Endometriosis affects 10 percent of women of reproductive age, yet we still know relatively little about its causes — largely due to a long-standing lack of research in women’s health. A McKinsey analysis found that in 2019-2023 funding for companies focused on erectile dysfunction was six times higher than that for companies focused on endometriosis.
For decades, delayed childbearing was incorrectly blamed as the primary cause, earning endometriosis the dismissive label of a “career woman’s disease.” Beyond this lack of information, reproductive pain is often normalized or overlooked, even by those experiencing it. Combine that with a disease that lacks a consistent presentation, it’s no wonder women with endometriosis have to wait 7 years on average to get a diagnosis.
Whether you have endometriosis or not, you may be wondering about the connection between the disease and your microbiome. While more research is needed to fully understand this link, knowledge is power. Understanding how your vaginal microbiome may influence endometriosis could be a valuable step in managing your reproductive health or your symptoms.
What is Endometriosis?
Endometriosis is a chronic disease where the tissue similar to the lining of the uterus grows outside the uterus, usually around the reproductive area, but sometimes elsewhere in the body. This causes inflammation that can lead to scarring, cysts, infertility, and pain. Endometriosis affects everyone differently, and some individuals may not even realize that they are suffering from the condition.
The most common symptoms of endometriosis are pain and infertility. Pain is usually in the pelvis, abdomen, or lower back, and can be felt during sex, periods, or when using the restroom. The pain can also get worse over time and prevent you from enjoying everyday activities. Other women also experience constipation, diarrhea, bloating, fatigue, mood problems, and asthma.
Too often, women are told to dismiss these symptoms as “normal.” But pain from endometriosis is not normal. And because symptoms often start during adolescence, it’s essential that young women understand they don’t have to simply endure it.
What Causes Endometriosis?
The exact cause of endometriosis is unknown, but several theories exist.
The prevailing thought is that reverse menstruation, when menstrual tissues may move upward into the fallopian tubes instead of exiting the body during a period, may cause endometriosis. But most women experience reverse menstruation in some capacity, and yet only 10 percent of women of reproductive age have endometriosis.Other likely causal factors include:
- Genetics: A family history, like a sister or mother with endometriosis, may increase the risk of endometriosis.
- Endometrial tissue transport: tissue may be accidentally transported via blood or lymphatic systems to other areas of the body.
- Cell transformation: Other cells in the body may transform into endometrial cells and start growing outside the uterus.
- Estrogen levels: High estrogen may stimulate the growth and inflammation associated with endometriosis.
- The vaginal microbiome: Emerging research also points to a possible link between endometriosis and the vaginal microbiome. One study found that inflammatory diseases of the cervix, vagina, and vulva increase the risk of developing endometriosis. Another pointed to the presence of fusobacterium and the development of endometriosis.
Without further research, we can’t say whether an imbalanced microbiome contributes to endometriosis. We do know that endometriosis and the treatments associated with it may cause changes in the vaginal microbiome.
“We’re learning more about how an imbalanced vaginal microbiome may have a relationship to inflammation, which is central to endometriosis. While research is ongoing, supporting a healthy vaginal microbiome—through probiotics, gentle hygiene, and avoiding unnecessary antibiotics—may help reduce overall inflammation and support better outcomes,” says Maria Alvi, M.D. Pathadvantage pathologist.
By maintaining a healthy vaginal microbiome, you lower your risk of developing inflammatory diseases or infections. This may decrease your risk of developing endometriosis, as well.
Caring for Yourself with Endometriosis
If you’ve already been diagnosed with endometriosis, monitoring the health of your microbiome is important. Some treatments may make you more susceptible to certain infections or microbiome imbalance. This can lead to increased inflammation and worsened symptoms.
Endometriosis is one of many women’s health issues that has been historically overlooked. While change is slow, it’s vital to recognize that chronic pain interfering with your work, school or everyday activities is not something you simply have to live with. If you’re experiencing persistent pain, don’t ignore it. Find a clinician who takes your symptoms seriously. Effective treatments are available — and you don’t have to suffer alone.
Sources:
Current Updates on the Role of Microbiome in Endometriosis: A Narrative Review | NIH
Endometriosis | Johns Hopkins Medicine
Association of endometriosis with asthma: a study of the NHANES database in 1999–2006 – NIH
Endometriosis | WHO
The Complex Link between the Female Genital Microbiota, Genital Infections, and Inflammation | NIH
The Dawn of the Femtech Revolution | Mckinsey
