Volume 30, Issue 167, January 2026

The role of the gut and reproductive tract microbiota in the development, diagnosis, and treatment of endometriosis

Malinowski M^1♦, Krasowski M², Kalinowska A¹, Pietras W¹, Koziel A¹, Kurek Z¹, Jentkiewicz A¹, Haj Obeid E¹, Ulrych J¹, Krupa J¹

¹Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland
²Poznań University of Medical Science, 10 Fredry Street, 61-701 Poznan, Poland

^♦Corresponding author
Maciej Malinowski, Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland

ABSTRACT

Endometriosis is an inflammatory disorder. Caused by the proliferation of endometrial tissue outside the uterine mucosa. Progression results from elaborate interactions among hormonal, immunological, and environmental factors. Growing evidence indicates that the gut and reproductive tract microbiota play a key role in the pathogenesis of endometriosis. In patients with endometriosis, an increase in potentially pathogenic taxa, including Escherichia, Gardnerella, and Streptococcus, is observed. Dysbiosis leads to the translocation of bacterial endotoxins (Lipopolysaccharide (LPS)), activation of the TLR4/NF-κB pathway, and increased production of pro-inflammatory cytokines (IL-6, IL-8, TNF-α), which promote angiogenesis and the proliferation of endometrial foci. Furthermore, disturbances in the activity of the enzyme β-glucuronidase, part of the oestrobolome, increase the pool of active oestrogens, playing a role in disease progression. Despite the growing number of studies, further prospective studies involving larger populations are needed to standardise diagnostic methods and confirm the therapeutic potential of microbiome modulation in treating endometriosis.

Keywords: endometriosis, gut microbiota, reproductive tract microbiota, estrabolome

Medical Science, 2026, 30, e9ms3757

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DOI: https://doi.org/10.54905/disssi.v30i167.e9ms3757

Published: 21 January 2026