Endometriosis: the Impact of hormones, sexual practice, and surgical treatments

Endometriosis is a chronic inflammatory disease modulated by estrogen levels, characterized by the presence of ectopic endometrial lesions and a pro-inflammatory environment. This condition is associated with microbial dysbiosis, an imbalance in bacterial communities affecting the gastrointestinal (GI) and urogenital (UG) tracts. These microbial alterations not only result from inflammation but also actively contribute to disease progression and symptoms.

To better understand these interactions and optimize therapeutic strategies, this study examines the impact of hormonal factors, sexual behaviors, and surgical interventions on the microbiota of patients with endometriosis.  

What are the key factors influencing dysbiosis in endometriosis patients?

This study compared 33 patients with endometriosis to 15 healthy controls by analyzing stool, urine, and vaginal swab samples. Microbial profiles were determined using sequencing of the V4 region of the 16S rRNA gene. The impact of hormonal treatments, surgical interventions, and the number of sexual partners on GI and UG microbiota was assessed.  

The analysis revealed that patients with endometriosis exhibit distinct microbiota profiles marked by reduced diversity and altered bacterial compositions in both GI and UG tracts. Specifically, bacterial genera such as Lactobacillus (vaginal tract), Bacteroidetes, and Firmicutes (GI tract) are particularly affected. Additionally, a higher number of sexual partners was found to exacerbate dysbiosis and reduce the benefits of treatments. In contrast, surgical interventions and hormonal treatments partially restored microbial homeostasis, though their efficacy varied depending on the site and patient characteristics.  

Toward Personalized Management of Endometriosis

This study highlights the importance of considering microbial factors in the management of endometriosis. The interplay between microbiota, treatments, and sexual behaviors could inform the development of new therapeutic approaches. Combining hormonal, surgical, and antimicrobial treatments may provide a promising avenue to restore a healthy microbiota, enhance treatment responses, and limit disease progression.