Endometriosis: an update (the Postcript to the 13th Congress of the Asian Society of Endometriosis, Colombo, Sri Lanka, October 31 - November 3, 2025)

Endometriosis is a chronic, estrogen-dependent inflammatory disease that affects approximately 10% of women of reproductive age worldwide and is associated with pelvic pain, infertility, and significant comorbidity. Despite more than a century of research, its pathogenesis, optimal diagnostic pathways, and long-term management strategies remain incompletely understood. Aim. To summarize and critically appraise recent advances in the understanding, diagnosis, and management of endometriosis, based on key findings presented at the 13th Congress of the Asian Society of Endometriosis (ACE- 2025). Materials and Methods. This mini-review is based on an analysis of scientific presentations, program abstracts, and selected recent publications discussed during ACE-2025, with integration of epidemiological, genetic, molecular, diagnostic, and therapeutic evidence. Results. Recent data reinforce the concept of endometriosis as a systemic, inflammatory, and fibrotic disorder with substantial heterogeneity. Large population studies confirm prolonged diagnostic delay, high multimorbidity, and significant reproductive impact. Advances in genomics, including genome-wide association studies and polygenic risk score analyses, demonstrate shared genetic architecture with several comorbid conditions. Pathophysiological insights highlight the central roles of estrogen dominance, progesterone resistance, immune dysregulation, and fibrosis. Diagnostic progress includes expert-guided ultrasound, MRI, and emerging multimarker approaches. Therapeutically, long-term medical management has become central, with extended GnRH analogue therapy using add-back regimens and dual progestin systems providing effective options for refractory pain. Special considerations in adolescents and infertility management emphasize early intervention and fertility preservation. Conclusion. Endometriosis care is undergoing a paradigm shift toward personalized, multidisciplinary, and long-term management. Continued integration of molecular research with clinical practice is essential to improve outcomes and quality of life for affected women.