Endometriosis: a study begins to understand how the microbiota influences the disease

Two thousand women, aged 18 and over, for a large study on the relationship between microbiota and endometriosis. It is the one that has just started at the IRCCS Ospedale Sacro Cuore Don Calabria in Negrar di Valpolicella (among the structures of excellence for gynecology) that aims to understand if the vaginal, rectal and cervical microbiota may hide traces useful for establishing the severity of endometriosis and the presence of factors capable of predicting the outcomes of surgical interventions, such as the risk of complications.

What is endometriosis?

Surgery still plays a major role in the disease. The main treatments against endometriosis – which in Italy alone is estimated to affect about three million women – are in fact based on surgical interventions and drugs (anti-inflammatories and hormonal therapies, above all). Only in some cases, the Istituto Superiore di Sanità reminds us , does endometriosis tend to regress spontaneously and surgery is used to eliminate the growth of endometriotic tissue that has grown outside the uterus.

The symptoms

Pain and infertility are the main manifestations of the disease, although endometriosis can present itself differently in each woman and with symptoms of varying severity, as Marcello Ceccaroni , director of the Department for the protection of women's health and quality of life of the Obstetrics and Gynecology Unit at the Veneto hospital, also recalled: "It is characterized by the presence of cells similar to endometrial tissue outside the uterine cavity: peritoneum, ovaries, fallopian tubes, intestine and bladder. The main symptom of this disease is pain, mainly during menstruation, sexual intercourse, defecation, urination or even outside the menstrual period. The disease can also be completely asymptomatic, leading to the impairment of some organs such as the kidney and intestine, in severe cases".

A disabling disease

Experts agree that, beyond the mildest cases, endometriosis should be considered a debilitating disease that seriously compromises the quality of life of women. Also because in many cases years pass before the patient is able to receive a diagnosis and access a therapeutic program. And this is why research in the field is also very active: only recently, for example, a test was presented that, with a blood sample, can identify the disease, both the most serious and mild cases with good precision.

Microbiota and endometriosis: what is the relationship?

The role of the microbiota in influencing the functioning of the immune system is well known. Now, the possible involvement of the immune system in the development of the disease – with a dysfunction that would prevent it from recognizing and eliminating endometrial cells in extrauterine locations – has prompted experts to wonder whether the microbiota could then be linked in some way to the disease.

But not only that: the idea is that the microbiota also participates in the regulation of estrogen metabolism, according to some studies. “Preliminary data suggest that the dysbiotic microbiome in its various districts can also accelerate the progression of endometriosis and worsen pain – says Alessandra Graziottin , contract professor at the Department of Obstetrics and Gynecology at the University of Verona.

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Biome-endo study underway

To understand what kind of relationship exists between microbiota and endometriosis, the experts will enroll about 2,000 women, aged 18 and over, among those with suspected benign gynecological pathology (endometriosis itself is also considered a benign condition) and indications for surgery. Subsequently, women diagnosed with endometriosis will be compared with those with other disorders, such as fibroids, prolapses and uterine polyps.