Endometriosis is considered as an estrogen-dependent inflammatory health issue, which is usually defined by the existence and growth of foci in endometrial tissue that is outside the uterine cavity. Two endometrial tissues, which are commonly affected by endometriosis, are stroma and glands. It has been evaluated that the most common anatomic location for the occurrence of endometriosis is ovarian surface and peritoneum, which is located near pelvic region. The growth of endometriosis will certainly result in chronic pelvic pain, adhesions, and infertility in most of the cases. The prevalence rate of endometriosis has been increased in developed countries at a constant rate. On the similar rate, the prevalence rate of endometriosis is extremely high among women, suffering from chronic pelvic pain, which is about 40% to 70% across the globe.

On the contrary, it has been evaluated that about 10% of the women, in regards to the reproductive age, usually experience the condition of endometriosis. It has been indicated that the natural history of this public health issue is extremely difficult to study because longitudinal studies are always challenged on the basis of ethical consideration. A baboon model has been presented earlier, which has identified that chronic endometriosis is a serious, progressive, and dynamic health issue, which may induce the rates of mortality and morbidity. From the perspective of pathogenesis, different theories have been presented in accordance with the pathophysiology of endometriosis. A unifying past theory related to the conditions of endometriosis has remained mystifying because of the disease’s nature.

On the contrary, there are a significant number of research theories, which have been arisen for providing their observations regarding the pathogenesis of endometriosis. Intrinsic theories have indicated different factors and certain genetic susceptibilities, which has been categorized according to the uterine endometrium. Similarly, endocrine disrupting chemicals usually play a major role in endometriosis as exogenous and endogenous estrogens have different stimulant candidates in accordance with the endometriosis pathogenesis. In the female reproductive tract, a genome-wide association study has demonstrated different predisposition mutation to serous ovarian cancer at a locus (17q21).

HOXB4 overexpression in HS cells usually enhances differentiation and expansion of such embryonic stem cells, yet this effect is lost in the adult cells. Another study has suggested that HOXB4 inhibits invasion of high-grade serous ovarian carcinoma cells. In the endometrium, HOXB4 was found to be expressed in the human primary glandular epithelial cells and such an expression is steroid dependent.

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