miRNA in Endometriosis-A New Hope or an Illusion?

Background: Endometriosis is a complex, estrogen-dependent condition that can significantly impact women's quality of life and fertility. Current diagnostic strategies remain invasive and often prolonged, demonstrating the need for reliable, non-invasive biomarkers. In this context, microRNAs (miRNAs), due to their stability in blood and regulatory roles in inflammation and cell proliferation, have emerged as promising candidates. Methods: This review systematically analyzes 17 studies published between 2010 and 2025 that investigated the diagnostic utility of circulating and tissue-based miRNAs in endometriosis. Results: A wide range of dysregulated miRNAs was identified, with miR-125b-5p, miR-451a, and miR-3613-5p showing the most consistent alterations across studies. However, diagnostic performance varied considerably-largely due to methodological heterogeneity. Key differences were observed in sample type (serum, plasma, endometrium), patient selection, and control group definition. The menstrual cycle phase and hormonal status were often not matched or reported, limiting reproducibility. Conclusions: Despite encouraging findings, the current evidence base is weakened by inconsistent protocols and limited validation. Standardized, multicenter research with well-characterized patient cohorts is essential to the establishment of clinically applicable miRNA-based diagnostics. If validated, miRNAs may offer a transformative, non-invasive approach for earlier detection and improved management of endometriosis.