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In women with endometriosis, the imbalance between ROS production and antioxidant defense leads to oxidative stress [26], which promotes inflammation, contributing clinically to pain at affected lesions [24] and infertility [25]

Upon cellular uptake, ketone bodies are metabolized back to acetyl-CoA, which enters the TCA cycle to support ATP production via mitochondrial oxidative phosphorylation [36, 41] (Fig