Volume 29, Issue 161, July 2025

Endometriosis and the Microbiome: A Hidden Link in the Female Reproductive Ecosystem

Sara Hassan¹, Szymon Bienia^2♦, Aisha Hassan³, Kamil Hassan⁴

¹Medical University of Silesia, 18 Medyków Street, 40-752 Katowice, Poland
²Medical University of Silesia, 18 Medyków Street, 40-752 Katowice, Poland
³Cardinal Stefan Wyszyński University in Warsaw, Wóycickiego 1/3, 01-938 Warsaw, Poland
⁴Social Academy of Sciences in Łódź, Henryka Sienkiewicza 9, 90-113 Łódź, Poland

^♦Corresponding author
Szymon Bienia, Medical University of Silesia, 18 Medyków Street, 40-752 Katowice, Poland

ABSTRACT

Endometriosis involves the persistent presence of endometrial-like tissue growing outside the uterus. These lesions respond to hormones, break down, and cause inflammation. This disease mainly affects women of reproductive age and is often accompanied by unpleasant symptoms such as pain and infertility. To this day, the actual cause of endometriosis has not been identified. There are many theories, such as coelomic metaplasia or retrograde menstruation, but they do not offer a complete picture of the cause. In recent years, research has emerged concerning the gut microbiome’s potential role as a contributing factor to the development of endometriosis. Results show that women with endometrial lesions exhibit a modified gut microbial composition, with an overgrowth of harmful bacteria (such as Pseudomonas) and a reduction in those with more beneficial effects (such as Ruminococcus). These changes may impact hormone metabolism and immune function, contributing to disease development. This has led to the “gut-reproductive tract axis” hypothesis — the idea that the digestive and reproductive systems interact via immune and hormonal pathways. Microbial imbalances in one system may trigger inflammation in the other. Laparoscopy remains the gold standard for diagnosis, but it’s invasive and often delayed due to overlapping symptoms. If microbial patterns are strongly linked to endometriosis, they could lead to noninvasive diagnostic methods. The gut microbiome is also being explored as a therapeutic target. While human data are limited, probiotics might one day support standard treatments. Large-scale clinical trials are needed to validate these findings.

Keywords: endometriosis, gut microbiota, dysbiosis, probiotics, inflammation

Medical Science, 2025, 29, e104ms3605

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DOI: https://doi.org/10.54905/disssi.v29i161.e104ms3605

Published: 12 July 2025