Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.

Vitamin D (VD) is a fat-soluble steroid hormone with essential physiological functions beyond calcium and bone metabolism. In recent years, its role in women’s reproductive health has gained attention, influencing ovarian function, follicular development, endometrial receptivity, and steroid hormone regulation. VD deficiency has been linked to reproductive disorders such as polycystic ovarian syndrome (PCOS), endometriosis, and infertility. Studies indicate that up to 40–50% of healthy pregnant women have insufficient VD levels, which may contribute to adverse pregnancy outcomes and reduced fertility. With growing evidence connecting VD to reproductive health, this review examines its molecular and endocrine mechanisms in fertility, endometriosis, and PCOS. It explores VD’s therapeutic potential and its implications for improving clinical approaches and future research in reproductive medicine. Maintaining adequate VD levels is crucial for ovarian function, immune modulation in reproductive tissues, and overall fertility. Its deficiency is associated with insulin resistance, hormonal imbalances, and inflammatory processes, which contribute to reproductive pathophysiology. Establishing reference values for VD in reproductive medicine is essential for optimizing fertility treatments and improving clinical outcomes. This review synthesizes current research on VD’s role in reproductive health and highlights the need for further investigation into its therapeutic applications.

Vitamin D (VD) is a fat-soluble steroid hormone with crucial physiological functions beyond calcium and bone metabolism. In recent years, the role of VD in women’s reproductive health has garnered significant attention. It has been implicated in ovarian function, follicular development, endometrial receptivity, and the regulation of steroid hormone production. VD deficiency has been associated with a range of reproductive health disorders, including Polycystic Ovarian Syndrome (PCOS), endometriosis, and infertility. Studies indicate that up to 40-50% of healthy pregnant women exhibit deficient serum VD levels, which may be linked to adverse pregnancy outcomes and impaired fertility. VD plays a key role in regulating ovarian function, promoting proper follicular development, and modulating the immune response in reproductive tissues. Its deficiency has been linked to insulin resistance, hormonal imbalances, and inflammatory processes, all of which contribute to the pathophysiology of reproductive disorders. This review synthesizes current research on VD's therapeutic potential in managing these disorders and enhancing fertility outcomes, emphasizing the importance of maintaining adequate VD levels for optimal reproductive health. Understanding the reference values for VD in reproductive medicine is essential for optimizing fertility treatments and improving clinical outcomes in women with reproductive health disorders.

Endometriosis is a systemic, estrogen dependent neuroinflammatory-mediated disease affecting approximately 10–15% of women of reproductive age. Clinical manifestations include chronic pelvic pain (CPP), dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility. Endometriosis-associated pain is multifactorial and comprises overlapping nociceptive, neuropathic, and nociplastic pain phenotypes driven by persistent inflammation, neuroangiogenesis, peripheral nerve involvement, and central sensitization (CS). These mechanisms may sustain pain beyond lesion excision, highlighting the importance of pelvic nervous system (PNS) involvement. This narrative review examines the role of neuropelveology (NP) in endometriosis, focusing on pain mechanisms, diagnostic implications, and surgical decision making. NP integrates pelvic neuroanatomy and neurophysiology into structured neurological assessment, pain mapping, symptom localization, and nerve sparing surgery. Current evidence suggests that NP may complement conventional evaluation in selected patients with refractory pain, neuropathic symptoms, discordance between symptom severity and imaging findings, or suspected involvement of the sacral plexus or sciatic nerve. Recognizing distinct pain phenotypes may support individualized treatment planning by balancing lesion excision with neural preservation and identifying patients who may benefit from multidisciplinary pain management, rehabilitation, neurolysis, or neuromodulation. Although current evidence remains limited, NP should be considered a complementary framework rather than a replacement for established endometriosis management. Prospective multicenter studies using standardized diagnostic criteria and long-term functional outcomes are needed to define its clinical utility.

Endometriosis is a systemic, estrogen dependent neuroinflammatory-mediated disease affecting approximately 10-15% of women of reproductive age. Clinical manifestations include chronic pelvic pain (CPP), dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility. Endometriosis-associated pain is multifactorial and comprises overlapping nociceptive, neuropathic, and nociplastic pain phenotypes driven by persistent inflammation, neuroangiogenesis, peripheral nerve involvement, and central sensitization (CS). These mechanisms may sustain pain beyond lesion excision, highlighting the importance of pelvic nervous system (PNS) involvement. This narrative review examines the role of neuropelveology (NP) in endometriosis, focusing on pain mechanisms, diagnostic implications, and surgical decision making. NP integrates pelvic neuroanatomy and neurophysiology into structured neurological assessment, pain mapping, symptom localization, and nerve sparing surgery. Current evidence suggests that NP may complement conventional evaluation in selected patients with refractory pain, neuropathic symptoms, discordance between symptom severity and imaging findings, or suspected involvement of the sacral plexus or sciatic nerve. Recognizing distinct pain phenotypes may support individualized treatment planning by balancing lesion excision with neural preservation and identifying patients who may benefit from multidisciplinary pain management, rehabilitation, neurolysis, or neuromodulation. Although current evidence remains limited, NP should be considered a complementary framework rather than a replacement for established endometriosis management. Prospective multicenter studies using standardized diagnostic criteria and long-term functional outcomes are needed to define its clinical utility.