Inflammation, estrogen, and matrix remodeling in female reproductive health: from crosstalk mechanisms to translational diagnostics

The female reproductive system is a hormonally driven, immune-active, and structurally dynamic system in which estrogen signaling, inflammation, and extracellular matrix (ECM) remodeling interact to support essential reproductive processes. Cyclical changes in hormone levels, inflammation, and ECM turnover are essential for normal physiology, but dysregulation of these processes can give rise to chronic inflammation, fibrosis, and dysfunction across multiple reproductive tissues. Chronic immune activation, abnormal estrogen signaling, and maladaptive ECM remodeling engage in positive feedback loops that drive pathologies such as endometriosis, cervicitis, uterine fibroids, and intrauterine adhesions. Integrating preclinical rodent models with clinical findings, this review synthesizes current knowledge on the individual and interconnected roles of inflammation, estrogen signaling, and ECM remodeling and highlights diagnostic tools to improve early detection and therapy. The highlight of diagnostic tools focuses on emerging non-invasive imaging modalities, particularly magnetic resonance-based techniques, for in vivo visualization and quantification of inflammation, fibrosis, and tissue biomechanics in the female reproductive system.