THE ROLE OF MICROBIOME ALTERATIONS IN THE PATHOGENESIS AND MANAGEMENT OF ENDOMETRIOSIS

Abstract

The condition endometriosis is a chronic gynecological disorder characterized by ectopic endometrial tissue, causing pelvic pain and infertility. Recent research suggests that changes in the gut, vaginal, and endometrial microbiomes may impact gut estrogen processing, inflammation, and immune modulation, which in turn may influence the development of the disorder and the diverse treatment outcomes.

Objectives: To explore the role of microbiome alterations in the pathogenesis of endometriosis and evaluate their potential therapeutic and management implications.

Methodology: This cross-sectional study involved analyzing cases of endometriosis diagnosed during laparoscopic surgeries performed on reproductive-age women at the Obstetrics and Gynecology department of Qazi Hussain Ahmed Medical Complex, Nowshera, from October 25, 2024, to 25 March 2025. 16S rRNA sequencing was performed on samples obtained from the endometrium, feces, and vagina of women, as well as on the microbial communities of these women, which were compared to those of healthy control women. Demographic and clinical symptomatology, as well as biochemical variables, were documented. For the statistical analysis, the Student t-test and p-statistic were used.

Results: In this research, we analyzed a cohort of 150 patients with surgically treated endometriosis. The mean age of these patients was 31.8 years, with a standard deviation of 6.2 years. In some comparisons, patients demonstrated a reduced presence of Lactobacillus species within their vaginal and endometrial microbiomes, and, relative to 150 healthy controls, an increased presence of vaginal and endometrial pathogens, primarily Gardnerella and Streptococcus. Additionally, the intestinal microbiome underwent an overall loss of diversity, changes in astrobleme composition, and an increase in the concentration of estrogen in systemic circulation. The differences between the studied groups were statistically significant (p < 0.01). The presence of dysbiosis of the gut microbiome was associated with a greater prevalence of chronic pelvic pain.

Conclusion: Alterations in the microbiome may contribute to the development of endometriosis and subsequently influence its pathogenesis through alterations in estrogen metabolism, immune response, and inflammation. Probiotic, dietary, and novel microbiome-centric approaches may serve as adjuncts in managing the disease. There is a need for longitudinal studies to assess the causation and efficacy of these treatments.