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Endometriosis and Microbiomes is there connection?

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3 fertility expert(s) answered this question

Answer from: Luciano Nardo, MD, MRCOG

Gynaecologist, Subspecialist in Reproductive Medicine, CEO & Founder, NOW-fertility
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There’s lots of interest on the topic of microbiomes and fertility microbiomes and miscarriage and there is also some interesting evidence showing that endometriosis could be associated within this presence of some Proteobacteria, Enterobacteriaceae and with Streptococcus. I think it is still a relatively novel field but there seems to be a relationship between the microbiome and endometriosis and I think further studies in the future will hopefully be able to highlight this link better.

Answer from: Ahmed Elgheriany, MRCOG, MD, MSc

Gynaecologist, Fertility Specialist GENNET City Fertility
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One of the new area in research about endometriosis is relation of endometriosis with something called microbiomes and what microbiomes it’s certain groups of bacteria that found in your body, could be found inside your uterus could be in your vagina or in your tummy or in your gut. This is a new area of research up until 2018, we did not know exactly what is a beneficial bacteria for your body, what is the harmful bacteria – all we knew is: its lactobacillus group or non-lactobacillus group. The very recently, I published a research about uterine dysbiosis – a new frontier in women health, I published it in 2021 and in this research, by systematic review, we find that certain group of bacteria are related to endometriosis, certain groups of bacteria by names that we know exactly which kind of bacteria, is related to cancer of the endometrium, certain groups are related to recurrent miscarriage, certain groups are related to chronic endometritis, certain groups are related to polyp formation inside the lining of the womb or certain groups are related to problems with IBS (Irritable bowel syndrome). All we know now, there are certain bacterial taxi with endometriosis, it’s fine there and this bacteria is active in endometriosis and what this mean, this means that could it be an inflammatory response of these bacteria that exaggerate the endometriosis or endometriosis itself make a proper niche for this bacteria to develop on it or no – nobody knows the answer, it’s cross-related but what is the significant of that because they tried an experiment, an experiment on mice and they found that when they gave metronidazole antibiotic, the mice endometriosis gland they start to decrease and when they tried on some women giving some antibiotic and some probiotic, their pain symptoms start to decrease. So, there is a correlation between microbiomes in your body and the endometriosis but we do not know until now, what kind of treatment we shall tackle these microbiomes. Is it healthy or not healthy? So, this bacteria is not healthy because it’s abnormal to be found, it’s found only on the endometriosis patient and what makes it very difficult – because all study about the microbiome came from most asian countries and it’s found that endometriosis are very low reported in black women and it’s highly reported in white women so, this is race related also or distribution between countries make it difficult for us. Microbiome in itself when we go through it deeply, we found that the microbiome can affect the metabolism of estrogen hormone in your body and the estrogen hormone, is the hormone that makes endometriosis flare up and that’s why we are thinking it’s related to menstruation and all this stuff but it’s due to the estrogen hormone. So, microbiomes affecting estrogen hormone and estrogen hormone flare up the endometriosis in the nodules and it’s just a vicious circle. We need to break this circle by any means and this is about microbiome, it’s a very recent area for research and it’s the future actually for treating and preventing endometriosis if I well expect it from now.

Answer from: Anu Chawla, MRCOG, MBBS, M.S., DNB

Gynaecologist, Specialist in Reproductive Medicine
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The microbiometer basically has the connection probably to any sub-fertile patient and if the endometriosis patient is having subfertility in that patient it is relevant but it is relevant to any sub-fertile patient actually. What I’m trying to say is that there is a role of probiotics so, the general flora of the vagina has a role. There are some traditional families in which they used to insert yogurt in the vagina actually, it is just having the same lactobacilli but maybe that is not the right way but these days we have a proper way of taking the right flora which is the probiotics. So, taking probiotics keeps the normal flora normal basically. Because the normal bacterial flora of the vagina keeps the ph right and it can be important when the normal intercourse so, there are three ways any couple gets pregnant: one is intercourse, the second is intrauterine insemination and the third is IVF and if you see in all of that, especially in the first option, the flora is very important because both early pregnancy and the way the pregnancy is conceived will be affected by the vaginal flora. Although the studies are not very massive, there are tests based on that so, EMMA and ALICE are the tests which are created to test these and then we know whether the normal flora is there or any other infection is there. Taking probiotics doesn’t need too much data so, I think probiotics should be a part of general treatment anyway for fertility. The evidence is gaining with time so as the more studies are conducted we don’t have enough evidence yet to say anything conclusive but we do have probiotics as our protocol in general to give to all patients, not just only to endometriosis. We don’t know the connections yet, how it affects but then all sub-fertile patients might benefit from adding probiotics. Some chronic endometritis can also be present when especially we have the history of previous miscarriages and in such patients we do give antibiotics also like doxycycline to cover that so, both probiotics and with the use of doxcycling or metronidazole – this combination sometimes works in certain cases where the imp

About this question:

Can BV (bacterial vaginosis) cause endometriosis?

Can endometriosis cause dysbiosis? How does gut health affect endometriosis? Does leaky gut cause endometriosis?

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