Natural bioactive compounds and herbal medicines targeting common signaling pathways in endometriosis: mechanisms and therapeutic implications.

For a very long time, herbal treatments have served as remedies for various humans and animals. Natural compounds typically have multiple pharmacological actions because they interact with various biological targets. This characteristic could be exploited to effectively treat disorders with complex physiopathological causes, such as endometriosis. Endometriosis is the proliferation, infiltration, and recurrent bleeding of endometrioid tissue, including stroma and glands, outside the uterine cavity, forming nodules or masses. It affects women of reproductive age and is characterized by persistent inflammation and estrogen dependence, significantly impacting patients' quality of life. Although the precise pathogenic mechanisms remain unclear, current treatments mainly include medication and surgery. Pharmacotherapy typically relies on nonsteroidal anti-inflammatory drugs and hormonal agents, which may cause adverse effects such as gastrointestinal disturbances, hepatic and renal dysfunction, and thrombosis when used as a long-term treatment. Surgical removal of lesions is possible but often followed by recurrence rates of 21.5% after 2 years and up to 50% within 5 years. Therefore, alternative or complementary therapeutic approaches are urgently needed. This review summarizes current evidence on bioactive plant extracts, both crude and refined, and their mechanisms of action against endometriosis, highlighting their multi-target therapeutic potential and underscoring the need for further pre-clinical and clinical studies to develop effective, safer natural treatment strategies.