The Main Theories on the Pathogenesis of Endometriosis Original paper
Researched by:
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Karen Pendergrass
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Karen Pendergrass
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
Fact-checked by:
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Karen Pendergrass
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Karen Pendergrass
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Endometriosis
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
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Karen Pendergrass
Researched by:
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Karen Pendergrass
ID
Karen Pendergrass
Fact-checked by:
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Karen Pendergrass
ID
Karen Pendergrass
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Karen Pendergrass
What Was Reviewed?
This review explored the primary theories underlying the pathogenesis of endometriosis, a chronic gynecological disorder characterized by the growth of endometrial-like tissue outside the uterus. The review evaluated various mechanisms, including retrograde menstruation, immune dysregulation, coelomic metaplasia, hormonal imbalance, and epigenetic regulation. Additionally, it considered the role of stem cells and environmental factors in disease onset and progression. The synthesis of these theories aimed to illuminate the multifactorial origins of the disease and its systemic implications.
Who Was Reviewed?
The review included a broad analysis of scientific literature, focusing on research involving women with endometriosis, animal models (notably baboons and mice), and cell-based experiments. Integrating data from diverse biological contexts provided a comprehensive overview of the disease’s potential mechanisms.
What Were the Most Important Findings?
The review highlighted that endometriosis likely results from an interplay of multiple pathogenic pathways. Immune dysregulation was a central focus, with macrophages, T cells, and dendritic cells contributing to chronic inflammation, suppressed apoptosis, and lesion growth. Hormonal imbalances, particularly estrogen dominance and progesterone resistance, were identified as pivotal in driving lesion persistence and infertility. Epigenetic changes, such as DNA methylation and micro-RNA dysregulation, emerged as significant contributors to disease progression, influencing inflammation, angiogenesis, and cellular proliferation.
This review did not address key microbial associations in endometriosis, but immune-modulated inflammation and altered hormonal environments suggest indirect links to microbiome perturbations. For example, increased inflammatory cytokines (e.g., TNF-α and IL-6) and VEGF in endometriotic lesions may influence local microbial dynamics.
What Are the Greatest Implications of This Review?
Understanding the multifactorial nature of endometriosis provides a foundation for developing targeted therapeutic strategies. The review underscores the need for integrative approaches combining hormonal regulation, immune modulation, and potential epigenetic therapies. Additionally, exploring microbiome interactions in this context may reveal novel interventions, particularly in immune-regulated inflammation and hormonal imbalances.
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
Retrograde Menstruation Theory
Retrograde menstruation theory holds that during menstruation, some endometrial tissue reverses through the fallopian tubes into the pelvic cavity. It implants on pelvic organs, thickens, breaks down, and bleeds cyclically, causing inflammation, pain, and scar tissue, characteristic of endometriosis.
Coelomic Metaplasia Theory
Coelomic Metaplasia Theory could help explain the cases of endometriosis in men or in women who are not yet menstruating.