Fig. 3

The endocannabinoid system in endometriosis pathophysiology. EMS has been associated with endocannabinoid dysregulation and deficiency that contributes to increased pain sensitivity, compromised decidualization, infertility, and related complications. Endometriotic lesions produce differential levels of endocannabinoids (ECs) but their role in disease progression versus bystander effect is not entirely known. In vivo studies have shown that synthetic cannabinoids and some ECs (palmitoylethanolamide-PEA) have anti-inflammatory effects and inhibit the proliferation of endometriosis (EMS)-like lesions in mice