Biomaterials for endometriosis treatment: Design, advances, and prospects

Endometriosis is a chronic gynecological disease characterized by the presence of ectopic endometrium. Achieving effective therapeutic outcomes for endometriosis has always been a significant clinical hurdle because of the high recurrence rate after surgery, serious systemic side effects of hormonal therapy, and the risk of surgical intervention. Recent advancements in biomaterial-based platforms have expanded the therapeutic strategies for endometriosis by enabling targeted drug delivery, lesion microenvironment modulation, and minimally invasive interventions. This review comprehensively summarizes the design and applications of diverse biomaterial-based platforms (or dosage forms) for endometriosis management. These platforms can achieve the prolonged drug release, reduction of postoperative recurrence, and modulation of the inflammatory or immune microenvironment through accurately delivering drugs and exerting the inherent properties of biomaterials. In addition, this review summarizes the current issues in the field of endometriosis treatment, including how to overcome fibrotic barriers for drug penetration, how to integrate diagnostic and therapeutic functions of biomaterials, and how to minimize long-term hormonal dependency. This review also highlights the future directions for realizing more effective endometriosis treatment, such as developing smart biomaterials tailored to the specific characteristics of endometriotic lesions, designing multifunctional platforms for integrating diagnosis and treatment of endometriosis, and customizing personalized therapy for overcoming the influence of individual differences among different endometriosis patients. By bridging material innovation with clinical needs, the biomaterial-based therapies hold great potential to inhibit the progression and reduce the recurrence of endometriosis. STATEMENT OF SIGNIFICANCE: Endometriosis is a common disorder that occurs mainly in women of reproductive age, and the currently used hormonal/nonhormonal drugs for endometriosis treatment are limited by the low lesion-targeting capacity and possible adverse events. Encouragingly, with the rapid development of diversified biomaterial-based platforms, the therapeutic precision and outcome of hormonal/nonhormonal drugs have been revolutionized. This review comprehensively summarizes the main types of biomaterials and their advantages for endometriosis treatment, deeply describes the fabrication, working mechanisms, and therapeutic effects of hormonal/nonhormonal drug-containing biomaterials, and raises the limitations and future directions of biomaterials for endometriosis treatments.