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  • Writer's pictureDr. H. Singh, ND

The Microbiome and its Impact on Endometriosis

The microbiome can refer to the populations of bacteria, fungi, and viruses covering the surface of a particular organ. Specifically, we will be talking about the gut microbiome - mainly the large intestine, and the reproductive microbiome - referring to the uterus, cervix, Fallopian tubes, ovaries, and vaginal canal. The microbiome has a pivotal role in impacting the severity of various chronic health conditions, particularly ones related to chronic low-grade inflammation. Endometriosis is characterized with chronic inflammation, contributing to its defining symptoms in patients - pain.

But the role of inflammation in endometriosis is two-fold. Not only is it one of the troublesome symptoms that negatively impacts quality of life and lowers fertility rates, it also is one of the factors that allows endometriosis to persist and grow. The inflammatory cytokines produced in the reproductive tract help to allow the endometrial lesions to grow and potentially spread to other sites as well.

The gut microbiome has been well established in its connection to chronic inflammation in the body. The persistence of harmful bacteria that produce excessive amounts of lipopolysaccharides can trigger an immune response and inflammation, which through the circulatory system, can affect other organs other than the digestive tract. The gut microbiome also has an important role in reabsorbing metabolized estrogen that the body is trying to excrete. Studies have shown that in Endometriosis, there exists a ´signature ´ microbiome. Some researchers were even able to diagnose endometriosis from a group of patients just by analyzing the bacteria present in their stool samples. So what does the signature microbiome for endometriosis look like and how does it impact the severity of the condition?

There appears to be increased growth of escherichia bacteria. This is a gram-negative bacteria that produces lpopolysaccharides, an endotoxin. This increased availability of lipopolysaccharides can trigger an increased inflammatory response in the colon and increase the secretion of inflammatory cytokines in to the circulatory system. If you have been reading our regular research updates in blog posts, we posted one recently talking about how increasing inflammation in the colon increases inflammation in the uterus as well through cross-talk.

Additionally, escherichia is part of the estrobolome, a group of bacteria that help to reabsorb estrogen from the colon in to the circulatory system. As endometriosis is marked by estrogen dominance - an increase in the amount of estrogen in the body relative to progesterone, this reabsorption of estrogen can potentially further worsen estrogen dominance. The increased presence of circulating estrogen stimulates endometriosis.There is also an increased presence of actinobacteria and lactobacillus spp. Both of which also make up the estrobolome.

The reproductive microbiome has an important role as well. Patients with endometriosis appear to have increased growth of gardnerella vaginalis, and this increases the inflammation in the uterus as well. In fact, one study found that using an antimicrobial medication significantly reduced endometrial lesion severity. The presence of more lactobacillus spp. in the reproductive tract appears to help lower inflammation.

Therefore, if you are suffering from endometriosis, it is important to also take in to consideration the role your gut and reproductive Microbiomes may be having on your condition. Manipulating the bacterial populations in the gut and reproductive tract may significantly impact the severity of symptoms associated with endometriosis.


  1. Leonardi, M., Hicks, C., El‐Assaad, F., El‐Omar, E., & Condous, G. (2019). Endometriosis and the microbiome: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 127(2), 239-249.

This article is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.

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