Association between endometriosis and gut microbiota: systematic review and meta-analysis

Yuanyue Li, Li Yuanyue, Ouyang Dimei, Ling Liu, Liu Ling, Ren Dongyan, Wu Xiaomei, Xiaomei Wu
Frontiers in microbiology · 2025 · vol. 16 , pp. 1552134 · doi:10.3389/fmicb.2025.1552134 · PMID:40400684 · W4410182124
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This meta-analysis found significant differences in gut microbiota diversity and composition between women with and without endometriosis, suggesting a role in disease pathogenesis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review and meta-analysis evaluated 11 observational studies (n=1,727 women; 433 with endometriosis and 1,294 controls) assessing gut microbiota differences using 16S rRNA sequencing (mostly) or one shotgun metagenomics approach, with alpha and beta diversity compared between groups. Across studies, women with endometriosis showed significant alterations in gut microbiota diversity, including differences on the Shannon Index (SMD = 0.39) and Simpson Index richness (SMD = 0.91), as well as reported dissimilarities in composition based on PCoA/PCA or Bray–Curtis measures; however, no significant difference was found for the Chao Index (SMD = 0.37). The authors state most included studies had relatively high quality (Newcastle–Ottawa Scale ≥7 stars) and found no evidence of publication bias via funnel plot/Egger testing, but they highlight a need for standardizing reporting methods to enable deeper quantitative analyses. Relevance to endometriosis: This paper directly synthesizes evidence linking gut microbiota diversity and composition to endometriosis across multiple included studies and concludes these microbiota alterations are associated with endometriosis.

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Abstract

Background Endometriosis, a complex gynecological disorder, has been increasingly linked to gut microbiota dysbiosis, suggesting its potential role in disease pathogenesis. Methods This systematic review and meta-analysis explore the association between gut microbiota and endometriosis by evaluating alpha and beta diversity measures across 11 studies involving 1,727 women, including 433 diagnosed with endometriosis and 1,294 controls. Statistical analysis was performed utilizing either random effects models or fixed models by Revmen5.2 and STATA softwares. Results Significant differences in alpha diversity between endometriosis and control groups were observed using the Shannon Index (SMD = 0.39; p < 0.00001), Subgroup analysis showed significant differences for Chinese (SMD = 0.48; 95% CI = 0.14 to 0.82; p = 0.006; I 2 = 30%), Swedish, (SMD = 0.55; 95% CI = 0.27 to 0.83; p = 0.0001; I 2 = 30%) and Spanish (SMD = 0.34; 95% CI = −0.02 to 0.85; p < 0.06; I 2 = 27%), compared to others which highlighting the correlation between gut microbiota diversity and endometriosis across different demographic groups. The Simpson Index also revealed a notable difference in richness (SMD = 0.91; p = 0.03). However, no significant differences were detected using the Chao Index (SMD = 0.37; p = 0.11). These findings underscore the importance of diversity measures in understanding gut microbiota’s role in endometriosis. Seven studies employed PCoA, two used the Bray–Curtis dissimilarity index, and one performed PCA, revealing notable dissimilarities in gut microbiota composition between the groups. Using the Newcastle-Ottawa Scale, most studies scored ≥7 stars, indicating high quality. The funnel plot and Egger’s linear regression analysis indicated no publication bias. Conclusion This study highlights significant alterations in gut microbiota diversity and composition in women with endometriosis, emphasizing the potential role of gut microbiota in its pathogenesis. Future research should focus on standardizing reporting methods to facilitate deeper quantitative analyses. Systematic Review Registration PROSPERO (registration number RD42024611701).

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endometriosis

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