{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:11:24Z","timestamp":1790809884296,"version":"4.1.0"},"reference-count":72,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since some observations, such as the clonal aspect, the biochemical variability of lesions and endometriosis in women without endometrium, the genetic-epigenetic (G-E) theory describes that endometriosis only begins after a series of cumulative G-E cellular changes. This explains that the endometriotic may originate from any pluripotent cell apart from the endometrium, that \u2018endometrium-like cells\u2019 can harbour important G-E differences, and that the risk is higher in predisposed women with more inherited incidents. A consequence is a high risk after puberty which decreases progressively thereafter. Considering a 10-year delay between initiation and performing a laparoscopy, this was observed in the United Arab Emirates, Belgium, France and USA. The subsequent growth varies with the G-E changes and the environment but is self-limiting probably because of the immunologic reaction and fibrosis. That each lesion has a different set of G-E incidents explains the variability of pain and the response to hormonal treatment. New lesions may develop, but recurrences after surgical excision are rare. The fibrosis around endometriosis belongs to the body and does not need to be removed. This suggests conservative excision or minimal bowel without safety margins and superficial treatment of ovarian endometriosis. This G-E concept also suggests prevention by decreasing oxidative stress from retrograde menstruation or the peritoneal microbiome. This suggests the prevention of vaginal infections and changes in the gastrointestinal microbiota through food intake and exercise. In conclusion, a higher risk of initiating endometriosis during adolescence was observed in UAE, France, Belgium and USA. This new understanding and the limited growth opens perspectives for earlier diagnosis and better treatment.<\/jats:p>","DOI":"10.3390\/ijerph19116725","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T09:24:29Z","timestamp":1653989069000},"page":"6725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["New Understanding of Diagnosis, Treatment and Prevention of Endometriosis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3015-6570","authenticated-orcid":false,"given":"Bedayah","family":"Amro","sequence":"first","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eugenia","family":"Ramirez Aristondo","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaima","family":"Alsuwaidi","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basma","family":"Almaamari","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Hakim","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Tahlak","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Wattiez","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"},{"name":"Department of OBGYN, Faculty of Medicine, University Strasbourg, 6081 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2929-0967","authenticated-orcid":false,"given":"Philippe R.","family":"Koninckx","sequence":"additional","affiliation":[{"name":"Latifa Hospital, Dubai 9115, United Arab Emirates"},{"name":"Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium"},{"name":"Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK"},{"name":"Department of OBGYN, Faculty of Medicine, University of Cattolica, 20123 Milano, Italy"},{"name":"Department of OBGYN, Faculty of Medicine, Moscow State University, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1001\/archsurg.1921.01110080003001","article-title":"Perforating hemorrhagic (chocolate) cysts of the ovary. 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