Uterine microbiota dynamics and new therapeutic opportunities in gynecological diseases

Traditional view holds that the uterus is a sterile environment. However, with the increased development of molecular biology technologies, this classical theory has been re-examined. Increasing evidence shows that a low-biomass, uniquely structured microecosystem exists in the healthy uterus. Its composition and dynamic changes are crucial in maintaining endometrial homeostasis, regulating immune responses, and influencing embryo implantation. Uterine microecological imbalance is associated with different gynecological diseases, such as chronic endometritis, endometriosis, and uterine-related tumors. This paper systematically reviews the compositional features of the uterine microecology and the dynamic changes in bacterial communities, as well as summarizes the evidence linking these changes to major gynecological diseases. This work examines current treatment and intervention strategies including antibiotics, probiotics, uterine cavity colonization, and fecal microbiota transplantation, and discusses their potential clinical value and methodological challenges. A deeper investigation of the relationship between uterine microecology and gynecological diseases is expected to provide new biomarkers and therapeutic targets for the precise diagnosis and treatment of gynecological disorders.