en Reproductive endocrinology Reproductive endocrinology مروری Review Article <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:14.0pt"><span style="text-autospace:none"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 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.</span></span></span></span></span></span><br /> <span style="font-size:11pt"><span style="line-height:14.0pt"><span style="text-autospace:none"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Main body:</span></span></b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 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-&alpha;alpha&alpha; 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.</span></span></span></span></span></span><br /> <span style="font-size:11pt"><span style="line-height:14.0pt"><span style="text-autospace:none"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></b><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 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.</span></span></span></span></span></span></div> Dysbiosis, Endometriosis, Female reproductive tract, Inflammation, Microbiota, Prebiotics, Probiotics, Synbiotic 50 58 http://caspjrm.ir/browse.php?a_code=A-12-174-2&slc_lang=en&sid=1 Shirin Dashtbin 10031947532846002670 10031947532846002670 No Marzie Mahdizade Ari 10031947532846002671 10031947532846002671 No Parisa Asadollahi 10031947532846002672 10031947532846002672 No Shiva MirKalantari mirkalantari.sh@iums.ac.ir 10031947532846002673 10031947532846002673 Yes Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran