Gut microbiota and female health

Abstract

The gut microbiota is recognized as an endocrine organ with the capacity to influence distant organs and associated biological pathways. Recent advancements underscore the critical role of gut microbial homeostasis in female health; with dysbiosis potentially leading to diseases among women such as polycystic ovarian syndrome, endometriosis, breast cancer, cervical cancer, and ovarian cancer etc. Despite this, there has been limited discussion on the underlying mechanisms. This editorial explores the three potential mechanisms through which gut microbiota dysbiosis may impact the development of diseases among women, namely, the immune system, the gut microbiota-estrogen axis, and the metabolite pathway. We focused on approaches for treating diseases in women by addressing gut microbiota imbalances through probiotics, prebiotics supplementation, and fecal microbiota transplantation (FMT). Future studies should focus on determining the molecular mechanisms underlying associations between dysbiosis of gut microbiota and female diseases to realize precision medicine, with FMT emerging as a promising intervention.

Keywords: Endometriosis; Estrogen; Female health; Gut microbiota; Polycystic ovarian syndrome.

Figure 1

Effects of gut microbiota on estrogen metabolism. Estrogens are primarily produced in the ovaries, adrenal glands, and adipose tissue and circulate in the bloodstream and first undergo metabolism in the liver, where estrogens are conjugated. Conjugated estrogens are eliminated from the body by metabolic conversion to water-soluble molecules, which are excreted in urine or bile into the gut. The gut microbiota significantly influences estrogen levels by secreting β-glucuronidase (GUS), an enzyme that converts conjugated estrogen into deconjugated estrogen in the gastrointestinal tract. This transformation allows it to bind to estrogen receptors, initiating downstream signaling and physiological effects. Decreased GUS activity may lead to reduced deconjugation of estrogen, resulting in decreased circulating estrogen levels and contributing to pathologies such as obesity and polycystic ovarian syndrome. In contrast, increased GUS activity can elevate estrogen levels, leading to conditions such as endometriosis and cancer. IEC: Intestinal epithelial cell; GUS: β-glucuronidase; PCOS: Polycystic ovarian syndrome.