Predictive markers of endometriosis: a future perspective

Endometriosis is a chronic gynecological disorder affecting up to 10% of women of reproductive age and is characterized by the presence of endometrial-like tissue outside the uterus. The condition is associated with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, and remains difficult to diagnose at early stages. Recent evidence suggests that endometriosis shares genetic and molecular pathways with other chronic pain and inflammatory disorders. Identifying reliable biomarkers is therefore essential to improve risk stratification and support earlier evaluation. Multiple domains have emerged as candidate markers for risk stratification, including genetic and epigenetic alterations, dysmenorrhea, migraine, autoimmune and endocrine disorders, and stress and early-life adversity. These factors have been associated with disease initiation, lesion development, and symptom severity. Understanding their interactions could support multimodal risk stratification approaches and guide preventive strategies. This narrative review highlights the multifactorial nature of endometriosis and synthesizes current evidence on emerging predictive markers. Although progress has been made, large prospective studies are still needed to validate these markers and facilitate the development of targeted interventions.