The microbiome and endometriosis

Carlos H Miyashira, Fernanda Reali Oliveira, Marina Paula Andres, Julian A. Gingold, Maurício Simões Abrão
In: Reproduction and Fertility · 2022 · vol. 3(3) , pp. R163–R175 · doi:10.1530/raf-21-0113 · W4285500584
article OA: diamond CC0 ⤵ 15 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review of 12 studies found highly heterogeneous microbiome alterations across various anatomical sites in women with endometriosis, with some bacteria like Pseudomonas and Streptococcus showing increased prevalence.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper is a systematic review that assessed human studies linking the microbiome to endometriosis, searching PubMed/Medline, Cochrane, and Embase from 1986 to August 2021 and including 12 case–control studies that used 16S rRNA or shotgun sequencing. Across multiple anatomical sampling sites (fecal, vaginal, cervical, peritoneal, endometrial, and intra-lesional), the review found that some bacteria differed between people with endometriosis and heterogeneous control groups, but results were highly inconsistent and stratification by endometriosis stage or site was limited and heterogeneous; study quality ranged from poor to good, with 8 rated fair. Repeatedly reported trends included Pseudomonas overrepresentation in peritoneal fluid and changes in other taxa such as Gardnerella, Atopium, Sphingobium, and Streptococcus depending on sampling site. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

The objective of this study was to systematically review the literature on the human microbiome in association with endometriosis. PubMed/Medline, Cochrane, and Embase databases were searched for literature published from 1986 to August 2021. All human studies that assessed the microbiome using 16S rRNA sequencing or shotgun sequencing in women with endometriosis were included. Two reviewers independently abstracted data from the selected articles into tables. To assess the quality of included studies, the National Institutes of Health Study Quality Assessment Tools were utilized. This review included 12 case–control studies. Included studies compared the microbiome from various anatomical sources (fecal, vaginal, cervical, peritoneal, endometrial, and intra-lesional) between patients with endometriosis and a heterogeneous set of control patients. Study quality ranged from poor to good, with 8 of 12 studies rated fair. Multiple studies reported a different distribution of bacteria among women with endometriosis across anatomical sites, but the results were highly heterogeneous. Pseudomonas was overrepresented in peritoneal fluid among women with endometriosis across multiple studies but was also observed to be increased in vaginal, endometrial, and intra-lesional samples. Among bacteria noted across different anatomical samples, Gardnerella was found to be increased in cervical but decreased in endometrial, fecal, and vaginal samples of patients with endometriosis, while Atopium was found to be decreased in vaginal and cervical samples from patients with endometriosis. Sphingobium was found to be increased in vagina, endometrium, and peritoneal fluid from patients with endometriosis. Streptococcus was found to be increased in peritoneal, endometrial, and cervical samples from women with endometriosis. Microbiomal comparisons stratified by endometriosis stage or site of endometriosis involvement were limited and highly heterogeneous. Lay summary The microbiome, a group of bacteria found in a particular place in the body, has been shown to vary when patients have some diseases, such as cancer or inflammatory bowel disease. Less is known about the microbiome in patients with endometriosis. This review looked at existing studies comparing the bacteria found in patients with endometriosis and others without. Twelve studies were found that assessed the bacteria from swabs collected from different places, including the vagina, cervix, endometrium, peritoneum, feces, and endometriosis lesions themselves. Most of the studies found higher or lower levels of specific bacteria at each of these places, but the findings were often inconsistent. The findings were probably limited by the small numbers of patients involved and variations in the groups studied. More research is needed to find out which bacteria are over- and underrepresented in patients with endometriosis and where they are found.

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Condition tags

endometriosis

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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.

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