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Review
. 2025 Mar 26;24(4):103752.
doi: 10.1016/j.autrev.2025.103752. Epub 2025 Jan 17.

Endometriosis and autoimmunity

Luz P Blanco  1 , Noemi Salmeri  2 , Sarah M Temkin  2 , Victoria K Shanmugam  3 , Pamela Stratton  4
Affiliations
Review

Endometriosis and autoimmunity

Luz P Blanco et al. Autoimmun Rev. .

Abstract

Endometriosis is a female-specific chronic condition that affects 1 in 10 women and other individuals with a uterus worldwide with common symptoms that include pelvic pain and infertility. Reliable and effective non-invasive biomarkers for endometriosis do not exist, and therefore currently a diagnosis of endometriosis requires direct visualization of lesions at surgery. Similarly, few safe and effective management strategies exist for endometriosis, with hormonal interventions and surgery only providing temporary symptom control. The development of endometriosis involves the implantation and proliferation of ectopic endometrial cells which triggers local and systemic inflammation and fibrosis. While multiple genetic, environmental, and lifestyle factors appear to influence the natural history of endometriosis, chronic inflammation is a hallmark feature associated with development and progression of the disease. Data further shows that endometriosis commonly co-occurs with autoimmune diseases, adding evidence that immune dysfunction likely contributes to the pathogenesis of this disorder. Specific innate and adaptive immune system drivers of endometriosis remain to be identified and additional research is needed to elucidate the mechanistic underpinnings of this debilitating disease. In this narrative review, we discuss the shared biological mechanisms and plausible immune-related connections between endometriosis and autoimmunity.

Keywords: Autoimmune disease; Autoimmunity; Endometriosis; Immunology; Infertility; Pain.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Pamela Stratton, MD reports financial support was provided by the Office of Research on Women's Health, National Institutes of Health. Pamela Stratton, MD reports a relationship with Massachusetts Institute of Technology that includes: travel reimbursement. PS has received royalties from UpToDate for a section about acute pelvic pain, from Frontiers in Reproductive Health as Specialty Chief Editor, Gynecology, and reviewed a book proposal on endometriosis for Elsevier. - Victoria K. Shanmugam, MBBS, FACR, CCD, reports financial support was provided by the Office of Autoimmune Disease Research, Office of Research on Women's Health, National Institutes of Health. Sarah M. Temkin, MD reports financial support was provided by the Office of Research on Women's Health, National Institutes of Health. Luz P. Blanco, PhD reports financial support was provided by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.

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