Zheng, Sai-Hua, Gao, Shao-Jun, Cai, Jing-Jing et al. · Autoimmunity reviews · 2026 · DOI
This systematic review examined whether endometriosis—a condition in which tissue grows outside the uterus—is associated with other chronic illnesses affecting the whole body, including autoimmune diseases, allergies, pain syndromes, and thyroid disorders. Researchers analysed 55 published studies and found that women with endometriosis reported higher rates of conditions like lupus, Sjögren's syndrome, fibromyalgia, and chronic fatigue syndrome, though the overall quality of evidence was reported as low or very low.
Chronic fatigue syndrome was observed to be associated with endometriosis (RR 1.41, 95% CI 1.31–1.51) in this meta-analysis, suggesting potential relevance to understanding systemic inflammatory associations in ME/CFS. By analogy, the study's proposed framework of endometriosis as a systemic immuno-inflammatory condition—involving immune dysregulation and central sensitization—may inform investigation of similar systemic features in ME/CFS, though direct mechanistic applicability remains unclear.
This systematic review of observational studies does not establish causation between endometriosis and comorbidities, nor does it identify specific shared mechanisms. The low to very low GRADE quality rating means the associations reported do not constitute high-confidence evidence, and generalisability to all women with endometriosis or to ME/CFS populations is not established. The study does not recommend or evaluate any treatment.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Zheng, Sai-Hua, Gao, Shao-Jun, Cai, Jing-Jing, Shen, Zong-Xiang, Wang, Zhen-Hong, Wang, Zhi-Jing, et al. (2026). Beyond the pelvis: redefining endometriosis as a systemic inflammatory disorder. A systematic review and meta-analysis.. Autoimmunity reviews. https://doi.org/10.1016/j.autrev.2026.104206
BibTeX
@article{mecfsatlas-zheng-2026-beyond-pelvis,
author = {Zheng, Sai-Hua and Gao, Shao-Jun and Cai, Jing-Jing and Shen, Zong-Xiang and Wang, Zhen-Hong and Wang, Zhi-Jing and Xu, Su-Qiong and Chen, Yi and Dong, Binhua and Chen, Xian-Qian},
title = {Beyond the pelvis: redefining endometriosis as a systemic inflammatory disorder. A systematic review and meta-analysis.},
journal = {Autoimmunity reviews},
year = {2026},
doi = {10.1016/j.autrev.2026.104206},
note = {PubMed: 42901254},
url = {https://www.mecfsatlas.com/evidence/zheng-2026-beyond-pelvis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-10-21. https://www.mecfsatlas.com/evidence/zheng-2026-beyond-pelvis
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