Obesity, endometriosis, and GLP-1 receptor agonists: A narrative review

Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting approximately 10% of women of reproductive age and is one of the leading causes of chronic pelvic pain and infertility. The relationship between obesity and endometriosis remains controversial. Although epidemiological studies indicate that endometriosis is diagnosed less frequently in women with a higher body mass index (BMI), excessive adipose tissue may promote disease progression through hormonal disturbances, chronic inflammation, and altered metabolic activity of adipose tissue. This review summarizes the current evidence regarding the mechanisms linking obesity and endometriosis and discusses the potential role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of this disease. In addition to their well-established efficacy in the management of obesity and type 2 diabetes, GLP-1RAs have been shown to promote weight loss, improve metabolic parameters, and reduce chronic inflammation. Available experimental and observational evidence suggests that these mechanisms may indirectly influence the course of endometriosis by modulating the chronic inflammation and the metabolic disturbances associated with obesity. To date, no randomized clinical trials have evaluated the efficacy of GLP-1 receptor agonists in women with endometriosis, and most of the available evidence is derived from preclinical studies, observational studies, and analyses conducted in patients with polycystic ovary syndrome (PCOS). Current evidence suggests that GLP-1RAs represent a promising area of research; however, their role in the treatment of endometriosis requires confirmation in well-designed clinical trials.