Volume 11, Issue 2 (8-2025)
Caspian J Reprod Med 2025, 11(2): 50-58 |
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Dashtbin S, Ari M M, Asadollahi P, MirKalantari S. Microbiota dysbiosis and probiotic interventions in endometriosis: Current evidence and therapeutic perspectives. Caspian J Reprod Med 2025; 11 (2) :50-58
URL: http://caspjrm.ir/article-1-295-en.html
URL: http://caspjrm.ir/article-1-295-en.html
Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran , mirkalantari.sh@iums.ac.ir
Abstract: (41 Views)
Background: Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by the presence of endometrial-like tissue outside the uterine cavity, leading to pelvic pain, infertility, and reduced quality of life. Emerging evidence suggests that dysbiosis of the gut and female reproductive tract microbiota may contribute to immune dysregulation, chronic inflammation, and disease progression.
Main body: This narrative review synthesizes current evidence on microbiota alterations in endometriosis and evaluates the therapeutic potential of microbiome-targeted interventions, particularly probiotics, prebiotics, and synbiotics. Available data indicate that women with endometriosis frequently exhibit reduced abundance of Lactobacillus spp. and increased representation of opportunistic or pro-inflammatory bacteria in the female reproductive tract and, in some studies, the gut microbiota. Microbial products such as lipopolysaccharide may activate Toll-like receptor 4-mediated inflammatory signaling, promoting cytokine production, immune dysfunction, and lesion persistence. Probiotic administration, especially with Lactobacillus and Bifidobacterium strains, has shown potential to restore microbial balance, enhance natural killer cell activity, modulate macrophage responses, and reduce pro-inflammatory mediators including TNF-αalphaα and IL-6. Preclinical studies suggest that probiotics may reduce lesion size and improve inflammatory profiles, whereas early clinical studies indicate possible benefits for pain-related symptoms. However, evidence for prebiotics and synbiotics in endometriosis remains limited.
Conclusion: Microbiota dysbiosis may represent an important component of endometriosis pathophysiology. Microbiome-targeted therapies, particularly probiotics, are promising adjunctive strategies; however, robust, well-designed clinical trials are required to determine optimal strains, dosing regimens, treatment duration, safety, and patient selection before routine clinical use can be recommended.
Main body: This narrative review synthesizes current evidence on microbiota alterations in endometriosis and evaluates the therapeutic potential of microbiome-targeted interventions, particularly probiotics, prebiotics, and synbiotics. Available data indicate that women with endometriosis frequently exhibit reduced abundance of Lactobacillus spp. and increased representation of opportunistic or pro-inflammatory bacteria in the female reproductive tract and, in some studies, the gut microbiota. Microbial products such as lipopolysaccharide may activate Toll-like receptor 4-mediated inflammatory signaling, promoting cytokine production, immune dysfunction, and lesion persistence. Probiotic administration, especially with Lactobacillus and Bifidobacterium strains, has shown potential to restore microbial balance, enhance natural killer cell activity, modulate macrophage responses, and reduce pro-inflammatory mediators including TNF-αalphaα and IL-6. Preclinical studies suggest that probiotics may reduce lesion size and improve inflammatory profiles, whereas early clinical studies indicate possible benefits for pain-related symptoms. However, evidence for prebiotics and synbiotics in endometriosis remains limited.
Conclusion: Microbiota dysbiosis may represent an important component of endometriosis pathophysiology. Microbiome-targeted therapies, particularly probiotics, are promising adjunctive strategies; however, robust, well-designed clinical trials are required to determine optimal strains, dosing regimens, treatment duration, safety, and patient selection before routine clinical use can be recommended.
Keywords: Dysbiosis, Endometriosis, Female reproductive tract, Inflammation, Microbiota, Prebiotics, Probiotics, Synbiotic
Type of Study: Review Article |
Subject:
Reproductive endocrinology
Received: 2025/11/4 | Accepted: 2025/12/25 | Published: 2025/12/28
Received: 2025/11/4 | Accepted: 2025/12/25 | Published: 2025/12/28
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