Advances in the Role of Endometrial Microbiota Alterations in the Pathogenesis of Endometriosis

The uterine cavity was formerly considered sterile; however, over recent years, researchers have identified the presence of endometrial microbiota. An imbalance in the endometrial microbiota, or dysbiosis, has been shown to be associated with a variety of gynecological diseases. Endometriosis (EM) is a chronic and inflammatory gynecological disease that affects 6–10% of all women of reproductive-age. Previous studies suggested that endometrial dysbiosis can participate in the development of EM by generating an inflammatory state, leading to disorders of immune homeostasis and thus creating an intrauterine environment conducive to endometrial stromal cell migration and adhesion. In this review, we investigate differences in the endometrial microbiota of patients with EM compared with that of healthy women and discuss the possible pathogenic mechanisms responsible for endometrial dysbiosis. Critically, we identified that an increase of lipopolysaccharides resulting from microbiological disorders may generate chronic inflammation, leading to increased adhesion and angiogenesis, and the development of EM. The findings of our review may identify new therapeutic strategies and potential therapeutic targets for EM. Similar content being viewed by others Data Availability All data generated or analyzed during this study are included in this published article. Additional information is available from the corresponding author upon reasonable request.

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Writing – Review & Editing: Ziying Xu, Weina Guo, Yi Shen. Visualization: Ziying Xu. Supervision: Yi Shen. Funding acquisition: Yi Shen. Corresponding author Ethics declarations Ethics approval This research did not involve any human or animal subjects; therefore, IACUC (or IRB) approval was not required. Consent To Participate Not applicable. Consent for Publication Not applicable. Competing Interests None of the authors have any conflicts of interest to declare. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Xu, Z., Guo, W. & Shen, Y. Advances in the Role of Endometrial Microbiota Alterations in the Pathogenesis of Endometriosis. Reprod. Sci. 33, 482–495 (2026). https://doi.org/10.1007/s43032-026-02050-6 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-026-02050-6