The Origin and Pathogenesis of Endometriosis

Yeh Wang, Kristen Nicholes, Ie Ming Shih

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


Recent molecular genetic findings on endometriosis and normal endometrium suggest a modified model in which circulating epithelial progenitor or stem cells intended to regenerate uterine endometrium after menstruation may become overreactive and trapped outside the uterus. These trapped epithelium-committed progenitor cells form nascent glands through clonal expansion and recruit polyclonal stromal cells, leading to the establishment of deep infiltrating endometriosis. Once formed, the ectopic tissue becomes subject to immune surveillance, resulting in chronic inflammation. The inflammatory response orchestrated by nuclear factor-κB signaling is exacerbated by aberrations in the estrogen receptor- beta and progesterone receptor pathways, which are also affected by local inflammation, forming a dysregulated inflammation-hormonal loop. Glandular epithelium within endometriotic tissue harbors cancer-associated mutations that are frequently detected in endometriosis-related ovarian cancers. In this review, we summarize recent advances that have illuminated the origin and pathogenesis of endometriosis and have provided new avenues for research that promise to improve the early diagnosis and management of endometriosis.

Original languageEnglish (US)
Pages (from-to)71-95
Number of pages25
JournalAnnual Review of Pathology: Mechanisms of Disease
StatePublished - Jan 24 2020


  • endometriosis, ovarian cancer, stem cell, genetic and epigenetic alterations, chronic inflammation, immune dysregulation, endocrine dysregulation

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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