Endometriosis: The Balance of Bugs Is Key To Treatment Success

Not enough professionals talk about the microbiome in endometriosis (endo) - let's change that. Let's talk about the microbes living inside you - mainly bacteria, viruses, yeasts and parasites. Research suggests these tiny bugs have a big impact on endo, affecting digestion and other body systems. We have evidence that infections play a role in endo, but so do subtler imbalances in our gut microbiome, infamously known as "dysbiosis". Here, we'll take a closer look.

For one, women with endometriosis are more likely to experience pelvic infections. If a woman has had pelvic inflammatory disease (PID, caused by sexually transmitted infections), she has triple the chance of developing endometriosis within 10 years. Studies show that infections in the uterus impact the success of in vitro fertilization (IVF). When it comes to viruses, the connection between endometriosis and human papillomavirus (HPV) is well-known. Even if you've been vaccinated against HPV, it’s important to remember that not all strains are covered. Other viruses like herpes, Epstein-Barr, and cytomegalovirus have also been linked to endometriosis. These viruses can cause the cells that normally line the uterus to behave abnormally and form endometrial tissue where it shouldn’t be. And it’s not just viruses—things like pollution, radiation, and stress can also trigger genetic changes that play a role in developing endometriosis.

Recent research supports that women with endo have a less diverse microbiome and an imbalance of microbes in both their gut and reproductive system, including higher levels of certain inflammation-triggering bacteria like E. coli, Shigella, Streptococcus, and Ureaplasma. In particular, E. coli and Shigella release toxins that activate the immune system, making inflammation worse. Another type of bacteria without cell walls—called mollicutes—are also more common in women with endometriosis and can have a sleeper effect on some immune cells, which can allow inflammation to persist in the body. Even the bacteria in your mouth might be involved! Women with severe endometriosis tend to have higher Fusobacterium, a type of bacteria often associated with gum disease and linked to the growth of endometriosis lesions.

And don't forget - certain bacteria can actually boost estrogen levels in your body by helping it recirculate in the gut. In an estrogen-sensitive condition like endometriosis, estrogen can act like a growth factor, giving us one more reason to prioritize gut bug balance.

It’s important to remember that when microbes die, they release toxins that can temporarily make you feel worse. Instead of a do-it-yourself approach to killing gut bugs, work with a naturopathic doctor to navigate this tricky terrain - together, we'll set you on a plan that works for you.

References

1. Oral, Vaginal, and Stool Microbial Signatures in Patients With Endometriosis as Potential Diagnostic Non-Invasive Biomarkers: A Prospective Cohort Study. Hicks et al. Oct 2024. https://doi.org/10.1111/1471-0528.17979

2. Shan J, Ni Z, Cheng W, Zhou L, Zhai D, Sun S, et al. Gut microbiota imbalance and its correlations with hormone and inflammatory factors in patients with stage 3/4 endometriosis. Arch Gynecol Obstet. 2021;304:1363–73. doi: 10.1007/s00404-021-06057-z.

3. Ata B, Yildiz S, Turkgeldi E, Brocal VP, Dinleyici EC, Moya A, et al. The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Sci Rep. 2019;9:2204. doi: 10.1038/s41598-019-39700-6. 

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5. Koninckx PR, Ussia A, Adamyan L, et al. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019;111:327–340. doi: 10.1016/j.fertnstert.2018.10.013.

6. de Ziegler D, Pirtea P, Galliano D, et al. Optimal uterine anatomy and physiology necessary for normal implantation and placentation. Fertil Steril. 2016;105:844–854. doi: 10.1016/j.fertnstert.2016.02.023. 

7. Tai FW, Chang CY, Chiang JH, et al. Association of Pelvic Inflammatory Disease with Risk of Endometriosis: A Nationwide Cohort Study Involving 141,460 Individuals. J Clin Med. 2018;7:379. doi: 10.3390/jcm7110379.