Endometriosis as a fibroinflammatory disease: enzyme therapy in comprehensive management. An Expert Council Resolution

This Resolution was prepared following the Expert Council meeting entitled «Endometriosis as a Fibro-Inflammatory Disease: The Role of Enzyme Therapy in the Comprehensive Management of Endometriosis-Associated Conditions,» held on June 3, 2026, at the V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, as part of the XXIX International Congress «New Technologies in the Diagnosis and Treatment of Gynecological Diseases» with an International Course in Endoscopy. The document summarizes current evidence on the clinical heterogeneity of endometriosis, the mechanisms underlying inflammation, fibrogenesis, and postoperative adhesion formation, and addresses surgical and conservative treatment, chronic endometritis, endometriosis-associated infertility, and preparation for assisted reproductive technology programs. Following the discussion, the Expert Council noted the pathophysiological rationale for including bovhyaluronidase azoximer in the comprehensive treatment of endometriosis and associated conditions. Experimental and clinical evidence supports considering enzyme therapy as a promising adjunct to surgical and hormonal treatment targeting the inflammatory, fibrotic, and adhesive components of the disease. Potential areas of its application include postoperative management, pelvic adhesions, and concomitant chronic inflammatory diseases of the pelvic organs.