ENDOMETRIOSIS AND THE MICROBIOME: EMERGING APPLICATIONS OF ARTIFICIAL INTELLIGENCE IN WOMEN’S HEALTH

In: International Journal of Innovative Technologies in Social Science · 2025 · vol. 4(4(48)) · doi:10.31435/ijitss.4(48).2025.4264 · W7127914730
article OA: gold CC0
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This review synthesizes microbiome alterations in endometriosis and explores how AI and machine learning can identify microbiome-derived biomarkers for improved diagnosis and treatment.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This narrative review synthesizes peer-reviewed studies from 2015–2025 on microbiome alterations in women with endometriosis, focusing on how gut dysbiosis and reproductive tract microbiota may influence estrogen metabolism, immune responses, and inflammation, and it surveys studies that apply artificial intelligence and machine learning to identify microbiome-derived biomarkers. Across the literature, AI/ML methods such as random forest, gradient boosting, and logistic regression are described as promising for predicting disease status and deriving candidate microbial signatures, often alongside multi-omics approaches. The review’s main limitation is that it uses a narrative (not systematic) approach with literature selection and quality assessment as described, and it notes the need for additional large-scale, multicenter validation. This paper is centrally about endometriosis — it focuses on how the microbiome and AI-driven modeling could support non-invasive diagnosis and classification.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Introduction: Endometriosis, a chronic and estrogen-dependent inflammatory condition, affects millions worldwide, frequently causing pain, infertility, and a diminished quality of life. Delayed diagnosis remains a major challenge due to the lack of sensitive non-invasive biomarkers. Emerging evidence suggests that alterations in the gut and reproductive tract microbiomes contribute to disease pathophysiology through immune and hormonal dysregulation. Purpose of the Work: This review aims to synthesize current knowledge on microbiome changes in endometriosis and explore the potential applications of artificial intelligence (AI) and machine learning (ML) for identifying microbiome-derived biomarkers and improving early diagnosis. Material and Methods: A narrative review of peer-reviewed literature from 2015–2025 was conducted using PubMed, Scopus, and Web of Science. Keywords included “endometriosis,” “microbiome,” “artificial intelligence,” and “machine learning.” Studies were assessed for relevance, methodological quality, and contributions to understanding microbiome alterations and AI applications in endometriosis. Results: Gut dysbiosis appears to influence estrogen metabolism, immune responses, and inflammation, while reproductive tract microbiota contribute to local immune modulation. AI and ML approaches, including Random Forest, Gradient Boosting, and logistic regression, have shown promise in predicting disease and identifying potential microbial biomarkers. Interventions such as probiotics, prebiotics, and fecal microbiota transplantation, coupled with multi-omics analyses, represent potential avenues for personalized treatment. Conclusion: Integrating microbiome profiling with AI-driven models may enable non-invasive diagnosis, improved disease classification, and precision therapeutic strategies. Further large-scale, multicenter studies are needed to validate these approaches and support their translation into clinical practice.
Full text 17,481 characters · extracted from oa-doi-fallback · 5 sections · click to expand

Introduction

Endometriosis, a chronic and estrogen-dependent inflammatory condition, affects millions worldwide, frequently causing pain, infertility, and a diminished quality of life. Delayed diagnosis remains a major challenge due to the lack of sensitive non-invasive biomarkers. Emerging evidence suggests that alterations in the gut and reproductive tract microbiomes contribute to disease pathophysiology through immune and hormonal dysregulation. Purpose of the Work: This review aims to synthesize current knowledge on microbiome changes in endometriosis and explore the potential applications of artificial intelligence (AI) and machine learning (ML) for identifying microbiome-derived biomarkers and improving early diagnosis.

Material and methods

A narrative review of peer-reviewed literature from 2015–2025 was conducted using PubMed, Scopus, and Web of Science. Keywords included “endometriosis,” “microbiome,” “artificial intelligence,” and “machine learning.” Studies were assessed for relevance, methodological quality, and contributions to understanding microbiome alterations and AI applications in endometriosis.

Results

Gut dysbiosis appears to influence estrogen metabolism, immune responses, and inflammation, while reproductive tract microbiota contribute to local immune modulation. AI and ML approaches, including Random Forest, Gradient Boosting, and logistic regression, have shown promise in predicting disease and identifying potential microbial biomarkers. Interventions such as probiotics, prebiotics, and fecal microbiota transplantation, coupled with multi-omics analyses, represent potential avenues for personalized treatment.

Conclusion

Integrating microbiome profiling with AI-driven models may enable non-invasive diagnosis, improved disease classification, and precision therapeutic strategies. Further large-scale, multicenter studies are needed to validate these approaches and support their translation into clinical practice.

References

Bień, A., Pokropska, A., Grzesik-Gąsior, J., Korżyńska-Piętas, M., Pieczykolan, A., Zarajczyk, M., Ali Pour, R., Frydrysiak-Brzozowska, A., & Rzońca, E. (2025). Quality of Life in Women with Endometriosis: The Importance of Socio-Demographic, Diagnostic-Therapeutic, and Psychological Factors. Journal of Clinical Medicine, 14(12), 4268. https://doi.org/10.3390/jcm14124268 Blanco, L. P., Salmeri, N., Temkin, S. M., Shanmugam, V. K., & Stratton, P. (2025). Endometriosis and autoimmunity. Autoimmunity Reviews, 24(4), 103752. https://doi.org/10.1016/j.autrev.2025.103752 Gałczyński, K., Jóźwik, M., Lewkowicz, D., Semczuk-Sikora, A., & Semczuk, A. (2019). Ovarian endometrioma - a possible finding in adolescent girls and young women: a mini-review. Journal of Ovarian Research, 12(1), 104. https://doi.org/10.1186/s13048-019-0582-5 Ottolina, J., Villanacci, R., D'Alessandro, S., He, X., Grisafi, G., Ferrari, S. M., & Candiani, M. (2024). Endometriosis and Adenomyosis: Modern Concepts of Their Clinical Outcomes, Treatment, and Management. Journal of clinical medicine, 13(14), 3996. https://doi.org/10.3390/jcm13143996 Mariadas, H., Chen, J.-H., & Chen, K.-H. (2025). The Molecular and Cellular Mechanisms of Endometriosis: From Basic Pathophysiology to Clinical Implications. International Journal of Molecular Sciences, 26(6), 2458. https://doi.org/10.3390/ijms26062458 Jones, G. L., Budds, K., Taylor, F., Musson, D., Raymer, J., Churchman, D., Kennedy, S. H., & Jenkinson, C. (2024). A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis. Human Reproduction Update, 30(2), 186–214. https://doi.org/10.1093/humupd/dmad029 Swift, B., Taneri, B., Becker, C. M., Basarir, H., Naci, H., Missmer, S. A., Zondervan, K. T., & Rahmioglu, N. (2024). Prevalence, diagnostic delay, and economic burden of endometriosis and its impact on quality of life: Results from an Eastern Mediterranean population. European Journal of Public Health, 34(2), 244–252. https://doi.org/10.1093/eurpub/ckad216 Ellis, K., Munro, D., & Clarke, J. (2022). Endometriosis Is Undervalued: A call to Action. Frontiers in Global Women's Health, 3, 902371. https://doi.org/10.3389/fgwh.2022.902371 Sims, O. T., Gupta, J., Missmer, S. A., & Aninye, I. O. (2021). Stigma and endometriosis: A brief overview and recommendations to improve psychosocial well-being and diagnostic delay. International Journal of Environmental Research and Public Health, 18(15), 8210. https://doi.org/10.3390/ijerph18158210 Uzuner, C., Mak, J., El-Assaad, F., & Condous, G. (2023). The bidirectional relationship between endometriosis and microbiome. Frontiers in endocrinology, 14, 1110824. https://doi.org/10.3389/fendo.2023.1110824 Talwar, C., Davuluri, G. V. N., Kamal, A. H. M., Coarfa, C., Han, S. J., Veeraragavan, S., Parsawar, K., Putluri, N., Hoffman, K., Jimenez, P., Biest, S., & Kommagani, R. (2025). Identification of distinct stool metabolites in women with endometriosis for non-invasive diagnosis and potential for microbiota-based therapies. Med (New York, N.Y.), 6(2), 100517. https://doi.org/10.1016/j.medj.2024.09.006 Wu, I. W., Liao, Y. C., Tsai, T. H., Lin, C. H., Shen, Z. Q., Chan, Y. H., Tu, C. W., Chou, Y. J., Lo, C. J., Yeh, C. H., Chen, C. Y., Pan, H. C., Hsu, H. J., Lee, C. C., Cheng, M. L., Sheu, W. H., Lai, C. C., Sytwu, H. K., & Tsai, T. F. (2025). Machine-learning assisted discovery unveils novel interplay between gut microbiota and host metabolic disturbance in diabetic kidney disease. Gut Microbes, 17(1), 2473506. https://doi.org/10.1080/19490976.2025.2473506 Xiong, R., Aiken, E., Caldwell, R., Vernon, S. D., Kozhaya, L., Gunter, C., Bateman, L., Unutmaz, D., & Oh, J. (2025). AI-driven multi-omics modeling of myalgic encephalomyelitis/chronic fatigue syndrome. Nature Medicine, 31(9), 2991–3001. https://doi.org/10.1038/s41591-025-03788-3 Zhu, Y., Geng, S. Y., Chen, Y., Ru, Q. J., Zheng, Y., Jiang, N., Zhu, F. Y., & Zhang, Y. S. (2025). Machine learning algorithms reveal gut microbiota signatures associated with chronic hepatitis B-related hepatic fibrosis. World Journal of Gastroenterology, 31(16), 105985. https://doi.org/10.3748/wjg.v31.i16.105985 Moro, F., Giudice, M. T., Ciancia, M., Zace, D., Baldassari, G., Vagni, M., Tran, H. E., Scambia, G., & Testa, A. C. (2025). Application of artificial intelligence to ultrasound imaging for benign gynecological disorders: systematic review. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 65(3), 295–302. https://doi.org/10.1002/uog.29171 Wang, M.-Y., Sang, L.-X., & Sun, S.-Y. (2024). Gut microbiota and female health. World Journal of Gastroenterology, 30(12), 1655–1662. https://doi.org/10.3748/wjg.v30.i12.1655 Yuanyue, L., Qian, H., Ling, L., Liufeng, Y., Jing, G., & Xiaomei, W. (2025). Impact of gut microbiota on endometriosis: Linking physical injury to mental health. Frontiers in Cellular and Infection Microbiology, 15, 1526063. https://doi.org/10.3389/fcimb.2025.1526063 Talwar, C., Singh, V., & Kommagani, R. (2022). The gut microbiota: A double-edged sword in endometriosis. Biology of Reproduction, 107(4), 881–901. https://doi.org/10.1093/biolre/ioac147 Qin, R., Tian, G., Liu, J., & Cao, L. (2022). The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Frontiers in Cellular and Infection Microbiology, 12, 1069557. https://doi.org/10.3389/fcimb.2022.1069557 Merrheim, J., Villegas, J., Van Wassenhove, J., Khansa, R., Berrih-Aknin, S., & Le Panse, R. (2020). Estrogen, estrogen-like molecules, and autoimmune diseases. Autoimmunity Reviews, 19(3), 102468. https://doi.org/10.1016/j.autrev.2020.102468 Beaud, D., Tailliez, P., & Anba-Mondoloni, J. (2005). Genetic characterization of the beta-glucuronidase enzyme from a human intestinal bacterium, Ruminococcus gnavus. Microbiology (Reading), 151(Pt 7), 2323–2330. https://doi.org/10.1099/mic.0.27712-0 Chadchan, S. B., Naik, S. K., Popli, P., Talwar, C., Putluri, S., Ambati, C. R., Lint, M. A., Kau, A. L., Stallings, C. L., & Kommagani, R. (2023). Gut microbiota and microbiota-derived metabolites promote endometriosis. Cell Death Discovery, 9(1), 28. https://doi.org/10.1038/s41420-023-01309-0 Qi, X., Yun, C., Pang, Y., & Qiao, J. (2021). The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes, 13(1), 1–21. https://doi.org/10.1080/19490976.2021.1894070 Yuanyue, L., Dimei, O., Ling, L., Dongyan, R., & Xiaomei, W. (2025). Association between endometriosis and gut microbiota: Systematic review and meta-analysis. Frontiers in Microbiology, 16, 1552134. https://doi.org/10.3389/fmicb.2025.1552134 Iang, I., Yong, P. J., Allaire, C., & Bedaiwy, M. A. (2021). Intricate connections between the microbiota and endometriosis. International Journal of Molecular Sciences, 22(11), 5644. https://doi.org/10.3390/ijms22115644 Fan, D., Wang, X., Shi, Z., Jiang, Y., Zheng, B., Xu, L., et al. (2023). Understanding endometriosis from an immunomicroenvironmental perspective. Chinese Medical Journal, 136(15), 1897–1909. https://doi.org/10.1097/CM9.0000000000002649 Kulkoyluoglu-Cotul, E., Arca, A., & Madak-Erdogan, Z. (2019). Crosstalk between estrogen signaling and breast cancer metabolism. Trends in Endocrinology & Metabolism, 30(1), 25–38. https://doi.org/10.1016/j.tem.2018.10.006 Zondervan, K. T., Becker, C. M., Koga, K., Missmer, S. A., Taylor, R. N., & Viganò, P. (2018). Endometriosis. Nature Reviews Disease Primers, 4, 9. https://doi.org/10.1038/s41572-018-0008-5 Kwon, O., Lee, S., Kim, J.-H., Kim, H., & Lee, S.-W. (2015). Altered gut microbiota composition in Rag1-deficient mice contributes to modulating homeostasis of hematopoietic stem and progenitor cells. Immune Network, 15(5), 252–259 Hufnagel, D., Li, F., Cosar, E., Krikun, G., & Taylor, H. (2015). The role of stem cells in the etiology and pathophysiology of endometriosis. Seminars in Reproductive Medicine, 33(5), 333–340 Chadchan, S. B., Cheng, M., Parnell, L. A., Yin, Y., Schriefer, A., Mysorekar, I. U., et al. (2019). Antibiotic therapy with metronidazole reduces endometriosis disease progression in mice: A potential role for gut microbiota. Human Reproduction, 34(6), 1106–1116. https://doi.org/10.1093/humrep/dez041 Li, Q., Yuan, M., Jiao, X., Ji, M., Huang, Y., Li, J., et al. (2021). Metabolite profiles in the peritoneal cavity of endometriosis patients and mouse models. Reproductive BioMedicine Online, 43, 810–819. https://doi.org/10.1016/j.rbmo.2021.06.029 Bailey, M. T., & Coe, C. L. (2002). Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction, 17(7), 1704–1708. https://doi.org/10.1093/humrep/17.7.1704 Huang, L., Liu, B., Liu, Z., Feng, W., Liu, M., Wang, Y., et al. (2021). Gut microbiota exceeds cervical microbiota for early diagnosis of endometriosis. Frontiers in Cellular and Infection Microbiology, 11, 788836. https://doi.org/10.3389/fcimb.2021.788836 Jimenez, N., Norton, T., Diadala, G., Bell, E., Valenti, M., Farland, L. V., et al. (2024). Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain. BMC Medicine, 22(1), 283. https://doi.org/10.1186/s12916-024-03500-1 Li, Y., Zhou, Z., Liang, X., Ding, J., He, Y., Sun, S., et al. (2024). Gut microbiota disorder contributes to the production of IL-17A that exerts chemotaxis via binding to IL-17RA in endometriosis. Journal of Inflammation Research, 17, 4199–4217. https://doi.org/10.2147/JIR.S458928 Svensson, A., Brunkwall, L., Roth, B., Orho-Melander, M., & Ohlsson, B. (2021). Associations between endometriosis and gut microbiota. Reproductive Sciences, 28(9), 2367–2377. https://doi.org/10.1007/s43032-021-00506-5 Highlander, S. K., Flores, R., Shi, J., et al. (2012). Association of fecal microbial diversity and taxonomy with selected enzymatic functions. PLoS ONE, 7(6), e39745. https://doi.org/10.1371/journal.pone.0039745 Liu, Z., Chen, P., Luo, L., Liu, Q., Shi, H., & Yang, X. (2023). Causal effects of gut microbiome on endometriosis: A two-sample Mendelian randomization study. BMC Women's Health, 23, 637. https://doi.org/10.1186/s12905-023-02742-0 Tang, Y., Yang, J., Hang, F., Huang, H., & Jiang, L. (2024). Unraveling the relationship between gut microbiota and site-specific endometriosis: A Mendelian randomization analysis. Frontiers in Microbiology, 15, 1363080. https://doi.org/10.3389/fmicb.2024.1363080 MacSharry, J., Kovács, Z., Xie, Y., et al. (2024). Endometriosis specific vaginal microbiota links to urine and serum N-glycome. Scientific Reports, 14, 25372. https://doi.org/10.1038/s41598-024-76125-2 Muraoka, A., et al. (2023). Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts. Science Translational Medicine, 15, eadd1531. https://doi.org/10.1126/scitranslmed.add1531 Salliss, M. E., Farland, L. V., Mahnert, N. D., & Herbst-Kralovetz, M. M. (2021). The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Human Reproduction Update, 28(1), 92–131. https://doi.org/10.1093/humupd/dmab035 Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., et al. (2019). Clinical diagnosis of endometriosis: A call to action. American Journal of Obstetrics and Gynecology, 220(4), 354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039 Ni, Z., Ding, J., Zhao, Q., Cheng, W., Yu, J., Zhou, L., et al. (2021). Alpha-linolenic acid regulates the gut microbiota and the inflammatory environment in a mouse model of endometriosis. American Journal of Reproductive Immunology, 86(4), e13471. https://doi.org/10.1111/aji.13471 Chadchan, S. B., Popli, P., Ambati, C. R., Tycksen, E., Han, S. J., Bulun, S. E., … & Shankar, S. (2021). Gut microbiota-derived short-chain fatty acids protect against the progression of endometriosis. Life Science Alliance, 4(1), e202101224. https://doi.org/10.26508/lsa.202101224 Shan, J., Ni, Z., Cheng, W., Zhou, L., Zhai, D., Sun, S., et al. (2021). Gut microbiota imbalance and its correlations with hormone and inflammatory factors in patients with stage 3/4 endometriosis. Archives of Gynecology and Obstetrics, 304, 1363–1373. https://doi.org/10.1007/s00404-021-06057-z Reis, F. M. D., Monteiro, C. de S., & Carneiro, M. M. (2017). Biomarkers of pelvic endometriosis. Revista Brasileira de Ginecologia e Obstetrícia, 39(2), 91–93. https://doi.org/10.1055/s-0037-1601398 Dungate, B., Tucker, D. R., Goodwin, E., & Yong, P. J. (2024). Assessing the utility of artificial intelligence in endometriosis: Promises and pitfalls. Women's health (London, England), 20, 17455057241248121. https://doi.org/10.1177/17455057241248121 Cetera, G. E., Tozzi, A. E., Chiappa, V., Castiglioni, I., Merli, C. E. M., & Vercellini, P. (2024). Artificial intelligence in the management of women with endometriosis and adenomyosis: Can machines ever be worse than humans? Journal of Clinical Medicine, 13, 2950. https://doi.org/10.3390/jcm13102950 Torraco, A., Di Nicolantonio, S., Cardisciani, M., Ortu, E., Pietropaoli, D., Altamura, S., & Del Pinto, R. (2025). Meta-analysis of 16S rRNA sequencing reveals altered fecal but not vaginal microbial composition and function in women with endometriosis. Medicina, 61(5), 888. https://doi.org/10.3390/medicina61050888 Perrotta, A. R., Borrelli, G. M., Martins, C. O., Kallas, E. G., Sanabani, S. S., Griffith, L. G., Alm, E. J., & Abrao, M. S. (2020). The vaginal microbiome as a tool to predict rASRM stage of disease in endometriosis: A pilot study. Reproductive Sciences, 27(4), 1064–1073. https://doi.org/10.1007/s43032-019-00113-5 Caballero, P., Gonzalez-Abril, L., Ortega, J. A., & Simon-Soro, Á. (2024). Data Mining Techniques for Endometriosis Detection in a Data-Scarce Medical Dataset. Algorithms, 17(3), 108. https://doi.org/10.3390/a17030108 Collie, B., Troisi, J., Lombardi, M., Symes, S., & Richards, S. (2025). The Current Applications of Metabolomics in Understanding Endometriosis: A Systematic Review. Metabolites, 15(1), 50. https://doi.org/10.3390/metabo15010050 Li, C., Xu, X., Zhao, X., & Du, B. (2025). The inconsistent pathogenesis of endometriosis and adenomyosis: insights from endometrial metabolome and microbiome. mSystems, 10(5), e0020225. https://doi.org/10.1128/msystems.00202-25 Kalopedis, E. A., Zorgani, A., Zinovkin, D. A., Barri, M., Wood, C. D., & Pranjol, M. Z. I. (2025). Leveraging the role of the microbiome in endometriosis: Novel non-invasive and therapeutic approaches. Frontiers in Immunology, 16, 1631522. https://doi.org/10.3389/fimmu.2025.1631522 Downloads Published Issue Section License All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles. CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Outcome instruments

rASRM

Condition tags

endometriosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (56)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK