Endometriosis is a common gynecological disease, that often leads to pain and infertility.  Endometriosis (en-doe-me-tree-O-sis) is an often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometriosis growths may be found beyond the area where pelvic organs are located. The potential role of Fusobacterium in causing endometriosis which, after further evidence, might call for a modified treatment plan. Vaginal samples showed an increased abundance of this bacterium in the vaginal area of women suffering from endometriosis. This supports the existing hypothesis that the vaginal microbiota plays a role in the pathogenesis of the disease, bearing in mind that the digestive microbiota also appears to be involved.

Endometriosis tissue acts as the lining inside the uterus would — it thickens, breaks down and bleeds with each menstrual cycle. But it grows in places where it doesn’t belong, and it doesn’t leave the body. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated and form scar tissue. Bands of fibrous tissue called adhesions also may form. These can cause pelvic tissues and organs to stick to each other. Endometriosis affects 10% to 15% of women of childbearing age, resulting in chronic pain, hypofertility, and even infertility. 

Common symptoms of endometriosis include:

• Painful periods. Pelvic pain and cramping may start before a menstrual period and last for days into it. You also may have lower back and stomach pain. Another name for painful periods is dysmenorrhea.
• Pain with sex. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. You’re most likely to have these symptoms before or during a menstrual period.
• Excessive bleeding. Sometimes, you may have heavy menstrual periods or bleeding between periods.
• Infertility. For some people, endometriosis is first found during tests for infertility treatment.
• Other symptoms. You may have fatigue, diarrhea, constipation, bloating or nausea. These symptoms are more common before or during menstrual periods.

Dysbiosis of the gut microbiota in patients with endometriosis

The gut microbiota not only plays an important role in food metabolism and intestinal physiology, and homeostasis imbalance in the gut microbiota can lead to the occurrence and development of various diseases. Studies have found that gut microbiota disorders can not only cause inflammatory bowel disease, irritable bowel syndrome, and colon cancer in the intestinal system, but can also induce diseases in the extraintestinal system, such as diabetes, mastitis, and polycystic ovary syndrome

Gut microbiota and estrogen

Endometriosis is an estrogen-dependent disease, that is characterized by the presence of endometrial glands and stromal cells outside the uterus. Estrogen plays an important role in maintaining female reproductive system development. Estrogen can regulate the microenvironment of the female lower genital tract by increasing epithelial thickness, glycogen levels and mucus secretion, and indirectly reducing vaginal pH by increasing Lactobacillus abundance and lactic acid levels. Studies have found that estrogen can induce proliferative diseases such as endometriosis, endometrial cancer, and hysteromyoma by stimulating the proliferation of female genital epithelial cells . The metabolism of estrogen mainly occurs in the liver. The liver can produce sex hormone binding globulin, and the combination of sex hormone binding globulin and estrogen can lead to loss of estrogen biological activity.The impact of the gut microbiota upon endometriosis-associated infertility is likely due to the effects of the sex hormones.

One important factor in the pathogenesis of endometriosis is that deficiency of the immune system leads to difficulty in clearing ectopic endometrial tissue. The increase in the levels of proinflammatory factors, anti-inflammatory factors and immune cells reflects an imbalance in the regulation of inflammation and anti-inflammatory processes, as well as changes in intestinal microbiota, intestinal permeability and other immune regulatory processes

Probiotics and Prebiotics and Diet

Probiotic supplementation in women with polycystic ovary syndrome could significantly improve serum sex hormone binding globulin and plasma total antioxidant capacity, significantly reduce total testosterone level, and benefit the body . Bifidobacterium longum alleviated the symptoms of lactose intolerance patients.  Lactobacillus gasseri has protective effects against endometriosis by inhibiting inflammation and the development of ectopic endometrial cells

Different dietary components deliver different carbohydrates and phytonutrients to the colon, causing different microbial changes . The addition of probiotics can inhibit the immune inflammatory cascade reaction in patients with depression and improve their mental state.

Adding ω-3 polyunsaturated fatty acids and probiotics can effectively prevent osteoporosis, obesity and diabetes. ω-3 polyunsaturated fatty acids were found to attenuate the inflammation in a mouse model of endometriosis. In addition, women who consume a large amount of ω-3 polyunsaturated fatty acids have a lower risk of developing endometriosis. It is speculated that regulation of the gut microbiota through diet may help prevent endometriosis.

My Thoughts:

As a Clinical Dietitian/ Nutritionist , I understand that effectively managing endometriosis requires a comprehensive treatment plan and commitment to following it. Quick fixes are not sufficient for addressing chronic health issues that have developed over time. It is essential to seek guidance from specialists in order to effectively manage and potentially reverse complex clinical conditions. By dedicating oneself to the treatment plan and seeking professional support, positive outcomes can be achieved through consistent effort.