Molecular biology of endometriosis: From aromatase to genomic abnormalities

Serdar E. Bulun*, Diana Monsivais, Toshiyuki Kakinuma, Yuichi Furukawa, Lia Bernardi, Mary Ellen Pavone, Matthew Dyson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Endometriosis has been initially described as the presence of ectopic endometrial tissue on pelvic organs or in extrapelvic sites; and this has been used as its key pathologic feature ever since. Endometriosis responds to fluctuations in estrogen and progesterone by growth and inflammation, leading to pain aggravated by menses. It was proposed that pelvic endometriosis primarily originate from retrograde menstruation of a critical number of eutopic endometrial cells with stem characteristics. This postulate is supported by the molecular defects found in ectopic endometriotic tissue. Genome-wide differences in CpG methylation between eutopic endometrial and endometriotic stromal cells are present. Defective CpG methylation affecting several genes that encode key transcription factors such as GATA6, steroidogenic factor-1, and estrogen receptor-β in endometriosis gives rise to overproduction of local estrogen and prostaglandins and suppression of progesterone receptor. Progesterone receptor deficiency leads to progesterone resistance, resulting in decreased retinol uptake and retinoic acid production and altered retinoic acid action. These molecular defects collectively give rise to poor cellular differentiation, enhanced survival, and increased inflammation, which are the biological hallmarks of endometriotic tissue.

Original languageEnglish (US)
Pages (from-to)220-224
Number of pages5
JournalSeminars in reproductive medicine
Issue number3
StatePublished - May 4 2015


  • DNA methylation
  • endometriosis
  • epigenetics
  • estrogen
  • progesterone
  • steroid receptors

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Reproductive Medicine
  • Endocrinology
  • Obstetrics and Gynecology
  • Physiology (medical)

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