Endometriosis in young women and trans men: impact beyond pain and new therapeutic approaches – a systematic review

Abstract

Introduction: Endometriosis is a chronic, estrogen-dependent inflammatory condition that primarily affects women of childbearing age, defined by the presence of endometrial implants (gland and/or stroma) outside the uterus, predominantly, but not exclusively, in the female pelvis. However, recent literature shows that the disease can also affect transgender men and transmasculine individuals who retain internal reproductive organs, a population that is frequently underdiagnosed and invisible in healthcare services. This endometrial tissue can affect various regions outside the uterine cavity, such as the ovaries, peritoneum, uterosacral ligaments, retrocervical region, rectovaginal septum, rectum/sigmoid colon, terminal ileum, appendix, bladder, and ureters. Objective: To understand the impacts of endometriosis on young women, including transgender men, reporting the main therapeutic approaches to improve quality of life. Methodology: This work was a qualitative, exploratory, and descriptive literature review. A bibliographic survey was conducted, in which the study was developed and based on scientific research, using books, monographs, and scientific articles accessible in scientific journals, virtual libraries, and book collections, using standardized descriptors in the databases. Articles published between 2019 and 2025 were analyzed. Results: This work analyzed the impacts of endometriosis on young women and transgender men, with emphasis on available treatments and their implications for quality of life. The results indicated that endometriosis mainly affects individuals between 20 and 35 years of age, with diagnosis frequently delayed and hampered by socioeconomic factors. In the case of transgender men, these difficulties are amplified by institutional barriers, prejudice, and lack of preparedness among healthcare professionals. Innovative therapies, such as vitamin and antioxidant supplementation, acupuncture, and the use of new technologies like artificial intelligence and therapeutic nanoparticles, have proven effective in relieving symptoms and improving quality of life. However, access to these therapies remains limited due to financial issues and a lack of public policies that guarantee equity in treatment. The relationship between endometriosis and infertility was also highlighted, with hormonal treatments and assisted reproductive techniques showing good results in restoring fertility. Conclusion: Endometriosis has a significant impact on the lives of young women and transgender men, affecting quality of life, reproductive health, and psychological well-being. Conventional treatments, such as GnRH agonists and progestogens, have demonstrated efficacy, but with limitations related to side effects. Therapeutic alternatives, such as nutritional supplements, acupuncture, and new technologies like artificial intelligence in diagnosis and therapeutic nanoparticles, show promising results in relieving symptoms. However, access to these approaches remains a challenge, especially for vulnerable populations, due to financial, social, and institutional barriers, highlighting the need for inclusive and equitable public policies.