Microbiota and Endometriosis: is there a relathionship? A review of the literature

Rocío González García
In: Enfermería Cuidándote · 2025 · pp. 142 · doi:10.51326/ec.8.1519194 · W4412151280
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This review analyzes changes in the vaginal, uterine, and intestinal microbiota of women with endometriosis, finding dysbiosis associated with inflammation and disease progression.

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This literature review evaluates evidence (2014–2024) on relationships between intestinal and female reproductive-tract microbiota—vaginal, uterine, and gut—and endometriosis, using an exhaustive database search with DeCS/MeSH terms and assessing quality across 30 selected articles. The review reports significant microbiota alterations in women with endometriosis, characterized by vaginal/uterine/gut dysbiosis with decreased beneficial bacteria and increased pathogenic taxa, which are linked to chronic inflammation, estrogen metabolism changes, and disease progression. The authors note a limitation implied by the review format: the synthesized studies vary in designs and evidence levels, so conclusions remain dependent on heterogenous literature rather than a single controlled dataset. Relevance to endometriosis: this paper is centrally about endometriosis—reviewing how microbiota changes in the vaginal, uterine, and intestinal sites may relate to endometriosis development and progression.

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Abstract

Introduction: Endometriosis is a disease characterized by the growth of endometrial tissue outside the uterus, causing pelvic pain, infertility, and inflammation. The microbiota, especially the intestinal and vaginal microbiota, plays a crucial role in hormonal and immune regulation, and may contribute to the pathogenesis of endometriosis. Objectives: To analyze the relationship between the intestinal microbiota and the female reproductive system and endometriosis, and to investigate the changes in the vaginal, uterine, and intestinal microbiota present in women with this disease. Methodology: An exhaustive search was carried out in scientific databases using DeCS/MeSH terms. The selected articles were in Spanish or English and published between 2014 and 2024. After evaluating their scientific quality, 30 relevant articles were analyzed. Results: The review shows significant alterations in the vaginal, uterine, and intestinal microbiota of women with endometriosis, highlighting dysbiosis characterized by the decrease of beneficial bacteria and the increase of pathogens. These alterations are associated with chronic inflammation, alterations in estrogen metabolism, and disease progression. Discussion: Microbiota analysis could be useful as a noninvasive diagnostic tool. The use of Lactobacillus, vaginal probiotics, and specific antibiotics is proposed as treatment. Conclusions: Microbiota plays a relevant role in the development of endometriosis. It is necessary to continue research and promote public health support to improve the diagnosis and treatment of the disease, which would contribute to improving the quality of life of affected women.
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Microbiota y Endometriosis: ¿existe relación? Una revisión de la literatura DOI: https://doi.org/10.51326/ec.8.1519194Palabras clave: Endometriosis, Microbiota, Útero, VaginaResumen Introducción: La endometriosis es una enfermedad caracterizada por el crecimiento de tejido endometrial fuera del útero que causa dolor pélvico, infertilidad e inflamación. La microbiota, especialmente la intestinal y vaginal, tiene un papel crucial en la regulación hormonal e inmunitaria, pudiendo contribuir a la patogénesis de la endometriosis. Objetivos: Analizar la relación entre la microbiota intestinal y del aparato reproductor femenino y la endometriosis, e investigar los cambios en la microbiota vaginal, uterina e intestinal presentes en mujeres con esta enfermedad. Metodología: Se realizó una búsqueda exhaustiva en bases de datos científicas utilizando términos DeCS/MeSH. Los artículos seleccionados fueron en español o inglés y publicados entre 2014 y 2024. Tras evaluar su calidad científica, se analizaron 30 artículos relevantes. Resultados: La revisión muestra alteraciones significativas en la microbiota vaginal, uterina e intestinal de mujeres con endometriosis, destacándose disbiosis caracterizada por la disminución de bacterias beneficiosas y el aumento de patógenos. Estas alteraciones se asocian con inflamación crónica, alteraciones en la metabolización de estrógenos y la progresión de la enfermedad. Discusión: El análisis de la microbiota podría ser útil como herramienta diagnóstica no invasiva. Se propone el uso de Lactobacillus, probióticos vaginales y antibióticos específicos como tratamiento. Conclusiones: La microbiota juega un papel relevante en el desarrollo de la endometriosis. Es necesario continuar la investigación y fomentar el apoyo en salud pública para mejorar el diagnóstico y tratamiento de la enfermedad, lo que contribuiría a mejorar la calidad de vida de las mujeres afectadas. Referencias 1. Jiang I, Yong PJ, Allaire C, Bedaiwy MA. Intricate Connections between the Microbiota and Endometriosis. Int J Mol Sci. 2021;22(11):5644. https://doi.org/10.3390/ijms22115644 2. Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Hum Reprod Update. 2021;28(1):92-131. https://doi.org/10.1093/humupd/dmab035 3. Servicio Andaluz de Salud. Guía de atención a mujeres con endometriosis en el sistema sanitario público de Andalucía. Sevilla: Servicio Andaluz de Salud; 2017. Disponible en: https://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/sites/default/files/sincfiles/wsas-media-mediafile_sasdocumento/2019/guia_endometriosis_2018.pdf [Consultado 05-02-2025] 4. Kobayashi H. Gut and reproductive tract microbiota: Insights into the pathogenesis of endometriosis (Review). Biomed Rep. 2023;19(1):43. https://doi.org/10.3892/br.2023.1626 5. 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Gut and Vaginal Microbiota in the Endometriosis: Systematic Review and Meta-Analysis. Biomed Res Int. 2023;2023:2675966. https://doi.org/10.1155/2023/2675966 18. Sobstyl A, Chałupnik A, Mertowska P, Grywalska E. How Do Microorganisms Influence the Development of Endometriosis? Participation of Genital, Intestinal and Oral Microbiota in Metabolic Regulation and Immunopathogenesis of Endometriosis. Int J Mol Sci. 2023;24(13):10920. https://doi.org/10.3390/ijms241310920 19. Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 2021;13(1):1-21. https://doi.org/10.1080/19490976.2021.1894070 20. Wang MY, Sang LX, Sun SY. Gut microbiota and female health. World J Gastroenterol. 2024;30(12):1655-62. https://doi.org/10.3748/wjg.v30.i12.1655 21. Agostinis C, Mangogna A, Bossi F, Ricci G, Kishore U, Bulla R. Uterine Immunity and Microbiota: A Shifting Paradigm. 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