Gut microbiota alterations in endometriosis: an observational study in a Spanish female cohort

PURPOSE: Purpose: To identify potential gut biomarkers linked to endometriosis for diagnosis and treatment. METHODS: The recruitment of this case-control study was done through the Endometriosis Health Profile-5 questionnaire, validated for endometriosis assessment. A total of 243 women completed the questionnaire and 73 women met the eligibility criteria of the study. Stool samples from the control group (n = 43) and patients with a positive diagnosis of endometriosis (n = 30) were collected and subjected to 16S ribosomal RNA (16S rRNA) gene sequencing using the V3-V4 regions. Various multivariate analysis approaches were used to assess diversity, composition, and abundance of intestinal microbiota. RESULTS: Among the 18 significantly different taxa (p < 0.05) between healthy controls and endometriosis patients, 3 families, 3 genera, and 12 species were identified. Endometriosis patients exhibited slightly higher diversity at the family and genus levels compared to controls (p > 0.05). This could indicate that endometriosis is characterized by the dominance of few species across diverse families and genera, associated with inflammation and estrogen signaling. Finally, several significant correlations (p < 0.05) were found between questionnaire variables related to "pain" and "infertility" items and certain families, genera, and species found in the endometriosis group. CONCLUSION: The differential presence of estrobolome-presenting gut taxa between endometriosis patients and controls endorses the possible role of the gut microbiome in female reproductive health, offering potential microbial markers for endometriosis diagnosis, monitoring, and treatment. Identified taxa may serve as future prognostic, diagnostic, and therapeutic targets for diagnosis and personalized, preventive or palliative/curative treatment of endometriosis. SUMMARY SENTENCE: Differential presence of estrobolome-related gut taxa in endometriosis (EMs) patients vs controls suggests a role of the gut microbiome in reproductive health, highlighting microbial markers for EMs diagnosis, monitoring, treatment, and future therapeutic targets.