ENDOMETRIOSIS AS A SYSTEMIC DISEASE: EVIDENCE FROM COMORBIDITIES, LARGE-SCALE DATA, AND PUBLIC HEALTH IMPLICATIONS

Abstract

Endometriosis, traditionally described as a gynecological disorder confined to the pelvis, is increasingly recognized as a chronic systemic inflammatory condition. The objective of this study was to critically review recent literature on the relationship between endometriosis and systemic comorbidities. A systematic search was conducted in PubMed, Scielo, and BVS databases from 2015 to 2025, including observational studies, population-based cohorts, electronic health records, and meta-analyses; only studies with confirmed endometriosis diagnosis and comorbidity assessment were included, yielding 24 publications. Results demonstrate consistent associations with autoimmune, cardiovascular, metabolic, and psychiatric diseases, with reported relative risks ranging from 1.3 to 2.0 for autoimmune conditions and up to 2.0 for psychiatric disorders. Large-scale big data studies identified distinct clinical clusters, highlighting heterogeneous trajectories and persistent risk even after surgical or hormonal treatments. These findings support the need to consider endometriosis as a systemic disease, requiring multidisciplinary care, comprehensive comorbidity screening, and stronger integration into women’s health policies.