Endometriosis: Pathogenesis, diagnosis, treatment and the role of gut microbiota

Hanna Senat, Patrycja Grabowska, Aleksandra Senat, Patrycja Bolla, Aleksandra Madej, Zuzanna Marczyńska, Karolina Libracka
In: Journal of Education, Health and Sport · 2024 · vol. 59 , pp. 87–101 · doi:10.12775/jehs.2024.59.006 · W4391774361
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This review examines endometriosis pathogenesis, diagnosis, and treatment, highlighting the suspected role of gut microbiota and potential therapeutic strategies involving microbiome modulation.

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This narrative article reviews endometriosis, focusing on its epidemiology, described lesion types (peritoneal, ovarian, and deep infiltrative), and the challenges of understanding its pathogenesis and achieving timely, accurate diagnosis and effective long-term treatment. It highlights that endometriosis is often asymptomatic until found incidentally during gynecologic evaluation or surgery, and notes associations reported in epidemiologic research with other conditions, including certain cancers and chronic inflammatory diseases. The paper emphasizes a proposed link between gut microbiota and endometriosis pathogenesis via effects on estrogen biology, immune function, and inflammation, while stating that correcting the gut microbiota with antibiotics, probiotics, or fecal bacterial transplantation is discussed as a potentially promising approach. This paper is centrally about endometriosis — it reviews endometriosis pathogenesis, diagnosis, treatment, and the role of gut microbiota in relation to endometriosis-related mechanisms.

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Abstract

Endometriosis is a common disease. It affects 5-10% of women of reproductive age worldwide. However, despite the prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and effective treatment takes years to achieve. Determining the mechanisms involved in its pathogenesis is vital, not only to pave the way for early identification, but also for disease management and development of less invasive but successful treatment strategies. Three main typed of endometriosis have been described in literature: peritoneal, ovarian and deep infiltrative. This is mainly due to the most common locations of ectopis endometrium. .Determining the precise pathogenesis of endometriosis has proved challenging and controversial for gynecologists, endocrinologists and researchers, but recent studies have focused on finding answers. This disease is often asymptomatic and diagnosed incidentally during various surgical interventions or follow-up gynecological examinations. Epidemiological research reports that women with this disease are more vulnerable to ovarian and breast cancer, asthma, skin cancer suhc as melanoma, cardiovascular disease and rheumatoid arthritis. The connection of the gut microbiota and endometriosis is nowadays higly suspected to exist. Scientists are focused on the influence of the microbiome on estrogens, estrogens-dependent disorders, immune system and inflammation. It is strongly velieved that correction of the gut microbiota with antibiotica, probiotics, or fecal bacterial transplantation sie a hopeful method for improving the clinical management of endometriosis.
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Endometriosis: Pathogenesis, diagnosis, treatment and the role of gut microbiota DOI: https://doi.org/10.12775/JEHS.2024.59.006Keywords endometriosis, microbiome, hormone therapy, surgery, chronic pain, inflammation, dienogest, endometriosis pathogenesis, endometriosis diagnosis, infertility in endometriosis, endometriosis treatmentAbstract Endometriosis is a common disease. It affects 5-10% of women of reproductive age worldwide. However, despite the prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and effective treatment takes years to achieve. Determining the mechanisms involved in its pathogenesis is vital, not only to pave the way for early identification, but also for disease management and development of less invasive but successful treatment strategies. Three main typed of endometriosis have been described in literature: peritoneal, ovarian and deep infiltrative. This is mainly due to the most common locations of ectopis endometrium. .Determining the precise pathogenesis of endometriosis has proved challenging and controversial for gynecologists, endocrinologists and researchers, but recent studies have focused on finding answers. This disease is often asymptomatic and diagnosed incidentally during various surgical interventions or follow-up gynecological examinations. Epidemiological research reports that women with this disease are more vulnerable to ovarian and breast cancer, asthma, skin cancer suhc as melanoma, cardiovascular disease and rheumatoid arthritis. The connection of the gut microbiota and endometriosis is nowadays higly suspected to exist. Scientists are focused on the influence of the microbiome on estrogens, estrogens-dependent disorders, immune system and inflammation. It is strongly velieved that correction of the gut microbiota with antibiotica, probiotics, or fecal bacterial transplantation sie a hopeful method for improving the clinical management of endometriosis. References Mangtani P, Booth M. Epidemiology of endometriosis. J Epidemiol Community Health. 1993 Apr;47(2):84-8. doi: 10.1136/jech.47.2.84. PMID: 8326278; PMCID: PMC1059733. Szyłło K, Górski J. Endometriosis – diagnosis and treatment according to current recommendations. Menopause Review/Przegląd Menopauzalny. 2011;10(6):464-468. Bednarowska-Flisiak, A., Bińkowska, M., and Dębski, R. (2004). Endometriosis: what is new?. Menopause Review/Przegląd Menopauzalny, 3(2), pp.22-29. Szubert, Maria, et al. "Is There a Possibility to Diagnose Endometriosis from the Endometrial Level?" Current Gynecologic Oncology, vol. 14, no. 1, Medical Communications, 2016, pp. 30-38. Polish, Position of the Team of Experts. "Diagnosis and treatment methods of endometriosis." Ginekol Pol 83 (2012): 871-876. Łukaszuk, Krzysztof, et al. "Diagnosis and treatment of infertility-recommendations of the Polish Society of Reproductive Medicine and Embryology (PTMRiE) and the Polish Society of Gynecologists and Obstetricians (PTGP)." Gynecology and Practical Perinatology 3.3 (2018): 112-140. Donnez J, Squifflet J, Casanas-Roux F, Pirard C, Jadoul P, Van Langendonckt A. Typical and subtle atypical presentations of endometriosis. Obstet Gynecol Clin North Am. 2003 Mar;30(1):83-93, viii. doi: 10.1016/s0889-8545(02)00054-2. PMID: 12699259 Hsu AL, Khachikyan I, Stratton P. Invasive and noninvasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010 Jun;53(2):413-9. doi: 10.1097/GRF.0b013e3181db7ce8. PMID: 20436318; PMCID: PMC2880548. Myszewska, Aleksandra, et al. "Clear cell cancer of the ovary developing within an advanced postmenopausal endometriosis. Case report and review of the literature." Current Gynecologic Oncology 11.1 (2013): 82. Gut, Agata. "Endometriosis-a current, unresolved problem." (2013). Sieberg CB, Lunde CE, Borsook D. Endometriosis and pain in the adolescent- striking early to limit suffering: A narrative review. Neurosci Biobehav Rev. 2020 Jan;108:866-876. doi: 10.1016/j.neubiorev.2019.12.004. Epub 2019 Dec 17. PMID: 31862211; PMCID: PMC7175958. Krzysztof, Drews, Barlik Magdalena, and Łukaszewski Tomasz. "Conservative treatment of endometriosis-review paper." Ginekol Pol 83 (2012): 209-213. Augustin Ewa, "2. Diplomas, scientific/artistic degrees held, with the name, place and year of their obtaining and the title of the dissertation." Nezhat C, Nezhat F, Nezhat C. Endometriosis: ancient disease, ancient treatments. Fertil Steril. 2012 Dec;98(6 Suppl):S1-62. doi: 10.1016/j.fertnstert.2012.08.001. Epub 2012 Oct 17. PMID: 23084567. Donnez J, Cacciottola L. Endometriosis: An Inflammatory Disease That Requires New Therapeutic Options. Int J Mol Sci. 2022 Jan 28;23(3):1518. doi: 10.3390/ijms23031518. PMID: 35163463; PMCID: PMC8836207. Schmidt CL. Endometriosis: a reappraisal of pathogenesis and treatment. Fertil Steril. 1985 Aug;44(2):157-73. doi: 10.1016/s0015-0282(16)48729-7. PMID: 3894056. Sampson J.A. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am. J. Pathol. 1927;3:93 Taylor H.S., Kotlyar A.M., Flores V.A. Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations. Lancet. 2021;10276:839–852. doi: 10.1016/S0140-6736(21)00389-5. Kapoor R, Stratopoulou CA, Dolmans MM. Pathogenesis of Endometriosis: New Insights into Prospective Therapies. Int J Mol Sci. 2021 Oct 28;22(21):11700. doi: 10.3390/ijms222111700. PMID: 34769130; PMCID: PMC8583778. Giudice L.C., Kao L.C. Endometriosis. Lancet. 2004;364:1789–1799. doi: 10.1016/S0140-6736(04)17403-5. Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and Subfertility. Cells. 2021 Jun 3;10(6):1381. doi: 10.3390/cells10061381. PMID: 34205040; PMCID: PMC8226491. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019 Feb;111(2):327-340. doi: 10.1016/j.fertnstert.2018.10.013. Epub 2018 Dec 7. PMID: 30527836. Gruenwald P. Origin of endometriosis from the mesenchyme of the celomic walls. Am J Obstet Gynecol. 1942; 44: 470-474 Jabr F.I. Mani V. An unusual cause of abdominal pain in a male patient: endometriosis. Avicenna J Med. 2014; 4: 99-101 Simpson J.L. Elias S. Malinak L.R. Buttram V.C.J. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol. 1980; 137: 327-331 Kennedy S. Hadfield R. Westbrook C. Weeks D.E. Barlow D. Golding S. Magnetic resonance imaging to assess familial risk in relatives of women with endometriosis. Lancet. 1998; 352: 1440-1441 Baranov V.S. Ivaschenko T.E. Liehr T. Yarmolinskaya M.I. Systems genetics view of endometriosis: a common complex disorder. Eur J Obstet Gynecol Reprod Biol. 2015; 185: 59-65 Gordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril. 2017 Dec;108(6):872-885.e1. doi: 10.1016/j.fertnstert.2017.08.036. Epub 2017 Oct 31. PMID: 29100623. Mehedintu C, Plotogea MN, Ionescu S, Antonovici M. Endometriosis still a challenge. J Med Life. 2014 Sep 15;7(3):349-57. Epub 2014 Sep 25. PMID: 25408753; PMCID: PMC4233437. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571. doi: 10.1097/AOG.0000000000002469. PMID: 29420391. Kiesel L, Sourouni M. Diagnosis of endometriosis in the 21st century. Climacteric. 2019 Jun;22(3):296-302. doi: 10.1080/13697137.2019.1578743. Epub 2019 Mar 25. PMID: 30905186. Saunders PTK, Horne AW. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell. 2021 May 27;184(11):2807-2824. doi: 10.1016/j.cell.2021.04.041. PMID: 34048704. Smolarczyk, Roman, and Jacek Sieƒko. "Proliferations of the Endometrium-Proceedings." Kaminski, Pawel, and Natalia Mazanowska. "Operative treatment of endometriosis." In Endometriosis. Wielgoś M (ed.). Via Medica, Gdansk (2010): 39-54 Stępniewska, Anna Katarzyna, et al. "Deeply infiltrating endometriosis-a significant clinical problem in gynecology." (2017). De Sanctis V, Soliman AT, Di Maio S, Soliman N, Elsedfy H. Long-term effects and significant Adverse Drug Reactions (ADRs) associated with the use of Gonadotropin-Releasing Hormone analogs (GnRHa) for central precocious puberty: a brief review of literature. Acta Biomed. 2019 Sep 6;90(3):345-359. doi: 10.23750/abm.v90i3.8736. PMID: 31580327; PMCID: PMC7233750. Api M. Surgery for endometriosis-related pain. Womens Health (Lond). 2015 Aug;11(5):665-9. doi: 10.2217/whe.15.52. Epub 2015 Oct 6. PMID: 26441217 Afors K, Murtada R, Centini G, Fernandes R, Meza C, Castellano J, Wattiez A. Employing laparoscopic surgery for endometriosis. Womens Health (Lond). 2014 Jul;10(4):431-43. doi: 10.2217/whe.14.28. PMID: 25259903. Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil. Steril. 62(4), 696–700 (1994). Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil. Steril. 98(3), 564–571 (2012) Sampson J.A. Peritoneal endometriosis due to menstrual dissemination of endome− trial tissue into the peritoneal cavity. Am. J. Obstet. Gynecol. 1927; 14: 442–469. Bafort C, Beebeejaun Y, Tomassetti C, Bosteels J, Duffy JM. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2020 Oct 23;10(10):CD011031. doi: 10.1002/14651858.CD011031.pub3. PMID: 33095458; PMCID: PMC8428328. Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord. 2022 Jun;23(3):333-355. doi: 10.1007/s11154-021-09666-w. Epub 2021 Aug 17. PMID: 34405378; PMCID: PMC9156507. Tanbo T, Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand. 2017 Jun;96(6):659-667. doi: 10.1111/aogs.13082. Epub 2017 Jan 30. PMID: 27998009. Giudice L. Clinical practice. Endometriosis. N Engl J Med. 2010, 362, 2389-2398 Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022 Nov 24;12:1069557. doi: 10.3389/fcimb.2022.1069557. PMID: 36506023; PMCID: PMC9729346. Svensson A, Brunkwall L, Roth B, Orho-Melander M, Ohlsson B. Associations Between Endometriosis and Gut Microbiota. Reprod Sci. 2021 Aug;28(8):2367-2377. doi: 10.1007/s43032-021-00506-5. Epub 2021 Mar 3. PMID: 33660232; PMCID: PMC8289757. Li Y, Wang K, Ding J, Sun S, Ni Z, Yu C. Influence of the gut microbiota on endometriosis: Potential role of chenodeoxycholic acid and its derivatives. Front Pharmacol. 2022 Aug 22;13:954684. doi: 10.3389/fphar.2022.954684. PMID: 36071850; PMCID: PMC9442031 Uzuner C, Mak J, El-Assaad F, Condous G. The bidirectional relationship between endometriosis and microbiome. Front Endocrinol (Lausanne). 2023 Mar 7;14:1110824. doi: 10.3389/fendo.2023.1110824. PMID: 36960395; PMCID: PMC10028178 Xholli A, Cremonini F, Perugi I, Londero AP, Cagnacci A. Gut Microbiota and Endometriosis: Exploring the Relationship and Therapeutic Implications. Pharmaceuticals (Basel). 2023 Dec 7;16(12):1696. doi: 10.3390/ph16121696. PMID: 38139822; PMCID: PMC10747908. . Ser, H.-L.; Yong, S.-J.A.; Shafiee, M.N.; Mokhtar, N.M.; Ali, R.A.R. Current Updates on the Role of Microbiome in Endometriosis: A Narrative Review. Microorganisms 2023, 11, 360 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. Arch. Gynecol. Obstet. 304 (5), 1363–1373. doi: 10.1007/s00404-021-06057-z Downloads Published How to Cite Issue Section License Copyright (c) 2024 Hanna Senat, Patrycja Grabowska, Aleksandra Senat, Patrycja Bolla, Aleksandra Madej, Zuzanna Marczyńska, Karolina Libracka This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Stats Number of views and downloads: 706 Number of citations: 0

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