Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jul 8;19(7):e0306780.
doi: 10.1371/journal.pone.0306780. eCollection 2024.

Correlation between dysbiosis of vaginal microecology and endometriosis: A systematic review and meta-analysis

Xuemei Qing  1   2 , Min Xie  1   3 , Ping Liu  1 , Ou Feng  1 , Hong Leng  1 , Hongying Guo  1 , Yong Zhang  2   4 , Ying Ma  4   5 , Wenxin Zheng  6
Affiliations
Meta-Analysis

Correlation between dysbiosis of vaginal microecology and endometriosis: A systematic review and meta-analysis

Xuemei Qing et al. PLoS One. .

Abstract

Background: Endometriosis, a complex gynecological condition, involves inflammation and immune dysregulation. The vaginal microbiota, characterized by its diversity, is an integral part of the vaginal microecology-interacting with vaginal anatomy, the endocrine system, and local mucosal immunity. Imbalances in this microecology are known to precipitate various inflammatory diseases. Despite extensive research, the connection between vaginal microbiota dysbiosis and endometriosis remains a subject of debate. Our study assesses the association between vaginal microecology dysbiosis and endometriosis.

Methods: We systematically searched major electronic databases in English, including Embase, PubMed, The Cochrane Library, MEDLINE (Ovid), BIOSIS (Ovid), China National Knowledge Infrastructure (CNKI), and Wanfang, up to August 15, 2023. Selected articles underwent screening based on predefined inclusion and exclusion criteria. Normal vaginal microecology was defined as a negative Amsel/Spiegel test or Nugent score of 0-3, or Lactobacillus predominance determined by 16S rRNA gene amplification sequencing. Deviations from this norm were classified as dysbiosis, further categorized into bacterial vaginosis (BV) and intermediate BV. Data analysis utilized Revman 5.4, with effect sizes presented as Odds Ratios (OR) and 95% Confidence Intervals (CI).

Results: Out of 1081 articles, eight met the inclusion criteria. Utilizing fixed-effect models due to low heterogeneity, the analysis revealed a positive association between dysbiosis and endometriosis (OR = 1.17, 95% CI 0.81-1.70; I2 = 0%), but showed a slight negative association between normal vaginal microecology with endometriosis (OR = 0.90, 95% CI 0.55-1.46; I2 = 29%). However, the association was not significant. Subgroup and sensitivity analyses corroborated the stability of these associations.

Conclusion: A positive correlation exists between vaginal microecology dysbiosis and endometriosis, notably with intermediate BV. However, the mechanisms underpinning this relationship remain elusive, highlighting the need for further research to overcome limitations.

Trial registration: Registration number: CRD42023445163.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of study selection.
Fig 2
Fig 2. Forest plot of correlation between dysbiosis and endometriosis.
Fig 3
Fig 3. Forest plot of correlation between BV and endometriosis.
Fig 4
Fig 4. Forest plot of correlation between intermediate BV and endometriosis.
Fig 5
Fig 5. Forest plot of correlation between normal vaginal microecology and endometriosis.
Fig 6
Fig 6. Funnel plots for dysbiosis with endometriosis.
See this image and copyright information in PMC

References

    1. Zondervan KT, Longo DL, Becker CM, Missmer SA. Endometriosis. New England Journal of Medicine. 2020;382(13):1244–1256. doi: 10.1056/NEJMra1810764 . - DOI - PubMed
    1. Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022. Nov 14;379:e070750. doi: 10.1136/bmj-2022-070750 . - DOI - PubMed
    1. Le N, Cregger M, Fazleabas A, Braundmeier-Fleming A. Effects of endometriosis on immunity and mucosal microbial community dynamics in female olive baboons. Scientific Reports. 2022. Jan 31;12(1):1590. doi: 10.1038/s41598-022-05499-y ; PMCID: PMC8803974. - DOI - PMC - PubMed
    1. Khan KN, Kitajima M, Hiraki K, Yamaguchi N, Katamine S, Matsuyama T, et al.. Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis. Fertility and Sterility. 2010. Dec;94(7):2860–3.e1-3. doi: 10.1016/j.fertnstert.2010.04.053 . - DOI - PubMed
    1. Muraoka A, Suzuki M, Hamaguchi T, Watanabe S, Iijima K, Murofushi Y, et al.. Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts. Science Translational Medicine. 2023. Jun 14;15(700):eadd1531. doi: 10.1126/scitranslmed.add1531 Epub 2023 Jun 14. . - DOI - PubMed

Substances