Endometriosis is a chronic inflammatory disorder affecting approximately 10% of reproductive-age women, yet non-hormonal therapeutic options remain limited. This study investigates the role of the TLR4/NF-κB/NLRP3 inflammasome axis in endometriosis pathogenesis and evaluates the therapeutic potential of pharmacologic TLR4 inhibition. Ectopic endometriotic tissues, eutopic endometrium, and peritoneal fluid were collected from 15 patients with ovarian endometriosis and 15 control subjects. The endometriotic epithelial cell line 11Z was stimulated with LPS and ATP with or without the TLR4 inhibitor TAK-242. A murine endometriosis model was established in wild-type C57BL/6 and TLR4⁻/⁻ mice treated with TAK-242. Expression of TLR4, p-p65, NLRP3, caspase-1, cleaved caspase-1 (p20), GSDMD-N, IL-1β, PCNA, and CD31 was assessed by qPCR, Western blot, IHC, and ELISA. Ectopic lesions showed significantly elevated TLR4/NF-κB/NLRP3/IL-1β signaling compared with eutopic and control endometrium (all p < 0.05). Peritoneal fluid IL-1β was increased in patients, indicating a localized pelvic inflammatory response. In vitro, TAK-242 suppressed LPS/ATP-induced NF-κB/NLRP3 activation, pyroptosis, and IL-1β secretion (p < 0.05). Furthermore, the NLRP3-specific inhibitor MCC950 confirmed the essential role of NLRP3 inflammasome activation in IL-1β maturation. In vivo, TLR4 deletion or TAK-242 treatment reduced lesion weight, PCNA proliferation, and CD31 microvessel density (all p < 0.05). TLR4 inhibition blocks NF-κB nuclear translocation and subsequent inflammasome activation, suggesting a potential role in attenuating inflammation and angiogenesis. The TLR4/NF-κB/NLRP3 axis may drive endometriosis progression by linking innate immunity, inflammasome activation, pyroptosis, with possible involvement in angiogenesis warranting further investigation. Pharmacological inhibition of TLR4 attenuates lesion growth, supporting TLR4 as a promising non-hormonal therapeutic target for endometriosis.

Surgery represents a primary treatment option in selected cases of bowel endometriosis (BE), particularly in patients with significant symptoms or those unresponsive to medical therapy, and effectively improves patients’ quality of life (QoL). This study compared postoperative clinical outcomes between conservative (shaving/disc excision) and radical (segmental resection) surgical approaches for bowel endometriosis, and provided supplementary real‑world evidence. This prospective cohort study enrolled patients who underwent surgery for bowel endometriosis between February 2023 and September 2023. A university-affiliated hospital. A total of 33 patients were initially recruited; 2 patients were lost to follow-up, and 31 patients were finally included for analysis. Patients underwent bowel lesion shaving, disc excision or segmental resection and anastomosis, with surgical strategies individualized according to disease conditions. Postoperative outcomes included complication rates, improvement in clinical symptoms, recovery of gastrointestinal function, and postoperative recurrence rate. Patients were followed up at 6, 12, 18, and 24 months post-surgery. Gastrointestinal function was evaluated using the Gastrointestinal Quality of Life Index (GIQLI). Consistent with previous evidence, both conservative and radical surgery yielded significant and comparable improvements in pelvic symptoms and QoL, with stable effects during the 2-year follow-up (all P >0.05). Low complication and recurrence rates were observed in both groups. Both surgical strategies achieve favorable clinical benefits for bowel endometriosis. No obvious intergroup superiority was confirmed, and surgical selection should be individualized based on lesion characteristics.

Background: Endometrial polyps (EPs) and non-atypical endometrial hyperplasia (EH) frequently cause abnormal uterine bleeding in reproductive-aged women. While hysteroscopy resects macroscopic lesions, postoperative recurrence is prevalent; progestogen therapy may mitigate recurrence. This study compared efficacy and safety of postoperative dydrogesterone, LNG-IUS and observation alone. Methods: A retrospective cohort study of 236 patients (18–46 years, Wuxi Eighth People’s Hospital, 2022.01–2025.02) with pathologically confirmed isolated EP, isolated simple EH or mixed lesions was conducted. Patients with preoperative hormone exposure within 3 months and concurrent AUB-related uterine/cervical disorders were excluded. Patients were grouped into observation ( n = 83), oral dydrogesterone (10 mg twice daily, days 10–23 of each cycle for 3 cycles, n = 128) and LNG-IUS ( n = 25). The primary endpoint was histologically confirmed recurrence at 6 and 12 months; secondary endpoints were symptom relief and adverse events. Multivariate logistic regression was used to identify independent predictors of recurrence. Results: Baseline BMI differed across groups ( P = 0.044, with the highest in LNG-IUS group). The 12-month symptomatic improvement rate was 87.9% (observation), 96.8% (dydrogesterone) and 96.0% (LNG-IUS, P = 0.030). Six‑month recurrence rates were 12.0%, 1.6%, 4.0% ( P = 0.005); 12‑month recurrence rates were 22.9%, 9.4%, 4.0% ( P = 0.007). For mixed lesions, the 12‑month recurrence rate was 40.0%, 11.1%, 0% ( P = 0.019) in the observation, dydrogesterone, and LNG-IUS groups, respectively. Dydrogesterone was independently associated with lower recurrence (OR = 0.114, 95%CI 0.024–0.536, P = 0.006), though this estimate should be interpreted cautiously due to the small sample size. Higher BMI was a significant predictor of increased recurrence (OR = 1.206, 95%CI 1.016–1.432, P = 0.033). Conclusions: Postoperative dydrogesterone effectively reduces 12‑month recurrence and is well tolerated for reproductive-aged patients. Mixed histology and higher BMI identify high-risk candidates for progestogen prophylaxis. LNG-IUS showed a descriptively lower recurrence rate, but the small sample size ( n = 25) precludes definitive conclusions, and these findings should be considered exploratory.