Evidence
What was published this week.
The weekly OpenEndo digest of new endometriosis papers, with PMIDs. It is the repository file, not a rewrite.
Last reviewed
A digest reports what papers say and how sure that evidence is. It is not a recommendation to start, stop, or change treatment.
Digests
Source file digest-2026-10-23.md · 2026-10-23.json
Week of 16–23 Oct 2026
In short
- No new guideline, Cochrane update, or regulatory decision this week. Nothing here changes an OpenEndo repurposing verdict. Nothing here is adopted as a patient-facing treatment recommendation. Knowledge pages for Yselty and for saliva diagnostics are unchanged.
- Comorbidity meta-analysis (PMID 42901254) is the broadest association paper: higher pooled estimates for several autoimmune, allergic, and pain conditions, an inflammatory-bowel-disease interval that includes no effect, thyroid associations that are not significant, and a GRADE rating of low or very low. The authors' call for a systemic disease model and multidisciplinary care is their interpretation. It is not a new care pathway.
- Non-invasive diagnosis (PMID 42885805) repeats a limit that matters for reading a scan: a normal expert ultrasound or MRI does not exclude superficial disease, and no circulating or endometrial biomarker is described as ready for clinical use, including salivary miRNA. That is a bound on what current tests can claim. It is not a new pathway.
- Frozen-embryo-transfer pretreatment (PMID 42892070) reports OR 26.7 for live birth after a GnRH-agonist plus aromatase-inhibitor lead-in, in a retrospective series of 51 patients and 217 cycles at three centres, one of them in Skive. The design (already-failed conventional transfers) and the width of the interval are the result. It does not change embryo-transfer practice.
- Supplements (PMID 42900597) and the diet narrative (PMID 42886549) are the records most likely to be read as advice. The supplement review covers 24 trials and 2,019 women and states that supplements should not replace standard treatment. The diet paper gives no effect size. Neither record is a recommendation to start a product or a diet.
Structured versus free-text MRI reports for deep pelvic endometriosis
Randomised trial likely · 15 readers
What it found. single-centre randomized reader study.
Why it matters. a reporting-format comparison, not a test of whether MRI detects endometriosis.
Details
single-centre randomized reader study. Twenty radiology residents were assigned to free-text or structured reporting; five became unavailable before report generation. The remaining 15 readers each reported the same 22 pelvic MRI examinations (330 reports: 154 free-text, 176 structured). The reference was expert imaging consensus, not surgical histology. Structured reporting increased completeness by 8.1 percentage points (95% CI 4.1–12.1) and clinically weighted completeness by 5.6 percentage points (95% CI 1.3–10.0), and took 4.52 minutes longer (95% CI 3.05–5.99). Structured reports also carried more explicit negative discrepancies versus the expert reference (rate ratio 2.94, 95% CI 1.73–4.98), mainly explicit compartment-based negative statements. In an exploratory paired reading, two gynaecologic surgeons scored 44 reports and rated structured reports higher for perceived completeness, usefulness, and adequacy; clarity ratings were similar. a reporting-format comparison, not a test of whether MRI detects endometriosis. Higher completeness is not diagnostic accuracy. Single centre, resident readers, imaging reference standard.
Platelet-to-lymphocyte ratio and CA-125 for endometrioma
Observational uncertain · 645 people
What it found. retrospective single-centre case-control study of 645 people having laparoscopic surgery in 2020–2024: 372 with endometriosis and 273 controls with benign ovarian teratomas.
Why it matters. another internal blood-marker comparison whose control group is teratoma, not the broader differential of an adnexal mass.
Details
retrospective single-centre case-control study of 645 people having laparoscopic surgery in 2020–2024: 372 with endometriosis and 273 controls with benign ovarian teratomas. Endometrioma was associated with higher platelet-to-lymphocyte ratio (PLR), higher CA-125, and higher products of CA-125 with the neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios. Stage IV had higher platelet counts and higher CA-125 products than stage III. Preoperative bilateral endometrioma and elevated CA-125 were independent factors for stage IV. The authors state that, for people with dysmenorrhoea or pelvic pain, CA-125 had better diagnostic value for ovarian endometrioma than PLR × CA-125. The abstract does not report an AUC. another internal blood-marker comparison whose control group is teratoma, not the broader differential of an adnexal mass. The authors' preference for CA-125 is not a new diagnostic standard. Low certainty for any staging claim.
Uterine corpus flexion angle and the question-mark sign
Observational uncertain
What it found. mixed prospective-retrospective case-control ultrasound study.
Why it matters. a proposed numeric definition of a sign sonographers already describe subjectively.
Details
mixed prospective-retrospective case-control ultrasound study. Uterine corpus flexion angle (UCFA) rose with revised ASRM stage and with pelvic-adhesion severity. In multivariable regression, adhesion score was the main associate of UCFA (β=0.441), while the uterine flexion angle was mainly associated with baseline uterine position (β=0.508). In an adenomyosis-free endometriosis subgroup of 166, adhesion score remained the main associate (β=0.457). A UCFA cutoff of ≥220° for the sonographic question-mark sign had AUC 0.958. Median UCFA was 179.0° in the benign control group and 178.0° in the normal control group. The abstract does not state the total sample size. a proposed numeric definition of a sign sonographers already describe subjectively. The cutoff and the AUC are internal. Not a reporting standard. Epub 2026-07-25; indexed this week.
Nerve-sparing surgery for deep infiltrating endometriosis
Systematic review uncertain · 1,623 women
What it found. systematic review and meta-analysis (PRISMA 2020; PubMed, Embase, Scopus, and LILACS, January 2000–August 2025).
Why it matters. a feasibility snapshot, not a comparative verdict.
Details
systematic review and meta-analysis (PRISMA 2020; PubMed, Embase, Scopus, and LILACS, January 2000–August 2025). Sixteen studies, 1,623 women with surgically confirmed deep disease. Pooled conversion to open surgery 0.3%, intraoperative complications 1.5%, postoperative complications 9.8%, urinary voiding dysfunction 6.9%, low anterior resection syndrome 10.2%, and postoperative Female Sexual Function Index 22.3. Several functional outcomes were substantially heterogeneous. The authors state that the evidence does not support a conclusion of equivalence or superiority versus conventional surgery. a feasibility snapshot, not a comparative verdict. Nerve-sparing is not established here as the better operation.
Headache burden after endometriosis surgery
Observational uncertain · 88 women
What it found. single-centre observational study of 88 women who had endometriosis surgery between 3 months and 5 years before enrolment.
Why it matters. a before/after comparison that depends on remembered preoperative scores.
Details
single-centre observational study of 88 women who had endometriosis surgery between 3 months and 5 years before enrolment. Participants completed the Headache Impact Test-6 and the 12-item Short Form by recalling their preoperative state and reporting their current state. Prospective preoperative questionnaires were not available. Headache-burden scores were lower, and physical and mental quality-of-life scores were higher, at the postoperative assessment than in the recalled preoperative period, in women with and without migraine (p<0.001). The differences were larger in the migraine group. a before/after comparison that depends on remembered preoperative scores. It is not evidence that surgery treats migraine. Epub 2026-07-27; indexed this week.
Unicornuate uterus, adenomyoma, renal agenesis, and deep endometriosis
Observational uncertain
What it found. one case, a 39-year-old woman, gravida 1 para 1, previously recorded as uterus didelphys.
Why it matters. one imaging reclassification.
Details
one case, a 39-year-old woman, gravida 1 para 1, previously recorded as uterus didelphys. MRI reclassified the uterus as unicornuate with a left cavitated non-communicating rudimentary horn (ESHRE/ESGE U4a) occupied by a 6 cm adenomyoma, contralateral adenomyosis, a deep endometriotic nodule to the left pelvic sidewall with rectal tenting and no transmural invasion, a left endometrioma, and an absent left kidney. Surgery and histology confirmed the horn, the adenomyoma, adenomyosis, and ovarian endometriosis. She recovered and the abstract describes her as asymptomatic. one imaging reclassification. It is not a new standard for Müllerian anomalies. Epub 2026-09-15.
Rat autologous-transplant model, checked with elagolix
Observational uncertain
What it found. video protocol.
Why it matters. a methods paper.
Details
video protocol. Endometrium sutured to the peritoneal wall of Sprague-Dawley rats formed cystic lesions in 18 of 20 animals at 21 days (90%). Elagolix at 100 mg/kg daily by oral gavage for 4 weeks reduced final lesion volume versus the model group (inhibition rate 86.7%) and lowered serum FSH, LH, and estradiol and peritoneal TNF-α, VEGF, and IL-6. Pain and behaviour were not measured. a methods paper. The 100 mg/kg figure is a rat dose in this protocol. It is not a human dose and it is not new evidence about elagolix in people.
Statins in female rodents, including induced endometriosis
Systematic review uncertain
What it found. systematic review of preclinical rodent studies (PubMed, Scopus, Embase, Web of Science, LILACS, SciELO; SYRCLE risk of bias).
Why it matters. a preclinical sentence on the statin thread that digest 2026-09-18 logged in humans (PMID 42668641).
Details
systematic review of preclinical rodent studies (PubMed, Scopus, Embase, Web of Science, LILACS, SciELO; SYRCLE risk of bias). In normocholesterolemic females, statin exposure was associated with ovarian morphological change, including impaired follicular dynamics. In rodents induced to have endometriosis, the abstract reports a reduction in the volume of endometriotic implants. It does not name the statin, the number of endometriosis studies, or a pooled effect. No hyperlipidemic rodent studies were found. a preclinical sentence on the statin thread that digest 2026-09-18 logged in humans (PMID 42668641). An unnamed implant reduction without an estimate does not change that observational status and is not an M3 verdict.
Endometriosis and systemic comorbidities
Systematic review uncertain
What it found. systematic review and meta-analysis of observational studies (Web of Science and Medline through 31 December 2025; CRD420251258716).
Why it matters. the largest association map this week, and the authors grade it as weak.
Details
systematic review and meta-analysis of observational studies (Web of Science and Medline through 31 December 2025; CRD420251258716). Fifty-five studies met inclusion; 48 were pooled. Thirty-two studies covered autoimmune diseases, with study counts that overlap across diseases (systemic lupus erythematosus 14, Sjögren's syndrome 8, rheumatoid arthritis 10, multiple sclerosis 5, celiac disease 5, inflammatory bowel disease 4), plus 17 allergy studies, 13 pain-syndrome studies, and 6 endocrine studies. In cohort studies the pooled risk ratios were 1.81 for systemic lupus erythematosus (95% CI 1.50–2.18), 1.54 for Sjögren's syndrome (1.40–1.71), and 1.71 for rheumatoid arthritis (1.40–2.09). In case-control and cross-sectional studies the pooled odds ratios were 3.93 (2.59–5.98), 3.13 (1.10–8.90), 2.27 (1.75–2.95), 2.30 (1.57–3.37), and 4.50 (1.94–10.42) for those first five, respectively. The inflammatory-bowel-disease odds ratio was 2.82 (95% CI 0.58–13.61); that interval includes 1, so it is not a demonstrated increase even though the abstract lists it with the significant odds ratios. Allergy and pain associations that excluded 1 included asthma (RR 1.27, 1.14–1.40), eczema (OR 1.58, 1.34–1.87), fibromyalgia (RR 1.65, 1.42–1.92), chronic fatigue syndrome (RR 1.41, 1.31–1.51), and irritable bowel syndrome (RR 2.51, 1.55–4.07; OR 3.49, 3.21–3.80). Hypothyroidism (OR 1.89, 0.61–5.90) and hyperthyroidism (OR 0.95, 0.60–1.52) were not significant. GRADE quality was generally low or very low because of bias in the included designs. The authors argue for treating endometriosis as a systemic immuno-inflammatory disease and for multidisciplinary care. the largest association map this week, and the authors grade it as weak. Associations are not mechanisms, and the practice sentence is theirs. This digest does not adopt a new disease definition or a new care model.
Information needs in Australia
Observational uncertain
What it found. cross-sectional anonymous online survey, convenience sample via Facebook and women's-health newsletters.
Why it matters. a map of what this self-selected group says it cannot find.
Details
cross-sectional anonymous online survey, convenience sample via Facebook and women's-health newsletters. Women aged 18 or older, living in Australia, with diagnosed or suspected endometriosis. Of 265 analysed participants from seven states, the highest "strongly agree" information needs were comorbidities (76.98%, 204/265), endometriosis clinics (75.85%, 179/236), and how to deal with dismissal by health professionals (75.54%, 176/233). Open answers also asked for pathogenesis, management including alternatives, public-versus-private care, and costs. a map of what this self-selected group says it cannot find. Denominators change by item. It is not an evaluation of an information resource. Epub 2026-10-18.
Nutritional supplements for endometriosis symptoms
Systematic review uncertain · 2,019 women
What it found. systematic review of 24 clinical trials, 2,019 women.
Why it matters. the patient-facing item this week.
Details
systematic review of 24 clinical trials, 2,019 women. Some trials reported improvements in pain and quality of life, particularly with formulated curcumin or with selenium, alone or with dienogest. Some fertility-related measures improved; pregnancy rates did not. Some combination treatments reduced ovarian endometriosis; supplements did not reduce recurrence after surgery. The authors' conclusion is that supplements may support standard treatment and should not replace it. The PubMed abstract does not report pooled effect sizes. the patient-facing item this week. The review's own limit is the one to keep: this is not a reason to replace hormonal or surgical care with a supplement, and it is not an OpenEndo recommendation to start curcumin, selenium, or any other product. The curcumin experiment in PMID 42892355 is a mouse finding and is a different record.
Diet as support, narrative review
Observational uncertain
What it found. no new cohort.
Why it matters. a narrative companion to the supplement review and to the low-FODMAP meta-analysis in digest 2026-10-16 (PMID 42876029), which pooled post-intervention scores rather than controlled effects.
Details
no new cohort. The abstract discusses an anti-inflammatory pattern (omega-3 fatty acids, cruciferous vegetables, fibre) as distinct from routine food elimination, plus selected supplements and probiotics, and states that diet should be treated as supportive rather than as causal treatment. It gives no study count and no effect size. a narrative companion to the supplement review and to the low-FODMAP meta-analysis in digest 2026-10-16 (PMID 42876029), which pooled post-intervention scores rather than controlled effects. Not a diet to prescribe. Issue date 2026-10-16 and absent from `weekly/2026-10-16.json`.
How this digest was made
The day-bounded publication-date query (`endometriosis[Title/Abstract]`, datetype=pdat, 2026-10-16..2026-10-23) returned **23** records. An entrez-date supplement (datetype=edat, 2026-10-17..2026-10-23) returned 42 records, **22** of which were not in the pdat set. The supplement starts the day after the 2026-10-16 digest's edat window, which already ran through 2026-10-16. Of the 45 records screened, **32** are endometriosis-relevant and appear below (1 carry-over, 12 dropped as noise). No Cochrane update and no new guideline. The one new randomized trial in the window is a surgical-adjunct study of vasopressin, and it did not separate ovarian-reserve decline. What stands out is a **comorbidity meta-analysis that rates its own evidence low or very low**, a **narrative review that restates the limit of a normal scan**, a **retrospective frozen-embryo-transfer association with a very large odds ratio**, and a **supplement review whose own conclusion is that supplements should not replace standard treatment**. Prior digest: 2026-10-16 (open as PR #51, updated onto main after the 2026-10-19 data refresh). Every entry below comes from a fetched PubMed record; PMIDs are live. Nothing here changes an OpenEndo repurposing verdict, the Yselty or saliva-diagnostics knowledge pages, or a patient-facing recommendation.