AUTHOR=Sherwani Subuhi , Khan Mohd Wajid Ali , Rajendrasozhan Saravanan , Al-Motair Khalid , Husain Qayyum , Khan Wahid Ali 

TITLE=The vicious cycle of chronic endometriosis and depression—an immunological and physiological perspective

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1425691

DOI=10.3389/fmed.2024.1425691

ISSN=2296-858X

ABSTRACT=Endometriosis is a chronic, estrogen-dependent, proinflammatory disease that can cause various dysfunctions. The main clinical manifestations of endometriosis include chronic pelvic pain and impaired fertility. Endometriosis The disease is characterized by a spectrum of dysfunctions spanning hormonal signaling, inflammation, immune dysregulation, angiogenesis, neurogenic inflammation, epigenetic alterations, and tissue remodeling. Dysregulated hormonal signaling, particularly involving estrogen and progesterone, drives abnormal growth and survival of endometrial-like tissue outside the uterus. Chronic inflammation, marked by immune cell infiltration and inflammatory mediator secretion, perpetuates tissue damage and pain. Altered immune function, impaired ectopic tissue clearance, and dysregulated cytokine production contribute to immune dysregulation. Enhanced angiogenesis driven by pro-angiogenic factors promotes lesion growth and survival. Epigenetic modifications influence gene expression patterns such as e.g. HSD11B1 gene, affecting disease pathogenesis. Endometriosis related changes and infertility lead to depression in diagnosed women diagnosed with endometriosis. Depression changes lifestyle and induces physiological and immunological changes. A higher rate of depression and anxiety has been reported found in women diagnosed with endometriosis diagnosed women, unleashing physiological, clinical and immune imbalances which further accelerate chronic endometriosis or vice versa. Thus, both endometriosis and depression are concomitantly develop part of a vicious cycle and that enhance the disease complications. A multidimensional treatment strategy is needed which can cater for both endometrial disease treatment and depression and anxiety disorders related counselling and treatment.