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About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024Reviewers 2026
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Obstetrics and Gynegology2026№9

The role of the gut microbiome in the pathogenesis of endometriosis: mechanisms of interaction and therapeutic prospects

DOI
https://dx.doi.org/10.18565/aig.2026.94

Sukhanova M.A., Sheshukova N.A., Levakov S.A.

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Endometriosis remains one of the most mysterious chronic inflammatory diseases of the reproductive system, and its pathogenesis is not fully understood. Estrogen-dependent growth of endometriotic lesions, systemic inflammation, and impaired immune surveillance form a persistent pathological cycle that is not always breakable with existing therapeutic approaches. In recent years, the gut microbiota has attracted increasing attention as a potential regulator of these processes. Changes in the composition of the microbiome can influence the immune response, intestinal barrier permeability and estrogen metabolism via the activity of the estrobolome and β-glucuronidase, thus creating conditions conducive to hyperestrogenism and inflammation. This review examines the key mechanisms of the gut microbiota involvement in the pathogenesis of endometriosis, including the regulation of short-chain fatty acid production, T-cell balance and hormonal homeostasis. Particular attention is paid to current and promising strategies for the therapeutic modulation of the microbiota ranging from diets and probiotics to personalized approaches based on microbiome profiling. 
Conclusion. The gut microbiome should be regarded not as a secondary factor, but as a potentially significant target in the pathogenetic model of endometriosis. A deeper understanding of the interactions between the microbiome, hormones and the immune system could form the basis for the development of more effective and personalized treatment strategies for this disease in the near future.

Authors’ contributions. Sheshukova N.A., Levakov S.A. – developing the concept of the article; Sukhanova M.A. – collecting and processing the material, writing the text; Sheshukova N.A. – editing the text.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. Whilst preparing the manuscript, the authors used artificial intelligence tools to edit the text stylistically and improve its structural coherence. The authors retain full responsibility for the final version, the interpretation of the results and the content.
For citation: Sukhanova M.A., Sheshukova N.A., Levakov S.A. The role of the gut microbiome in 
the pathogenesis of endometriosis: mechanisms of interaction and therapeutic prospects.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (9): 32-39 (in Russian)
https://dx.doi.org/10.18565/aig.2026.94

Keywords

endometriosis
gut microbiota
dysbiosis
inflammation
estrobolome
β-glucuronidase
intestinal permeability
SCFA
Full text (in Russian)

References

  1. Crump J., Suker A., White L. Endometriosis: A review of recent evidence and guidelines. Aust. J. Gen. Pract. 2024; 53(1-2):11-8. https://dx.doi.org/10.31128/AJGP/04-23-6805
  2. Adilbayeva A., Kunz J. Pathogenesis of endometriosis and endometriosis-associated cancers. Int. J. Mol. Sci. 2024; 25(14): 7624. https://dx.doi.org/10.3390/ijms25147624
  3. Hämisch B., Büngeler A., Kielar C., Keller A., Strube O., Huber K. Self-assembly of fibrinogen in aqueous, thrombin-free solutions of variable ionic strengths. Langmuir. 2019; 35(37): 12113-22. https://dx.doi.org/10.1021/acs.langmuir.9b01515
  4. Табеева Г.И., Думановская М.Р., Чернуха Г.Е., Припутневич Т.В. Современные представления о микробиоте в гинекологии. Акушерство и гинекология. 2020; 2: 38-44. https://dx.doi.org/10.18565/aig.2020.2. 38-44 [Tabeeva G.I., Dumanovskaya M.R., Chernukha G.E., Priputnevich T.V. Current views on microbiota in gynecology. Obstetrics and Gynecology. 2020; (2): 38-44 (in Russian). https://dx.doi.org/10.18565/aig.2020.2.38-44].
  5. Cuffaro F., Russo E., Amedei A. Endometriosis, pain, and related psychological disorders: Unveiling the interplay among the microbiome, inflammation, and oxidative stress as a common thread. Int. J. Mol. Sci. 2024; 25(12): 6473. https://dx.doi.org/10.3390/ijms25126473
  6. Jiang I., Yong P.J., Allaire C., Bedaiwy M.A. Intricate connections between the microbiota and endometriosis. Int. J. Mol. Sci. 2021; 22(11): 5644. https://dx.doi.org/10.3390/ijms22115644
  7. Ярмолинская М.И., Русина Е.И., Семенова В.О., Беганова А.К. Экстрагенитальный эндометриоз: сложности диагностики, современная тактика лечения. Акушерство и гинекология. 2022; 8: 154-62. https://dx.doi.org/10.18565/aig.2022.8.154-162 [Yarmolinskaya M.I., Rusina E.I., Semenova V.O., Beganova A.K. Extragenital endometriosis: diagnostic difficulties, modern treatment policy. Obstetrics and Gynecology. 2022; (8): 154-12 (in Russian). https://dx.doi.org/10.18565/aig.2022.8.154-162].
  8. Shen H.H., Zhang T., Yang H.L., Lai Z.Z., Zhou W.J., Mei J. et al. Ovarian hormones-autophagy-immunity axis in menstruation and endometriosis. Theranostics. 2021; 11(7): 3512-26. https://dx.doi.org/10.7150/thno.55241
  9. Horne A.W., Missmer S.A. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022; 379: e070750. https://dx.doi.org/10.1136/bmj-2022-070750
  10. Raman K., Siegert R.J., Bharatharaj J., Krägeloh C.U. Validation of a Tamil Version of the Five Facet Mindfulness Questionnaire Using Rasch Analysis. Indian J. Psychol. Med. 2024; 46(2): 147-58. https://dx.doi.org/10.1177/02537176231220564
  11. Zizolfi B., Foreste V., Gallo A., Martone S., Giampaolino P., Di Spiezio Sardo A. Endometriosis and dysbiosis: State of art. Front. Endocrinol (Lausanne). 2023; 14: 1140774. https://dx.doi.org/10.3389/fendo.2023.1140774
  12. Giacomini E., Minetto S., Li Piani L., Pagliardini L., Somigliana E., Viganò P. Genetics and inflammation in endometriosis: improving knowledge for development of new pharmacological strategies. Int. J. Mol. Sci. 2021; 22(16): 9033. https://dx.doi.org/10.3390/ijms22169033
  13. Pašalić E., Tambuwala M.M., Hromić-Jahjefendić A. Endometriosis: Classification, pathophysiology, and treatment options. Pathol. Res. Pract. 2023; 251: 154847. https://dx.doi.org/10.1016/j.prp.2023.154847
  14. Hon J.X., Wahab N.A., Karim A.K.A., Mokhtar N.M., Mokhtar M.H. MicroRNAs in endometriosis: insights into inflammation and progesterone resistance. Int. J. Mol. Sci. 2023; 24(19): 15001. https://dx.doi.org/10.3390/ijms241915001
  15. Maddern J., Grundy L., Castro J., Brierley S.M. Pain in endometriosis. Front. Cell. Neurosci. 2020; 14: 590823. https://dx.doi.org/10.3389/fncel.2020.590823
  16. Manos J. The human microbiome in disease and pathology. APMIS. 2022; 130(12): 690-705. https://dx.doi.org/10.1111/apm.13225
  17. Martin-Gallausiaux C., Marinelli L., Blottière H.M., Larraufie P., Lapaque N. SCFA: mechanisms and functional importance in the gut. Proc. Nutr. Soc. 2021; 80(1): 37-49. https://dx.doi.org/10.1017/S0029665120006916
  18. Di Tommaso N., Gasbarrini A., Ponziani F.R. Intestinal barrier in human health and disease. Int. J. Environ. Res. Public Health. 2021; 18(23): 12836. https://dx.doi.org/10.3390/ijerph182312836
  19. Yan J.B., Luo M.M., Chen Z.Y., He B.H. The function and role of the Th17/Treg cell balance in inflammatory bowel disease. J. Immunol. Res. 2020; 2020: 8813558. https://dx.doi.org/10.1155/2020/8813558
  20. Sisnett D.J., Zutautas K.B., Miller J.E., Lingegowda H., Ahn S.H., McCallion A. et al. The dysregulated IL-23/TH17 axis in endometriosis pathophysiology. J. Immunol. 2024; 212(9): 1428-41. https://dx.doi.org/10.4049/jimmunol.2400018
  21. Di Vincenzo F., Del Gaudio A., Petito V., Lopetuso L.R., Scaldaferri F. Gut microbiota, intestinal permeability, and systemic inflammation: a narrative review. Intern. Emerg. Med. 2024; 19(2): 275-93. https://dx.doi.org/10.1007/s11739-023-03374-w
  22. Kinashi Y., Hase K. Partners in leaky gut syndrome: intestinal dysbiosis and autoimmunity. Front. Immunol. 2021; 12: 673708. https://dx.doi.org/10.3389/fimmu.2021.673708
  23. Martel J., Chang S.H., Ko Y.F., Hwang T.L., Young J.D., Ojcius D.M. Gut barrier disruption and chronic disease. Trends Endocrinol. Metab. 2022; 33(4): 247-65. https://dx.doi.org/10.1016/j.tem.2022.01.002
  24. Qi X., Yun C., Pang Y., Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 2021; 13(1): 1-21. https://dx.doi.org/10.1080/19490976.2021.1894070
  25. Чернуха Г.Е., Пронина В.А., Припутневич Т.В. Микробиота кишечника и репродуктивного тракта при эндометриозе. Акушерство и гинекология. 2022; 8: 22-9. https://dx.doi.org/10.18565/aig.2022.8.22-29 [Chernukha G.E., Pronina V.A., Priputnevich T.V. Gut and genital microbiota in endometriosis. Obstetrics and Gynecology. 2022; (8): 22-9 (in Russian). https://dx.doi.org/10.18565/aig.2022.8.22-29].
  26. Aragón A., Jurado R., Jara J., Rodríguez J.M., Orgaz B. Investigating the Metabolism of estrogens in Ligilactobacillus salivarius strains isolated from human milk and vaginal microbiota. Nutrients. 2024; 16(6): 861. https://dx.doi.org/10.3390/nu16060861
  27. Baușic A.I.G., Scurtu F., Manu A., Matasariu D.R., Brătilă E. Gut microbiota dysbiosis in endometriosis: a potential link to inflammation and disease progression. Int. J. Mol. Sci. 2025; 26(11): 5144. https://dx.doi.org/10.3390/ijms26115144
  28. Hu S., Ding Q., Zhang W., Kang M., Ma J., Zhao L. Gut microbial beta-glucuronidase: a vital regulator in female estrogen metabolism. Gut Microbes. 2023; 15(1): 2236749. https://dx.doi.org/10.1080/19490976.2023.2236749
  29. Le N., Cregger M., Brown V., Loret de Mola J., Bremer P., Nguyen L. et al. Association of microbial dynamics with urinary estrogens and estrogen metabolites in patients with endometriosis. PLoS One. 2021; 16(12): e0261362. https://dx.doi.org/10.1371/journal.pone.0261362
  30. Green T., See J., Schauch M., Reil J., Glover M., Brix J. et al. A randomized, double-blind, placebo-controlled, cross-over trial to evaluate the effect of EstroSense®on 2-hydroxyestrone:16α-hydroxyestrone ratio in premenopausal women. J. Complement. Integr. Med. 2022; 20(1): 199-206. https://dx.doi.org/10.1515/jcim-2022-0301
  31. Tatullo M., Nor J., Orrù G., Piattelli A., Cascardi E., Spagnuolo G. Oral-gut-estrobolome axis may exert a selective impact on oral cancer. J. Dent. Res. 2024; 103(5): 461-6. https://dx.doi.org/10.1177/00220345241236125
  32. Fritsch J., Garces L., Quintero M.A., Pignac-Kobinger J., Santander A.M., Fernández I. et al. Low-fat, high-fiber diet reduces markers of inflammation and dysbiosis and improves quality of life in patients with ulcerative colitis. Clin. Gastroenterol. Hepatol. 2021; 19(6): 1189-1199.e30. https://dx.doi.org/10.1016/j.cgh.2020.05.026
  33. Vennberg Karlsson J., Patel H., Premberg A. Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open. 2020; 10(2): e032321. https://dx.doi.org/10.1136/bmjopen-2019-032321
  34. Barnard N.D., Holtz D.N., Schmidt N., Kolipaka S., Hata E., Sutton M. et al. Nutrition in the prevention and treatment of endometriosis: A review. Front. Nutr. 2023; 10: 1089891. https://dx.doi.org/10.3389/fnut.2023.1089891
  35. Nirgianakis K., Egger K., Kalaitzopoulos D.R., Lanz S., Bally L., Mueller M.D. Effectiveness of dietary interventions in the treatment of endometriosis: A systematic review. Reprod. Sci. 2022; 29(1): 26-42. https://dx.doi.org/10.1007/s43032-020-00418-w
  36. Schwartz N.R.M., Afeiche M.C., Terry K.L., Farland L.V., Chavarro J.E., Missmer S.A. et al. Glycemic index, glycemic load, fiber, and gluten intake and risk of laparoscopically confirmed endometriosis in premenopausal women. J. Nutr. 2022; 152(9): 2088-96. https://dx.doi.org/10.1093/jn/nxac107
  37. Kamal D.A.M., Salamt N., Yusuf A.N.M., Kashim M.I.A.M., Mokhtar M.H. Potential health benefits of curcumin on female reproductive disorders: A review. Nutrients. 2021; 13(9): 3126. https://dx.doi.org/10.3390/nu13093126
  38. Vallée A., Lecarpentier Y. Curcumin and endometriosis. Int. J. Mol. Sci. 2020; 21(7): 2440. https://dx.doi.org/10.3390/ijms21072440
  39. Cao F., Jin L., Gao Y., Ding Y., Wen H., Qian Z. et al. Artificial-enzymes-armed Bifidobacterium longum probiotics for alleviating intestinal inflammation and microbiota dysbiosis. Nat. Nanotechnol. 2023; 18(6): 617-27. https://dx.doi.org/10.1038/s41565-023-01346-x
  40. Yalçın Bahat P., Ayhan I., Üreyen Özdemir E., İnceboz Ü., Oral E. Dietary supplements for treatment of endometriosis: A review. Acta Biomed. 2022; 93(1): e2022159. https://dx.doi.org/10.23750/abm.v93i1.11237
  41. Molina N.M., Sola-Leyva A., Saez-Lara M.J., Plaza-Diaz J., Tubić-Pavlović A., Romero B. et al. New opportunities for endometrial health by modifying uterine microbial composition: Present or Future? Biomolecules. 2020; 10(4): 593. https://dx.doi.org/10.3390/biom10040593
  42. Qin R., Tian G., Liu J., Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front. Cell. Infect. Microbiol. 2022; 12: 1069557. https://dx.doi.org/10.3389/fcimb.2022.1069557
  43. Jiang I., Yong P.J., Allaire C., Bedaiwy M.A. Intricate connections between the microbiota and endometriosis. Int. J. Mol. Sci. 2021; 22(11): 5644. https://dx.doi.org/10.3390/ijms22115644
  44. Talwar C., Singh V., Kommagani R. The gut microbiota: a double-edged sword in endometriosis. Biol. Reprod. 2022; 107(4): 881-901. https://dx.doi.org/10.1093/biolre/ioac147
  45. Brennan C., Chan K., Kumar T., Maissy E., Brubaker L., Dothard M.I. et al. Harnessing the power within: engineering the microbiome for enhanced gynecologic health. Reprod. Fertil. 2024; 5(2): e230060. https://dx.doi.org/10.1530/RAF-23-0060
  46. Chadchan S.B., Popli P., Ambati C.R., Tycksen E., Han S.J., Bulun S.E. et al. Gut microbiota-derived short-chain fatty acids protect against the progression of endometriosis. Life Sci. Alliance. 2021; 4(12): e202101224. https://dx.doi.org/10.26508/lsa.202101224
  47. Kim N., Yang C. Butyrate as a potential modulator in gynecological disease progression. Nutrients. 2024; 16(23): 4196. https://dx.doi.org/10.3390/nu16234196
  48. Shi Y., Wang G., Lau H.C., Yu J. Metagenomic sequencing for microbial DNA in human samples: Emerging technological advances. Int. J. Mol. Sci. 2022; 23(4): 2181. https://dx.doi.org/10.3390/ijms23042181
  49. Hantsoo L., Zemel B.S. Stress gets into the belly: Early life stress and the gut microbiome. Behav. Brain Res. 2021; 414: 113474. https://dx.doi.org/10.1016/j.bbr.2021.113474
  50. Aruchunan M., Nivethitha L. Yoga may help to reduce gut microbiota dysbiosis in rheumatoid arthritis: A hypothesis. Int. J. Rheum. Dis. 2023; 26(10): 1908-10. https://dx.doi.org/10.1111/1756-185X.14589

Поступила 19.03.2026

Принята в печать 06.07.2026

Received 19.03.2026

Accepted 06.07.2026

About the Authors

Maria A. Sukhanova, student, N.V. Sklifosovsky Institute of Clinical Medicine, Educational Track: Research, Sechenov First Moscow State Medical University
(Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, suxanovamaria@gmail.com, https://orcid.org/0009-0001-4792-4353
Natalya A. Sheshukova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, N.V. Sklifosovsky Institute of Clinical Medicine,
Sechenov First Moscow State Medical University (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, sheshukova_n_a@staff.sechenov.ru,
https://orcid.org/0000-0002-8757-0131
Sergey A. Levakov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, N.V. Sklifosovsky Institute of Clinical Medicine,
Sechenov First Moscow State Medical University (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, levakov_s_a@staff.sechenov.ru,
https://orcid.org/0000-0002-4591-838X

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