The Multifactorial Pathogenesis of Endometriosis: A Narrative Review Integrating Hormonal, Immune, and Microbiome Aspects
Datkhayeva Z. Iskakova A. Mireeva A. Seitaliyeva A. Skakova R. Kulniyazova G. Shayakhmetova A. Koshkimbayeva G. Sarmuldayeva C. Nurseitova L. Koshenova L. Imanbekova G. Maxutova D. Yerkenova S. Shukirbayeva A. Pernebekova U. Dushimova Z. Amirkhanova A.
May 2025Multidisciplinary Digital Publishing Institute (MDPI)
Medicina (Lithuania)
2025#61Issue 5
Endometriosis (EM) is a common estrogen-dependent chronic inflammatory disorder affecting reproductive-aged women, yet its pathogenesis remains incompletely understood. Recent evidence suggests that the gut microbiota significantly influence immune responses, estrogen metabolism, and systemic inflammation, potentially contributing to EM progression. This narrative review explores the relationship between the gut microbiota and EM, emphasizing microbial dysbiosis, inflammation, estrogen regulation, and potential microbiome-targeted therapies. Studies published within the last 30 years were included, focusing on the microbiota composition, immune modulation, estrogen metabolism, and therapeutic interventions in EM. The selection criteria prioritized peer-reviewed articles, clinical trials, meta-analyses, and narrative reviews investigating the gut microbiota’s role in EM pathophysiology and treatment. Microbial dysbiosis in EM is characterized by a reduced abundance of beneficial bacteria (Lactobacillus, Bifidobacterium, and Ruminococcaceae) and an increased prevalence of pro-inflammatory taxa (Escherichia/Shigella, Streptococcus, and Bacteroides). The gut microbiota modulate estrogen metabolism via the estrobolome, contributing to increased systemic estrogen levels and lesion proliferation. Additionally, lipopolysaccharides (LPS) from Gram-negative bacteria activate the TLR4/NF-κB signaling pathway, exacerbating inflammation and EM symptoms. The interaction between the gut microbiota, immune dysregulation, and estrogen metabolism suggests a critical role in EM pathogenesis. While microbiota-targeted interventions offer potential therapeutic benefits, further large-scale, multi-center studies are needed to validate microbial biomarkers and optimize microbiome-based therapies for EM. Integrating microbiome research with precision medicine may enhance the diagnostic accuracy and improve the EM treatment efficacy.
endometriosis , estrogen , fecal microbiota transplantation , gut microbiota , inflammation , microbial , probiotics
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Department of General Medical Practice No. 2, School of Medicine, S.D. Asfendiyarov Kazakh National Medical University, Tole-bi 94, Almaty, 050012, Kazakhstan
Department of Public Health and Social Sciences, Kazakhstan’s Medical University “KSPH, Utepov str.19A., Almaty, 050000, Kazakhstan
Higher School of Medicine, Al-Farabi Kazakh National University, Tole-bi 96, Almaty, 050040, Kazakhstan
Department of Obstetrics and Gynecology, School of Medicine, S.D. Asfendiyarov Kazakh National Medical University, Tole-bi 94, Almaty, 050012, Kazakhstan
Department of General Medical Practice with Courses, Kazakh-Russian Medical University, Abylai Khan 51/53, Almaty, 050000, Kazakhstan
City Center for Human Reproduction, st. Zhibek-Zholy 7W6M+CQR, Almaty, 050000, Kazakhstan
“Almaty City Hospital No. 29” Communal State Enterprise on the Right of Economic Management, Microdistrict Zerdeli 371/3, Almaty, 050000, Kazakhstan
School of Pharmacy, S.D. Asfendiyarov Kazakh National Medical University, Tole-bi 94, Almaty, 050012, Kazakhstan
Department of General Medical Practice No. 2
Department of Public Health and Social Sciences
Higher School of Medicine
Department of Obstetrics and Gynecology
Department of General Medical Practice with Courses
City Center for Human Reproduction
“Almaty City Hospital No. 29” Communal State Enterprise on the Right of Economic Management
School of Pharmacy
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