Menstrual Effluent in the Pathogenesis and Diagnosis of Endometriosis: A Systematic Review
Watrowski R, Kostov S, Tsoneva E, et al.Diagnostics · 2026DOI 10.3390/diagnostics16050677
In plain language
A systematic review of 35 studies, published from 1990 to 2025, that analyzed menstrual effluent or cells grown from it in women with and without endometriosis. Menstrual effluent consistently reflected core features of the disease, such as impaired decidualization and immune changes, and nine studies reported diagnostic accuracy, led by aromatase mRNA (AUC 0.977), TGF-β1 (AUC 0.973) and a decidualization assay (AUC 0.92).
Key numbers
- 35
- Studies included, 1990 to 2025
- 9
- Studies reporting diagnostic accuracy
- AUC 0.977
- Aromatase mRNA, the strongest single marker
What it means
The evidence that menstrual effluent mirrors the endometrium in endometriosis is consistent across many groups and methods. The diagnostic numbers look promising, but none has yet been tested in a prospective group.
What it does not show
Every diagnostic study was case-control, most were small and at high risk of bias in patient selection, and none included prospective validation. Methods ranged from live cell culture to dried blood spots, so results are hard to compare.
How to cite
Watrowski R, Kostov S, Tsoneva E, Schäfer SD, Sparić R, Palumbo M, et al. Menstrual Effluent in the Pathogenesis and Diagnosis of Endometriosis: A Systematic Review. Diagnostics. 2026;16(5):677. doi:10.3390/diagnostics16050677