The Hidden Link Between Endometriosis and Obesity: A State-of-the-Art Review

Endometriosis remains an under-researched disease with a wide range of symptoms. Endometriosis reduces a woman's quality of life and professional productivity, yet its exact causes, risk factors, and treatment have yet to be elucidated. Body mass index and endometriosis have been observed to be inversely related; however, this relationship may only be a correlation rather than a causation. Obesity may play a role in the inflammation and cell proliferation associated with endometriosis through the complex signaling pathways of adipokines. A literature review was done on endometriosis and obesity to gain insight and synthesize knowledge about opportunities to improve endometriosis care, its inflammatory pathogenesis, and the treatment potential of glucagon-like peptide-1. A Boolean search was performed via the Texas Medical Center Library with keywords including "endometriosis", "adipose tissue", "obesity", "adipokines", "glucagon-like peptide-1", and "inflammation". After screening titles, abstracts, and full texts, articles were excluded due to irrelevance, lack of access to full-text, and repetition. The literature revealed that at the onset of endometriosis symptoms in obese women, chronic pelvic pain and decreased appetite could cause misdiagnosis and weight loss, lowering the incidence of endometriosis in the obese population. Poor visualization, ventilatory compromise, and conversion to laparotomy during laparoscopy hinders diagnostic quality for obese patients. Interestingly, endometriosis and obesity share similar pathological markers, including leptin, adiponectin, tumor-necrosis-factor-α, and interleukin-6. Finally, glucagon-like peptide-1 was found to decrease pro-inflammatory secretions and macrophage infiltration.