Microbiota-metabolite axis in endometriosis: Pathogenic mechanisms and clinical implications

Area of Science:

• Microbiome research
• Endocrinology
• Metabolomics

Background:

• Growing evidence implicates the microbiota in endometriosis (EM) pathogenesis.
• Endometriosis is associated with microbial imbalance, reduced beneficial bacteria, and increased pathogens.
• Microbiota influence host immune and endocrine responses via metabolic activity.

Purpose of the Study:

• To explore the role of microbiota and their metabolic activity in endometriosis.
• To identify key metabolic disturbances associated with EM.
• To discuss potential non-hormonal therapeutic strategies targeting the microbiota.

Main Methods:

• Review of existing studies on microbiota and endometriosis.
• Analysis of metabolomic data from EM patients.
• Examination of microbial influence on host immune and endocrine functions.

Main Results:

• Microbial imbalance in EM patients characterized by reduced beneficial bacteria and increased pathogens.
• Key metabolic disturbances include decreased short-chain fatty acids (especially butyrate), altered tryptophan metabolism, elevated β-glucuronidase, increased lipopolysaccharide, and changed bile acid profiles.
• These metabolic alterations promote EM by disrupting immune homeostasis, enhancing estrogen signaling, and driving inflammation.

Conclusions:

• Microbiota-driven metabolic dysregulation is a key factor in endometriosis pathogenesis.
• Targeted interventions like probiotics and dietary changes show promise for non-hormonal EM therapy.
• Further multi-omics and longitudinal studies are needed to establish causality and develop personalized treatments.