In fibroblasts, lifestyle and, to lesser extent, metformin normalized elevated HIF1A (impairing stromal fibroblast decidualization critical for embryo implantation)33, RUNX1 (linked to endometrial cancer and angiogenesis)34, MMP3 and MMP10 (involved in extracellular remodeling and associated with endometriosis)35 and ITGA2, often upregulated in endometrial cancer and PCOS epithelial cells24. Here, MMP3 is linked to endometriosis.