Pathogenesis and Pathophysiology of Endometriosis

Capsule:
Endometriosis is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. This work reviews the disease process from theories regarding origin to the molecular basis for disease sequelae.

Authors:
Richard O. Burney, M.D., M.Sc. and Linda C. Giudice, M.D., Ph.D.

Volume 98, Issue 3, Pages 511-519, September 2012

Abstract:
The exact factor or factors that orchestrate the survival and subsequent implantation of the displaced endometrium remain unknown. Innate or acquired properties of the endometrium and defective immune clearance are systems of interest in elucidating the establishment of endometriotic implants. Disease heterogeneity, particularly in lesional phenotype, requires adherence to histopathologic confirmation of implants in clinical and molecular research. The underpinnings for the observed hallmarks of inflammation, estrogen dependence, and progesterone resistance in the pathophysiology of endometriosis associated pain and infertility are areas of active research. With further advances in our understanding of endometriosis, preventive strategies, novel non-surgical diagnostic modalities and targeted therapeutics hold great promise of becoming realities.

  • This is an extremely thorough review of the complex topic of endometriosis that infertility specialists and general gynecologists encounter on a daily basis. The detailed review on theories regarding etiology / factors contributing to the pathogenesis are a must-read for any clinician, especially residents and fellows- since an understanding of the basic scientific background allows a better understanding of current and future therapies for this disease (eg aromatase inhibitors / treatments targeting angiogenesis etc).

    • Micah Hill

      I completely agree, this a thorough and very helpful review from Dr Burney and Dr Giudice!

  • Raul Gomez, PhD, IUIVI

    Terrific review, congrutalations to the authors as they have smartly summarized all the factors which have been described to be associated to the origin and further development of this condition. The authors have drawn a very usefull map for not getting lost in the jungle of endometriosis. For all those of us familiarized with Dr Giudicee work, we know she has pioneered in the past in employing the new technologies (i.e microarrays) for better characterizing endometriosis. In the context of such expertise I would like to know the authors opinion on how they envision that the recently new findings provided by the ENCODE group (analysis of the so called “non-coding genome”) will improve our understanding of endometriosis.
    Thanks

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