**8. Conclusions**

Even if the pathophysiology of EM is not completely understood, it is well established that the immune system plays a key role in this disease. Moreover, the peripheral and central nervous systems are intimately involved in EM disease and symptomatology. No-

ciceptor neurons possess many of the same molecular recognition pathways for danger as immune cells and in response to danger, the peripheral nervous system directly communicates with the immune system, forming an integrated protective mechanism. The dense innervation network of sensory and autonomic fibres in peripheral tissues and high speed of neural transduction allows for rapid local and systemic neurogenic modulation of immunity. Peripheral neurons also appear to play a significant role in immune dysfunction in autoimmune and allergic diseases. The literature provides evidence for an overall heterogeneity in EM, rather than a standard approach. This strongly suggests a personalized treatment approach based on aetiology and symptomatology. Current treatments, both pharmacological and surgical, are addressed at providing symptom relief and are mainly focused on complex pain management, without effective results for all patients. Several studies are attempting to overcome these obstacles by identifying molecular targets to develop new therapeutic approaches to improve the quality of life of affected women. Once we put aside the paradigm of lesion-specific and cyclical inflammatory pain, further areas will open up and increase the treatment opportunities in a multimodal approach.

**Author Contributions:** R.V.V. and S.M. wrote the initial draft of the manuscript; R.V.V., E.T., J.S. and S.M. reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité—Universitätsmedizin Berlin.

**Acknowledgments:** The figure was created using BioRender.com.

**Conflicts of Interest:** The authors declare no conflict of interest.
