Endometriosis – is there consensus on a role for the gut microbiome?
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Endometriosis – is there consensus on a role for the gut microbiome?

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Imogen Wolsey
Imogen is a registered dietitian and our HCP Development Manager here at Symprove. She has clinical expertise in eating disorders and gastroenterology. After undertaking a Masters degree in Sports Nutrition, with specific focus on the role of probiotics, she worked within high performance athletes to explore the effects of the microbiome on training and performance.

At present, there is no conclusive evidence regarding the role of the gut microbiome in endometriosis. 

A systematic review concluded that there are differences in microbiome composition of individuals with and without endometriosis (e.g. increased levels of Proteobacteria, Enterobacteriaceae, Streptococcus spp. and Escherichia coli in endometriosis). However, of the eighteen included in the review, only 6 had studied the gut microbiome, and only one study had investigated the human gut microbiome. 

A cross-sectional study in women with and without endometriosis (n=264) suggested that the gut microbiome may be altered in women with endometriosis, with significant differences at genus level for a number of bacteria. In this study, it was not possible to conclude whether the gut microbiome impacted endometriosis or whether endometriosis impacted the gut microbiome.

While the role of the gut microbiome in endometriosis remains unclear, studies to date suggest it may be implicated in development and progression. Additionally, given the emerging research on the estrobolome, and the fact that endometriosis is considered highly oestrogen-dependent, further research exploring the link between this condition and the role of the gut microbiome in hormone regulation is required.

Finally, it has been reported that women with endometriosis are three times more likely to have IBS compared with women without endometriosis. In these scenarios, evidence-based can support with symptom management.

References

  1. M Leonardi, C Hicks, F El-Assaad, E El-Omar, G Condous. Endometriosis and the microbiome: a systematic review.  BJOG vol 27 (2) pages 239-249, Jan 2020.  https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15916#:~:text=Main%20results,%3B%20however%2C%20this%20remains%20unclear.
  2. Svensson A, Brunkwall L, Roth B, Orho-Melander M, Ohlsson B. Associations Between Endometriosis and Gut Microbiota. Reprod Sci. 2021 Aug;28(8):2367-2377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289757/
  1. Chandni Talwar, Vertika Singh, Ramakrishna Kommagani, The gut microbiota: a double-edged sword in endometriosis, Biology of Reproduction, Volume 107, Issue 4, October 2022, Pages 881–901, https://doi.org/10.1093/biolre/ioac147
  1. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103, pages 45-53. https://pubmed.ncbi.nlm.nih.gov/28778332/
  1. Nabi MY, Nauhria S, Reel M, Londono S, Vasireddi A, Elmiry M and Ramdass PVAK (2022) Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Front. Med. 9: 914356. https://doi.org/10.3389/fmed.2022.914356

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