Low-energy extracorporeal shock wave therapy is associated with reduced inflammation and fibrosis in an E2-induced rat model of endometriosis and remains effective under menopause-mimicking conditions

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BACKGROUND: Endometriosis is an estrogen-dependent inflammatory disorder marked by ectopic lesions, chronic pelvic inflammation, and frequent recurrence. Extracorporeal shock wave therapy (ESWT) is a non-invasive modality with anti-inflammatory and regenerative potential, but its efficacy under varying estrogen conditions remains unclear. METHODS: were assessed. Inflammatory and fibrotic markers were analyzed as follows: transforming growth factor beta (TGF-β) and tumor necrosis factor-alpha (TNF-α) were evaluated by both immunohistochemistry (IHC) and quantitative real-time RT-PCR (qRT-PCR), whereas interleukin (IL)-6, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), cyclooxygenase (COX)-2, vascular endothelial growth factor (VEGF), cytokeratin (CK)-18, superoxide dismutase (SOD), inducible nitric oxide synthase (iNOS), and hypoxia-inducible factor-1 alpha (HIF-1α) were assessed by qRT-PCR only. RESULTS: levels, whereas OVX resulted in reduced serum estrogen levels. These effects were also observed under menopause-mimicking conditions with controlled estrogen exposure. These findings suggest that ESWT may serve as a complementary non-hormonal adjunctive approach and may provide a useful experimental framework for future mechanistic and preclinical studies.