Peritoneal endometriosis is an inflammatory disease
Open accessAbstract
Peritoneal endometriosis is a chronic inflammatory disease characterized by increased numbers of peritoneal macrophages and their secreted products. Inflammation plays a major role in pain and infertility associated with endometriosis, but is also extensively involved in the molecular processes that lead to peritoneal lesion development. Peritoneal oxidative stress is currently thought to be a major constituent of the endometriosisassociated inflammatory response. Excessive production of reactive oxygen species, secondary to peritoneal influx of pro-oxidants such as heme and iron during retrograde menstruation, may induce cellular damage and increased proinflammatory gene expression through nuclear factorkappa B activation. In particular, prostaglandin biosynthetic enzyme expression is regulated by this transcriptional factor, and increased peritoneal prostaglandin concentrations have been demonstrated in endometriosis. In the light of available data collected from patient biopsies, as well as in vitro and in vivo studies, the respective involvement and potential molecular interactions of iron, nuclear factor-kappa B and prostaglandins in the pathogenesis of endometriosis are explored and discussed. The key role of peritoneal macrophages is emphasized and potential therapeutic targets are examined.
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Retrograde menstruation and bleeding of endometriotic lesions are responsible for erythrocytes in the pelvic cavity, which release pro-oxidant and proinflammatory factors like hemoglobin and its byproducts heme and iron.
“Retrograde menstruation and bleeding of endometriotic lesions are responsible for the presence of erythrocytes in the pelvic cavity, which are likely to release pro-oxidant and proinflammatory factors like hemoglobin and its highly toxic byproducts heme and iron [27,28,29,30].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [29]
Peritoneal endometriosis is characterized by increased numbers of peritoneal macrophages and their secreted products.
“Peritoneal endometriosis is characterized by increased numbers of peritoneal macrophages and their secreted products.69”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [69]
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The heterogeneity of endometriotic lesions could be explained by their progesterone resistance
Donnez, J. (2021) · Human Reproduction · doi:10.1093/humrep/deab151 · Cited by 8 · see citing works
Self-citationAssociation of Endometriosis and Oxidative Stress
Udayana, I. G. N. B. S., Adnyana, I. B. P., Diningrat, M. A., & Setiawan, W. A. (2022) · European Journal of Medical and Health Sciences · doi:10.24018/ejmed.2022.4.5.1387 · Cited by 8 · see citing works
Gao, Z., & Du, J. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1594702 · Cited by 6 · see citing works
Shen, D., Qi, C., Hu, P., Li, J., & Shen, Y. (2025) · Reproductive Sciences · doi:10.1007/s43032-025-01827-5 · Cited by 6 · see citing works
Mathyk, B. A., Cetin, E. C., Youssef, Y., Imudia, A. N., Soto, D. E., Mikhail, E., & Moawad, G. (2024) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2024.102501 · Cited by 6 · see citing works
Ajdary, M., Mehdizadehkashi, A., Derakhshan, R., Chaichian, S., Tahermanesh, K., Mehdizadeh, M., Minaeian, S., & Govahi, A. (2024) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2024.102744 · Cited by 5 · see citing works
- Authors
- Donnez, J.
- Affiliations
- UCLouvain (BE)
- Corresponding author
- Donnez, Jacques
- ORCID
- Donnez, Jacques
- Venue
- Frontiers in Bioscience
- Publisher
- IMR Press
- Published
- 2012
- Volume
- E4
- Issue
- 1
- Pages
- 23-40
- ISSN
- 1944-7892 (ISSN-L)
- 1945-0494
- 1945-0508
- DOI
- 10.2741/e358
- OpenAlex
- W4213343843
- Cited by
- 127
- References
- 97
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 13 · 2023: 15 · 2022: 14 · 2021: 13 · 2020: 8 · 2019: 8 · 2018: 1 · 2017: 5 · 2016: 12 · 2015: 6 · 2014: 5 · 2013: 11 · 2012: 1
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Frontiers in Bioscience-Elite (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Rheumatology › Omental and Epiploic Conditions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- peritoneal endometriosis, chronic inflammation, peritoneal macrophages, oxidative stress, reactive oxygen species, iron, heme, retrograde menstruation, NF-κB, prostaglandins, prostaglandin synthesis, endometriosis pathogenesis, infertility, pain, therapeutic target
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