Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)

In the paper

“Analysis of the available literature data shows that there are no controlled and randomized trials determining whether and to what extent exercise can be beneficial for women with endometriosis. So far, researchers have only speculated on this subject [140].”

What the sources say

• Not checked yetcites [140] Koppan, 2010, Pelvic pain in endometriosis: Painkillers or sport to alleviate symptoms?, Acta Physiol. Hung. source

In the paper

“Complications after DIE surgery include rectal fistula (0.3–2%), intestinal stenosis (2%), and bladder atony (4–6%) [123,124,125].”

What the sources say

• Not checked yetcites [123] Roman, 2013, Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum, Fertil. Steril. source
• Not checked yetcites [124] Spagnolo, 2014, Urodynamic Evaluation and Anorectal Manometry Pre- and Post-operative Bowel Shaving Surgical Procedure for Posterior Deep Infiltrating Endometriosis: A Pilot Study, J. Minim. Invasive Gynecol. source
• Not checked yetcites [125] Mabrouk, 2019, Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up, J. Minim. Invasive Gynecol. source

In the paper

“A sample of 667 human miRNAs were studied in patients with endometriosis compared to the control group. Two of the study miRNAs were elevated, while 13 miRNAs had reduced levels of expression in eutopic endometrium in endometriosis patients compared to control.”

What the sources say

• Not checked yetcites [162] Laudanski, 2015, Profiling of Selected MicroRNAs in Proliferative Eutopic Endometrium of Women with Ovarian Endometriosis, Biomed. Res. Int. source

In the paper

“This disease affects from 10–15% of women of reproductive age and 35–50% of women with pelvic pain and/or infertility.”

What the sources say

• Not checked yetcites [17] Lousse, 2008, Potential involvement of iron in the pathogenesis of peritoneal endometriosis, Mol. Hum. Reprod. source

In the paper

“However, it should be noted that there are also cases of patients with endometriosis after menopause, and it also happens in adolescent women [17].”

What the sources say

• Not checked yetcites [17] Lousse, 2008, Potential involvement of iron in the pathogenesis of peritoneal endometriosis, Mol. Hum. Reprod. source

In the paper

“The vast majority of cases of endometriosis occur in women between menarche and menopause. The peak of the disease falls in the period between 25 and 45 years of age [18].”

What the sources say

• Not checked yetcites [18] Eskenazi, 1997, Epidemiology of endometriosis, Obstet. Gynecol. Clin. N. Am. source

In the paper

“Literature data indicate that endometriosis is found in 0.1–53% of women operated on laparoscopically or by laparotomy, of which 12–32% are women after diagnostic laparoscopy due to pelvic pain delays and 10–60% of the patient after diagnostic laparoscopy due to disability [19,20,21].”

What the sources say

• Not checked yetcites [19] Lu, 1995, Endometriosis: Current management, Mayo Clin. Proc. source
• Not checked yetcites [20] Dmowski, 1999, Endometriosis at the end of the millenium; the controversy remains, Pol. J. Gyn. Investig.
• Not checked yetcites [21] Kao, 2002, Global gene profiling in human endometrium during the window of implantation, Endocrinology source

In the paper

“Endometriosis is in many women the cause of infertility, chronic pain and the deterioration of the quality of life.”

In the paper

“Endometriosis in 7% of women is associated with their genetic predisposition in the family.”

What the sources say

• Not checked yetcites [22] Cramer, 2002, The epidemiology of endometriosis, Ann. N. Y. Acad. Sci. source
• Not checked yetcites [23] Gadomska, 1997, Endometrioza, Medipress Ginekol.

In the paper

“It also represents a significant financial burden on health systems.”

What the sources say

• Not checked yetcites [27] Simoens, 2012, The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres, Hum. Reprod. source

In the paper

“Endometriosis is a “mysterious” disease and its exact cause has not yet been established.”

In the paper

“Despite such frequent occurrence of this disease, the mechanism of its formation remains unexplained, and a good marker of this disease has still not been discovered [39,40].”

What the sources say

• Not checked yetcites [39] Nisenblat, 2016, Blood biomarkers for the non-invasive diagnosis of endometriosis, Cochrane Database Syst. Rev.
• Not checked yetcites [40] Gupta, 2016, Endometrial biomarkers for the non-invasive diagnosis of endometriosis, Cochrane Database Syst. Rev.

In the paper

“Literature data indicate that in 80% of women with open fallopian tubes there is a retrograde outflow of menstrual blood, while endometriosis occurs only in some.”

What the sources say

• Not checked yetcites [54] Witz, 1997, Semin Reprod Endocrinol, Pathogenesis

In the paper

“Endometriosis has a significant negative impact on aspects of social life, family, and sexual, educational and professional life [27,28,29].”

What the sources say

• Not checked yetcites [27] Simoens, 2012, The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres, Hum. Reprod. source
• Not checked yetcites [28] Nnoaham, 2011, World Endometriosis Research Foundation Global Study of Women’s Health consortium. Impact of endometriosis on quality of life and work productivity: A multi-center study across ten countries, Fertil. Steril. source
• Not checked yetcites [29] Dunselman, 2013, The significant effect of endometriosis on physical, mental and social well-being: Results from an inter-national cross-sectional survey, Hum. Reprod. source

In the paper

“There have been isolated cases of endometriosis in men around the world who have been treated with hormones for prostate cancer [25].”

What the sources say

• Not checked yetcites [25] Martin, 1985, Endometriosis in the male, Am. Surg.

In the paper

“Interestingly, the latest data indicate that there is generally no association between BMI and the incidence of endometriosis, but there has been a significant increase in the incidence of endometriosis in obese women compared to women with normal body weight.”

What the sources say

• Not checked yetcites [50] Tang, 2020, Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: A case-control study in China?, BMJ Open source

In the paper

“The presence of lateral parametrial endometriosis (LPE) can be considered a reflection of a more severe disease, ureteral stenosis and dilatation, and voiding dysfunctions, mainly because of the involvement of the inferior hypogastric plexus.”

What the sources say

• Not checked yetcites [42] Mabrouk, 2019, Parametrial Endometriosis: The Occult Condition that Makes the Hard Harder, J. Minim. Invasive Gynecol. source

In the paper

“World literature also reports the occurrence of foci of endometriosis in fetuses [24].”

What the sources say

• Not checked yetcites [24] Signorile, 2010, New evidence of the presence of endometriosis in the human fetus, Reprod. Biomed. Online source

In the paper

“This disease was found in 2% of women undergoing tubal ligation and 17% of women after surgery to remove the ovaries [22,23].”

What the sources say

• Not checked yetcites [22] Cramer, 2002, The epidemiology of endometriosis, Ann. N. Y. Acad. Sci. source
• Not checked yetcites [23] Gadomska, 1997, Endometrioza, Medipress Ginekol.

In the paper

“Studies indicate that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). Pain was associated with PFM hypertonia and difficulty in PFM relaxation [41].”

What the sources say

• Not checked yetcites [41] Fraga, 2021, Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association, Int. J. Clin. Pract. source

In the paper

“In 66% of women with endometriosis, the first symptoms of the disease appear before the age of 20 [32].”

What the sources say

• Not checked yetcites [32] Bourdel, 2006, Endometriosis in teenagers, Gynecol. Obstet. Fertil. source

In the paper

“The risk of developing endometriosis is the lowest in black women, the highest in Asian women. Caucasian women have a higher risk of getting sick than black women [26].”

What the sources say

• Not checked yetcites [26] Goldstein, 1980, Laparoscopy on the diagnosis and management of pelvic pain in adolescents, J. Reprod. Med.

In the paper

“The annual costs of endometriosis treatment in Europe range from €0.8 billion to €12.5 billion depending on the country and are comparable to other chronic diseases such as diabetes [27].”

What the sources say

• Not checked yetcites [27] Simoens, 2012, The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres, Hum. Reprod. source

In the paper

“Laparoscopically assisted robotics are associated with longer duration of relief than laparoscopic surgery, but the results are controversial [129,130].”

What the sources say

• Not checked yetcites [129] Magrina, 2015, Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors, J. Minim. Invasive Gynecol. source
• Not checked yetcites [130] Nezhat, 2015, Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis, J. Minim. Invasive Gynecol. source

In the paper

“Gonadoliberin analogues are substances with a structure similar to GnRH, which “deceive” the hypothalamus, causing a decrease in the production of real GnRH. This results in a decrease in LH and FSH levels and a significant reduction in estrogen levels.”

What the sources say

• Not checked yetcites [116] Donnez, J., and Dolmans, M.M. (2021). Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med., 10. source

In the paper

“Physical therapy techniques are known to reduce pain and improve quality of life in endometriosis.”

What the sources say

• Not checked yetcites [136] Troyer, 2007, Differential diagnosis of endometriosis in a young adult woman with nonspecific low back pain, Phys. Ther. source

In the paper

“Regular exercise is thought to promote reduced menstrual flow, ovarian stimulation, and estrogen effects [139].”

What the sources say

• Not checked yetcites [139] Warren, 2001, The effects of intense exercise on the female reproductive system, J. Endocrinol. source

In the paper

“Non-steroidal anti-inflammatory drugs inhibit the synthesis of prostaglandins, contribute to reducing the inflammatory process and resolve pain [114].”

What the sources say

• Not checked yetcites [114] Horne, 2019, Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: Time for a rethink?, BJOG source

In the paper

“Danazol—a derivative of the male sex hormone testosterone. It inhibits the secretion of GnRH, causing a decrease in the secretion of LH and FSH by the pituitary gland.”

What the sources say

• Not checked yetcites [116] Donnez, J., and Dolmans, M.M. (2021). Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med., 10. source

In the paper

“As evidenced by literature data, although there is a risk of bone loss when elagolix is used, the effect of elagolix on the long-term risk of fracture is minimal [119,120].”

What the sources say

• Not checked yetcites [119] Bradley, 2017, Reproductive endocrinology: Elagolix in endometriosis, Nat. Rev. Endocrinol. source
• Not checked yetcites [120] Kilpatrick, 2020, Estimating the Effect of Elagolix Treatment for Endometriosis on Postmenopausal Bone Outcomes: A Model Bridging Phase III Trials to an Older Real-World Population, JBMR Plus source

In the paper

“In the case of endometriosis, a mini-invasive laparoscopic or laparoscopic approach using a robot is strongly recommended [108].”

What the sources say

• Not checked yetcites [108] Youssef, 2015, A new simple technique for 3-dimensional sonographic assessment of the pelvic floor muscles, J. Ultrasound Med. source

In the paper

“Physiotherapy in endometriosis focuses on non-invasive and conservative treatment of pelvic floor disorders in women. It deals with the restoration of the efficiency and function of tissues and organs in the pelvic area, supports the process of surgical treatment, relieves pain, thus improving the quality of life [135].”

What the sources say

• Not checked yetcites [135] Vural, 2018, Pelvic pain rehabilitation, Turk. J. Phys. Med. Rehabil. source

In the paper

“Laparoscopic rectal nodulectomy with nerve-sparing robots has been shown to be a feasible and safe treatment for isolated sting-rectal DIE [133].”

What the sources say

• Not checked yetcites [133] Ercoli, 2017, Robotic-assisted conservative excision of retrocervical-rectal deep infiltrating endometriosis: A case series, J. Minim. Invasive Gynecol. source

In the paper

“Laparoscopy is the recommended surgical technique for the treatment of endometriosis, regardless of its stage [122].”

What the sources say

• Not checked yetcites [122] Schipper, 2012, Video-assisted laparoscopy for the detection and diagnosis of endometriosis: Safety, reliability, and invasiveness, Int. J. Womens Health

In the paper

“All recognized methods of pharmacological treatment have similar therapeutic effectiveness. They differ in the scope and speed of the appearance of side effects.”

In the paper

“An intrauterine device releasing levonorgestrel is a progesterone derivative. The effect is the same as progestogen preparations. Recommended especially for women with severe pain.”

What the sources say

• Not checked yetcites [116] Donnez, J., and Dolmans, M.M. (2021). Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med., 10. source

In the paper

“Physical exercise has been shown to have a beneficial effect on muscle relaxation in patients suffering from endometriosis, which in turn helps to break their pain cycle [141].”

What the sources say

• Not checked yetcites [141] Awad, 2017, Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design, J. Phys. Sci.

In the paper

“Cardiovascular activity helps endometriosis patients maintain good energy levels. Exercise is one of the most effective strategies for increasing serotonin levels; physical activity and deep breathing exercises can increase the rate of burning serotonin neurons in the brain, which can stimulate the production of mood-enhancing substances.”

What the sources say

• Not checked yetcites [143] Carpenter, 1995, The effect of regular exercise on women receiving danazol for treatment of endometriosis, Int. J. Gynaecol. Obstet. source

In the paper

“Oral contraceptives (estrogen-progestogen preparations)—their action consists in lowering the level of FSH and stabilizing the endometrium, which leads to a reduction in pain.”

What the sources say

• Not checked yetcites [116] Donnez, J., and Dolmans, M.M. (2021). Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med., 10. source

In the paper

“Elagolix is a non-peptide GnRH (gonadotropin-releasing hormone) antagonist. Elagolix enables dose-dependent reductions in estrogen levels and is effective in relieving moderate to severe endometriosis pain with long-lasting, sustained effects. As a GnRH antagonist, elagolix may also reduce bone mineral density through its estrogen reduction mechanism [118].”

What the sources say

• Not checked yetcites [118] Shebley, 2020, Clinical Pharmacology of Elagolix: An Oral Gonadotropin-Releasing Hormone Receptor Antagonist for Endometriosis, Clin. Pharm. source

In the paper

“However, there are literature data that draw attention to the possibility of inferring the non-protective effects of exercise in women with endometriosis, which may result from the discomfort felt that prevents physical exercise [141,144].”

What the sources say

• Not checked yetcites [141] Awad, 2017, Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design, J. Phys. Sci.
• Not checked yetcites [144] Lund, 2016, Is acupuncture effective in the treatment of pain in endometriosis?, J. Pain Res. source

In the paper

“A study by the Cui et al. team explains that LINC01116 promotes the progression of endometriosis through the miR-9-5p/FOXP1 axis. This discovery provides a new therapeutic target for endometriosis patients [174].”

What the sources say

• Not checked yetcites [174] Cui, 2021, LINC01116 promotes proliferation and migration of endometrial stromal cells by targeting FOXP1 via sponging miR-9-5p in endometriosis, J. Cell Mol. Med. source

In the paper

“The sensitivity of Ca-125 is characteristic of the advanced form of the disease, but its specificity is low because it is often elevated in other gynecological diseases [156].”

What the sources say

• Not checked yetcites [156] Hirsch, 2016, International Collaboration to Harmonise Outcomes and Measures for Endometriosis. Diagnostic accuracy of cancer antigen 125 for endometriosis: A systematic review and meta-analysis, BJOG source

In the paper

“It is known that in places affected by endometriosis, oxidative stress further intensifies the immune response, as a result of which there may be an exacerbation of the development of endometriosis [151,152,153].”

What the sources say

• Not checked yetcites [151] Agarwal, 2005, Role of oxidative stress in female reproduction, Reprod. Biol. Endocrinol. source
• Not checked yetcites [152] Christodoulakos, 2007, Pathogenesis of endometriosis: The role of defective ‘immunosurveillance’, Eur. J. Contracept. Reprod. Health Care source
• Not checked yetcites [153] Augoulea, 2009, The role of the oxidative-stress in the endometriosis-relatedinfertility, Gynecol. Endocrinol. source

In the paper

“The concentrations of Ca-125 and Ca-19-9 glycoproteins do not give us definitive answers in the differential diagnostic and therapeutic process, but they help in decision-making and direction of management and therefore remain the recommended complementary tool.”

In the paper

“Liu et al. showed that LncRNA H19 may be involved in the pathogenesis of endometriosis especially in the mechanism of recurrence and is a novel potential predictor of the recurrence of endometriosis. In this study LncRNA H19 expression in the ectopic and eutopic endometria of endometriosis patients was significantly higher than that in the normal endometrium [172].”

What the sources say

• Not checked yetcites [172] Liu, 2020, LncRNA H19 Overexpression in Endometriosis and its Utility as a Novel Biomarker for Predicting Recurrence, Reprod. Sci. source

In the paper

“IL-6 is the most characteristic of endometriosis. Its sensitivity is 63% and its specificity is 69% [149].”

What the sources say

• Not checked yetcites [149] Nisenblat, 2016, Combination of the non-invasive tests for the diagnosis of endometriosis, Cochrane Database Syst. Rev.

In the paper

“Altered expression levels of miR-139-5p and miR-375 were observed in the tissues of the ectopic endometrium. These microRNAs may regulate the expression of the transcription factors HOXA9 and HOXA10 and the endothelin 1 gene (EDN1) playing a role in vascular homeostasis, which may be related to the development of endometriosis [160].”

What the sources say

• Not checked yetcites [160] Liu, 2018, Role of miR-449b-3p in endometriosis via effects on endometrial stromal cell proliferation and angiogenesis, Mol. Med. Rep.

In the paper

“Zhou et al. found that 388 transcripts of lncRNA tested showed overexpression and 188 showed decreased expression levels in the ectopic endometrium compared to eutopic endometrium [172].”

What the sources say

• Not checked yetcites [172] Liu, 2020, LncRNA H19 Overexpression in Endometriosis and its Utility as a Novel Biomarker for Predicting Recurrence, Reprod. Sci. source

In the paper

“Despite the fact that research on biomarkers of endometriosis are still ongoing, there are still no satisfactory results, which makes it impossible to carry out effective laboratory diagnostics used in the diagnosis and monitoring of the treatment of the disease [157].”

What the sources say

• Not checked yetcites [157] May, 2010, Peripheral biomarkers of endometriosis: A systematic review, Hum. Reprod. Update source

In the paper

“To date, no specific miRNA has been validated for diagnostic purposes (systematic review conducted on PubMed®, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE® and Web of Science databases using the search terms endometriosis (all fields) AND miRNA (all fields), evaluating all publications up to May 2019) [168].”

What the sources say

• Not checked yetcites [168] Monnaka, 2021, Overview of miRNAs for the non-invasive diagnosis of endometriosis: Evidence, challenges and strategies. A systematic review, Einstein source

In the paper

“Liu et al. suggested that miR449b3p altered expression in endometriosis affects the development of the disease [159].”

What the sources say

• Not checked yetcites [159] Sahin, 2018, microRNA Let-7b: A Novel treatment for endometriosis, J. Cell Mol. Med. source

In the paper

“There is monthly bleeding within them, which trigger an immune response. This causes the foci of endometriosis to increase [146].”

What the sources say

• Not checked yetcites [146] Sourial, 2014, Theories on the pathogenesis of endometriosis, Int. J. Reprod. Med. source

In the paper

“The team identified two regions of the genome associated with an increased risk of endometriosis.”

What the sources say

• Not checked yetcites [183] Nyholt, 2012, Genome-wide association meta-analysis identifies new endometriosis risk loci, Nat. Genet. source

In the paper

“The protein encoded by the RHOJ gene is activated by vascular endothelial growth factor and can regulate angiogenesis and also plays an important role in adipocyte differentiation, endothelial motility, and cytoskeletal formation [190].”

What the sources say

• Not checked yetcites [190] Kim, 2014, Vascular RhoJ is an effective and selective target for tumor angiogenesis and vascular disruption, Cancer Cell source

In the paper

“Studies of the Japanese population showed the relationship of polymorphism rs10965235, in the CDKN2BAS gene at locus 9p21 and rs16826658, in the area of the WNT4 gene at locus 1p36 [183].”

What the sources say

• Not checked yetcites [183] Nyholt, 2012, Genome-wide association meta-analysis identifies new endometriosis risk loci, Nat. Genet. source

In the paper

“Three of the single nucleotide polymorphisms (SNPs) associated with the disease have been identified: LINC00339-WNT4 at locus 1p36.12 (rs2235529) and RND3-RBM43 at locus 2q23.3 (rs1519761 and rs6757804).”

What the sources say

• Not checked yetcites [188] Albertsen, H.M., Chettier, R., Farrington, P., and Ward, K. (2013). Genome-wide association study link novel loci to endometriosis. PLoS ONE, 8. source

In the paper

“Christofolini et al. showed a correlation of the polymorphisms rs10928050 of the KAZN gene and the rs2427284 of the LAMA5 gene with endometriosis [194].”

What the sources say

• Not checked yetcites [194] Christofolini, 2019, New candidate genes associated to endometriosis, Gynecol. Endocrinol. source

In the 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].”

What the sources say

• Not checked yetcites [179] Koninckx, 2019, Pathogenesis of endometriosis: The genetic/epigenetic theory, Fertil. Steril. source

In the paper

“Rho are also involved in cancer transformation and metastasis.”

What the sources say

• Not checked yetcites [190] Kim, 2014, Vascular RhoJ is an effective and selective target for tumor angiogenesis and vascular disruption, Cancer Cell source

In the paper

“Rho proteins regulate the dynamic assembly of cytoskeleton components in several physiological processes, such as cell proliferation and motility.”

What the sources say

• Not checked yetcites [190] Kim, 2014, Vascular RhoJ is an effective and selective target for tumor angiogenesis and vascular disruption, Cancer Cell source

In the paper

“However, the clinical significance and biological mechanism of lncRNA in the development of endometriosis remain largely unknown.”

In the paper

“The first GWAS study on endometriosis was published between 2010 and 2011—two papers on the Japanese population and one study of European women [180,181,182].”

What the sources say

• Not checked yetcites [180] Uno, 2010, A genome-wide association study identifies genetic variants in the CDKN2BAS locus associated with endometriosis in Japanese, Nat. Genet. source
• Not checked yetcites [181] Adachi, 2010, Meta-analysis of genome-wide association scans for genetic susceptibility to endometriosis in Japanese population, J. Hum. Genet. source
• Not checked yetcites [182] Painter, 2011, Genome-wide association study identifies a locus at 7p15.2 associated with endometriosis, Nat. Genet. source

In the paper

“Since the 1940s, a much higher incidence among women from families in which women suffered from endometriosis has been described, as well as a high incidence among siblings, especially monozygotic twins, where the percentage of co-occurrence exceeds 80% [177].”

What the sources say

• Not checked yetcites [177] Hadfield, 1997, Endometriosis in monozygotic twins, Fertil. Steril. source

In the paper

“This place is among the genes known so far responsible for the development of the uterus and placenta [182].”

What the sources say

• Not checked yetcites [182] Painter, 2011, Genome-wide association study identifies a locus at 7p15.2 associated with endometriosis, Nat. Genet. source

In the paper

“Gen RHOJ encodes one of many small proteins of the Rho family that bind GTP (guanosine-5′-triphosphate), which acts as an energy transporter in the cell.”

What the sources say

• Not checked yetcites [190] Kim, 2014, Vascular RhoJ is an effective and selective target for tumor angiogenesis and vascular disruption, Cancer Cell source

In the paper

“Unfortunately, the treatment of this disease is still ineffective.”

In the paper

“The new mutations can affect both the eutopic endometrium and endometriosis foci, and do not have to occur in the germline cell line.”

What the sources say

• Not checked yetcites [203] Zondervan, 2020, Endometriosis, N. Engl. J. Med. source

In the paper

“Estrogen receptors, acting as transcription factors, play a significant role in endometrial growth and differentiation, as well as in numerous biological functions in eutopic endometrium and endometriosis.”

What the sources say

• Not checked yetcites [198] Bulun, 2012, Role of estrogen receptor-β in endometriosis, Semin. Reprod. Med. source

In the paper

“However, the progress of knowledge, especially at the genetic level, which has taken place in recent years, allows the separation of certain molecular shields for new therapeutic methods.”

In the paper

“The location of the mutation in the genome appears to be specific to the patient and is not repeated in others.”

What the sources say

• Not checked yetcites [203] Zondervan, 2020, Endometriosis, N. Engl. J. Med. source

In the paper

“It is emphasized that the impact of these mutations on the development of the disease is complex and requires further evaluation.”

What the sources say

• Not checked yetcites [203] Zondervan, 2020, Endometriosis, N. Engl. J. Med. source

In the paper

“Recent studies have shown that the polymorphisms rs17179740 of the ESR2 gene and rs2899470 of the CYP19A1 gene are associated with the occurrence of endometriosis [202].”

What the sources say

• Not checked yetcites [202] Smolarz, 2021, Association between single nucleotide polymorphism of the CYP19A1 and ESR2 genes and endometriosis, Arch. Gynecol. Obstet. source