The estrobolome and its emerging role in endometriosis pathogenesis: no guts, no story?

This editorial discusses the gut microbiota’s proposed role in endometriosis, focusing on the “estrobolome,” the subset of the gut microbiome involved in estrogen metabolism, particularly through bacterial enzymes like β-glucuronidase and β-glucosidase that deconjugate estrogen metabolites and enable enterohepatic recycling. It summarizes evidence that estrobolome alterations may contribute to endometriosis by increasing systemic estrogen levels and by intersecting with immune activation via mechanisms such as increased intestinal permeability, while also noting a bidirectional feedback between estrogen, immune mediators, and microbial composition. The main caveat is that many observations are described as preliminary and that causal pathways and effective interventions remain unresolved, requiring mechanistic studies and animal-model work to disentangle cause versus consequence. This paper is centrally about endometriosis — it is an editorial/review framing the estrobolome as a systemic contributor to endometriosis pathogenesis, including estrogen recycling and inflammation-related mechanisms.

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