Vol 95, No 11 (2024)
Review paper
Published online: 2023-09-28

open access

Page views 1099
Article views/downloads 1009
Get Citation

Connect on Social Media

Connect on Social Media

Relationship between the gut microbiome and endometriosis and its role in pathogenesis, diagnosis, and treatment: a systematic review

Isabella Weber1, Anna Sienko1, Aleksandra Urban2, Carolyn Szwed3, Krzysztof Czajkowski2, Pawel Basta4, Jacek Sienko2
Pubmed: 37772919
Ginekol Pol 2024;95(11):893-901.

Abstract

Endometriosis is a chronic inflammatory disease affecting approximately 10% of women. It is defined as endometrial tissue outside of the uterus and produces a variety of symptoms including pelvic pain, dysmenorrhea, dyspareunia, and intermenstrual bleeding. Although several theories have been postulated regarding the pathogenesis of endometriosis, no theory has provided a complete explanation, therefore limiting our progress in diagnostic tools and management of endometriosis. Recently, much attention has been paid to the importance and role of the gut microbiome in endometriosis. As defined by Joshua Lederberg — microbiome is a set of the genome of microorganisms inhabiting a human body, including commensal, symbiotic and pathogenic microorganisms. The aim of this systematic review was to conduct a search in the Embase, Medline, and PubMed databases for literature from July 2013 to July 2023 regarding the relationship between the gut microbiome and endometriosis. 147 records were screened, of which 26 met the eligibility criteria, and 16 were included in this review. Our review concludes that patients with endometriosis show an altered gut microbiome, and that this has the potential to provide insight for pathogenesis, markers for diagnosis, as well as therapeutic options for treatment of endometriosis. Future research is necessary to confirm this and further investigate the relationship between the gut microbiome and endometriosis.

Article available in PDF format

View PDF Download PDF file

References

  1. Smolarz B, Szyłło K, Romanowicz H, et al. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021; 22(19).
  2. Giudice L, Kao L, Giudice L, et al. Endometriosis. The Lancet. 2004; 364(9447): 1789–1799.
  3. Sinaii N, Plumb K, Cotton L, et al. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008; 89(3): 538–545.
  4. Bulletti C, Coccia ME, Battistoni S, et al. Endometriosis and infertility. J Assist Reprod Genet. 2010; 27(8): 441–447.
  5. Horne A, Saunders P, Horne A, et al. SnapShot: Endometriosis. Cell. 2019; 179(7): 1677–1677.e1.
  6. Sampson JA, McCunn R, Aus der Fünten K, et al. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol. 1927; 3(2): 93–110.43.
  7. Matsuura K, Ohtake H, Katabuchi H, et al. Coelomic metaplasia theory of endometriosis: evidence from in vivo studies and an in vitro experimental model. Gynecol Obstet Invest. 1999; 47 Suppl 1: 18–20; discussion 20.
  8. Kapoor R, Stratopoulou CA, Dolmans MM. Pathogenesis of Endometriosis: New Insights into Prospective Therapies. Int J Mol Sci. 2021; 22(21).
  9. Wang Y, Nicholes K, Shih IM, et al. The Origin and Pathogenesis of Endometriosis. Annu Rev Pathol. 2020; 15: 71–95.
  10. Marquardt RM, Kim TH, Shin JH, et al. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? Int J Mol Sci. 2019; 20(15).
  11. Asghari S, Valizadeh A, Aghebati-Maleki L, et al. Endometriosis: Perspective, lights, and shadows of etiology. Biomed Pharmacother. 2018; 106: 163–174.
  12. Cho I, Blaser MJ, Cho I, et al. The human microbiome: at the interface of health and disease. Nat Rev Genet. 2012; 13(4): 260–270.
  13. Ogunrinola GA, Oyewale JO, Oshamika OO, et al. The Human Microbiome and Its Impacts on Health. Int J Microbiol. 2020; 2020: 8045646.
  14. Sun J, Kato I. Gut microbiota, inflammation and colorectal cancer. Genes Dis. 2016; 3(2): 130–143.
  15. Baothman OA, Zamzami MA, Taher I, et al. The role of Gut Microbiota in the development of obesity and Diabetes. Lipids Health Dis. 2016; 15: 108.
  16. Sun Y, Gao S, Ye C, et al. Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol. 2023; 13: 1142041.
  17. Xu J, Li Ke, Zhang L, et al. Dysbiosis of Gut Microbiota Contributes to Chronic Stress in Endometriosis Patients via Activating Inflammatory Pathway. Reproductive and Developmental Medicine. 2017; 1(4): 221–227.
  18. Yuan M, Li D, Zhang Z, et al. Endometriosis induces gut microbiota alterations in mice. Hum Reprod. 2018; 33(4): 607–616.
  19. Chompre G, Cruz M, Arroyo G, et al. Probiotic Administration in an Endometriosis Animal Model Can Influence the Gut Microbiota and Gut‐Brain Axis to Counteract the Effects of Stress. The FASEB Journal. 2018; 32(S1).
  20. Ata B, Yildiz S, Turkgeldi E, et al. The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Sci Rep. 2019; 9(1): 2204.
  21. Chadchan SB, Cheng M, Parnell LA, et al. Antibiotic therapy with metronidazole reduces endometriosis disease progression in mice: a potential role for gut microbiota. Hum Reprod. 2019; 34(6): 1106–1116.
  22. Hantschel J, Weis S, Schäfer KH, et al. Effect of endometriosis on the fecal bacteriota composition of mice during the acute phase of lesion formation. PLoS One. 2019; 14(12): e0226835.
  23. Cao Y, Jiang C, Jia Y, et al. Letrozole and the Traditional Chinese Medicine, Shaofu Zhuyu Decoction, Reduce Endometriotic Disease Progression in Rats: A Potential Role for Gut Microbiota. Evid Based Complement Alternat Med. 2020; 2020: 3687498.
  24. Ni Z, Sun S, Bi Y, et al. Correlation of fecal metabolomics and gut microbiota in mice with endometriosis. Am J Reprod Immunol. 2020; 84(6): e13307.
  25. Chadchan SB, Popli P, Ambati CR, et al. Gut microbiota-derived short-chain fatty acids protect against the progression of endometriosis. Life Sci Alliance. 2021; 4(12).
  26. Huang L, Liu B, Liu Z, et al. Gut Microbiota Exceeds Cervical Microbiota for Early Diagnosis of Endometriosis. Front Cell Infect Microbiol. 2021; 11: 788836.
  27. Le N, Cregger M, Brown V, et al. Association of microbial dynamics with urinary estrogens and estrogen metabolites in patients with endometriosis. PLoS One. 2021; 16(12): e0261362.
  28. Ni Z, Ding J, Zhao Q, et al. Alpha-linolenic acid regulates the gut microbiota and the inflammatory environment in a mouse model of endometriosis. Am J Reprod Immunol. 2021; 86(4): e13471.
  29. Svensson A, Brunkwall L, Roth B, et al. Associations Between Endometriosis and Gut Microbiota. Reprod Sci. 2021; 28(8): 2367–2377.
  30. Chadchan SB, Naik SK, Popli P, et al. Gut microbiota and microbiota-derived metabolites promotes endometriosis. Cell Death Discov. 2023; 9(1): 28.
  31. Chen P, Wang K, Zhuang M, et al. An insight into gut microbiota and metabolites in the mice with adenomyosis. Front Cell Infect Microbiol. 2023; 13: 1075387.
  32. Wei Y, Tan H, Yang R, et al. Gut dysbiosis-derived β-glucuronidase promotes the development of endometriosis. Fertil Steril. 2023; 120(3 Pt 2): 682–694.
  33. Conlon MA, Bird AR. The impact of diet and lifestyle on gut microbiota and human health. Nutrients. 2014; 7(1): 17–44.
  34. Mayfosh AJ, Baschuk N, Hulett MD. Leukocyte Heparanase: A Double-Edged Sword in Tumor Progression. Front Oncol. 2019; 9: 331.
  35. Chen C, Song X, Wei W, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun. 2017; 8(1): 875.
  36. Saad MJA, Santos A, Prada PO. Linking Gut Microbiota and Inflammation to Obesity and Insulin Resistance. Physiology (Bethesda). 2016; 31(4): 283–293.
  37. Cao Y, Jiang C, Jia Y, et al. Letrozole and the Traditional Chinese Medicine, Shaofu Zhuyu Decoction, Reduce Endometriotic Disease Progression in Rats: A Potential Role for Gut Microbiota. Evid Based Complement Alternat Med. 2020; 2020: 3687498.
  38. Zhu G, Jiang C, Yan X, et al. Shaofu Zhuyu Decoction Regresses Endometriotic Lesions in a Rat Model. Evid Based Complement Alternat Med. 2018; 2018: 3927096.
  39. Chadchan SB, Cheng M, Parnell LA, et al. Antibiotic therapy with metronidazole reduces endometriosis disease progression in mice: a potential role for gut microbiota. Hum Reprod. 2019; 34(6): 1106–1116.