Endometriosis Genetic

Epigenetics and Endometriosis Hereditary: Unraveling the Complex Web of Hereditary Implications

Endometriosis, a medical condition afflicting numerous women worldwide, continues to puzzle medical researchers due to its complex nature and the myriad of genetic and environmental factors contributing to its development. This article aims to dissect the convoluted genetic aspect of endometriosis, providing a comprehensive understanding of its hereditary implications.

1. Introduction to Endometriosis

Endometriosis is a condition characterized by the growth of endometrium-like tissue outside the uterus. This disease exhibits significant diversity in its manifestation, with the tissue appearing in various forms and locations. It has a significant impact on the quality of life of the affected individual, often causing pain, infertility, and other related complications.

2. The Puzzle of Endometriosis Hereditary

2.1 Hereditary Factors in Endometriosis

Endometriosis has been confirmed as a hereditary disease, with the risk of developing the condition significantly higher in first-degree relatives of affected women. Twin studies further corroborate this, showing a similar prevalence and age of onset in twins. Despite this, the exact genetic mechanisms contributing to endometriosis remain elusive and likely presents with an inheritance pattern that is multifactorial. 

2.2 Genetic and Epigenetic Incidents in Endometriosis

Genetic and epigenetic incidents, both inherited and acquired, significantly contribute to the development of endometriosis. These incidents, which can cause changes in gene expression, are often triggered by environmental factors such as oxidative stress and inflammation. Familial clustering of endometriosis has been shown in an array of studies with similar findings. First-degree relatives are 5 to 7 times more likely to have surgically confirmed disease. 

Familial endometriosis may be more severe than sporadic cases. This also supports the multifactorial inheritance of endometriosis and a genetic propensity as it may spread more severely to offspring or siblings. These women with familial inheritance may also have earlier age of onset and symptoms. 

3. Theories on the Pathogenesis of Endometriosis

3.1 The Implantation Theory

The implantation theory, popularized by Sampson in 1927, suggests that endometriosis is caused by the implantation of endometrial cells in locations outside the uterus. This theory, while reasonable, fails to explain certain observations, such as the occurrence of endometriosis in men and women without endometrium.

3.2 The Metaplasia Theory

The metaplasia theory postulates that endometriosis is a result of metaplastic changes, a process where one type of cell changes into another type due to environmental stress. This theory, while accounting for some observations, is limited by the varying definitions of “metaplasia” and the disregard for genetic or epigenetic changes.

3.3 The Genetic/Epigenetic Theory

The genetic/epigenetic theory proposes that endometriosis results from a series of genetic and epigenetic incidents, both hereditary and acquired. This theory is compatible with all known observations of endometriosis, providing a comprehensive understanding of the disease’s pathogenesis.

4. The Genetic/Epigenetic Theory: A Closer Look

4.1 Genetic and Epigenetic Incidents: The Triggers of Endometriosis

According to the genetic/epigenetic theory, endometriosis is triggered by a series of genetic and epigenetic incidents. These incidents can be hereditary, transmitted at birth, or acquired later in life due to environmental factors such as oxidative stress and inflammation.

4.2 The Role of Redundancy in the Development of Endometriosis

Redundancy, where a task can be accomplished by multiple pathways, plays a significant role in the development of endometriosis. This redundancy can mask the effects of minor genetic and epigenetic changes, causing them to become visible only when a higher capacity is needed.

4.3 The Genetic/Epigenetic Theory and Endometriosis Lesions

Endometriosis lesions are clonal, meaning they originate from a single cell that has undergone genetic or epigenetic changes. The genetic/epigenetic theory proposes that these lesions can remain dormant for extended periods, similar to uterine myomas, and may only be reactivated by certain triggers such as trauma.

5. Clinical Implications of the Genetic/Epigenetic Theory

5.1 Understanding the Nature of Endometriosis Lesions

According to the genetic/epigenetic theory, most subtle or microscopic lesions are normal endometrium-like cells that would likely resolve without intervention. In contrast, typical, cystic, and deep lesions are benign tumors that do not recur after complete excision but may progress slowly or remain dormant for an extended period.

5.2 The Role of Factors in Endometriosis Hereditary

The genetic/epigenetic theory suggests that genetic and epigenetic defects inherited at birth may play a significant role in the development of endometriosis. These hereditary factors may not only contribute to the disease’s onset but also to associated conditions such as subfertility and pregnancy complications.

5.3 Variability in Endometriosis Lesions

The genetic/epigenetic theory explains that endometriosis lesions can vary significantly in their reaction to hormones and other environmental factors. This variability is due to the specific set of genetic and epigenetic changes present in each lesion.

6. Prevention and Treatment of Endometriosis: A Genetic/Epigenetic Perspective

6.1 Prevention of Genetic/Epigenetic Incidents

Preventing the genetic/epigenetic incidents that trigger endometriosis can be a complex task. However, reducing repetitive stress may be useful in this regard.

6.2 Treatment of Endometriosis

The genetic/epigenetic theory suggests that the treatment of endometriosis should focus on the complete excision of the lesions to prevent recurrence. However, it also proposes that less radical surgery may be sufficient in some cases where the surrounding fibrosis and outer cell layers are composed of normal cells with reversible changes.

7. Conclusion

While the genetic/epigenetic theory provides a comprehensive understanding of the pathogenesis of endometriosis, it remains a theory until disproven by new observations. Further research is needed to fully elucidate the genetic and epigenetic mechanisms contributing to endometriosis, paving the way for more effective prevention and treatment strategies. Despite the complexity and challenges, the pursuit of knowledge in this field continues, offering hope for a future where endometriosis can be effectively managed and potentially prevented.


  1. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019 Feb;111(2):327-340. [PubMed]
  2. Simpson J, Elias S, Malinak L, et al. Heritable aspects of endometriosis: 1. Genetic studies. Am J Obstet Gynecol. 1980;137:327–331. [PubMed] [Google Scholar]
  3. Kennedy S, Hadfield R, Mardon H, Barlow D. Age of onset of pain symptoms in non-twin sisters concordant for endometriosis. Hum Reprod. 1996;11:403–405. [PubMed] [Google Scholar]
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