-2):1-12. doi:10.1159/000512628
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Bernadetta Wilk, Piotr Stachura, Edyta Witkowska, Marcin Ciechański, Szymon Cholewiński, Klaudia Wilk, Piotr Rejman, Katarzyna Jurkiewicz, Aleksandra Kasprzyk, Katarzyna Pszczoła
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 207
Number of citations: 0
