Intestinal and reproductive tract microbiota in adenomyosis patients
V.B. TSKHAY
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk
Contact details:
Tskhay V.B. — MD, Professor, Head of the Department of Perinatology, Obstetrics and Gynecology
Address: 2A/1 Akademika Kirenskogo St., Krasnoyarsk 660074, Russian Federation, tel.: +7-923-287-21-34, e-mail: tchai@yandex.ru
Female health and the reproductive tract microbiota are closely associated. Current data indicate that changes in the intestinal and/or different levels of the female reproductive tract microbiota composition can be used prognostically as a diagnostic tool for the disease, and a number of microorganisms can be «markers» for assessing its form and prevalence. Studies of the reproductive organs microbiota cover both the vagina and cervical canal, and the upper parts of the reproductive organs. The endometrium in women contains microbiota consisting of various microorganisms.
The purpose was to evaluate the latest discoveries in the microbiota role in the adenomyosis pathogenesis. In an attempt to clarify the relationship between adenomyosis and the reproductive organs microbiota, we analyzed 2020–2025 publications from PubMed and eLIBRARY databases using the keywords «adenomyosis», «intestinal microbiota», «vaginal microbiota», «endometrial microbiota», and «pathogenesis».
Conclusion. Adenomyosis is closely associated with bacterial dysbiosis of the endometrium. Potential changes in the microbial environment of the endometrium can contribute to the adenomyosis development. The study of the microbiota composition in women with adenomyosis seems to be a fairly new and very promising direction, both from a scientific and practical point of view.
Key words: adenomyosis, intestinal microbiota, vaginal microbiota, endometrial microbiota.
REFERENCES
- Jandhyala S.M., Talukdar R., Subramanyam C., Vuyyuru H., Sasikala M., Nageshwar Reddy D. Role of the normal gut microbiota. World J. Gastroenterol, 2015, vol. 21 (29), pp. 8787–8803. DOI: 10.3748/wjg.v21.i29.8787
- Lagutina S.N., Zuykova A.A., Chizhkov P.A., Popov V.N., Syromyatnikov M.Yu., Skuratova O.S. Features of the biodiversity of intestinal microbiota in inflammatory bowel diseases: a clinical case. Sibirskoe meditsinskoe obozrenie, 2023, no. 2, pp. 97–100 (in Russ.). DOI: 10.20333/25000136-2023-2-97-100
- Allaband C., McDonald D., Vázquez-Baeza Y., Minich J.J., Tripathi A., Brenner D.A. et al. Microbiome 101: Studying, analyzing, and interpreting gut microbiome data for clinicians. Clin. Gastroenterol. Hepatol, 2019, vol. 17 (2), pp. 218–230. DOI: 10.1016/j.cgh.2018.09.017
- Bharti R., Grimm D.G. Current challenges and best-practice protocols for microbiome analysis. Brief Bioinform, 2021, vol. 22 (1), pp. 178–193. DOI: 10.1093/bib/bbz155
- Ughade P.A., Shrivastava D., Chaudhari K. navigating the microbial landscape: understanding dysbiosis in human genital tracts and its impact on fertility. Cureus, 2024, vol. 16 (8), p. e67040. DOI: 10.7759/cureus.67040
- Liptáková A., Čurová K., Záhumenský J., Visnyaiová K., Varga I. Microbiota of female genital tract — functional overview of microbial flora from vagina to uterine tubes and placenta. Physiol. Res, 2022, vol. 71 (suppl 1), pp. S21–S33. DOI: 10.33549/physiolres.934960
- Qin R., Tian G., Liu J., Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front. Cell. Infect. Microbiol, 2022, vol. 12. 1069557. DOI: 10.3389/fcimb.2022.1069557
- Xholli A., Cremonini F., Perugi I., Londero A.P., Cagnacci A. gut microbiota and endometriosis: exploring the relationship and therapeutic implications. Pharmaceuticals (Basel), 2023, vol. 16 (12), p. 1696. DOI: 10.3390/ph16121696
- Agostinis C., Mangogna A., Bossi F., Ricci G., Kishore U., Bulla R. Uterine immunity and microbiota: a shifting paradigm. Front. Immunol, 2019, vol. 10, p. 2387. DOI: 10.3389/fimmu.2019.02387
- Chernukha G.E., Pronina V.A., Priputnevich T.V. Intestinal and reproductive tract microbiota in endometriosis. Akusherstvo i ginekologiya, 2022, vol. 8, pp. 22–29 (in Russ.). DOI: 10.18565/aig.2022.8.22-29
- Li F., Chen C., Wei W., Wang Z., Dai J., Hao L. et al. The metagenome of the female upper reproductive tract. Gigascience, 2018, vol. 7 (10). giy107. DOI: 10.1093/gigascience/giy107
- Yuan C., Xie K., Feng L., Gao S., Cai L. The role and challenges of regulating endometrial microbiome in uterine health and diseases. Crit. Rev. Microbiol, 2024, vol. 50 (5), pp. 937–954. DOI: 10.1080/1040841X.2024.2320247
- Peric A., Weiss J., Vulliemoz N., Baud D., Stojanov M. Bacterial colonization of the female upper genital tract. Int. J. Mol. Sci., 2019, vol. 20 (14), p. 3405. DOI: 10.3390/ijms20143405
- de Medeiros Garcia Torres M., Lanza D.C.F. A standard pipeline for analyzing the endometrial microbiome. Reprod. Sci, 2024, vol. 31 (8), pp. 2163–2173. DOI: 10.1007/s43032-024-01557-0
- Moreno I., Codoñer F.M., Vilella F., Valbuena D., Martinez-Blanch J.F., Jimenez-Almazán J. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am. J. Obstet. Gynecol, 2016, vol. 215 (6), pp. 684–703. DOI: 10.1016/j.ajog.2016.09.075
- Chen C., Song X., Wei W., Zhong H., Dai J., Lan Z. et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat. Commun, 2017, vol. 8 (1), p. 875. DOI: 10.1038/s41467-017-00901-0
- Budilovskaya O.V., Cheberya A.S., Cheberya A.R., Vasil’eva S.K., Vorob’eva N.E., Shirshova N.Yu. et al. Age-related aspects of vaginal microbiocenosis and the prevalence of opportunistic mycoplasmas in gynecologically healthy women. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 2024, vol. 12, no. 2, pp. 21–29 (in Russ.). DOI: 10.33029/2303-9698-2024-12-2-21-29
- Zhou J.Z., Way S.S., Chen K. Immunology of uterine and vaginal mucosae. Trends Immunol, 2018, vol. 39, pp. 302–314. DOI: 10.1016/j.it.2018.01.007
- Kobayashi H. molecular targets for nonhormonal treatment based on a multistep process of adenomyosis development. Reprod. Sci, 2022. DOI: 10.1007/s43032-022-01036-4
- Lin Q., Duan H., Wang S., Guo Z., Wang S., Chang Y. et al. Endometrial microbiota in women with and without adenomyosis: A pilot study. Front. Microbiol, 2023, vol. 14. 1075900. DOI: 10.3389/fmicb.2023.1075900
- Antero M.F., Ayhan A., Segars J., Shih I.M. Pathology and pathogenesis of adenomyosis. Semin. Reprod. Med, 2020, vol. 38 (2-03), pp. 108–118. DOI: 10.1055/s-0040-1718922
- Li Q., Shi J., Yi D., Li X., Gu Z., Yan H., Leng J. The pathogenesis of endometriosis and adenomyosis: insights from single-cell RNA sequencing. Biol. Reprod, 2024, vol. 110 (5), pp. 854–865. DOI: 10.1093/biolre/ioae032
- Habiba M., Benagiano G., Guo S.W. An appraisal of the tissue injury and repair (TIAR) theory on the pathogenesis of endometriosis and adenomyosis. Biomolecules, 2023, vol. 13 (6), p. 975. DOI: 10.3390/biom13060975
- Leyendecker G., Bilgicyildirim A., Inacker M., Stalf T., Huppert P., Mall G. et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An. MRI Study. Arch. Gynecol. Obstet, 2015, vol. 291 (4), pp. 917–932. DOI: 10.1007/s00404-014-3437-8
- Guo S.W. Cracking the enigma of adenomyosis: an update on its pathogenesis and pathophysiology. Reproduction, 2022, vol. 164 (5), pp. R101–R121. DOI: 10.1530/REP-22-0224
- Bourdon M., Santulli P., Jeljeli M. et al. Immunological changes associated with adenomyosis: a systematic review. Hum. Reprod. Update, 2021, vol. 4 (27), pp. 108–129. DOI: 10.1093/humupd/dmaa038
- Zhai J., Vannuccini S., Petraglia F., Giudice L.C. Adenomyosis: mechanisms and pathogenesis. Semin. Reprod. Med, 2020, vol. 8 (38), pp. 129–143. DOI: 10.1055/s-0040-1716687
- Bulun S.E., Yildiz S., Adli M., Wei J.J. Adenomyosis pathogenesis: insights from next-generation sequencing. Hum. Reprod. Update, 2021, vol. 27 (6), pp. 1086–1097. DOI: 10.1093/humupd/dmab017
- Li C., Xu X., Zhao X., Du B. The inconsistent pathogenesis of endometriosis and adenomyosis: insights from endometrial metabolome and microbiome. mSystems, 2025, e0020225. DOI: 10.1128/msystems.00202-25
- Gumenyuk L.N., Dobrokhotova Yu.E., Puchkina G.A., Urezko O.A., Kunitsyna E.Yu., Stolyarova S.V., Koblichenko S.V. Changes in the intestinal microbiota and their relationship with some indicators of the cytokine profile in patients with external genital endometriosis. Problemy reproduktsii, 2023, vol. 29, no. 6, pp. 87–94 (in Russ.).
- Melkozerova O.A., Braslavskaya E.P., Ustyuzhanin A.V., Chistyakova G.N., Semenov Yu.A., Mikhel’son A.A. et al. Intestinal microbiota in patients with recurrent deep endometriosis. Voprosy ginekologii, akusherstva i perinatologii, 2025, vol. 24, no. 2, pp. 97–109 (in Russ.). DOI: 10.20953/1726-1678-2025-2-97-109
- Valdés-Bango M., Gracia M., Rubio E., Vergara A., Casals-Pascual C., Ros C. et al. Comparative analysis of endometrial, vaginal, and gut microbiota in patients with and without adenomyosis. Acta Obstet. Gynecol. Scand, 2024, vol. 103 (7), pp. 1271–1282. DOI: 10.1111/aogs.14847
- Chen P., Wang K., Zhuang M., Fu X., Liu S., Chen M., Lei Y. An insight into gut microbiota and metabolites in the mice with adenomyosis. Front. Cell. Infect. Microbiol, 2023, vol. 13. 1075387. DOI: 10.3389/fcimb.2023.1075387
- Savicheva A.M., Moskvicheva M.A. Global’nyy vzglyad na mikromir. Rekomendatsii ISSVD po vul’vovaginitom (2023): Informatsionnyy byulleten’ [Global view of the microworld. ISSVD recommendations on vulvovaginitis (2023): Information bulletin]. Moscow: Redaktsiya zhurnala Status Presens. 2024. 20 p.
- France M.T., Ma B., Gajer P. et al. VALENCIA: a nearest centroid classification method for vaginal microbial communities based on composition. Microbiome, 2020, vol. 8 (1), p. 166. DOI: 10.1186/s40168-020-00934-6.2020
- Smetankina A.V., En’kova E.V., Obernikhin K.I., En’kova V.V., Kasymov N.O., Ignatova Yu.S., Orlova A.V. Assessment of the state of the vaginal microbiome in perimenopause. Sibirskoe meditsinskoe obozrenie, 2024, no. 3, pp. 69–76 (in Russ.). DOI: 10.20333/25000136-2024-3-69-76
- Galkin F., Mamoshina P., Aliper A. et al. Human gut microbiome aging clock based on taxonomic profiling and deep learning. iScience, 2020, vol. 23 (6), 101199. DOI: 10.1016/j.isci.2020.101199
- Krog M.C., Hugerth L.W., Fransson E. et al. The healthy female microbiome across body sites: effect of hormonal contraceptives and the menstrual cycle[J]. Hum. Reprod, 2022, vol. 37 (7), pp. 1525–1543. DOI: 10.1093/humrep/deac094
- Z. Pan
- Kunaseth J., Waiyaput W., Chanchaem P., Sawaswong V., Permpech R., Payungporn S., Sophonsritsuk A. Vaginal microbiome of women with adenomyosis: A case-control study. PLoS One, 2022, vol. 17 (2). e0263283. DOI: 10.1371/journal.pone.0263283
- Chen S., Gu Z., Zhang W., Jia S., Wu Y., Zheng P. et al. Microbiome of the lower genital tract in Chinese women with endometriosis by 16s-rRNA sequencing technique: a pilot study. Ann. Transl. Med, 2020, vol. 8, p. 1440. DOI: 10.21037/atm-20-1309
- Chao X., Liu Y., Fan Q., Shi H., Wang S., Lang J. The role of the vaginal microbiome in distinguishing female chronic pelvic pain caused by endometriosis/adenomyosis. Ann. Transl. Med, 2021, vol. 9, p. 771. DOI: 10.21037/atm-20-4586
- Huang P., Lv C., Zhang C., Feng H., Li C., Zhang H. et al. Expression and significance of T-cell immunoglobulin mucin molecule 3 and its ligand galectin-9 in patients with adenomyosis. Gynecol. Endocrinol, 2020, vol. 36 (7), pp. 605–610. DOI: 10.1080/09513590.2020.1754788
- Zhai J., Li S., Sen S., Opoku-Anane J., Du Y., Chen Z.J. et al. m(6)A RNA methylation regulators contribute to eutopic endometrium and myometrium dysfunction in adenomyosis. Front. Genet, 2020, vol. 11, p. 716. DOI: 10.3389/fgene.2020.00716
- Qu H., Li L., Wang T.L., Seckin T., Segars J., Shih I.M. Epithelial cells in endometriosis and adenomyosis upregulate STING expression. Reprod. Sci, 2020, vol. 27 (6), pp. 1276–1284. DOI: 10.1007/s43032-019-00127-z


