Endometriosis: Epidemiology, Risk Factors, Molecular Mechanisms, Diagnosis, and Management

Endometriosis is a chronic estrogen-dependent gynecological disorder characterized by the ectopic growth of endometrial-like tissue outside the uterine cavity, affecting approximately 10% of women of reproductive age worldwide. It is a leading cause of chronic pelvic pain, dysmenorrhea, and infertility, imposing a substantial burden on individual health and healthcare systems. Despite decades of research, the pathogenesis of endometriosis remains incompletely elucidated, and clinical management is often limited by delayed diagnosis and suboptimal treatment efficacy. This review provides a comprehensive and updated overview of endometriosis, covering its updated epidemiology, established and emerging risk factors, and key molecular mechanisms including inflammation, epigenetic regulation, hormonal imbalance, oxidative stress, and abnormal cell invasion and proliferation. We further summarize current diagnostic approaches, including imaging modalities, laparoscopy, and biomarkers, as well as clinical management strategies such as hormonal therapy, surgical intervention, and emerging targeted treatments. Finally, we discuss existing diagnostic and therapeutic challenges, unresolved questions, and future directions toward precision medicine and noninvasive management. This review aims to integrate recent advances and provide an updated framework for understanding and improving the clinical care of endometriosis. This review also highlights actionable translational directions for noninvasive early diagnosis, precision targeted therapy, and postoperative recurrence prevention, providing a key theoretical framework for translating basic research findings into clinical practice.