The DOI matches its Crossref record; 267 of the 290 references it cites were found in a registry or an index; none of the 83 sources its claims cite is checked for support yet.
Pathogenesis of endometriosis: the genetic/epigenetic theory
Open accessAbstract
OBJECTIVE To study the pathophysiology of endometriosis. DESIGN Overview of observations on endometriosis. SETTING Not applicable. PATIENT(S) None. INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) The hypothesis is compatible with all observations. RESULT(S) Endometriosis, endometrium-like tissue outside the uterus, has a variable macroscopic appearance and a poorly understood natural history. It is a hereditary and heterogeneous disease with many biochemical changes in the lesions, which are clonal in origin. It is associated with pain, infertility, adenomyosis, and changes in the junctional zone, placentation, immunology, plasma, peritoneal fluid, and chronic inflammation of the peritoneal cavity. The Sampson hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread, or the metaplasia theory cannot explain all observations if metaplasia is defined as cells with reversible changes and an abnormal behavior/morphology due to the abnormal environment. We propose a polygenetic/polyepigenetic mechanism. The set of genetic and epigenetic incidents transmitted at birth could explain the hereditary aspects, the predisposition, and the endometriosis-associated changes in the endometrium, immunology, and placentation. To develop typical, cystic ovarian or deep endometriosis lesions, a variable series of additional transmissible genetic and epigenetic incidents are required to occur in a cell which may vary from endometrial to stem cells. Subtle lesions are viewed as endometrium in a different environment until additional incidents occur. Typical cystic ovarian or deep endometriosis lesions are heterogeneous and represent three different diseases. CONCLUSION(S) The genetic epigenetic theory is compatible with all observations on endometriosis. Implications for treatment and prevention are discussed.
Overview
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Written from the paper’s full text.
TL;DR
Koninckx proposes a polygenetic/polyepigenetic theory in which inherited and acquired genetic/epigenetic incidents explain endometriosis predisposition, heterogeneity, and progression from subtle lesions to typical, cystic, or deep disease. The theory is argued to be compatible with all observations, but it remains speculative and untested.
Key findings
- Endometriosis is hereditary: risk is 6%–9% higher in first-degree relatives and 15% higher when relatives had severe disease; hereditary factors are estimated to account for 50% of endometriosis. GWAS identified 10 or 15 loci, and a meta-analysis identified five loci regulating sex steroid hormone pathways, five secondary signals, and 19 SNPs robustly associated with endometriosis.
- The genetic/epigenetic theory holds that genetic and epigenetic incidents transmitted at birth explain predisposition and endometriosis-associated changes in endometrium, immunology, and placentation; additional transmissible incidents in a cell—ranging from endometrial to stem cells—are required for typical, cystic ovarian, or deep lesions. Subtle lesions are viewed as endometrium in a different environment until additional incidents occur.
- Typical cystic ovarian and deep endometriosis lesions are heterogeneous and represent three different diseases; lesions are clonal in origin. Deep endometriosis lesions are generally unique, larger than 1 cm, with some 20% lymph node involvement; depth distribution shows two populations overlapping at 6 mm, and a >5 mm definition was later suggested.
- Natural history is described as mostly non-progressive: most subtle lesions do not progress, most typical/cystic/deep lesions are not progressive after diagnosis, and most are not recurrent after surgery. Cystic ovarian endometriosis recurrence after stripping is less than 20% within 6 months; recurrence of deep endometriosis after complete excision is rare.
Methods
- Design: overview of observations on endometriosis; setting not applicable; no patients and no interventions. Main outcome measure: the hypothesis is compatible with all observations.
- Data: clinical, histologic, and biochemical observations and research on endometriotic tissues; the paper notes there is no nonhuman animal model with sufficient similarity to human myometrium, junctional zone, endometrium, placentation, and pregnancy disorders.
- Analysis: narrative synthesis of observations and historical theories—Sampson’s retrograde menstruation/implantation, metaplasia, and the endometriotic disease theory—into a polygenetic/polyepigenetic mechanism, with figures and a table summarizing clinical observations.
Limitations
- The paper states the theory “will remain a theory until disproven by new observations”; it can only speculate what combination of genetic and epigenetic incidents leads to typical, cystic, deep, or extragenital endometriosis, and redundancy of biologic processes can mask phenotypic effects.
- The paper states that absence of experimentation limits views to clinical, histologic, and biochemical observations; natural history is unclear, progression of subtle lesions or from typical to cystic/deep lesions has not been observed directly, epidemiology is unclear, and recurrence data are limited. Some cited observations are personal or unpublished.
- Evident from the text: this is a narrative hypothesis paper with no new primary data, no systematic review or meta-analysis, and no formal experimental test of the proposed mechanism.
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Claims the paper makes
0 of 83 cited sources checked · 0 supported · 0 flagged
In the paper
“Recurrence rates of deep endometriosis lesions after complete excision are rare (personal observations) (60).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [60] Ianieri, 2018, Recurrence in deep infiltrating endometriosis: a systematic review of the literature, J Minim Invasive Gynecol source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“The risk of developing endometriosis is 6%-9% higher in first-degree relatives of women with endometriosis (34,35)”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“A recent meta-analysis identified five loci regulating sex steroid hormone pathways, five secondary signals, and 19 single-nucleotide polymorphisms robustly associated with endometriosis (54)”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [54] Sapkota, 2017, Meta-analysis identifies five novel loci associated with endometriosis highlighting key genes involved in hormone metabolism, Nat Commun source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Endometriosis lesions are clonal, as demonstrated for typical (149), deep (150), and cystic ovarian (151-153) endometriosis.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [149] Wu, 2003, Resolution of clonal origins for endometriotic lesions using laser capture microdissection and the human androgen receptor (HUMARA) assay, Fertil Steril source
- Not checked yetcites [150] Mayr, 2003, Does endometriosis really have premalignant potential? A clonal analysis of laser-microdissected tissue, FASEB J source
- Not checked yetcites [151] Tamura, 1998, Analysis of clonality in human endometriotic cysts based on evaluation of X chromosome inactivation in archival formalin-fixed, paraffin-embedded tissue, Lab Invest
- Not checked yetcites [152] Yano, 1999, Molecular analysis of clonality in ovarian endometrial cysts, Gynecol Obstet Invest source
- Not checked yetcites [153] Jimbo, 1997, Evidence for monoclonal expansion of epithelial cells in ovarian endometrial cysts, Am J Pathol
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Endometriosis is a hereditary disease.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“and 15% higher when they had severe disease (36,37).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [36] Kennedy, 1998, The genetics of endometriosis, J Reprod Med
- Not checked yetcites [37] Kennedy, 1998, Magnetic resonance imaging to assess familial risk in relatives of women with endometriosis, Lancet source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“In the endometrium of women with endometriosis several hundred minor biochemical changes have been described (124-128).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [124] Carvalho, 2011, Role of eutopic endometrium in pelvic endometriosis, J Minim Invasive Gynecol source
- Not checked yetcites [125] Lessey, 2013, Eutopic endometrium in women with endometriosis: ground zero for the study of implantation defects, Semin Reprod Med source
- Not checked yetcites [126] Herndon, 2016, Global transcriptome abnormalities of the eutopic endometrium from women with adenomyosis, Reprod Sci source
- Not checked yetcites [127] Lagana, 2016, Natural killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner, Arch Gynecol Obstet source
- Not checked yetcites [128] da Costa e Silva Rde, 2016, Estrogen signaling in the proliferative endometrium: implications in endometriosis, Rev Assoc Med Bras (1992) source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“More recently, hereditary factors were estimated to account for 50% of endometriosis (45)(46)(47).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [45] Sapkota, 2015, Genetic burden associated with varying degrees of disease severity in endometriosis, Mol Hum Reprod source
- Not checked yetcites [46] Saha, 2015, The heritability of endometriosis, Fertil Steril source
- Not checked yetcites [47] Baranov, 2015, Systems genetics view of endometriosis: a common complex disorder, Eur J Obstet Gynecol Reprod Biol source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Endometriosis seems associated with a higher risk of cancer, as recently reviewed (139, 140).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [139] Lim, 2018, Type and risk of cancer related to endometriosis: ovarian cancer and beyond, BJOG source
- Not checked yetcites [140] Dawson, 2018, Endometriosis and endometriosis-associated cancers: new insights into the molecular mechanisms of ovarian cancer development, Ecancermedicalscience source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“In addition, regression of smaller lesions is common (57).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [57] Evers, 2013, Is adolescent endometriosis a progressive disease that needs to be diagnosed and treated?, Hum Reprod source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 20
- It may state two separate claims as one. 24
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most deep endometriosis lesions do not (or very slowly) progress over time, but some lesions can be fast progressive (unpublished observations).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Although most women with deep endometriosis have severe pain, especially during menstruation (65), some large lesions (estimated to be 5%) are not painful.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [65] Koninckx, 1996, Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration, Fertil Steril source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Subtle endometriosis lesions decrease with age, whereas typical, cystic, and deep lesions increase with age, at least until menopause (58).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [58] Koninckx, 2016, Epidemiology of subtle, typical, cystic, and deep endometriosis: a systematic review, Gynaecol Surg source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Endometriosis has a variable appearance.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Recurrence rates of cystic ovarian endometriosis after stripping are less than 20% within 6 months (61, 62) but vary with the surgeon (63) and the technique used.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [61] Busacca, 1999, Recurrence of ovarian endometrioma after laparoscopic excision, Am J Obstet Gynecol source
- Not checked yetcites [62] Moscarini, 2014, Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate, Arch Gynecol Obstet source
- Not checked yetcites [63] Muzii, 2011, The singer, not the song, J Minim Invasive Gynecol source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Endometriosis is associated with higher concentrations of Escherichia coli in menstrual blood (134, 135), with vaginal infections (136), and with chronic endometritis (137).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [134] Khan, 2010, Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis, Fertil Steril source
- Not checked yetcites [135] Khan, 2018, Bacterial contamination hypothesis: a new concept in endometriosis, Reprod Med Biol source
- Not checked yetcites [136] Lin, 2016, Increased risk of endometriosis in patients with lower genital tract infection: a nationwide cohort study, Medicine (Baltimore) source
- Not checked yetcites [137] Cicinelli, 2017, Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link, Fertil Steril source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“That the low natural killer (NK) cell activity in plasma remains low whereas the elevated CA-125 concentrations return to normal after surgical excision of deep endometriosis suggests that the NK cell defect is a cause and the elevated CA-125 a consequence of endometriosis (89).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OTHER OBSERVATIONS ASSOCIATED WITH ENDOMETRIOSIS
What the sources say
- Not checked yetcites [89] Oosterlynck, 1994, CO2-laser excision of endometriosis does not improve the decreased natural killer activity, Acta Obstet Gynecol Scand source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Cystic ovarian endometriosis causes pain in more than 80%, and deep endometriosis causes severe pain in the large majority of women (27).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OTHER OBSERVATIONS ASSOCIATED WITH ENDOMETRIOSIS
What the sources say
- Not checked yetcites [27] Koninckx, 1991, Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain, Fertil Steril source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Endometriosis, especially cystic ovarian and deep endometriosis (130, 131), and adenomyosis (132, 133) are associated with abnormal placentation, insufficient physiologic changes in the spiral arteries, and an increased risk of preterm birth, small for gestational age (SGA) babies, and preeclampsia (131).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [130] Pan, 2017, Risk of gestational hypertension-preeclampsia in women with preceding endometriosis: a nationwide population-based study, PLoS One source
- Not checked yetcites [131] Koninckx, 2018, Endometriosis and pregnancy outcome, Fertil Steril source
- Not checked yetcites [132] Hasdemir, 2016, The role of adenomyosis in the pathogenesis of preeclampsia, Geburtshilfe Frauenheilkd source
- Not checked yetcites [133] Hashimoto, 2018, Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition, J Matern Fetal Neonatal Med source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Genomewide association studies identified 10 (50) or 15 (51) loci with single-nucleotide polymorphisms (52) associated with severe endometriosis, but located in DNA sequences regulating target genes (53).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [50] Rahmioglu, 2015, Genome-wide enrichment analysis between endometriosis and obesity-related traits reveals novel susceptibility loci, Hum Mol Genet source
- Not checked yetcites [51] Fung, 2018, Genetics of endometriosis: state of the art on genetic risk factors for endometriosis, Best Pract Res Clin Obstet Gynaecol source
- Not checked yetcites [52] Matalliotakis, 2017, The role of gene polymorphisms in endometriosis, Mol Med Rep source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Endometriosis is a heterogeneous disease.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Estrogens stimulate growth, whereas progestogen therapy and pregnancy stop growth or cause decidualization and decrease endometriosis-associated pain.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Clinical observations suggest that the prevalence and severity of deep endometriosis have markedly increased during the past 20 years (58).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [58] Koninckx, 2016, Epidemiology of subtle, typical, cystic, and deep endometriosis: a systematic review, Gynaecol Surg source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“However, progression of subtle lesions or progression from typical to cystic or deep lesions has not been observed directly (56).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > OBSERVATIONS IN ENDOMETRIOSIS
What the sources say
- Not checked yetcites [56] Canis, 2016, Endometriosis may not be a chronic disease: an alternative theory offering more optimistic prospects for our patients, Fertil Steril source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinical consequence is that lesions vary, that occasional lesions can be rapidly progressive, and that the effect of medical therapy can be variable between patients.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If, on the contrary, metaplasia indicates stable and transmissible genetic or epigenetic changes, this comes close to the genetic/epigenetic theory.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > THE PATHOGENESIS OF ENDOMETRIOSIS: THE GENETIC/EPIGENETIC THEORY Historical Background
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Typical, cystic, and deep lesions are benign tumors, which after an initial period of rapid growth stop growing or progress slowly and which do not recur after complete excision.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In addition, we recently realized the association of endometriosis with vaginal and pelvic infection (78, 136, 138) and the presence of an important metabolome in the uterine and peritoneal cavities.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
What the sources say
- Not checked yetcites [78] Kobayashi, 2014, Pathogenesis of endometriosis: the role of initial infection and subsequent sterile inflammation, Mol Med Rep source
- Not checked yetcites [136] Lin, 2016, Increased risk of endometriosis in patients with lower genital tract infection: a nationwide cohort study, Medicine (Baltimore) source
- Not checked yetcites [138] Heidarpour, 2017, Prevalence of high-risk human papillomavirus infection in women with ovarian endometriosis, J Obstet Gynaecol Res source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, these defects might also explain the associated subfertility, with monthly fecundity rates below 10% being similar to women with unexplained infertility, the associated changes in the endometrium, and the associated pregnancy problems.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The endometriotic disease theory (EDT) postulated (246) that genetic incidents are required for the development of typical, cystic, or deep endometriosis.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
What the sources say
- Not checked yetcites [246] Koninckx, 1999, Implantation versus infiltration: the Sampson versus the endometriotic disease theory, Gynecol Obstet Invest source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subtle or microscopic lesions will progress to more severe lesions only if additional incidents happen.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Local estrogen production (154) and progesterone resistance (155-162) were demonstrated in larger endometriosis lesions (154-163)”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [154] Bulun, 2015, Molecular biology of endometriosis: from aromatase to genomic abnormalities, Semin Reprod Med source
- Not checked yetcites [155] Bulun, 2006, Progesterone resistance in endometriosis: link to failure to metabolize estradiol, Mol Cell Endocrinol source
- Not checked yetcites [156] Wang, 2009, Endometriosis is associated with progesterone resistance in the baboon (Papio anubis) oviduct: evidence based on the localization of oviductal glycoprotein 1 (OVGP1), Biol Reprod source
- Not checked yetcites [157] Bruner-Tran, 2010, Dioxin and endometrial progesterone resistance, Semin Reprod Med source
- Not checked yetcites [158] Bulun, 2010, 17β-Hydroxysteroid dehydrogenase-2 deficiency and progesterone resistance in endometriosis, Semin Reprod Med source
- Not checked yetcites [159] Al-Sabbagh, 2012, Mechanisms of endometrial progesterone resistance, Mol Cell Endocrinol source
- Not checked yetcites [160] Barragan, 2016, Human endometrial fibroblasts derived from mesenchymal progenitors inherit progesterone resistance and acquire an inflammatory phenotype in the endometrial niche in endometriosis, Biol Reprod source
- Not checked yetcites [161] Joshi, 2017, Progesterone resistance in endometriosis is modulated by the altered expression of microRNA-29c and FKBP4, J Clin Endocrinol Metab
- Not checked yetcites [162] Patel, 2017, Progesterone resistance in endometriosis: origins, consequences and interventions, Acta Obstet Gynecol Scand source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Incidents also occur in lesions, and a clonal origin does not exclude heterogeneity within a lesion as demonstrated for breast (257) and other (258, 259) cancers.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
What the sources say
- Not checked yetcites [257] Geyer, 2010, Molecular analysis reveals a genetic basis for the phenotypic diversity of metaplastic breast carcinomas, J Pathol source
- Not checked yetcites [258] Dagogo-Jack, 2018, Tumour heterogeneity and resistance to cancer therapies, Nat Rev Clin Oncol source
- Not checked yetcites [259] McGranahan, 2017, Clonal heterogeneity and tumor evolution: past, present, and the future, Cell source
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The implantation theory (1, 11, 201) was a reasonable hypothesis when formulated, while the metaplasia theory (31) was a histologic observation that did not consider genetic or epigenetic changes.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
What the sources say
- Not checked yetcites [1] Sampson, 1927, Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity, Am J Obstet Gynecol source
- Not checked yetcites [11] Sampson, 1924, Benign and malignant endometrial implants in the peritoneal cavity, and their relation to certain ovarian tumors, Surg Gynecol Obstet
- Not checked yetcites [201] Sampson, 1925, Heterotopic or misplaced endometrial tissue, Am J Obstet Gynecol source
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A better interpretation of metaplasia is that the underlying mechanisms can be reversible or irreversible changes, and both can be transmitted.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If metaplasia is defined as metaplastic changes without permanent and transmissible genetic or epigenetic changes, the resulting endometriosis cells are genetically and epigenetically similar to endometrium and lesions after retrograde menstruation and implantation.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > THE PATHOGENESIS OF ENDOMETRIOSIS: THE GENETIC/EPIGENETIC THEORY Historical Background
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“As an example, the high glycodelin concentrations in peritoneal fluid might protect early lesions from NK cell attack (261, 262) and could thus facilitate survival.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > GROWTH AND MATURATION OF TYPICAL, CYSTIC, AND DEEP ENDOMETRIOSIS LESIONS
What the sources say
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is compatible with hereditary aspects and with a predisposition to develop endometriosis, and it explains why dioxin and total body radiation could increase the risk of endometriosis.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The retrograde menstruation and implantation theory does not explain all clinical observations (Table 1), such as extragenital endometriosis (220), endometriosis in women without endometrium (31) and in men (33), or the clonal aspect (149).”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > THE PATHOGENESIS OF ENDOMETRIOSIS: THE GENETIC/EPIGENETIC THEORY Historical Background
What the sources say
- Not checked yetcites [220] Davis, 2017, Extrapelvic endometriosis, Semin Reprod Med
- Not checked yetcites [31] Gruenwald, 1942, Origin of endometriosis from the mesenchyme of the celomic walls, Am J Obstet Gynecol source
- Not checked yetcites [33] Jabr, 2014, An unusual cause of abdominal pain in a male patient: endometriosis, Avicenna J Med source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinical suggestion that typical, cystic, and deep endometriosis are three different diseases seems logical.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
Strength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It can explain the high prevalence in the peritoneal cavity and the increasing prevalence with increased retrograde menstruation.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, new lesions can be formed after new incidents, and the probability that this happens increases with the cumulative genetic and epigenetic abnormalities transmitted at birth and acquired throughout life.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > Koninckx. Pathogenesis of endometriosis. Fertil Steril 2018.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The genetic/epigenetic theory (Fig. 2) is an update of the EDT by adding current knowledge of genetic and epigenetic changes and of the redundancy of cellular processes.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > The Genetic/Epigenetic Theory
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Rests on an assumption: Functional redundancy is a characteristic of many cellular processes.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Las lesiones sutiles se visualizan como endometrio en un entorno diferente hasta que aparecen alteraciones adicionales.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > References
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
In the paper
“Although the mechanisms of reactivation are not understood, deep endometriosis seems to be reactivated by trauma, such as by in vitro fertilization-related needle punctures for oocyte pick-up, triggering the subsequent development of more severe lesions and even a frozen pelvis (56), as frequently observed.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
What the sources say
- Not checked yetcites [56] Canis, 2016, Endometriosis may not be a chronic disease: an alternative theory offering more optimistic prospects for our patients, Fertil Steril source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These models remain valid to study the effect of abnormal environments on (normal) endometrium.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The polygenetic/ polyepigenetic theory is compatible with observations made up to now.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is suggested that the same mechanisms apply to adenomyosis.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Similarly to uterine myomas, endometriosis lesions can remain dormant without progression for longer periods of time.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The poor definition of metaplasia continues to create confusion.”
§ Pathogenesis of endometriosis: the genetic/epigenetic theory > DISCUSSION
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
- Rests on an assumption: Many words in the endometriosis literature are not clear.
The paper relies on this without support.
There is no nonhuman animal model with sufficient similarity to the human myometrium, junctional zone, endometrium, placentation, and pregnancy disorders such as preeclampsia.
“There is no nonhuman animal model with sufficient similarity to the human myometrium, junctional zone (JZ), endometrium, placentation, and pregnancy disorders, such as preeclampsia.”
The paper relies on this without support.
Functional redundancy is a characteristic of many cellular processes.
“Second, functional redundancy is a characteristic of many cellular processes.”
The authors state this as an assumption.
The original cell can be an endometrial cell, a stem cell, or a bone marrow cell with inherited genetic and epigenetic defects.
“The original cell can be an endometrial cell, a stem cell, or a bone marrow cell with their inherited genetic and epigenetic defects.”
The paper relies on this without support.
Many words in the endometriosis literature are not clear.
“Many words in the endometriosis literature are not clear.”
The paper relies on this without support.
The meanings of words often change over time, especially after new clinical and molecular-biologic observations are added to the initial clinical, macroscopic, and microscopic descriptions.
“This confusion stems from the fact that the meanings of words often change over time, especially after new clinical and molecular-biologic observations are added to the initial clinical, macroscopic, and microscopic descriptions.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“It is believed that genetic and epigenetic conditions are rather conducive to the development of endometriosis, which is caused by environmental factors, or genetic and epigenetic changes caused by environmental factors are necessary to move from subtle changes in endometriosis to the disease stage [179].”
From Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature) (2021) · cites this paper as [179]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Twin-sister claim cites a study of nontwin sisters
MinorThe paper cites reference 44 for a claim about age of onset in twin sisters, but reference 44 is explicitly about nontwin sisters.
“In twin sisters, the prevalence (40)(41)(42)(43) and the age of onset (44) of endometriosis are similar.”
“44. Kennedy S, Hadfield R, Mardon H, Barlow D. Age of onset of pain symp- toms in nontwin sisters concordant for endometriosis.”
Citations
Cites
Mutation and cancer: statistical study of retinoblastoma
Knudson, A. G. (1971) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.68.4.820 · Cited by 7,612
Tumour heterogeneity and resistance to cancer therapies
Dagogo-Jack, I., & Shaw, A. T. (2018) · Nature Reviews Clinical Oncology · doi:10.1038/nrclinonc.2017.166 · Cited by 3,846
Clonal heterogeneity and tumor evolution: past, present, and the future
McGranahan, N., & Swanton, C. (2017) · Cell · doi:10.1016/j.cell.2017.01.018 · Cited by 2,840
Sampson, J. A. (1927) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(15)30003-x · Cited by 2,334
An operational definition of epigenetics: Figure 1.Preprint
Berger, S. L., Kouzarides, T., Shiekhattar, R., & Shilatifard, A. (2009) · Genes & Development · doi:10.1101/gad.1787609 · Cited by 1,889
Bulun, S. E. (2009) · New England Journal of Medicine · doi:10.1056/nejmra0804690 · Cited by 1,772
(1927) · PubMed Central · Cited by 1,008
(1984) · PubMed · Cited by 997
Koninckx, P. R., Meuleman, C., Demeyere, S., Lesaffre, E., & Cornillie, F. J. (1991) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54244-7 · Cited by 849
Recurrence of endometriosis and its control
Guo, S.-W. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp007 · Cited by 719
Flagged first, then by citations
23 of the 290 references couldn’t be matched to a known paper.
Research works printed but not linked: 9
- Rokitansky, 1860, Über Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen, Zeitschr Ges Aerzte Wien, 16, 577
- Cullen, 1896, Adeno-myoma of the round ligament, Johns Hopkins Hosp Bull, 7, 112
- Cullen, 1896, Adenoma-myoma uteri diffusum benignum, J Hopkins Hosp Bull, 6, 133
- Cullen, 1919, The distribution of adenomyomata containing uterine mucosa, Am J Obstet Gynecol, 80, 130
- Batt, 2007, Mullerianosis, Histol Histopathol, 22, 1161
- Sampson, 1924, Benign and malignant endometrial implants in the peritoneal cavity, and their relation to certain ovarian tumors, Surg Gynecol Obstet, 38, 287
- Fallon, 1950, Endometriois: a report of 400 cases, R I Med J, 33
- Asencio FA, Ribeiro HA, Ribeiro PA, Mario M, Adamyan L, Ussia A, et al. Case reports and systematic review of estrogen independent symptomatic postmenopausal endometriosis. Gynecol Surgery 2018. In press.
- Meyer, 1923, Zur frage der Urnieren-genese van Adenomyomen, Zentralbl Gynakol, 15, 577
Cited by
Sorted by citations
Items 101–200 of 419
Systematic review on the DNA methylation role in endometriosis: current evidence and perspectives
Ducreux, B., Patrat, C., Firmin, J., Ferreux, L., Chapron, C., Marcellin, L., Parpex, G., Bourdon, M., Vaiman, D., Santulli, P., et al. (2025) · Clinical Epigenetics · doi:10.1186/s13148-025-01828-w · Cited by 32
“As a result, the concept of genetic/epigenetic theory for the pathogenesis of endometriosis is gaining attention [17].”
Koninckx, P. R., Ussia, A., Adamyan, L. V., Wattiez, A., Gomel, V., & Martin, D. C. (2019) · Europe PMC (PubMed Central) · Cited by 27
Self-citationNezhat, C. R., Oskotsky, T. T., Robinson, J. F., Fisher, S. J., Tsuei, A., Liu, B., Irwin, J. C., Gaudilliere, B., Sirota, M., Stevenson, D. K., et al. (2025) · npj Women s Health · doi:10.1038/s44294-024-00052-w · Cited by 25
Zubrzycka, A., Migdalska‐Sęk, M., Jędrzejczyk, S., & Brzeziańska‐Lasota, E. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24032453 · Cited by 25
Chen, Z., Wang, C., Lin, C., Zhang, L., Zheng, H., Zhou, Y., Li, X., Li, C., Zhang, X., Yang, X., et al. (2021) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2021/9979953 · Cited by 25
“Immune deficiency, heightened oxidative stress, and systemic chronic inflammation have been considered as critical facilitators in the progression of this disease [35, 36].”
BackgroundLong noncoding RNAs in endometriosis: Biological functions, expressions, and mechanisms
Wang, X., Zhang, J., Liu, X., Wei, B., & Zhan, L. (2021) · Journal of Cellular Physiology · doi:10.1002/jcp.29847 · Cited by 24
Bandini, V., Giola, F., Ambruoso, D., Cipriani, S., Chiaffarino, F., & Vercellini, P. (2024) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14887 · Cited by 28
“46,47 This is likely due to the presence of an abundant fibrotic component, which is a manifesta - tion of a post-inflammatory scarring outcome that confers stability to the entire endometriotic lesion, regardless of location, overall di - mension, and infiltrative characteristics.”
BackgroundHypomethylation of the GSTM1 promoter is associated with ovarian endometriosis
Zhao, J., Wang, L., Li, Y., Zhao, W., & Kang, S. (2019) · Human Reproduction · doi:10.1093/humrep/dez039 · Cited by 23
“riosis may be an epigenetic disease (Guo, 2009; Koninckx et al., 2019).”
BackgroundTehrani, H. G., Tavakoli, R., Hashemi, M. S., & Haghighat, S. (2022) · Archives of Academic Emergency Medicine · doi:10.22037/aaem.v10i1.1636 · Cited by 24
“Ovarian endometrioma is characterized by excessive proliferation of fibroblasts (4).”
BackgroundWarzecha, D., Załęcka, J., Mańka, G., Kiecka, M., Lipa, M., Spaczyński, R., Piekarski, P., Banaszewska, B., Jakimiuk, A. J., Issat, T., et al. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232415669 · Cited by 24
Kim, H., Lee, H., Kazmi, S. Z., Hann, H. J., Kang, T., Cha, J., Choi, S.-B., Swan, H., Kim, H. J., Lee, Y.-S., et al. (2021) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16769 · Cited by 23
Gajbhiye, R., Montgomery, G. W., Pai, M. V., Phukan, P. K., Shekhar, S., Padte, K., DasMahapatra, P., John, B., Shembekar, C. A., Bhurke, A. V., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-050844 · Cited by 22
Meggyes, M., Szereday, L., Bohonyi, N., Koppán, M., Szegedi, S., Marics-Kutas, A., Marton, M., Totsimon, A., & Polgár, B. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21072343 · Cited by 23
The Impact of Endometriosis on Pregnancy
Tsikouras, P. N., Oikonomou, E., Bothou, Α., Chaitidou, P., Kyriakou, D., Nikolettos, K., Andreou, S., Gaitatzi, F., Nalbanti, T., Peitsidis, P., et al. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14010126 · Cited by 25
“Notable examples of such duplicated epigenetic changes involve genes such as Hox-A10 (HOXA10), progesterone receptor B (PRB, encoded by PGR), and E-cadherin (also known as cadherin 1, CDH1) [30,33–35].”
BackgroundHasan, A., Deyab, A., Monazea, K., Salem, A., Futooh, Z., Mostafa, M. A., Youssef, A., Nasr, M., Omar, N., Rabaan, A. A., et al. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.01.029 · Cited by 24
“Therefore, the AWE should not be traumatized when possible [37,38].”
BackgroundImpact of endometriosis on reproductive health: an integrative review
Namazi, M., Moghadam, Z. B., Zareiyan, A., & Jafarabadi, M. N. (2021) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2020.1862772 · Cited by 22
“These genetic and epigenetic changes include hormones, immune and growth factors, oxidative stress, micro-traumas, methylation, demethylation of DNA, and modifications in histone code (Koninckx et al. 2019).”
BackgroundBălan, A., Moga, M., Dima, L., Dinu, C. G., Martinescu, C. C., Panait, D. E., Irimie, C. A., & Anastasiu, C. V. (2021) · Plants · doi:10.3390/plants10030587 · Cited by 22
“Pro-inflammatory peritoneal habitat, immune alteration and the abnormal arrangement of the stem cells will evolve into endometriosis [3,12].”
BackgroundLiu, Y., Kang, J., Zhang, Y., Song, S., Xu, Q., Zhang, H., Lü, L., Wei, S., Chen, L., & Su, R. (2023) · Food & Function · doi:10.1039/d3fo00750b · Cited by 21
Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis
Movilla, P. R., van Reesema, L. L. S., Andrews, B. C., Gaughan, T. J., Loring, M., Bhakta, A. S., & Hoffman, M. R. (2022) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2022.09.005 · Cited by 20
Donnez, J., Cacciottola, L., Squifflet, J.-L., & Dolmans, M. (2023) · Drug Design Development and Therapy · doi:10.2147/dddt.s269976 · Cited by 22
Wu, X., Tian, Y., Zhu, H., Xu, P., Zhang, J., Hu, Y., Ji, X., Yan, R., Yue, H., & Sang, N. (2023) · Toxics · doi:10.3390/toxics11121000 · Cited by 20
“The clinical manifestations of EM are pelvic pain, adhesions, and infertility [178].”
BackgroundMutation and methylation profiles of ectopic and eutopic endometrial tissues
Li, L., Antero, M. F., Zhang, M., Chu, T., Seckin, T. A., Ayhan, A., Pisanic, T. R., Wang, T., Cope, L., Segars, J. H., et al. (2021) · The Journal of Pathology · doi:10.1002/path.5778 · Cited by 19
“From this perspective, the two estrogen-dependent diseases, adenomyosis and endometriosis, appear to be closely related [13,14].”
BackgroundHou, S., Lei, S., Peng, H., Weng, L., Lv, S., Li, M., & Zhao, D. (2022) · Biology of Reproduction · doi:10.1093/biolre/ioac081 · Cited by 20
“Besides the widely accepted retrograde menstruation theory [4], factors from genetics [5, 6], immunology [7], endocrinology [8], environment and metabolism [9] might get involved.”
BackgroundRobotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?
Ferrari, F. A., Youssef, Y., Naem, A., Ferrari, F. G., Odicino, F. E., Krentel, H., & Moawad, G. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1387036 · Cited by 20
Prospects for potential therapy targeting immune‑associated factors in endometriosis (Review)
Zhang, W., Li, K., Jian, A., Zhang, G., & Zhang, X. (2024) · Molecular Medicine Reports · doi:10.3892/mmr.2024.13422 · Cited by 25
Nonvisualized palpable bowel endometriotic satellites
Roman, H., Merlot, B., Forestier, D., Noailles, M., Magne, E., Carteret, T., Tuech, J., & Martin, D. C. (2020) · Human Reproduction · doi:10.1093/humrep/deaa340 · Cited by 17
“Second, some residual lesions do not become symptomatic (Moen and Stokstad, 2002; Koninckx et al., 2019).”
BackgroundSelf-citationThe Pathogenesis of Endometriosis: Are Endometrial Stem/Progenitor Cells Involved?
Laganà, A. S., & Naem, A. (2022) · Stem cell biology and regenerative medicine · doi:10.1007/978-3-030-90111-0_9 · Cited by 21
Multigenerational endometriosis : consequence of fetal exposure to diethylstilbestrol ?
Gaspari, L., Soyer‐Gobillard, M., Paris, F., Kalfa, N., Hamamah, S., & Sultan, C. (2021) · Environmental Health · doi:10.1186/s12940-021-00780-5 · Cited by 19
“A recent meta-analysis identified 5 loci regulating steroid hormone pathways [29], 5 transduction signals and 19 single-nucleotide polymorphisms associated with endometriosis [30].”
Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review
Maillard, C., Alami, Z. C., Squifflet, J.-L., Luyckx, M., Jadoul, P., Thomas, V., & Wyns, C. (2021) · Frontiers in Surgery · doi:10.3389/fsurg.2021.637180 · Cited by 19
“82 (2-204) Excision Post-op: 4 GnRHa (3 months), 2 mifepristone 1 month, 1 progesterone 1 1 74.”
BackgroundInfluentialEndometrioma and assisted reproductive technology: a review
Kheil, M. H., Sharara, F. I., Ayoubi, J. M., Rahman, S., & Moawad, G. (2022) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-022-02403-5 · Cited by 21
Adamyan, L. V., Pivazyan, L. G., & Mailova, K. S. (2023) · Russian Journal of Human Reproduction · doi:10.17116/repro20232905192 · Cited by 18
Self-citationGhosh, D., Filaretova, L. P., Bharti, J., Roy, K. K., Sharma, J. B., & Sengupta, J. (2020) · Reproductive Medicine · doi:10.3390/reprodmed1010004 · Cited by 18
“Endometrial cells, stem cells and bone marrow cells with genetic and epigenetic defects after implantation and metaplasia within an abnormal environment of the peritoneal cavity progress to form the typical ectopic lesions in ovary, peritoneum and rectovaginal compartments [6,7].”
BackgroundChronic endometritis in women with endometriosis-associated infertility
Orazov, M. R., Radzinsky, V. E., Владимировна, В. С., Khamoshina, M. B., Михалева, Л. М., Abitova, M. Z., & Shustova, V. B. (2020) · GYNECOLOGY · doi:10.26442/20795696.2020.3.200174 · Cited by 17
Adenomyosis: Disease, uterine aging process leading to symptoms, or both?
Πρωτόπαπας, Α., Grimbizis, G., Athanasiou, S., & Loutradis, D. (2020) · PubMed Central · Cited by 17
The role of miR-27b-3p/HOXA10 axis in the pathogenesis of endometriosis
Li, L., Guo, X., Liu, J., Chen, B., Gao, Z., & Wang, Q. (2021) · Annals of Palliative Medicine · doi:10.21037/apm-21-343 · Cited by 16
Molecular dysregulations underlying the pathogenesis of endometriosis
Balasubramanian, V., Saravanan, R., Joseph, L. D., Dev, B., Shanmugasundaram, G., Srinivasan, B., Dharmarajan, A., Rayala, S. K., & Venkatraman, G. (2021) · Cellular Signalling · doi:10.1016/j.cellsig.2021.110139 · Cited by 16
Endometriosis and Infertility: Gynecological Examination Practical Guide
Moïse, A., Dzeitova, M., de Landsheere, L., Nisolle, M., & Brichant, G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14061904 · Cited by 25
Brandes, I., Kleine‐Budde, K., Heinze, N. R., Binder, S., Klug, C., Schippert, C., Ebert, A. D., & Halis, G. (2022) · BMC Women s Health · doi:10.1186/s12905-022-02044-x · Cited by 41
“Background Endometriosis is a chronic inflammatory disorder in which tissue similar to that which lines the inside of the uterus grows outside the uterine cavity [1, 2].”
BackgroundMoreira, M. D. F., Gamboa, O. L., & Oliveira, M. A. P. (2021) · Women & Health · doi:10.1080/03630242.2021.1993423 · Cited by 18
“Regarding the etiology of endometriosis, retrograde menstruation is the most widely accepted hypothesis, although no current theories can explain the full spectrum of the condition (Koninckx et al. 2019).”
BackgroundMier‐Cabrera, J., Cruz-Orozco, O., la Jara-Díaz, J. F. D., Galicia-Castillo, O., Buenrostro-Jáuregui, M. H., Parra‐Carriedo, A., & Hernández‐Guerrero, C. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01941-5 · Cited by 18
“The genetic-epigenetic (G/E) theory [4] proposes that after the accumulation of several cellular G/E events, the cell crosses a limit threshold which gives arise to a number of alterations.”
BackgroundMilewski, Ł., Ścieżyńska, A., Ponińska, J. K., Soszyńska, M., Barcz, E., Roszkowski, P. I., Kamiński, P., Wlodarski, P. K., Płoski, R., & Malejczyk, J. (2021) · Cells · doi:10.3390/cells10030695 · Cited by 16
“There exist several theories of development of endometriosis [2,5,6].”
BackgroundXiang, Y., Wang, G., Zhou, L., Wang, Q., & Yang, Q. (2022) · Annals of Palliative Medicine · doi:10.21037/apm-21-3761 · Cited by 14
Wattiez, A., Schindler, L., Ussia, A., Campo, R., Keckstein, J., Grimbizis, G., Exacoustós, C., Kondo, W., Nezhat, C., Canis, M. J., et al. (2023) · Facts Views and Vision in ObGyn · doi:10.52054/fvvo.15.3.094 · Cited by 16
“Hypotheses on pathophysiology vary from implantation of endometrium after retrograde menstruation (Sampson, 1921; Sampson, 1940) or transport by the bloodstream, to genetic or epigenetic (G-E) ‘incidents’ in endometrial or precursor cells (Koninckx et al., 2019) leading to immunologic changes.”
BackgroundSelf-citationWang, Y., Duan, H., Wang, S., Quan, Y., Huang, J., & Guo, Z. (2021) · BioMed Research International · doi:10.1155/2021/8868700 · Cited by 15
“Particularly, the active proliferation and enhanced invasion ability of endometrial epithelial and stromal cells, similar to the malignant tumor cells, have been considered as the key step to induce the ectopic implantation and infiltration of the endometrium inside myometrium, eventually leading to the onset of ADS […”
BackgroundHeme induced progesterone-resistant profiling and promotion of endometriosis in vitro and in vivo
Ma, X.-Q., Liu, Y.-Y., Zhong, Z.-Q., Chen, S., Hu, W., Sheng, Y., Liu, Y., Wei, C., Li, M., & Zhu, X. (2023) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2023.166761 · Cited by 15
Endometriosis through an immunological lens: a pathophysiology based in immune dysregulation
McCallion, A., Sisnett, D. J., Zutautas, K. B., Hayati, D., Spiess, K. G., Aleksieva, S., Lingegowda, H., Koti, M., & Tayade, C. (2022) · Exploration of Immunology · doi:10.37349/ei.2022.00062 · Cited by 16
Zubrzycka, A., Migdalska‐Sęk, M., Jędrzejczyk, S., & Brzeziańska‐Lasota, E. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24076637 · Cited by 15
“The course of this disease is heterogeneous, with a complex etiopathogenesis involving many genetic, epigenetic, immunological, hormonal, and environmental factors [3,5,6].”
BackgroundPeripheral and central neuroplasticity in a mouse model of endometriosis
Castro, J., Maddern, J., Erickson, A., Harrington, A. M., & Brierley, S. M. (2023) · Journal of Neurochemistry · doi:10.1111/jnc.15843 · Cited by 14
“Endometriosis is a chronic inflammatory gynaecological disorder affecting approximately 10% of females of reproductive age (Koninckx et al., 2019 ; Zito et al., 2014 ), which imparts an economic load of almost $80 billion/year in the USA alone (Soliman et al., 2016 ).”
Emerging strategies for the treatment of endometriosis
Chen, Q., Wang, J., Ding, X., Zhang, Q., & Duan, P. (2024) · Biomedical Technology · doi:10.1016/j.bmt.2024.08.002 · Cited by 18
Integrated analysis of mRNA and protein expression profiling in tubal endometriosis
Qi, H., Zhang, H., Zhao, X., Qin, Y., Liang, G., He, X., & Zhang, J. (2020) · Reproduction · doi:10.1530/rep-19-0587 · Cited by 14
Possover, M. (2021) · Facts Views and Vision in ObGyn · doi:10.52054/fvvo.13.4.047 · Cited by 16
“1994;53:646-62. of this enigmatic disease called ESN (Koninckx et al., 2019).”
Castro, J., Maddern, J., Erickson, A., Caldwell, A., Grundy, L., Harrington, A. M., & Brierley, S. M. (2020) · Pain · doi:10.1097/j.pain.0000000000002036 · Cited by 14
“Despite this, the aetiology and pathogenesis of chronic pain associated with endometriosis- and vulvodynia-induced dyspareunia remains to be identified.(25,40,67,79)”
BackgroundPreoperative imaging of deep endometriosis: pitfalls of a diagnostic test before surgery.
Koninckx, P. R., Deslandes, A., Ussia, A., Giovanni, A. D., Hanan, G., Tahlak, M., Адамян, Л. В., Keckstein, J., & Wattiez, A. (2021) · PubMed Central · Cited by 15
Self-citationThe effect of endometriosis on oocyte quality: mechanisms, diagnosis and treatment
Fan, Y., Yang, Q., Lin, Y., Fu, X., & Shu, J. (2025) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-025-07965-0 · Cited by 19
Smycz‐Kubańska, M., Kondera‐Anasz, Z., Sikora, J., Wendlocha, D., Królewska‐Daszczyńska, P., Englisz, A., Janusz, A., Janusz, J., & Mielczarek‐Palacz, A. (2021) · Processes · doi:10.3390/pr9122229 · Cited by 15
Postmenopausal endometriosis: a challenging condition beyond menopause
Vallée, A., Carbonnel, M., Ceccaldi, P., Féki, A., & Ayoubi, J.-M. (2024) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002338 · Cited by 14
Shi, S., Huang, C., Tang, X., Liu, H., Feng, W., & Chen, C. (2024) · Journal of Biological Engineering · doi:10.1186/s13036-024-00466-9 · Cited by 13
Zheng, W., Fu, Z., Tan, X., Liang, X., & Cao, L. (2024) · Biochemical Genetics · doi:10.1007/s10528-024-10725-5 · Cited by 12
“Despite the absence of somatic mutations in endometriotic stromal cells, which constitute the majority of endometriosis lesions, these cells can exhibit specific epigenetic abnormalities such as DNA methylation, histone acetylation, microRNA dysregulation, and m6A methylation (Koninckx et al. 2019).”
The Cellular Respiration of Endometrial Biopsies from Patients with Various Forms of Endometriosis
Александрович, Т. К., Malkov, A. A., Biryukov, N. S., Gorbacheva, E. Y., Boyarintsev, V. V., & Ogneva, I. V. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25073680 · Cited by 14
“This pathology is characterized by the appearance of an ectopic focus of endometrial-like tissue outside the epithelial layer of the uterine cavity [1].”
BackgroundZhang, Y., Shaukat, A., Zhang, H., Yang, Y.-F., Li, H., Li, G., Liu, Y., Liang, C., Kang, J., Li, S.-C., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252313150 · Cited by 12
“Factors Factors influencing the pathogenesis of endometriosis include hormonal imbalances, immune dysfunction, genetic predisposition, and oxidative stress in the peritoneal cavity [6–9].”
Koninckx, P. R., Ussia, A., & Martin, D. C. (2021) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.11.022 · Cited by 12
Self-citationPoli‐Neto, O. B., Carlos, D., Favaretto, A. L., Silva, J. C. R. E., Meola, J., & Tiezzi, D. G. (2021) · Journal of Reproductive Immunology · doi:10.1016/j.jri.2021.103307 · Cited by 13
Imanaka, S., Maruyama, S., Kimura, M., Nagayasu, M., Kawahara, N., & Kobayashi, H. (2021) · Gynecologic and Obstetric Investigation · doi:10.1159/000514972 · Cited by 12
Genetic aspects of endometriosis and adenomyosis: a modern view on the problem
Adamyan, L. V., Kuznetsova, M. V., Pivazyan, L. G., Davydova, Y. D., & Trofimov, D. Y. (2023) · Russian Journal of Human Reproduction · doi:10.17116/repro20232904214 · Cited by 12
Self-citationDeep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome
Gruber, T. M., Ortlieb, L., Henrich, W., & Mechsner, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm11010157 · Cited by 11
“This fact leads to the hypothesis that AM and EM might be manifestations of the same underlying pathology [9,10].”
BackgroundDNA Methylation: A Key Regulator in Male and Female Reproductive Outcomes
Adetunji, A. O., Owusu, H., Adewale, E. F., Adesina, P. A., Xedzro, C., Saliu, T. P., Islam, S., Zhu, Z., & Morenikeji, O. B. (2025) · Life · doi:10.3390/life15071109 · Cited by 13
“Koninckx et al. (2018) described that the extended duration of the usage of combined oral contraceptives resulted in effects on the methylation patterns within endometrial tissue, respectively affecting decidualization and implantation-related genes [120].”
Do we need to separate initiation and growth to understand endometriosis?
Koninckx, P. R., Martin, D. C., & Donnez, J. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.06.008 · Cited by 11
“(4) postulates that the onset of the disease/invasion requires that the cumulative set of G-E incidents has reached a certain threshold.”
BackgroundSelf-citationNaem, A., Krentel, H., Moawad, G., Naem, J., Venezia, R., Etrusco, A., Terzic, S., & Laganà, A. S. (2024) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2024.102500 · Cited by 15
Yang, M., Li, L., Huang, X., Xing, H., Hong, L., & Jiang, C. (2023) · BMC Molecular and Cell Biology · doi:10.1186/s12860-023-00470-9 · Cited by 10
Liu, H., Liang, J., Dai, X., Peng, Y., Xiong, W., Zhang, L., Li, X., Li, W., Liu, K., Bi, S., et al. (2024) · Genomics · doi:10.1016/j.ygeno.2024.110803 · Cited by 9
A bird-eye view of diaphragmatic endometriosis: current practices and future perspectives
Naem, A., Roman, H., Martin, D. C., & Krentel, H. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1505399 · Cited by 16
Self-citationVitamin D and Endometriosis: Is There a Mechanistic Link?
Jennings, B. S., & Hewison, M. (2024) · Cell Biochemistry and Function · doi:10.1002/cbf.70037 · Cited by 10
Marshall, A., Kommoss, K. S., Ortmann, H., Kirchner, M., Jauckus, J., Sinn, H., Strowitzki, T., & Germeyer, A. (2023) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-023-01083-9 · Cited by 10
Gerontakos, S., Leach, M., Steel, A., & Wardle, J. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09582-6 · Cited by 11
Zhao, X., Luo, D., Liu, T., Zhang, H., Xie, Y., & Kong, W. (2023) · Gynecologic and Obstetric Investigation · doi:10.1159/000530460 · Cited by 10
Exosomal microRNAs and long noncoding RNAs: as novel biomarkers for endometriosis
Fard, E. S., Asadi, M., Taghvimi, S., Vafadar, A., Vosough, P., Tajbakhsh, A., & Savardashtaki, A. (2023) · Cell and Tissue Research · doi:10.1007/s00441-023-03802-5 · Cited by 10
“…linkage analysis, genetic association, and genome-wide association studies, have provided an insight into the pathophysiology of endometriosis (Koninckx et al. 2019 The pathological examinations followed by histopathological exams are the gold standard for diagnosing endo-metriosis,…”
BackgroundZarkadoulas, N., Pergialiotis, V., Dimitroulis, D., Stefanidis, K., Verikokos, C., Perrea, D., & Kontzoglou, K. (2019) · Medical Hypotheses · doi:10.1016/j.mehy.2019.109414 · Cited by 9
Surgical management of endometriosis-associated pain
Koninckx, P. R., Ussia, A., Porpora, M. G., Malzoni, M., Adamyan, L. V., & Wattiez, A. (2021) · Minerva Obstetrics and Gynecology · doi:10.23736/s2724-606x.21.04864-8 · Cited by 10
Self-citationПокровенко, Д. А., Vozniuk, V., & Medvediev, M. V. (2021) · Journal of Turkish Society of Obstetric and Gynecology · doi:10.4274/tjod.galenos.2021.07277 · Cited by 10
Samartzis, K., Kathopoulis, N., Loutradis, D., & Πρωτόπαπας, Α. (2021) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2021.1962817 · Cited by 9
“Recently, Koninckx et al. (2019) proposed the genetic - epigenetic theory for the pathogenesis of endometriosis.”
BackgroundZhou, L., Cai, E., Liu, H., Cheng, H., Ye, X., Zhu, H., & Chang, X. (2023) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2023.166895 · Cited by 10
Adamyan, L. V., Alyasova, A. V., Pivazyan, L. G., & Stepanyan, A. A. (2024) · Russian Journal of Human Reproduction · doi:10.17116/repro20243002115 · Cited by 10
Self-citationNunziato, M. F., & Pollack, A. Z. (2024) · Seminars in Reproductive Medicine · doi:10.1055/s-0045-1802986 · Cited by 9
“17 Exposure to phthalates occurs primarily through ingestion of contaminated food and beverages — chemicals can seep into the products from the packaging.”
Szukiewicz, D. (2022) · Vitamins and hormones · doi:10.1016/bs.vh.2022.11.005 · Cited by 10
Yang, H., & Zhuang, Y. (2023) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-023-06964-3 · Cited by 9
The voltage‐gated sodium channel Na V 1 .7 underlies endometriosis‐associated chronic pelvic pain
Castro, J., Maddern, J., Chow, C. Y., Tran, P., Vetter, I., King, G. F., & Brierley, S. M. (2023) · Journal of Neurochemistry · doi:10.1111/jnc.15795 · Cited by 9
“Currently, there is a lack of effective analgesic treatments for endometriosis-associated CPP mainly because of our lack of knowledge about its aetiology and pathogenesis (Koninckx et al., 2019; Zito et al., 2014 ).”
Expression of ZEB1 in different forms of endometriosis: A pilot study
Ntzeros, K., Mavrogianni, D., Blontzos, N., et al. (2023) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2023.05.022 · Cited by 9
The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach
Koninckx, P. R., Ussia, A., Gordts, S., Keckstein, J., Sarıdoğan, E., Malzoni, M., Stepanian, A. A., Setúbal, A., Adamyan, L. V., & Wattiez, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134547 · Cited by 11
“In addition, subtle, typical, cystic, and deep endometriosis might be genetically or epigenetically different diseases [26].”
BackgroundSelf-citationBlontzos, N., Mavrogianni, D., Ntzeros, K., Kathopoulis, N., Moustogiannis, A., Philippou, Α., Koutsilieris, M., & Πρωτόπαπας, Α. (2023) · Biomolecules · doi:10.3390/biom14010007 · Cited by 9
“Our findings support the genetic-epigenetic theory for the pathogenesis of endometriosis that has been recently proposed [24].”
BackgroundResultSteroids receptors immunohistochemical expression in different sites of endometriosis
Massarotti, C., Badenier, I. M., Paudice, M., et al. (2020) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2020.101861 · Cited by 9
Conservative Surgery of Deep Bowel Endometriosis
Koninckx, P. R., Ussia, A., Адамян, Л. В., Al-Suwaidi, S., Amro, B., Gharbi, H., Tahlak, M., & Wattiez, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-50446-5_11 · Cited by 10
Self-citationActual research trends in etiology and pathogenesis of endometriosis (a review)
Владимировна, С. А., Gunin, A. G., Sidorov, A. Е., Denisova, T., Chernyshov, V. V., & Smirnova, T. L. (2020) · Russian Journal of Human Reproduction · doi:10.17116/repro202026051118 · Cited by 9
Wei, Z., Hu, Y., He, X., Zhang, M., Zhang, X., Wang, Y., Fang, X., & Li, L. (2021) · Aging · doi:10.18632/aging.203799 · Cited by 9
“Sampson [3] first proposed the theory of menstrual blood reflux: the endometrial glandular epithelium and mesenchymal cells flow back into the fallopian tube and the abdominal cavity with menstrual blood, and implant in the bottom of abdominal organs such as the ovaries or pelvic peritoneum [4].”
The prospects of cell therapy for endometriosis
Artemova, D. A., Vishnyakova, P., Gantsova, E. A., Elchaninov, A. V., Fatkhudinov, T., & Sukhikh, G. T. (2023) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-023-02772-5 · Cited by 9
Bi, X., Liu, S., Liu, D., & Li, C. (2024) · International Journal of Neuroscience · doi:10.1080/00207454.2023.2285709 · Cited by 9
Schawlochow, K., Samartzis, N., Burla, L., Eberhard, M., Kalaitzopoulos, D. R., & Leeners, B. (2024) · Biomedicines · doi:10.3390/biomedicines12112527 · Cited by 8
“However, this theory alone fails to explain several critical aspects of the disease, particularly the various clinical presentations [9,16].”
Estrogen Regulates the Expression and Function of lncRNA-H19 in Ectopic Endometrium
Liu, S., Qiu, J., Tang, X., et al. (2022) · International Journal of Women s Health · doi:10.2147/ijwh.s365943 · Cited by 8
Modern non-invasive diagnosis of endometriosis
Kudryavtseva, E. V., Геец, А. В., Mangileva, Y. A., Chizhova, A. V., & Patsyuk, O. V. (2023) · Ural Medical Journal · doi:10.52420/2071-5943-2023-22-4-140-147 · Cited by 8
Julio, T., Fenerich, B. A., Halpern, G., Carrera‐Bastos, P., Schor, E., & Kopelman, A. (2024) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2024.102830 · Cited by 8
Metadata
- Authors
- Koninckx, P. R., Ussia, A., Adamyan, L., Wattiez, A., Gomel, V., & Martin, D. C.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- Russian University of Medicine (RU)
- Latifa Hospital (AE)
- University of British Columbia (CA)
- University of Tennessee Health Science Center (US)
- Corresponding author
- Koninckx, Philippe R.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 111
- Issue
- 2
- Pages
- 327-340
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2903882793
- Semantic Scholar
- bda1b43240a49c67f04356783de4dff519d10820
- Cited by
- 427
- References
- 290
- Citations by year
- 2026: 35 · 2025: 60 · 2024: 52 · 2023: 80 · 2022: 61 · 2021: 76 · 2020: 44 · 2019: 19
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis pathogenesis, genetic theory, epigenetic theory, retrograde menstruation, metaplasia, cystic ovarian lesions, deep infiltrating endometriosis, infertility, adenomyosis, peritonitis, placentation, stem cells
- MeSH terms
- Animals, Endometriosis, Endometrium, Female, Genetic Markers, Humans, Phenotype, Prognosis, Risk Factors, Genetic Predisposition to Disease, Heredity, Epigenesis, Genetic
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