ENDOMETRIOSIS AND VTE: A REVIEW OF THE EVIDENCE AND PATHOPHYSIOLOGICAL MECHANISMS
Abstract
Introduction and objective: Endometriosis is a chronic inflammatory condition affecting approximately 10% of women of reproductive age. Venous thromboembolism (VTE) is a major cause of mortality worldwide. Because the relationship between endometriosis and VTE is not well-defined, we conducted a review of studies that assessed the occurrence of VTE in women with endometriosis.
Review methods: A structured PubMed search was conducted to identify studies published between January 2015 and April 2025 assessing the risk of VTE in patients with endometriosis. Seven studies met the inclusion criteria after screening for relevance and exclusion of case reports.
Abbreviated description of the state of knowledge: Some large-scale studies suggest an elevated VTE risk in women with endometriosis, particularly in younger individuals, during pregnancy, or when using hormonal therapy. However, results vary due to differences in study design, diagnostic definitions, and confounder adjustment. Pathophysiologically, endometriosis-related inflammation, hormonal influences, and endothelial dysfunction may contribute to a prothrombotic state.
Summary: The association between endometriosis and VTE remains unclear; biologically plausible mechanisms and clinical patterns suggest it may be relevant in certain populations. Future research should focus on well-characterized, prospective studies. Clinicians should remain alert to thrombotic risk in women with endometriosis, especially when additional risk factors are present.
References
Giudice, L. C., & Kao, L. C. (2004). Endometriosis. Lancet (London, England), 364(9447), 1789–1799. https://doi.org/10.1016/S0140-6736(04)17403-5
Shafrir, A. L., Farland, L. V., Shah, D. K., Harris, H. R., Kvaskoff, M., Zondervan, K., & Missmer, S. A. (2018). Risk for and consequences of endometriosis: A critical epidemiologic review. Best practice & research. Clinical obstetrics & gynaecology, 51, 1–15. https://doi.org/10.1016/j.bpobgyn.2018.06.001
Sinaii, N., Plumb, K., Cotton, L., Lambert, A., Kennedy, S., Zondervan, K., & Stratton, P. (2008). Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertility and sterility, 89(3), 538–545. https://doi.org/10.1016/j.fertnstert.2007.03.069
Taylor, H. S., Kotlyar, A. M., & Flores, V. A. (2021). Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet (London, England), 397(10276), 839–852. https://doi.org/10.1016/S0140-6736(21)00389-5
Naess, I. A., Christiansen, S. C., Romundstad, P., Cannegieter, S. C., Rosendaal, F. R., & Hammerstrøm, J. (2007). Incidence and mortality of venous thrombosis: a population-based study. Journal of thrombosis and haemostasis : JTH, 5(4), 692–699. https://doi.org/10.1111/j.1538-7836.2007.02450.x
Brækkan, S. K., & Hansen, J.-B. (2023). VTE epidemiology and challenges for VTE prevention at the population level. Thrombosis Update, 10, Article 100132. https://doi.org/10.1016/j.tru.2023.100132
Waheed, S. M., Kudaravalli, P., & Hotwagner, D. T. (2023). Deep vein thrombosis. StatPearls Publishing.
Kumar, D. R., Hanlin, E., Glurich, I., Mazza, J. J., & Yale, S. H. (2010). Virchow's contribution to the understanding of thrombosis and cellular biology. Clinical medicine & research, 8(3-4), 168–172. https://doi.org/10.3121/cmr.2009.866
Zhang, W., Liu, X., Cheng, H., Yang, Z., & Zhang, G. (2018). Risk factors and treatment of venous thromboembolism in perioperative patients with ovarian cancer in China. Medicine, 97(31), e11754. https://doi.org/10.1097/MD.0000000000011754
Mammen E. F. (1992). Pathogenesis of venous thrombosis. Chest, 102(6 Suppl), 640S–644S. https://doi.org/10.1378/chest.102.6_supplement.640s
Li, N., Huang, J., Feng, Y., Yan, H., Min, S., & Chen, X. (2024). Association Between Systemic Immune Inflammation Indexes and DVT in Patients With Malignancy Requiring PICC Insertion. Biological research for nursing, 26(4), 518–525. https://doi.org/10.1177/10998004241252468
Beckman, M. G., Hooper, W. C., Critchley, S. E., & Ortel, T. L. (2010). Venous thromboembolism: a public health concern. American journal of preventive medicine, 38(4 Suppl), S495–S501. https://doi.org/10.1016/j.amepre.2009.12.017
De Corte, P., Milhoranca, I., Mechsner, S., Oberg, A. S., Kurth, T., & Heinemann, K. (2025). Unravelling the Causal Relationship between Endometriosis and the Risk for Developing Venous Thromboembolism: A Pooled Analysis. Thrombosis and haemostasis, 125(4), 385–394. https://doi.org/10.1055/a-2407-9498
Nassiri Kigloo, H., Mai, V., Suarthana, E., Tulandi, T., & Provencher, S. (2025). Polycystic Ovary Syndrome, Endometriosis, and Venous Thromboembolism: A Population-Based Study. Gynecologic and obstetric investigation, 1–8. Advance online publication. https://doi.org/10.1159/000545518
Epelboin, S., Labrosse, J., Fauque, P., Levy, R., Gervoise-Boyer, M. J., Devaux, A., Bergère, M., de Vienne, C., Jonveaux, P., De Mouzon, J., & Pessione, F. (2021). Endometriosis and assisted reproductive techniques independently related to mother-child morbidities: a French longitudinal national study. Reproductive biomedicine online, 42(3), 627–633. https://doi.org/10.1016/j.rbmo.2020.11.017
Sugiura-Ogasawara, M., Ebara, T., Matsuki, T., Yamada, Y., Omori, T., Matsumoto, Y., Kato, S., Kano, H., Kurihara, T., Saitoh, S., Kamijima, M., & the Japan Environment & Children's Study (JECS) Group (2019). Endometriosis and Recurrent Pregnancy Loss as New Risk Factors for Venous Thromboembolism during Pregnancy and Post-Partum: The JECS Birth Cohort. Thrombosis and haemostasis, 119(4), 606–617. https://doi.org/10.1055/s-0039-1677733
Stewart, K. A., Tessier, K. M., & Lebovic, D. I. (2022). Comparing Characteristics of and Postoperative Morbidity after Hysterectomy for Endometriosis versus other Benign Indications: A NSQIP Study. Journal of minimally invasive gynecology, 29(7), 884–890.e2. https://doi.org/10.1016/j.jmig.2022.04.009
Mottais-Cosnefroy, V., Pecourt, M., Yannoutsos, A., Fels, A., Beaussier, H., Alran, S., Priollet, P., & Hugon-Rodin, J. (2022). Hormone-dependent gynaecological disorders and contraceptive modalities in women with a history of venous thromboembolic event: The THROMBOGYN study. Journal de medecine vasculaire.., 47(5-6), 228–237. https://doi.org/10.1016/j.jdmv.2022.10.015
Wiegers, H. M. G., Scheres, L. J. J., Tahir, L., Hutten, B. A., Middeldorp, S., & Mijatovic, V. (2022). Risk of venous thromboembolism in women with endometriosis. Thrombosis research, 217, 104–106. https://doi.org/10.1016/j.thromres.2022.07.014
Lidegaard, Ø., Løkkegaard, E., Svendsen, A. L., & Agger, C. (2009). Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ (Clinical research ed.), 339, b2890. https://doi.org/10.1136/bmj.b2890
van Hylckama Vlieg, A., Helmerhorst, F. M., Vandenbroucke, J. P., Doggen, C. J., & Rosendaal, F. R. (2009). The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ (Clinical research ed.), 339, b2921. https://doi.org/10.1136/bmj.b2921
Lidegaard, O., Nielsen, L. H., Skovlund, C. W., & Løkkegaard, E. (2012). Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ (Clinical research ed.), 344, e2990. https://doi.org/10.1136/bmj.e2990
Dunselman, G. A., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D'Hooghe, T., De Bie, B., Heikinheimo, O., Horne, A. W., Kiesel, L., Nap, A., Prentice, A., Saridogan, E., Soriano, D., Nelen, W., & European Society of Human Reproduction and Embryology (2014). ESHRE guideline: management of women with endometriosis. Human reproduction (Oxford, England), 29(3), 400–412. https://doi.org/10.1093/humrep/det457
Meknas, D., Brækkan, S. K., Hansen, J. B., & Morelli, V. M. (2023). Surgery As a Trigger for Incident Venous Thromboembolism: Results from a Population-Based Case-Crossover Study. TH open : companion journal to thrombosis and haemostasis, 7(3), e244–e250. https://doi.org/10.1055/a-2159-9957
Smeets, M. J. R., Touw, C. E., Rosendaal, F. R., Nemeth, B., & Cannegieter, S. C. (2023). The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study. Journal of thrombosis and haemostasis : JTH, 21(4), 975–982. https://doi.org/10.1016/j.jtha.2022.11.035
Esmon C. T. (2003). Inflammation and thrombosis. Journal of thrombosis and haemostasis : JTH, 1(7), 1343–1348. https://doi.org/10.1046/j.1538-7836.2003.00261.x
Rana, N., Braun, D. P., House, R., Gebel, H., Rotman, C., & Dmowski, W. P. (1996). Basal and stimulated secretion of cytokines by peritoneal macrophages in women with endometriosis. Fertility and sterility, 65(5), 925–930.
Pircher, J., Merkle, M., Wörnle, M., Ribeiro, A., Czermak, T., Stampnik, Y., Mannell, H., Niemeyer, M., Vielhauer, V., & Krötz, F. (2012). Prothrombotic effects of tumor necrosis factor alpha in vivo are amplified by the absence of TNF-alpha receptor subtype 1 and require TNF-alpha receptor subtype 2. Arthritis research & therapy, 14(5), R225. https://doi.org/10.1186/ar4064
van Aken, B. E., Reitsma, P. H., & Rosendaal, F. R. (2002). Interleukin 8 and venous thrombosis: Evidence for a role of inflammation in thrombosis. British Journal of Haematology, 116(1), 173–177. https://doi.org/10.1046/j.1365-2141.2002.03245.x
May, K. E., Conduit-Hulbert, S. A., Villar, J., Kirtley, S., Kennedy, S. H., & Becker, C. M. (2010). Peripheral biomarkers of endometriosis: a systematic review. Human reproduction update, 16(6), 651–674. https://doi.org/10.1093/humupd/dmq009
Nisenblat, V., Prentice, L., Bossuyt, P. M., Farquhar, C., Hull, M. L., & Johnson, N. (2016). Combination of the non-invasive tests for the diagnosis of endometriosis. The Cochrane database of systematic reviews, 7(7), CD012281. https://doi.org/10.1002/14651858.CD012281
Smyk, J. M., Danielecka, Z., Kotowska, M., Zawadka, M., Andruszkiewicz, P., Grąt, M., Główczyńska, R., Grabowski, M., Gąsecka, A., & Romejko‑Wolniewicz, E. (2024). Cardiovascular risks and endothelial dysfunction in reproductive‑age women with endometriosis. Scientific Reports, 14(1), Article 24127. https://doi.org/10.1038/s41598-024-73841-7
Viganò, P., Ottolina, J., Sarais, V., Rebonato, G., Somigliana, E., & Candiani, M. (2018). Coagulation Status in Women With Endometriosis. Reproductive sciences (Thousand Oaks, Calif.), 25(4), 559–565. https://doi.org/10.1177/1933719117718273
Ottolina, J., Bartiromo, L., Dolci, C., Salmeri, N., Schimberni, M., Villanacci, R., Viganò, P., & Candiani, M. (2020). Assessment of Coagulation Parameters in Women Affected by Endometriosis: Validation Study and Systematic Review of the Literature. Diagnostics (Basel, Switzerland), 10(8), 567. https://doi.org/10.3390/diagnostics10080567
Views:
5
Downloads:
2
Copyright (c) 2025 Julia Dura, Julia Ciechanowicz, Stanisław Ciechanowicz, Marika Gutowska, Piotr Kupidłowski, Agata Nowacka, Adrianna Perzanowska, Aleksandra Przybylska, Zuzanna Tomaszewska, Anna Zielińska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
