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While urinary measures provide a useful integrated assessment of total daily hormone production, they fail to capture the critical circadian variations – the peaks and troughs – that characterize a healthy HPA axis response ( Despite these physiological advantages, a sharp dichotomy persists between mainstream endocrinology and functional medicine regarding the utility of the ASI

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Endometriosis often coexists with adenomyosis, and both conditions share immunological alterations, including abnormal immune cell function and pro-inflammatory cytokine secretion, which collectively disrupt reproductive processes ( 2.2.1 Immune cell alterations Macrophages are key drivers of immune dysfunction, constituting over 50% of immune cells in the peritoneal fluid of affected women