Международный эндокринологический журнал Том 21, №2, 2025

Актуальність. За даними Національного канцер-реєстру України, смертність від раку молочної залози (РМЗ) продовжує посідати перші місця у структурі онкологічної патології жіночого населення. Визначну роль у розвитку РМЗ може відігравати перехресний синдром (оверлап-синдром) генітального ендометріозу (ГЕ) та доброякісного захворювання молочної залози (ДЗМЗ). Мета: використовуючи дані сучасних літературних джерел, розглянути оверлап-синдром ГЕ та ДЗМЗ як передраковий патерн у розвитку РМЗ і окреслити можливі кроки вирішення проблеми. Матеріали та методи. Пошук і відбір публікацій здійснювався у базах даних PubMed та Google Scholar за такими термінами: генітальний ендометріоз, доброякісне захворювання молочної залози, мастопатія, фіброзно-кістозна дисплазія, масталгія, рак молочної залози, гормонотерапія. Результати. Переконливий зв’язок між ендометріозом і фіброзно-кістозною хворобою встановлено у фертильних жінок: поширеність ДЗМЗ у пацієнток з ендометріозом становить 36–38 %. Пілотні клінічні дослідження підтвердили, що в жінок з ендометріозом, які отримували дієногест у дозі 20 мг/добу перорально впродовж 24 тижнів, при оцінці впливу прогестагену на груди за допомогою ультразвукового дослідження спостерігалося вірогідне зменшення розмірів молочної залози (p < 0,023) та регрес мастопатичних змін. Відзначалося незначне зменшення (p = 0,089) максимального діаметра проток. На етапах розвитку оверлап-синдрому ГЕ та ДЗМЗ із підтвердженим підвищеним ризиком виникнення РМЗ формується складна патогенетична матриця, процеси у якій часто не є лінійними, а можуть відбуватися паралельно, демонструючи розмаїття і непередбачуваність біологічних подій. Високий відсоток наявності перехресного синдрому генітального ендометріозу та ДЗМЗ підтверджує думку про єдність генезу патологічних змін в органах-мішенях і синхронний розвиток доброякісних гіперпластичних процесів у них. Висновки. Розглядати гіперпластичні захворювання як генералізований процес у репродуктивній системі є доцільним, а розробка єдиної терапевтичної тактики при поєднанні гінекологічної патології з захворюваннями молочних залоз — необхідною. Оверлап-синдром ГЕ і ДЗМЗ, який є доведеним фактором підвищеного ризику РМЗ, потребує відповідальної та злагодженої командної роботи ендокринологів, мамологів і акушерів-гінекологів, яка покликана створити необхідні умови для значущого поліпшення ефективності терапії. Розробка найближчим часом алгоритму клінічного моніторингу пацієнток з оверлап-синдромом ГЕ та ДЗМЗ буде логічним і обґрунтованим кроком, адже рання діагностика РМЗ забезпечує кращі результати лікування та підвищення якості життя хворих.

Background. According to the National Cancer Registry of Ukraine, mortality from breast cancer (BC) continues to be at the first places in the structure of oncological pathology among the female population. The overlap syndrome of genital endometriosis (GE) and benign breast disease (BBD) can play a significant role in the development of BC. The purpose: using data from modern literature sources, to consider the overlap syndrome of GE and BBD as a precancerous pattern in the development of BC and outline possible steps to solve the problem. Materials and methods. The search and selection of publications was carried out in the PubMed and Google Scholar databases using the following terms: genital endometriosis, benign breast disease, mastopathy, fibrocystic dysplasia, mastalgia, breast cancer, hormone therapy. Results. A convincing link between endometriosis and fibrocystic disease has been established in fertile women: the prevalence of BBD in patients with endometriosis is 36–38 %. Pilot clinical studies have confirmed that in women with endometriosis who received dienogest at a dose of 20 mg/day orally for 24 weeks, a significant decrease in breast size (p < 0.023) and regression of mastopathic changes were observed when assessing the effect of progestogen on the breast using ultrasound. A slight decrease (p = 0.089) in the maximum diameter of the ducts was observed. At the stages of development of the overlap syndrome of GE and BBD with a confirmed increased risk of BC, a complex pathogenetic matrix is formed, the processes in which are often not linear, but can occur in parallel, demonstrating the diversity and unpredictability of biological events. The high percentage of overlap syndrome of GE and BBD confirms the idea of the unity of the origin of pathological changes in target organs and the synchronous development of benign hyperplastic processes in them. Conclusions. It is advisable to consider hyperplastic diseases as a generalized process in the reproductive system, and to develop single therapeutic tactics when gynecological pathology is combined with breast diseases. The overlap syndrome of GE and BBD, which is a proven factor of increased risk of breast cancer, requires responsible and coordinated teamwork of endocrinologists, mammologists and obstetricians-gynecologists, which is designed to create necessary conditions for a significant improvement in the effectiveness of therapy. The development in the near future of an algorithm for clinical monitoring of patients with overlap syndrome of GE and BBD will be a logical and justified step, because early diagnosis of BC provides better treatment results and an increase in the quality of life of patients.

генітальний ендометріоз; доброякісне захворювання молочної залози; оверлап-синдром; фіброзно-кістозна мастопатія; гормонотерапія; рак молочної залози; кісткові метастази; якість життя

genital endometriosis; benign breast disease; overlap syndrome; fibrocystic breast disease; hormone therapy; breast cancer; bone metastases; quality of life

1. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025 Jan-Feb;75(1):10-45. doi: 10.3322/caac.21871. Epub 2025 Jan 16. PMID: 39817679; PMCID: PMC11745215. 
2. Fedorenko ZP, Sumkina OV, Gulak LO, et al. Cancer in Ukraine 2022–2023: Incidence, mortality, prevalence, and other relevant statistics. Bull Nat Cancer Reg Ukraine. 2024:25. 
3. Neborets A, Nikolaenko S, Smolanka I, Krotevych M, Med V, Gichka S, Chekhun V. Expression Patterns of Matricellular Proteins in Metastatic Breast Cancer at the Background of Metabolic Syndrome. Experimental Oncology. 2025;46(4):333-340. https://doi.org/–10.15407/exp-oncology.2024.04.333. 
4. Burke A, O’Driscoll J, Abubakar M, Bennett KE, Carmody E, Flanagan F, Gierach GL, Mullooly M. A systematic review of determinants of breast cancer risk among women with benign breast disease. NPJ Breast Cancer. 2025 Feb 15;11(1):16. doi: 10.1038/s41523-024-00703-w. PMID: 39955290; PMCID: PMC11829998. 
5. Sherman ME, Vierkant RA, Winham SJ, Vachon CM, Carter JM, Pacheco-Spann L, Jensen MR, et al. Benign Breast Disease and Breast Cancer Risk in the Percutaneous Biopsy Era. JAMA Surg. 2024 Feb 1;159(2):193-201. doi: 10.1001/jamasurg.2023.6382. PMID: 38091020; PMCID: PMC10719829. 
6. Degnim AC, Ghosh K, Vierkant RA, Winham SJ, Hoskin TL, Carter JM, McCauley BM, et al. Changes in breast cancer risk associated with benign breast disease from 1967 to 2013. JNCI Cancer Spectr. 2025 Jan 3;9(1):pkae128. doi: 10.1093/jncics/pkae128. PMID: 39786446; PMCID: PMC11770946. 
7. Expert Panel on Breast Imaging; Klein KA, Kocher M, Lourenco AP, Niell BL, Bennett DL, Chetlen A, Freer P, et al. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. J Am Coll Radiol. 2023 May;20(5S):S146-S163. doi: 10.1016/j.jacr.2023.02.013. PMID: 37236740. 
8. Faguy K. Fibrocystic Breast Changes. Radiol Technol. 2022 Jan;93(3):303M-315M. PMID: 35017277. 
9. Ameen F, Reda SA, El-Shatoury SA, Riad EM, Enany ME, Alarfaj AA. Prevalence of antibiotic resistant mastitis pathogens in dairy cows in Egypt and potential biological control agents produced from plant endophytic actinobacteria. Saudi J Biol Sci. 2019 Nov;26(7):1492-1498. doi: 10.1016/j.sjbs.2019.09.008. Epub 2019 Sep 14. PMID: 31762615; PMCID: PMC6864200. 
10. McMullen ER, Zoumberos NA, Kleer CG. Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations. Arch Pathol Lab Med. 2019 Dec;143(12):1492-1496. doi: 10.5858/arpa.2019-0396-RA. PMID: 31765246. 
11. Hawkins SS. Barriers to Diagnosis and Innovations in Care for Endometriosis. J Obstet Gynecol Neonatal Nurs. 2025 Feb 6:S0884-2175(25)00006-1. doi: 10.1016/j.jogn.2025.01.002. 
12. Zhang B, Li SJ, Yuan H, Cong SS, Zhao SJ, Yang XJ. FOXL2 Knockdown Inhibits the Progression of Endometriosis. Am J Reprod Immunol. 2025 Jan;93(1):e70043. doi: 10.1111/aji.70043. PMID: 39776079. 
13. Liu S, Li X, Gu Z, Wu J, Jia S, Shi J, Dai Y, et al. Single-cell and spatial transcriptomic profiling revealed niche interactions sustaining growth of endometriotic lesions. Cell Genom. 2025 Jan 8;5(1):100737. doi: 10.1016/j.xgen.2024.100737. 
14. Chen Y, Waseem S, Luo L. Advances in the diagnosis and management of endometriosis: A comprehensive review. Pathol Res Pract. 2025 Feb;266:155813. doi: 10.1016/j.prp.2025.155813. 
15. Hablase R, Kyrou I, Randeva H, Karteris E, Chatterjee J. The “Road” to Malignant Transformation from Endometriosis to Endometrio–sis-Associated Ovarian Cancers (EAOCs): An mTOR-Centred Review. Cancers. 2024; 16(11):2160. https://doi.org/10.3390/cancers16112160. 
16. Coxon L, Horne AW, Vincent K. Pathophysiology of endometriosis-associated pain: A review of pelvic and central nervous system mechanisms. Best Pract Res Clin Obstet Gynaecol. 2018;51:53-67. 10.1016/j.bpobgyn.2018.01.014.  
17. Barbara G, Facchin F, Buggio L, Somigliana E, Berlanda N, Kustermann A, et al. What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature. Reprod Sci. 2017;24:1566-76. 
18. Peeri NC, Bertrand KA et al. Understanding risk factors for endometrial cancer in young women. J Natl Cancer Inst. 2025 Jan 1;117(1):76-88. doi: 10.1093/jnci/djae210. 
19. Forder BH, Ardasheva A, Atha K, Nentwich H, Abhari R, Kartsonaki C. Models for predicting risk of endometrial cancer: a systematic review. Diagn Progn Res. 2025 Feb 4;9(1):3. doi: 10.1186/s41512-024-00178-0.  
20. Gianni C et al. Hormonal Therapy In Endometriosis And Breast Cancer Risk: A Propensity Score-Matched Real-World Analysis. International Journal of Gynecological Cancer. 2025;35(2):101267. 
21. Drobotun OV, Kolotilov NN, Konovalenko VF, Konovalenko SV, Ternovyy NN. Comorbidity in oncology: modern challenges and the search for ways to solve the problem. Clinical and preventive medicine. 2024;33(3):132-141. doi: 10.31612/2616-4868.3.2024.16. 
22. Konovalenko L, Litus O, Konovalenko S. The phenomenon of neurological components prevalence in influencing the quality of life of patients with the atopic dermatitis and allergic contact dermatitis overlap syndrome in modern realities. International Neurological Journal. 2024;​20(8):422-426. https://doi.org/10.22141/2224-0713.20.8.2024.1125. 
23. McGrath IM, Montgomery GW, et al. Genomic characterisation of the overlap of endometriosis with 76 comorbidities identifies pleiotropic and causal mechanisms underlying disease risk. Internatio–nal Endometriosis Genetics Consortium. Hum. Genet. 2023;142:1345-1360. https://doi.org/10.1007/s00439-023-02582-w. 
24. Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, et al. The burden of endometriosis: costs and quali–ty of life of women with endometriosis and treated in referral centres. Hum Reprod. 2012;27:1292-9. 10.1093/humrep/des073. 
25. Vercellini P, Buggio L, Frattaruolo MP, Borghi A, Dridi D, Somigliana E. Medical treatment of endometriosis-related pain. Best Pract Res Clin Obstet Gynaecol. 2018;51:68-91. 10.1016/j.bpobgyn.2018.01.015. 
26. Patel BG, Rudnicki M, Yu J, Shu Y, Taylor RN. Progesterone resistance in endometriosis: origins, consequences and interventions. Acta Obstet Gynecol Scand. 2017;96:623-32. 10.1111/aogs.13156. 
27. Reis FM, Coutinho LM, Vannuccini S, Batteux F, Chapron C, Petraglia F. Progesterone receptor ligands for the treatment of endometriosis: the mechanisms behind therapeutic success and failure. Hum Reprod Update. 2020;26:565-85. 10.1093/humupd/dmaa009. 
28. Dworkin RH, Turk DC, McDermott MP, Peirce-Sandner S, Burke LB, Cowan P, et al. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain. 2009;146:238e44. 10.1016/j.pain.2009.08.019. 
29. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400-12. 10.1093/humrep/det457. 
30. American College of Obstetricians and Gynecologists. Mana–gement of endometriosis. ACOG practice bulletin no. 114. Obstet Gynecol. 2010;116:223-36. 10.1097/AOG.0b013e3181e8b073. 
31. Buggio L, Somigliana E, Barbara G, Frattaruolo MP, Vercellini P. Oral and depot progestin therapy for endometriosis: towards a personalized medicine. Expert Opin Pharmacother. 2017;18:1569-81. 10.1080/14656566.2017.1381086.  
32. Casper RF. Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril. 2017;107:533-6. 10.1016/j.fertnstert.2017.01.003. 
33. Berlanda N, Somigliana E, Viganò P, Vercellini P. Safety of medical treatments for endometriosis. Expert Opin Drug Saf. 2016;15:21-30. 10.1517/14740338.2016.1121991. 
34. Morotti M, Remorgida V, Venturini PL, Ferrero S. Progestogen-only contraceptive pill compared with combined oral contraceptive in the treatment of pain symptoms caused by endometriosis in patients with migraine without aura. Eur J Obstet Gynecol Reprod Biol. 2014;179:63-8. 10.1016/j.ejogrb.2014.05.016. 
35. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25:94e100. 10.1093/humrep/dep361. 
36. Kvaskoff M, Mahamat-Saleh Y, Farland LV, Shigesi N, Terry KL, Harris HR, Roman H, Becker CM, As-Sanie S, Zondervan KT, Horne AW, Missmer SA. Endometriosis and cancer: a systematic review and meta-analysis. Hum Reprod Update. 2021 Feb 19;27(2):393-420. doi: 10.1093/humupd/dmaa045. PMID: 33202017. 
37. Vercellini P, Somigliana E, Consonni D, Frattaruolo MP, De Giorgi O, Fedele L. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod. 2012;27:3450e9. 10.1093/humrep/des313. 
38. Vercellini P, Frattaruolo MP, Somigliana E, Jones GL, Consonni D, Alberico D, et al. Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: effect on sexual functioning, psychological status and health-related quality of life. Hum Reprod. 2013;28:1221e30. 10.1093/humrep/det041. 
39. Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D, et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2016;105:734e43.e3. 10.1016/j.fertnstert.2015.11.016. 
40. Morotti M, Venturini PL, Biscaldi E, Racca A, Calanni L, Vellone VG, et al. Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017;213:4e10. 10.1016/j.ejogrb.2017.03.033. 
41. Chu MC, Zhang X, Gentzschein E, Stanczyk FZ, Lobo RA. Formation of ethinyl estradiol in women during treatment with norethindrone acetate. J Clin Endocrinol Metab. 2007;92:2205e7. 10.1210/jc.2007-0044. 
42. Carr B, Dmowski WP, O’Brien C, Jiang P, Burke J, Jimenez R, et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci. 2014;21:1341e51. 10.1177/1933719114549848. 
43. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. N Engl J Med. 2017;377:28e40. 10.1056/NEJMoa1700089. 
44. Osuga Y, Seki Y, Tanimoto M, Kusumoto T, Kudou K, Tera–kawa N. Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain in a dose-response manner: a randomized, double-blind, placebo-controlled study. Fertil Steril. 2021;115:397-405. 10.1016/j.fertnstert.2020.07.055. 
45. Huang KJ, Li YX, Wu CJ, Chang WC, Wei LH, Sheu BC. Effects of Dienogest on breasts of women of reproductive age and women in menopausal transition: A cohort study. Int J Gynaecol Obstet. 2023 Sep;162(3):1114-1116. doi: 10.1002/ijgo.14930. 
46. Gao S, Sun Y, Shi H, Fang J, Liu Z. Efficacy and Safety of Acupuncture for Cyclic Mastalgia: Study Protocol for a Randomized, Sham-–Controlled Trial. Int J Womens Health. 2023 May 29;15:845-855. doi: 10.2147/IJWH.S410000. PMID: 37275513; PMCID: PMC10237189. 
47. Niazi A, Rahimi VB, Hatami H, Shirazinia R, Esmailzadeh-Dizaji R, Askari N, Askari VR. Effective Medicinal Plants in the Treatment of the Cyclic Mastalgia (Breast Pain): A Review. J Pharmacopuncture. 2019 Sep;22(3):131-139. doi: 10.3831/KPI.2019.22.017. 
48. Eremici I, Borlea A, Dumitru C, Stoian D. Breast Cancer Risk Factors among Women with Solid Breast Lesions. Clinics and Practice. 2024;14(2):473-485. https://doi.org/10.3390/clinpract14020036. 
49. Schindler AE. Dydrogesterone and other progestins in benign breast disease: an overview. Arch Gynecol Obstet. 2011 Feb;283(2):369-71. doi: 10.1007/s00404-010-1456-7. Epub 2010 Apr 11. PMID: 20383772. 
50. Shao C, Lou P, Liu R, Bi X, Li G, Yang X, Sheng X, Xu J, Lv C, Yu Z. Hormone-Responsive BMP Signaling Expands Myoepi–thelial Cell Lineages and Prevents Alveolar Precocity in Mammary Gland. Front Cell Dev Biol. 2021 Jul 15;9:691050. doi: 10.3389/fcell.2021.691050. PMID: 34336839; PMCID: PMC8320003. 
51. LE Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: Effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncol Lett. 2013 Apr;5(4):1305-1310. doi: 10.3892/ol.2013.1156. 
52. Maiorana A, Maranto M, Restivo V, Gerfo DL, Minneci G, Mercurio A, Incandela D. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024 Feb;309(2):589-597. doi: 10.1007/s00404-023-07271-7. Epub 2023 Nov 29. PMID: 38019280; PMCID: PMC10808538. 
53. Shi J, Tan X, Feng G, Zhuo Y, Jiang Z, Banda S, Wang L, Zheng W, Chen L, Yu D, Guo C. Research advances in drug therapy of endometriosis. Front Pharmacol. 2023 Jun 21;14:1199010. doi: 10.3389/fphar.2023.1199010. 
54. Choudhury S, Jena SK, Mitra S, Padhy BM, Mohakud S. Comparison of efficacy between levonorgestrel intrauterine system and dienogest in adenomyosis: a randomized clinical trial. Ther Adv Reprod Health. 2024 Jan 25;18:26334941241227401. doi: 10.1177/26334941241227401. PMID: 38283750; PMCID: PMC10812097. 
55. Etrusco A, Barra F, Chiantera V, Ferrero S, Bogliolo S, Evangelisti G, Oral E, Pastore M, Izzotti A, Venezia R, Ceccaroni M, Laganà AS. Current Medical Therapy for Adenomyosis: From Bench to Bedside. Drugs. 2023 Nov;83(17):1595-1611. doi: 10.1007/s40265-023-01957-7. Epub 2023 Oct 14. PMID: 37837497; PMCID: PMC10693526. 
56. Kim H. et al. Long-term efficacy and safety of levonorgestrel-releasing intrauterine system as a maintenance treatment for endometriosis. Medicine. 2022 March 11;101(10):e29023. doi: 10.1097/MD.0000000000029023. 
57. Langlade C, Gouverneur A, Bosco-Lévy P, Gouraud A, Pérault-Pochat MC, Béné J, Miremont-Salamé G, Pariente A; French Network of Pharmacovigilance Centres. Adverse events reported for Mirena levonorgestrel-releasing intrauterine device in France and impact of media coverage. Br J Clin Pharmacol. 2019 Sep;85(9):2126-2133. doi: 10.1111/bcp.14027. Epub 2019 Jul 31. PMID: 31218710; PMCID: PMC6710510. 
58. Moray KV, Chaurasia H, Sachin O, et al. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18(4). https://doi.org/10.1186/s12978-020-01054-y. 
59. Soini T et al. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: A nationwide cohort study. Acta Oncologica. 2016;55(2):188-192. doi: 10.3109/0284186X.2015.1062538. 
60. Conz L, Mota BS, Bahamondes L, et al. Levonorgestrel-releasing intrauterine system and breast cancer risk: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020;99:970-982. 
61. Eisenberg VH, Decter DH, Chodick G, Shalev V, Weil C. Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization. J Clin Med. 2022 Feb 21;11(4):1133. doi: 10.3390/jcm11041133. PMID: 35207404; PMCID: PMC8880408. 
62. Holdsworth-Carson Sarah J, Ng Cecilia HM, Dior Uri P. Editorial: Comorbidities in Women With Endometriosis: Risks and Implications. Frontiers in Reproductive Health. 2022;4. doi: 10.3389/frph.2022.875277. 
63. Trabert B, Sherman ME, Kannan N, Stanczyk FZ. Progesterone and Breast Cancer. Endocr Rev. 2020 Apr 1;41(2):320-44. doi: 10.1210/endrev/bnz001. 
64. Kim J, Munster PN. Estrogens and breast cancer. Ann Oncol. 2025 Feb;36(2):134-148. doi: 10.1016/j.annonc.2024.10.824. Epub 2024 Nov 8. PMID: 39522613. 
65. Garnsey MR, Wang Y, Edmonds DJ, et al. Design and application of synthetic 17B-HSD13 substrates reveals preserved cataly–tic activity of protective human variants. Nat Commun 2025;16:297. https://doi.org/10.1038/s41467-024-54487-5. 
66. Boogers LS, Brüggenwirth HT, Wolffenbuttel KP, Hersmus R, Bryce J, Ahmed SF, Lucas-Herald AK, Baronio F, Cools M, Ellaithi M, Globa E, Güran T, Hiort O, Holterhus PM, MсElreavey K, Niedziela M, Stancampiano MR, Tosun BG, van Bever Y, Ooster–huis JW, Looijenga LHJ, Hannema SE. Gonadal function and pathology in 17beta-HSD 3 and 5alpha-reductase deficiency. Eur J Endocrinol. 2025 Jan 6;192(1):34-45. doi: 10.1093/ejendo/lvae154.
67. Greygoose E, Metharom P, Kula H, Seckin TK, Seckin TA, Ayhan A, Yu Y. The Estrogen-Immune Interface in Endometriosis. Cells. 2025 Jan 6;14(1):58. doi: 10.3390/cells14010058. 
68. Zang Y, Li H, Liu S, Zhao R, Zhang K, Zang Y, Wang Y, Xue F. The roles and clinical applications of interleukins in endometrial carcinoma. Front Oncol. 2022 Nov 30;12:1001693. doi: 10.3389/fonc.2022.1001693. 
69. Hu Y, Chen H, Jin L, Chi X, Zhao J, Cao Q. Hypomethylation of IL6ST promotes development of endometriosis by activating JAK2/STAT3 signaling pathway. PLoS One. 2025 Jan 16;20(1):e0317569. doi: 10.1371/journal.pone.0317569. 
70. Pérez-Chacón G, Santamaría PG, Redondo-Pedraza J, González-Suárez E. RANK/RANKL Signaling Pathway in Breast Development and Cancer. Adv Exp Med Biol. 2025;1464:309-345. doi: 10.1007/978-3-031-70875-6_16. 
71. Al-Shami K, Awadi S, Khamees A, Alsheikh AM, Al-Sha–rif S, Ala’ Bereshy R, Al-Eitan SF, Banikhaled SH, Al-Qudimat AR, Al-Zoubi RM, Al Zoubi MS. Estrogens and the risk of breast cancer: A narrative review of literature. Heliyon. 2023 Sep 17;9(9):e20224. doi: 10.1016/j.heliyon.2023.e20224. 
72. Miziak P, Baran M, Błaszczak E, Przybyszewska-Podstawka A, Kałafut J, Smok-Kalwat J, Dmoszyńska-Graniczka M, Kiełbus M, Stepulak A. Estrogen Receptor Signaling in Breast Cancer. Cancers (Basel). 2023 Sep 23;15(19):4689. doi: 10.3390/cancers15194689. 
73. Ye J, Peng H, Huang X, Qi X. The association between endometriosis and risk of endometrial cancer and breast cancer: a meta-analysis. BMC Womens Health. 2022 Nov 18;22(1):455. doi: 10.1186/s12905-022-02028-x. PMID: 36401252; PMCID: PMC9673303. 
74. Chekhun V, Pavlova A, Zadvornyi T, Borikun T, Naleskina L, Mushii O, Bazas V, Lukianova N. Expression of SPP1 and SPARC genes in tumor tissue of patients with breast cancer. Exp Oncol. 2024 May 31;46(1):13-21. doi: 10.15407/exp-oncology.2024.01.013. PMID: 38852057.