{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:08:44Z","timestamp":1788469724149,"version":"build-2803163510"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The reproductive microbiome plays a key role in disease progression and fertility in women with endometriosis. Vaginal and endometrial dysbiosis has been increasingly linked to inflammation, impaired reproductive outcomes, and symptom severity. Although estro-progestins, progestins, and GnRH agonists are widely used, their impact on microbial communities remains poorly understood, highlighting the need to clarify microbiome\u2013therapy interactions. This systematic review aims to comprehensively synthesize current evidence on how hormonal therapies influence the reproductive microbial environment and to offer insights for optimizing clinical management of endometriosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Literature screening and data extraction followed PRISMA guidelines using PubMed, Scopus, and Google Scholar. The search combined terms on endometriosis, hormonal therapy, and reproductive microbiome. Non-English studies, reviews, and those without original data were excluded. Risk of bias was assessed with ROBINS-I-V2, and microbial composition and diversity were analyzed and synthesized qualitatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The literature search retrieved 577 publications, of which 6 met eligibility criteria and were analyzed. The evidence collected through sequencing or culture-based methods suggested that the use of hormonal therapies to treat endometriosis may impact both vaginal and endometrial microbiome, favoring the colonization of bacterial species associated with infertility. GnRHa resulted to foster the dominance of potentially pathogenic bacteria, as\n                      <jats:italic>Gardnerella<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcaceae<\/jats:italic>\n                      , in the endometrium, and supporting bacterial vaginosis by increasing intermediate flora (Nugent score 4\u20136). A similar effect on the vaginal environment has been reported upon the use of oral contraceptive pills, which was shown to prompt the increase of\n                      <jats:italic>Prevotella<\/jats:italic>\n                      ,\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      ,\n                      <jats:italic>Streptococcus anginosus<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcus agalactiae<\/jats:italic>\n                      , among other pathogenic microbes, and to enhance the\n                      <jats:italic>Bacillota\/Bacteroidota<\/jats:italic>\n                      ratio.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Despite affected by several limitations and heterogeneity of included studies, this review provides a preliminary overview of the possible pejorative effect of hormonal therapy on the reproductive microbiome of endometriosis patients. While further investigations are required to consolidate these findings, the observations raised offer a valuable basis for opening a discussion about improving management strategies for affected women. By highlighting confounding factors overlooked in the selected papers, the present work will also be functional to optimize the design of future studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251042858<\/jats:ext-link>\n                      , identifier PROSPERO (CRD420251042858)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1755725","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:50:27Z","timestamp":1770879027000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of hormonal treatments for endometriosis on the reproductive microbiome: a systematic review"],"prefix":"10.3389","volume":"17","author":[{"given":"Stefania","family":"Luppi","sequence":"first","affiliation":[{"name":"Physiopathology of Human Reproduction, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghergana Alexandrova","family":"Topouzova","sequence":"additional","affiliation":[{"name":"Physiopathology of Human Reproduction, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Campisciano","sequence":"additional","affiliation":[{"name":"Advanced Translational Microbiology, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Giolo","sequence":"additional","affiliation":[{"name":"Physiopathology of Human Reproduction, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Bulfone","sequence":"additional","affiliation":[{"name":"Maternal-Neonatal Department, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Rossi","sequence":"additional","affiliation":[{"name":"Maternal-Neonatal Department, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Zito","sequence":"additional","affiliation":[{"name":"Physiopathology of Human Reproduction, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste","place":["Trieste, Italy"]},{"name":"Maternal-Neonatal Department, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manola","family":"Comar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste","place":["Trieste, Italy"]},{"name":"Advanced Translational Microbiology, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Andreuzzi","sequence":"additional","affiliation":[{"name":"Maternal-Neonatal Department, Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2387","DOI":"10.3389\/fimmu.2019.02387","article-title":"Uterine immunity and microbiota: a shifting paradigm","volume":"10","author":"Agostinis","year":"2019","journal-title":"Front. Immunol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/s0015-0282(97)81391-x","article-title":"Revised American Society for Reproductive Medicine classification of endometriosis: 1996","volume":"67","year":"1997","journal-title":"Fertil. Steril."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1001\/jama.2025.2975","article-title":"Endometriosis: A Review","volume":"334","author":"As-Sanie","year":"2025","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1038\/s41598-019-39700-6","article-title":"The Endobiota study: comparison of vaginal, cervical and gut microbiota between women with stage 3\/4 endometriosis and healthy controls","volume":"9","author":"Ata","year":"2019","journal-title":"Sci. Rep."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"686167","DOI":"10.3389\/fcimb.2021.686167","article-title":"The vaginal microbiome: a long urogenital colonization throughout woman life","volume":"11","author":"Auriemma","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1055472","DOI":"10.3389\/frmbi.2022.1055472","article-title":"The impact of contraceptives on the vaginal microbiome in the non-pregnant state","volume":"1","author":"Bakus","year":"2023","journal-title":"Front. Microbiomes"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e13785","DOI":"10.1111\/aji.13785","article-title":"Contraceptive effects on the cervicovaginal microbiome: recent evidence including randomized trials","volume":"90","author":"Balle","year":"2023","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum Reprod Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1007\/s10815-019-01564-0","article-title":"Effect of the vaginal microbiome on the pregnancy rate in women receiving assisted reproductive treatment","volume":"36","author":"Bernabeu","year":"2019","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.3389\/fphys.2019.01543","article-title":"Mast cells in peritoneal fluid from women with endometriosis and their possible role in modulating sperm function","volume":"10","author":"Borelli","year":"2019","journal-title":"Front. Physiol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.contraception.2016.11.006","article-title":"Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome","volume":"95","author":"Brooks","year":"2017","journal-title":"Contraception"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3390\/microorganisms9010039","article-title":"Lactobacillus iners and gasseri, Prevotella bivia and HPV belong to the microbiological signature negatively affecting human reproduction","volume":"9","author":"Campisciano","year":"2020","journal-title":"Microorganisms"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"174","DOI":"10.3390\/biomedicines10010174","article-title":"A more diverse cervical microbiome associates with better clinical outcomes in patients with endometriosis: a pilot study","volume":"10","author":"Chang","year":"2022","journal-title":"Biomedicine"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1038\/s41467-017-00901-0","article-title":"The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases","volume":"8","author":"Chen","year":"2017","journal-title":"Nat. Commun."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2675966","DOI":"10.1155\/2023\/2675966","article-title":"Gut and vaginal microbiota in the endometriosis: systematic review and Meta-analysis","volume":"2023","author":"Colonetti","year":"2023","journal-title":"Biomed. Res. Int."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/AOG.0b013e3181e8b073","article-title":"Practice Bulletin No. 114: Management of endometriosis","volume":"116","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2451","DOI":"10.3389\/fmicb.2019.02451","article-title":"The vaginal community state types microbiome-immune network as key factor for bacterial vaginosis and aerobic vaginitis","volume":"10","author":"De Seta","year":"2019","journal-title":"Front. Microbiol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1582283","DOI":"10.3389\/fcimb.2025.1582283","article-title":"Dietary habits and vaginal environment: can a beneficial impact be expected?","volume":"15","author":"Djusse","year":"2025","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"103112","DOI":"10.1016\/j.arcmed.2024.103112","article-title":"Influence of hormonal factors, number of sexual partners, surgical intervention on gastrointestinal and urogenital microbiota of patients endometriosis","volume":"55","author":"Do","year":"2024","journal-title":"Arch. Med. Res."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.3390\/diagnostics11081434","article-title":"Molecular and clinical insights on the complex interaction between oxidative stress, apoptosis, and Endobiota in the pathogenesis of endometriosis","volume":"11","author":"Doroftei","year":"2021","journal-title":"Diagnostics"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e70026","DOI":"10.1111\/aji.70026","article-title":"Vaginal microbiome: environmental, biological, and racial influences on gynecological health across the lifespan","volume":"92","author":"Dub\u00e9-Zinatelli","year":"2024","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1059825","DOI":"10.3389\/fcimb.2022.1059825","article-title":"Gut and genital tract microbiomes: Dysbiosis and link to gynecological disorders","volume":"12","author":"Elkafas","year":"2022","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"hoaf061","DOI":"10.1093\/hropen\/hoaf061","article-title":"Microbiome dysbiosis and endometriosis: a systematic scoping review of current literature and knowledge gaps","author":"Facciotti","year":"2025","journal-title":"Hum. Reprod. Open"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.3390\/life13061251","article-title":"The impact of the microbiological vaginal swab on the reproductive outcome in infertile women","volume":"13","author":"Findeklee","year":"2023","journal-title":"Life"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"102365","DOI":"10.1016\/j.bpobgyn.2023.102365","article-title":"Vaginal microbiome in obesity and its impact on reproduction","volume":"90","author":"Garg","year":"2023","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/1471-0528.15178","article-title":"Reproductive outcome of patients undergoing in vitro fertilisation treatment and diagnosed with bacterial vaginosis or abnormal vaginal microbiota: a systematic PRISMA review and meta-analysis","volume":"126","author":"Haahr","year":"2019","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1007\/s00404-020-05675-3","article-title":"The association between vaginal microbiota and female infertility: a systematic review and meta-analysis","volume":"302","author":"Hong","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"5644","DOI":"10.3390\/ijms22115644","article-title":"Intricate connections between the microbiota and endometriosis","volume":"22","author":"Jiang","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1093\/humrep\/dew293","article-title":"World endometriosis society consensus on the classification of endometriosis","volume":"32","author":"Johnson","year":"2017","journal-title":"Hum. Reprod."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2446","DOI":"10.1093\/humrep\/deu222","article-title":"Intra-uterine microbial colonization and occurrence of endometritis in women with endometriosis\u2020","volume":"29","author":"Khan","year":"2014","journal-title":"Hum. Reprod."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.ejogrb.2016.01.040","article-title":"Molecular detection of intrauterine microbial colonization in women with endometriosis","volume":"199","author":"Khan","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ejogrb.2021.07.014","article-title":"Levofloxacin or gonadotropin releasing hormone agonist treatment decreases intrauterine microbial colonization in human endometriosis","volume":"264","author":"Khan","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"90","DOI":"10.3390\/reprodmed5020010","article-title":"Prevalence of pathogenic microbes within the endometrium in normal weight vs. obese women with infertility","volume":"5","author":"King","year":"2024","journal-title":"Reprod. Med."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3892\/br.2023.1626","article-title":"Gut and reproductive tract microbiota: insights into the pathogenesis of endometriosis (review)","volume":"19","author":"Kobayashi","year":"2023","journal-title":"Biomed Rep."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.3390\/life13061313","article-title":"The female reproductive tract microbiota: friends and foe","volume":"13","author":"Kumar","year":"2023","journal-title":"Life"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"5615","DOI":"10.3390\/ijms20225615","article-title":"The pathogenesis of endometriosis: molecular and cell biology insights","volume":"20","author":"Lagan\u00e0","year":"2019","journal-title":"Int. J. Mol. Sci."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e0049924","DOI":"10.1128\/iai.00499-24","article-title":"Exploring the vaginal ecosystem: insights into host-microbe interactions and microbial community dynamics","volume":"93","author":"Landolt","year":"2025","journal-title":"Infect. Immun."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e0261362","DOI":"10.1371\/journal.pone.0261362","article-title":"Association of microbial dynamics with urinary estrogens and estrogen metabolites in patients with endometriosis","volume":"16","author":"Le","year":"2021","journal-title":"PLoS One"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1111\/1471-0528.15916","article-title":"Endometriosis and the microbiome: a systematic review","volume":"127","author":"Leonardi","year":"2020","journal-title":"BJOG"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e70109","DOI":"10.1111\/aji.70109","article-title":"Impact of gut and reproductive tract microbiota on estrogen metabolism in endometriosis","volume":"93","author":"Li","year":"2025","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12958-025-01421-z","article-title":"Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021","volume":"23","author":"Li","year":"2025","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2905","DOI":"10.3390\/nu13092905","article-title":"Human microbiota network: unveiling potential crosstalk between the different microbiota ecosystems and their role in health and disease","volume":"13","author":"Mart\u00ednez","year":"2021","journal-title":"Nutrients"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"6098961","DOI":"10.1155\/2018\/6098961","article-title":"Immunomodulatory effects of 17\u03b2-estradiol on epithelial cells during bacterial infections","volume":"2018","author":"Medina-Estrada","year":"2018","journal-title":"J Immunol Res"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"R163","DOI":"10.1530\/RAF-21-0113","article-title":"The microbiome and endometriosis","volume":"3","author":"Miyashira","year":"2022","journal-title":"Reproduct. Fertil."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40168-021-01184-w","article-title":"Endometrial microbiota composition is associated with reproductive outcome in infertile patients","volume":"10","author":"Moreno","year":"2022","journal-title":"Microbiome"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"eadd1531","DOI":"10.1126\/scitranslmed.add1531","article-title":"Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts","volume":"15","author":"Muraoka","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"12199","DOI":"10.1038\/s41598-022-16505-8","article-title":"Association between dietary patterns and bacterial vaginosis: a case\u2013control study","volume":"12","author":"Noormohammadi","year":"2022","journal-title":"Sci. Rep."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.jpag.2024.07.005","article-title":"Noninvasive diagnosis of endometriosis in adolescents and young female adults: a systematic review","volume":"38","author":"Oliveira","year":"2025","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1007\/s43032-019-00113-5","article-title":"The vaginal microbiome as a tool to predict rASRM stage of disease in endometriosis: a pilot study","volume":"27","author":"Perrotta","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1007\/s10815-021-02247-5","article-title":"The impact of the female genital tract microbiome in women health and reproduction: a review","volume":"38","author":"Punz\u00f3n-Jim\u00e9nez","year":"2021","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"732423","DOI":"10.3389\/fcimb.2021.732423","article-title":"The effect of exogenous sex steroids on the vaginal microbiota: a systematic review","volume":"11","author":"Ratten","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref53","year":""},{"key":"ref54","doi-asserted-by":"publisher","first-page":"fuaf039","DOI":"10.1093\/femsre\/fuaf039","article-title":"Impact of bacterial vaginosis on sexually transmitted viral infections: a bacterial point of view","volume":"49","author":"Segui-Perez","year":"2025","journal-title":"FEMS Microbiol. Rev."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.xfre.2022.11.009","article-title":"GnRH agonists in the treatment of symptomatic endometriosis: a review","volume":"4","author":"Surrey","year":"2022","journal-title":"F S Rep"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"123427","DOI":"10.1016\/j.lfs.2025.123427","article-title":"A possible association between low MBL\/lectin pathway functionality and microbiota dysbiosis in endometriosis patients","volume":"364","author":"Toffoli","year":"2025","journal-title":"Life Sci."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e1671","DOI":"10.52225\/narra.v5i1.1671","article-title":"Effective probiotic regimens for bacterial vaginosis treatment and recurrence prevention: a systematic review","volume":"5","author":"Udjianto","year":"2025","journal-title":"Narra J."},{"key":"ref58","year":"2017"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"1110824","DOI":"10.3389\/fendo.2023.1110824","article-title":"The bidirectional relationship between endometriosis and microbiome","volume":"14","author":"Uzuner","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"e096959","DOI":"10.1136\/bmjopen-2024-096959","article-title":"ProVag: the effect of oral probiotics on the vaginal microbiota composition in women receiving medical assisted reproduction in a Dutch fertility clinic \u2013 protocol of a randomised, placebo-controlled, double-blind study","volume":"15","author":"van Haren","year":"2025","journal-title":"BMJ Open"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s11154-021-09666-w","article-title":"Hormonal treatments for endometriosis: the endocrine background","volume":"23","author":"Vannuccini","year":"2022","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s40618-022-01752-3","article-title":"Human genital tracts microbiota: dysbiosis crucial for infertility","volume":"45","author":"Venneri","year":"2022","journal-title":"J. Endocrinol. Investig."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"e73055","DOI":"10.1371\/journal.pone.0073055","article-title":"Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and Meta-analysis","volume":"8","author":"Vodstrcil","year":"2013","journal-title":"PLoS One"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"1521216","DOI":"10.3389\/fmicb.2025.1521216","article-title":"Broadening horizons: microbiota as a novel biomarker and potential treatment for endometriosis","volume":"16","author":"Wang","year":"2025","journal-title":"Front. Microbiol."},{"key":"ref65","doi-asserted-by":"publisher","first-page":"114671","DOI":"10.1016\/j.ejogrb.2025.114671","article-title":"Research progress on the correlation between microbiota and endometriosis","volume":"314","author":"Wang","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref66","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1111\/ajo.12754","article-title":"A retrospective pilot study to determine whether the reproductive tract microbiota differs between women with a history of infertility and fertile women","volume":"58","author":"Wee","year":"2018","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"114078","DOI":"10.1016\/j.celrep.2024.114078","article-title":"Vaginal microbiomes show ethnic evolutionary dynamics and positive selection of Lactobacillus adhesins driven by a long-term niche-specific process","volume":"43","author":"Wei","year":"2024","journal-title":"Cell Rep."},{"key":"ref68","doi-asserted-by":"publisher","first-page":"qzad005","DOI":"10.1093\/gpbjnl\/qzad005","article-title":"Microbiome in female reproductive health: implications for fertility and assisted reproductive technologies","volume":"22","author":"Xiao","year":"2024","journal-title":"Genomics Proteomics Bioinformatics"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7555\/JBR.39.20250205","article-title":"Comparison of pregnancy outcomes and vaginal microbiota in endometriosis patients undergoing frozen embryo transfer using Letrozole combined HMG versus hormone replacement therapy with GnRH-a pretreatment","volume":"39","author":"Zhang","year":"2025","journal-title":"J. Biomed. Res."},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1519690","DOI":"10.3389\/fcimb.2025.1519690","article-title":"Reproductive tract microbiome dysbiosis associated with gynecological diseases","volume":"15","author":"Zheng","year":"2025","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"e0018121","DOI":"10.1128\/mmbr.00181-21","article-title":"Roles of the microbiota of the female reproductive tract in gynecological and reproductive health","volume":"86","author":"Zhu","year":"2022","journal-title":"Microbiol. Mol. Biol. Rev."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1755725\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:50:28Z","timestamp":1770879028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1755725\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":71,"alternative-id":["10.3389\/fmicb.2026.1755725"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1755725","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"article-number":"1755725"}}