Pathophysiology and Immune Dysfunction in Endometriosis

Abstract

Endometriosis is an estrogen-dependent, chronic, proinflammatory disease prevalent in 10% of women of reproductive age worldwide. Characterized by the growth of endometrium-like tissue in aberrant locations outside of the uterus, it is responsible for symptoms including chronic pelvic pain, dysmenorrhea, and subfertility that degrade quality of life of women significantly. In Canada, direct and indirect economic cost of endometriosis amounts to 1.8 billion dollars, and this is elevated to 20 billion dollars in the United States. Despite decades of research, the etiology and pathophysiology of endometriosis still remain to be elucidated. This review aims to bring together the current understanding regarding the pathogenesis of endometriosis with specific focus on mechanisms behind vascularization of the lesions and the contribution of immune factors in facilitating lesion establishment and development. The role of hormones, immune cells, and cytokine signaling is highlighted, in addition to discussing the current pharmaceutical options available for management of pain symptoms in women with endometriosis.

Endometriosis en colon sigmoides asociada a hematoquecia en una paciente histerectomizada

“…La más aceptada es sobre la menstruación retrograda de Sampson, que consiste en que el tejido endometrial se disemina a la cavidad peritoneal al pasar a contraflujo por los oviductos durante la menstruación e implantándose subsecuentemente en el tejido peritoneal u órganos pélvicos (8) . Otra teoría, es la metaplásica, en la que la endometriosis surge de la metaplasia de células que recubren el peritoneo visceral y abdominal, al ser estimuladas por factores ambientales, hormonales o infección (8) .…”

“…La más aceptada es sobre la menstruación retrograda de Sampson, que consiste en que el tejido endometrial se disemina a la cavidad peritoneal al pasar a contraflujo por los oviductos durante la menstruación e implantándose subsecuentemente en el tejido peritoneal u órganos pélvicos (8) . Otra teoría, es la metaplásica, en la que la endometriosis surge de la metaplasia de células que recubren el peritoneo visceral y abdominal, al ser estimuladas por factores ambientales, hormonales o infección (8) . La teoría más reciente es sobre el rol de las células troncales endometriales localizadas en la capa basal del endometrio, que podrían viajar a través de la menstruación retrograda, vía linfática o por diseminación vascular hacia la cavidad peritoneal y consecuentemente desarrollar lesión endometriótica (8) .…”

Is M235T polymorphism of the angiotensinogen gene involved in the development of endometriosis?

“…Other frequently mentioned and already classical theories explaining the development of endometriosis are the theory of metaplasia and the theory of induction. The involvement of immune and environmental factors is also indicated [2,7]. Furthermore, risk factors for disease development and progression include, among others, Caucasian race, age 25 to 35 years, positive family history of endometriosis, early menarche (below 11 years of age) and short menstrual cycles (less than 25 days) with heavy bleeding [8,9].…”

What Does Diagnosis of Endometriosis Mean? The Patient′s Perspective

“…The most widely accepted theory for pathogenic origination of endometriosis is that of retrograde menstruation (ejection of endometrial fragments from the Fallopian tubal openings during menstruation) followed by implantation of endometrial stem cell niches contained within the shed endometrial fragments (reviewed in [8,9]). However, retrograde menstruation occurs in nearly 70 percent of all reproductively active women and the prevalence of symptomatic endometriosis is only 10-15%.…”

“…However, retrograde menstruation occurs in nearly 70 percent of all reproductively active women and the prevalence of symptomatic endometriosis is only 10-15%. Therefore, pathogenesis of endometriosis must also involve hereditary genetic traits and/or also immune dysfunction leading to improper clearance of menstrual tissue within the abdominal cavity (reviewed in [8]). Identification of factors involved with the pathogenesis of endometriosis is currently the topic of several research investigations.…”