Immune and endocrine regulation in endometriosis: what we know

Endometriosis is an estrogen-dependent chronic inflammatory disease. The pathogenesis of endometriosis is affected by numerous factors including immune, endocrine, genetic, and environmental influences. The relative and absolute levels of various immune cells and factors that play key regulatory roles are altered in patients with endometriosis. Concurrently, hormones, which are important micro-regulatory factors targeting various organs and tissues in the body, also play critical roles in the course of endometriosis. However, the immune and endocrine regulatory mechanisms do not work independently of each other in the pathogenesis of endometriosis; indeed, the immune and endocrine systems share mutual regulatory pathways and influence each other. Herein, we discuss the roles of the immune and endocrine systems, and describe the mechanisms of immune–endocrine interaction, in the pathogenesis of endometriosis. We also address current problems, difficulties, and prospects for the future in the study of endometriosis pathogenesis. In this review, we summarize the immune–endocrine regulatory mechanisms in the pathogenesis of endometriosis, discuss new ideas for future in-depth research, and provide guidance for accurate and individualized treatment of patients with endometriosis.