Endometriosis and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis.
Compton, Sabrina, Alkabalan, Rodolf, Cadet, Judd et al. · Diagnostics (Basel, Switzerland) · 2025 · DOI
Quick Summary
This research found that women with endometriosis (a painful condition affecting the uterus) are nearly three times more likely to develop ME/CFS than women without endometriosis. Both conditions involve similar patterns of immune system problems and ongoing inflammation. The study combined results from multiple research papers to show this connection is real and consistent across different groups of patients.
Why It Matters
This study provides epidemiological evidence that ME/CFS and endometriosis frequently co-occur, suggesting clinicians should screen for comorbidity and consider shared inflammatory mechanisms in treatment planning. For researchers, the findings support investigation of common pathophysiological pathways and may guide development of integrated care models for patients experiencing both conditions.
Observed Findings
Women with endometriosis had 2.79-fold higher odds of developing ME/CFS (95% CI: 2.00-3.89) in a meta-analysis of five studies with 2,261 participants.
A separate meta-analysis of two studies found a pooled odds ratio of 2.52 (95% CI: 2.45-2.60, p<0.001) for the ME/CFS-endometriosis association.
Minimal statistical heterogeneity was detected across meta-analyses (I²=0.0%), suggesting consistent effect sizes across studies.
Thirteen studies met inclusion criteria for systematic review from an initial screening of 236 records.
Inferred Conclusions
A significant bidirectional association exists between endometriosis and ME/CFS, likely driven by shared immune dysregulation and chronic inflammation.
Clinical vigilance for comorbidity screening is warranted despite methodological heterogeneity across source studies.
Integrated care approaches addressing overlapping symptomatology in both conditions are needed.
Future research with standardized diagnostic criteria is essential to elucidate whether these associations reflect shared causal pathways or common upstream mechanisms.
Remaining Questions
What specific immune dysregulation mechanisms are shared between endometriosis and ME/CFS, and do they represent causal pathways or independent consequences of common risk factors?
What This Study Does Not Prove
This study demonstrates association but cannot establish causation—it does not prove that endometriosis causes ME/CFS or vice versa. The authors acknowledge high heterogeneity across studies and emphasize that standardized diagnostic criteria are needed to clarify whether these conditions share causal mechanisms or are independently linked to common risk factors.