{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T00:19:11Z","timestamp":1793751551907,"version":"4.6.1"},"reference-count":244,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by the ectopic implantation and persistence of endometrial-like tissue outside the uterine cavity. Despite its high prevalence and significant impact on quality of life, the pathogenesis of endometriosis remains incompletely understood and involves a complex interplay between hormonal dysregulation, immune dysfunction, and chronic inflammation. In recent years, growing evidence has highlighted the role of the microbiota as a potential modulator of these interconnected pathways. This review proposes an integrative framework in which the microbiota acts as a central modulator of immune\u2013endocrine interactions in endometriosis, while synthesizing current evidence on underlying biological mechanisms. We discuss how alterations in the gut, vaginal, and endometrial microbiota contribute to disease pathophysiology through multiple mechanisms, including disruption of intestinal barrier integrity, activation of pro-inflammatory signaling pathways, immune dysregulation, and modulation of estrogen metabolism via the estrobolome. Microbial \u03b2-glucuronidase activity and enterohepatic recirculation of estrogens are explored as key processes linking gut dysbiosis to the hyperestrogenic environment characteristic of endometriosis. Furthermore, we review current pharmacological treatments and highlight their limitations, emphasizing the need for novel therapeutic strategies targeting upstream disease mechanisms. Emerging approaches, including probiotics, postbiotics, short-chain fatty acids, and dietary interventions, are discussed as promising adjunctive therapies capable of modulating inflammation, immune responses, and metabolic pathways. Although current evidence remains heterogeneous and largely derived from preclinical and observational studies, the microbiota emerges not only as a potential therapeutic target but as a key integrative node linking endocrine, immune, and metabolic pathways in endometriosis. Future research should focus on well-designed clinical trials to validate microbiome-based interventions and to define their role in personalized management strategies for endometriosis.<\/jats:p>","DOI":"10.3390\/ijms27114883","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:45:08Z","timestamp":1780404308000},"page":"4883","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Microbiota\u2013Endometriosis Axis: An Immune\u2013Endocrine Integration Model and Emerging Therapeutic Targets"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8567-1246","authenticated-orcid":false,"given":"Georgiana","family":"Nemeti","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Elena","family":"Cr\u0103ciun","sequence":"additional","affiliation":[{"name":"2nd Department of Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania"},{"name":"Department of Diabetes and Nutrition Diseases, Emergency Clinical County Hospital Cluj, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4883-3856","authenticated-orcid":false,"given":"Dan Claudiu","family":"M\u0103gureanu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina Claudia","family":"Militaru","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3279-5384","authenticated-orcid":false,"given":"Ioana Corina","family":"Bocsan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian-Ioan","family":"Cr\u0103ciun","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0977-8874","authenticated-orcid":false,"given":"Adriana","family":"Rusu","sequence":"additional","affiliation":[{"name":"2nd Department of Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania"},{"name":"Department of Diabetes and Nutrition Diseases, Emergency Clinical County Hospital Cluj, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Stanca","family":"Melincovici","sequence":"additional","affiliation":[{"name":"Discipline of Histology, Department of Morpho-Functional Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3511-2788","authenticated-orcid":false,"given":"Anca Dana","family":"Buzoianu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mure\u0219an","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3904-2852","authenticated-orcid":false,"given":"Maria Adriana","family":"Neag","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Clinical Pharmacology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Healthcare-Associated Infections, Emergency Clinical County Hospital Cluj, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Blanco, L.P., Salmeri, N., Temkin, S.M., Shanmugam, V.K., and Stratton, P. (2025). Endometriosis and Autoimmunity. Autoimmun. Rev., 24.","DOI":"10.1016\/j.autrev.2025.103752"},{"key":"ref_2","doi-asserted-by":"crossref","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":"ref_3","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1056\/NEJMcp1000274","article-title":"Clinical Practice. Endometriosis","volume":"362","author":"Giudice","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1016\/j.ajog.2024.08.043","article-title":"Endometriosis and Adenomyosis Unveiled through Single-Cell Glasses","volume":"232","author":"Giudice","year":"2025","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_6","unstructured":"(2026, March 28). European Endometriosis Alliance\u2014Endometriosis.Org. Available online: https:\/\/endometriosis.org\/news\/support-awareness\/european-endometriosis-alliance\/."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Vigan\u00f2, P., Casalechi, M., and Dolmans, M.M. (2024). European Union Underinvestment in Endometriosis Research. J. Endometr. Uterine Disord., 5, Erratum in J. Endometr. Uterine Disord. 2024, 8, 100097. https:\/\/doi.org\/10.1016\/j.jeud.2024.100097.","DOI":"10.1016\/j.jeud.2023.100058"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Della Corte, L., Di Filippo, C., Gabrielli, O., Reppuccia, S., La Rosa, V.L., Ragusa, R., Fichera, M., Commodari, E., Bifulco, G., and Giampaolino, P. (2020). The Burden of Endometriosis on Women\u2019s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134683"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s10815-010-9436-1","article-title":"Endometriosis and Infertility","volume":"27","author":"Bulletti","year":"2010","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1093\/humrep\/deg136","article-title":"Time Elapsed from Onset of Symptoms to Diagnosis of Endometriosis in a Cohort Study of Brazilian Women","volume":"18","author":"Arruda","year":"2003","journal-title":"Hum. Reprod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.tjog.2022.08.002","article-title":"Endometriosis: Part I. Basic Concept","volume":"61","author":"Wang","year":"2022","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Orisaka, M., Mizutani, T., Miyazaki, Y., Shirafuji, A., Tamamura, C., Fujita, M., Tsuyoshi, H., and Yoshida, Y. (2023). Chronic Low-Grade Inflammation and Ovarian Dysfunction in Women with Polycystic Ovarian Syndrome, Endometriosis, and Aging. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1324429"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ni, Z., Li, Y., Song, D., Ding, J., Mei, S., Sun, S., Cheng, W., Yu, J., Zhou, L., and Kuang, Y. (2022). Iron-Overloaded Follicular Fluid Increases the Risk of Endometriosis-Related Infertility by Triggering Granulosa Cell Ferroptosis and Oocyte Dysmaturity. Cell Death Dis., 13.","DOI":"10.1038\/s41419-022-05037-8"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hosseinzadeh, R., Moini, A., Hosseini, R., Fatehnejad, M., Yekaninejad, M.S., Javidan, M., Changaei, M., Feizisani, F., and Rajaei, S. (2023). A Higher Number of Exhausted Local PD1+, but Not TIM3+, NK Cells in Advanced Endometriosis. Heliyon, 10.","DOI":"10.1016\/j.heliyon.2023.e23294"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.fertnstert.2015.11.047","article-title":"Surgical Removal of Endometriotic Lesions Alters Local and Systemic Proinflammatory Cytokines in Endometriosis Patients","volume":"105","author":"Monsanto","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ajpath.2013.10.023","article-title":"Serum Level of IL-10 Is Increased in Patients with Endometriosis, and IL-10 Promotes the Growth of Lesions in a Murine Model","volume":"184","author":"Suen","year":"2014","journal-title":"Am. J. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0015-0282(01)01816-7","article-title":"Role of Cytokines in Endometriosis","volume":"76","author":"Harada","year":"2001","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1136\/annrheumdis-2015-207704","article-title":"Endometriosis and the Risks of Systemic Lupus Erythematosus and Rheumatoid Arthritis in the Nurses\u2019 Health Study II","volume":"75","author":"Harris","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Jiang, I., Yong, P.J., Allaire, C., and Bedaiwy, M.A. (2021). Intricate Connections between the Microbiota and Endometriosis. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22115644"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1210\/er.2018-00242","article-title":"Endometriosis","volume":"40","author":"Bulun","year":"2019","journal-title":"Endocr. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis Is a Chronic Systemic Disease: Clinical Challenges and Novel Innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3934","DOI":"10.1210\/en.2003-0289","article-title":"Transactivation of Steroidogenic Acute Regulatory Protein in Human Endometriotic Stromalcells Is Mediated by the Prostaglandin EP2 Receptor","volume":"144","author":"Sun","year":"2003","journal-title":"Endocrinology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/nyas.12411","article-title":"Aromatase and Endometriosis: Estrogens Play a Role","volume":"1317","author":"Ferrero","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(04)17403-5","article-title":"Endometriosis","volume":"364","author":"Giudice","year":"2004","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1055\/s-0029-1242992","article-title":"17\u03b2-Hydroxysteroid Dehydrogenase-2 Deficiency and Progesterone Resistance in Endometriosis","volume":"28","author":"Bulun","year":"2010","journal-title":"Semin. Reprod. Med."},{"key":"ref_26","first-page":"4474","article-title":"Deficient 17\u03b2-Hydroxysteroid Dehydrogenase Type 2 Expression in Endometriosis: Failure to Metabolize 17\u03b2-Estradiol","volume":"83","author":"Zeitoun","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Jin, P., Cai, J., Chen, N., Liu, Y., Zhao, H., Wang, Y., Chen, J., Li, M., Xiao, T., and Shan, C. (2025). TGF-\u03b2\/Snail-Mediated Epithelial-to-Mesenchymal Transition Disrupts Estradiol Metabolism through Suppressing the HSD17B2 Expression in Endometriotic Epithelial Cells. Biochem. Biophys. Res. Commun., 771.","DOI":"10.1016\/j.bbrc.2025.151964"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1093\/humupd\/dmt010","article-title":"Endometriosis: Hormone Regulation and Clinical Consequences of Chemotaxis and Apoptosis","volume":"19","author":"Reis","year":"2013","journal-title":"Hum. Reprod. Update"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1210\/jc.2008-1466","article-title":"Estrogen Receptor (ER) \u03b2 Regulates ER\u03b1 Expression in Stromal Cells Derived from Ovarian Endometriosis","volume":"94","author":"Trukhacheva","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1055\/s-0031-1299596","article-title":"Role of Estrogen Receptor-\u03b2 in Endometriosis","volume":"30","author":"Bulun","year":"2012","journal-title":"Semin. Reprod. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1095\/biolreprod.107.061804","article-title":"Promoter Methylation Regulates Estrogen Receptor 2 in Human Endometrium and Endometriosis","volume":"77","author":"Xue","year":"2007","journal-title":"Biol. Reprod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.cell.2015.10.034","article-title":"Estrogen Receptor \u03b2 Modulates Apoptosis Complexes and the Inflammasome to Drive the Pathogenesis of Endometriosis","volume":"163","author":"Han","year":"2015","journal-title":"Cell"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1210\/en.2019-00442","article-title":"Genomic Function of Estrogen Receptor \u03b2 in Endometriosis","volume":"160","author":"Han","year":"2019","journal-title":"Endocrinology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1093\/humupd\/dmz005","article-title":"Endometriosis and Nuclear Receptors","volume":"25","author":"Yilmaz","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Pu, H., Wen, X., Luo, D.X., and Guo, Z. (2023). Regulation of Progesterone Receptor Expression in Endometriosis, Endometrial Cancer, and Breast Cancer by Estrogen, Polymorphisms, Transcription Factors, Epigenetic Alterations, and Ubiquitin-Proteasome System. J. Steroid Biochem. Mol. Biol., 227.","DOI":"10.1016\/j.jsbmb.2022.106199"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1093\/humupd\/dmaa009","article-title":"Progesterone Receptor Ligands for the Treatment of Endometriosis: The Mechanisms behind Therapeutic Success and Failure","volume":"26","author":"Reis","year":"2020","journal-title":"Hum. Reprod. Update"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1210\/endrev\/bnad020","article-title":"Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics","volume":"44","author":"Marquardt","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Chen, S., Liu, Y., Zhong, Z., Wei, C., Liu, Y., and Zhu, X. (2023). Peritoneal Immune Microenvironment of Endometriosis: Role and Therapeutic Perspectives. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1134663"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wang, L., Li, L., Li, Y., Huang, C., Lian, R., Wu, T., Ma, J., Zhang, Y., Cheng, Y., and Diao, L. (2021). A History of Endometriosis Is Associated with Decreased Peripheral NK Cytotoxicity and Increased Infiltration of Uterine CD68+ Macrophages. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.711231"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1097\/CM9.0000000000002649","article-title":"Understanding Endometriosis from an Immunomicroenvironmental Perspective","volume":"136","author":"Fan","year":"2023","journal-title":"Chin. Med. J."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Jiang, W., Xu, W., and Chen, F. (2025). Dysfunction of Natural Killer Cells Promotes Immune Escape and Disease Progression in Endometriosis. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1657605"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Reis, J.L., Rosa, N.N., \u00c2ngelo-Dias, M., Martins, C., Borrego, L.M., and Lima, J. (2022). Natural Killer Cell Receptors and Endometriosis: A Systematic Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24010331"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Walankiewicz, M., Grywalska, E., Polak, G., Korona-Glowniak, I., Witt, E., Surdacka, A., Kotarski, J., and Rolinski, J. (2018). The Increase of Circulating PD-1- and PD-L1-Expressing Lymphocytes in Endometriosis: Correlation with Clinical and Laboratory Parameters. Mediat. Inflamm., 2018.","DOI":"10.1155\/2018\/7041342"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Sobstyl, M., Mertowska, P., Mertowski, S., Zaborek-\u0141yczba, M., Dudzi\u0144ski, D., Polak, G., and Grywalska, E. (2024). The PD-1\/PD-L1 Gateway: Peripheral Immune Regulation in the Pathogenesis of Endometriosis. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25126775"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Suszczyk, D., Skiba, W., Zardzewia\u0142y, W., Paw\u0142owska, A., W\u0142odarczyk, K., Polak, G., Tarkowski, R., and Wertel, I. (2022). Clinical Value of the PD-1\/PD-L1\/PD-L2 Pathway in Patients Suffering from Endometriosis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231911607"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4400","DOI":"10.7150\/ijbs.72707","article-title":"An Update on the Multifaceted Role of NF-KappaB in Endometriosis","volume":"18","author":"Liu","year":"2022","journal-title":"Int. J. Biol. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1016\/j.fertnstert.2010.01.013","article-title":"Involvement of the Nuclear Factor-\u039aB Pathway in the Pathogenesis of Endometriosis","volume":"94","author":"Lousse","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"E1404","DOI":"10.1210\/jc.2015-2031","article-title":"C-Jun NH2-Terminal Kinase and P38 Inhibition Suppresses Prostaglandin E2-Stimulated Aromatase and Estrogen Receptor Levels in Human Endometriosis","volume":"100","author":"Zeng","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"As-Sanie, S., Mackenzie, S.C., Morrison, L., Schrepf, A., Zondervan, K.T., Horne, A.W., and Missmer, S.A. (2025). Endometriosis. JAMA, 334.","DOI":"10.1001\/jama.2025.2975"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Chen, Y., and Li, T. (2025). Unveiling the Mechanisms of Pain in Endometriosis: Comprehensive Analysis of Inflammatory Sensitization and Therapeutic Potential. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26041770"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Yu, W. (2025). Mechanism of Vascular Endothelial Growth Factor Regulating Hypoxia and Inflammatory Microenvironment in Endometriosis: Based on Bioinformatics and Multi-Level Validation. Arch. Biochem. Biophys., 774.","DOI":"10.1016\/j.abb.2025.110639"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Hoffmann-M\u0142odzianowska, M., Maksym, R.B., Pucia, K., Kuciak, M., Mackiewicz, A., and Kieda, C. (2024). Endometriosis Development in Relation to Hypoxia: A Murine Model Study. Mol. Med., 30.","DOI":"10.1186\/s10020-024-00973-x"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.4049\/jimmunol.1501138","article-title":"IL-17A Contributes to the Pathogenesis of Endometriosis by Triggering Proinflammatory Cytokines and Angiogenic Growth Factors","volume":"195","author":"Ahn","year":"2015","journal-title":"J. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Jana, S., Chatterjee, K., Ray, A.K., Dasmahapatra, P., and Swarnakar, S. (2016). Regulation of Matrix Metalloproteinase-2 Activity by COX-2-PGE2-PAKT Axis Promotes Angiogenesis in Endometriosis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0163540"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1172\/JCI118815","article-title":"Vascular Endothelial Growth Factor Is Produced by Peritoneal Fluid Macrophages in Endometriosis and Is Regulated by Ovarian Steroids","volume":"98","author":"McLaren","year":"1996","journal-title":"J. Clin. Investig."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Wang, X., Wu, N., and Xue, Q. (2025). Macrophages in Endometriosis: Key Roles and Emerging Therapeutic Opportunities\u2014A Narrative Review. Reprod. Biol. Endocrinol., 23.","DOI":"10.1186\/s12958-025-01471-3"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Henlon, Y., Panir, K., McIntyre, I., Hogg, C., Dhami, P., Cuff, A.O., Senior, A., Moolchandani-Adwani, N., Courtois, E.T., and Horne, A.W. (2024). Single-Cell Analysis Identifies Distinct Macrophage Phenotypes Associated with Prodisease and Proresolving Functions in the Endometriotic Niche. Proc. Natl. Acad. Sci. USA, 121.","DOI":"10.1073\/pnas.2405474121"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1093\/humupd\/dmy001","article-title":"Basic Mechanisms of Vascularization in Endometriosis and Their Clinical Implications","volume":"24","author":"Laschke","year":"2018","journal-title":"Hum. Reprod. Update"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1093\/humupd\/dmae023","article-title":"The Role of Fibrosis in Endometriosis: A Systematic Review","volume":"30","author":"Vissers","year":"2024","journal-title":"Hum. Reprod. Update"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Zhong, Y., Huang, X., Li, Y., Wang, R., Qiao, X., Li, F., Wu, L., Liu, C., Han, Y., and Ouyang, Y. (2025). TGFB1\/SMAD3-Driven Macrophage-Myofibroblast Transition Promotes Fibrosis Progression in Endometriosis. Mol. Hum. Reprod., 31.","DOI":"10.1093\/molehr\/gaaf051"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Xu, X., Li, J., Lin, H., Lin, Z., and Ji, G. (2025). The Role of TGF-\u03b2 Superfamily in Endometriosis: A Systematic Review. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1638604"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Kusama, K., Fukushima, Y., Yoshida, K., Azumi, M., Yoshie, M., Mizuno, Y., Kajihara, T., and Tamura, K. (2021). PGE2 and Thrombin Induce Myofibroblast Transdifferentiation via Activin A and CTGF in Endometrial Stromal Cells. Endocrinology, 162.","DOI":"10.1210\/endocr\/bqab207"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.fertnstert.2020.08.012","article-title":"Sphingosine 1-Phosphate Receptors Are Dysregulated in Endometriosis: Possible Implication in Transforming Growth Factor \u03b2-Induced Fibrosis","volume":"115","author":"Bernacchioni","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1007\/s43032-022-01083-x","article-title":"Endometriosis: Cellular and Molecular Mechanisms Leading to Fibrosis","volume":"30","author":"Vannuzzi","year":"2023","journal-title":"Reprod. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jmig.2019.11.011","article-title":"Cellular Components Contributing to Fibrosis in Endometriosis: A Literature Review","volume":"27","author":"Ottolina","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1093\/humrep\/deac098","article-title":"Persistent Activation of Signal Transducer and Activator of Transcription 3 via Interleukin-6 Trans-Signaling Is Involved in Fibrosis of Endometriosis","volume":"37","author":"Matsuzaki","year":"2022","journal-title":"Hum. Reprod."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Lagan\u00e0, A.S., Garzon, S., G\u00f6tte, M., Vigan\u00f2, P., Franchi, M., Ghezzi, F., and Martin, D.C. (2019). The Pathogenesis of Endometriosis: Molecular and Cell Biology Insights. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20225615"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Bulun, S.E. (2025). Endometriosis and Ovulatory Menstruation: Beyond the Sampson Principle. J. Clin. Investig., 135.","DOI":"10.1172\/JCI188787"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Lamceva, J., Uljanovs, R., and Strumfa, I. (2023). The Main Theories on the Pathogenesis of Endometriosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054254"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Mariadas, H., Chen, J.H., and Chen, K.H. (2025). The Molecular and Cellular Mechanisms of Endometriosis: From Basic Pathophysiology to Clinical Implications. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26062458"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ajog.2020.10.019","article-title":"Bacterial Vaginosis and Its Association with Infertility, Endometritis, and Pelvic Inflammatory Disease","volume":"224","author":"Ravel","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_72","unstructured":"(2026, March 29). Bacterial Vaginosis. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/bacterial-vaginosis\/."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Chen, X., Lu, Y., Chen, T., and Li, R. (2021). The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.631972"},{"key":"ref_74","unstructured":"Colonna, C., and Steelman, M. (2026, April 22). Amsel Criteria, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK542319\/."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal Microbiome of Reproductive-Age Women","volume":"108","author":"Ravel","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"8467","DOI":"10.1038\/s41598-022-12095-7","article-title":"Endometrial Microbiome: Sampling, Assessment, and Possible Impact on Embryo Implantation","volume":"12","author":"Reschini","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Kumari, N., Kumari, R., Dua, A., Singh, M., Kumar, R., Singh, P., Duyar-Ayerdi, S., Pradeep, S., Ojesina, A.I., and Kumar, R. (2024). From Gut to Hormones: Unraveling the Role of Gut Microbiota in (Phyto)Estrogen Modulation in Health and Disease. Mol. Nutr. Food Res., 68.","DOI":"10.1002\/mnfr.202300688"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Hu, S., Ding, Q., Zhang, W., Kang, M., Ma, J., and Zhao, L. (2023). Gut Microbial Beta-Glucuronidase: A Vital Regulator in Female Estrogen Metabolism. Gut Microbes, 15.","DOI":"10.1080\/19490976.2023.2236749"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.str.2017.05.003","article-title":"An Atlas of \u03b2-Glucuronidases in the Human Intestinal Microbiome","volume":"25","author":"Pollet","year":"2017","journal-title":"Structure"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.maturitas.2017.06.025","article-title":"Estrogen-Gut Microbiome Axis: Physiological and Clinical Implications","volume":"103","author":"Baker","year":"2017","journal-title":"Maturitas"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.envint.2015.05.012","article-title":"Estrogenic Endocrine Disruptors: Molecular Mechanisms of Action","volume":"83","author":"Kiyama","year":"2015","journal-title":"Environ. Int."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1080\/19490976.2016.1234657","article-title":"Effects of Exposure to Bisphenol A and Ethinyl Estradiol on the Gut Microbiota of Parents and Their Offspring in a Rodent Model","volume":"7","author":"Javurek","year":"2016","journal-title":"Gut Microbes"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2273","DOI":"10.1007\/s43032-024-01548-1","article-title":"Connecting Bisphenol A Exposure to PCOS: Findings from a Case-Control Investigation","volume":"31","author":"Patel","year":"2024","journal-title":"Reprod. Sci."},{"key":"ref_84","first-page":"7529","article-title":"Relationship between estrogens and gut microbiota","volume":"24","author":"Gupta","year":"2024","journal-title":"J. Cell Tissue Res."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Kocot, A.M., Jarocka-Cyrta, E., and Drabi\u0144ska, N. (2022). Overview of the Importance of Biotics in Gut Barrier Integrity. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23052896"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.tem.2022.01.002","article-title":"Gut Barrier Disruption and Chronic Disease","volume":"33","author":"Martel","year":"2022","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Di Tommaso, N., Gasbarrini, A., and Ponziani, F.R. (2021). Intestinal Barrier in Human Health and Disease. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312836"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.3748\/wjg.v29.i11.1651","article-title":"Microbiome-Liver Crosstalk: A Multihit Therapeutic Target for Liver Disease","volume":"29","author":"Kirundi","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"You, Y., Xiang, T., Yang, C., Xiao, S., Tang, Y., Luo, G., Ling, Z., Luo, F., and Chen, Y. (2025). Interactions between the Gut Microbiota and Immune Cell Dynamics: Novel Insights into the Gut-Bone Axis. Gut Microbes, 17.","DOI":"10.1080\/19490976.2025.2545417"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Ata, B., Yildiz, S., Turkgeldi, E., Brocal, V.P., Dinleyici, E.C., Moya, A., and Urman, B. (2019). The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3\/4 Endometriosis and Healthy Controls. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-39700-6"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Datkhayeva, Z., Iskakova, A., Mireeva, A., Seitaliyeva, A., Skakova, R., Kulniyazova, G., Shayakhmetova, A., Koshkimbayeva, G., Sarmuldayeva, C., and Nurseitova, L. (2025). The Multifactorial Pathogenesis of Endometriosis: A Narrative Review Integrating Hormonal, Immune, and Microbiome Aspects. Medicina, 61.","DOI":"10.3390\/medicina61050811"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"G\u00fcemes-Gonz\u00e1lez, A.M., Arriaga-Pizano, L.A., Chac\u00f3n-Salinas, R., Wong-Baeza, I., and Ferat-Osorio, E. (2025). Regulation of Intestinal Permeability in Health and Disease: Possible Therapeutic Applications. Arch. Med. Res., 57.","DOI":"10.1016\/j.arcmed.2025.103321"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"16799","DOI":"10.1073\/pnas.0906773106","article-title":"Identification of Human Zonulin, a Physiological Modulator of Tight Junctions, as Prehaptoglobin-2","volume":"106","author":"Tripathi","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1749-6632.2000.tb05244.x","article-title":"Regulation of Intercellular Tight Junctions by Zonula Occludens Toxin and Its Eukaryotic Analogue Zonulin","volume":"915","author":"Fasano","year":"2000","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_95","first-page":"6547","article-title":"Elucidating the Significance of Zonulin in the Pathogenesis of Chronic Inflammatory Disorders: Emphasis on Intestinal Barrier Function and Tight Junction Regulation","volume":"32","author":"Mousavi","year":"2024","journal-title":"Curr. Med. Chem."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Miranda-Ribera, A., Ennamorati, M., Serena, G., Cetinbas, M., Lan, J., Sadreyev, R.I., Jain, N., Fasano, A., and Fiorentino, M. (2019). Exploiting the Zonulin Mouse Model to Establish the Role of Primary Impaired Gut Barrier Function on Microbiota Composition and Immune Profiles. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.02233"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Huo, C., Li, G., Hu, Y., and Sun, H. (2022). The Impacts of Iron Overload and Ferroptosis on Intestinal Mucosal Homeostasis and Inflammation. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232214195"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1196\/annals.1326.027","article-title":"Disrupted Barrier Function through Epithelial Cell Apoptosis","volume":"1072","author":"Schulzke","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/mi.2008.46","article-title":"Epithelial Apoptosis Is a Prominent Feature of the Epithelial Barrier Disturbance in Intestinal Inflammation: Effect of pro-Inflammatory Interleukin-13 on Epithelial Cell Function","volume":"1","author":"Heller","year":"2008","journal-title":"Mucosal Immunol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1038\/s41590-025-02298-1","article-title":"Necroptotic Cell Death Consequences and Disease Relevance","volume":"26","author":"Vince","year":"2025","journal-title":"Nat. Immunol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"jcs260091","DOI":"10.1242\/jcs.260091","article-title":"Necroptosis at a Glance","volume":"135","author":"Kang","year":"2022","journal-title":"J. Cell Sci."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1038\/s12276-022-00868-z","article-title":"Roles of RIPK3 in Necroptosis, Cell Signaling, and Disease","volume":"54","author":"Morgan","year":"2022","journal-title":"Exp. Mol. Med."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Churchill, M.J., Mitchell, P.S., and Rauch, I. (2022). Epithelial Pyroptosis in Host Defense. J. Mol. Biol., 434.","DOI":"10.1016\/j.jmb.2021.167278"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Zhang, S., Liang, Y., Yao, J., Li, D.F., and Wang, L.S. (2022). Role of Pyroptosis in Inflammatory Bowel Disease (IBD): From Gasdermins to DAMPs. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.833588"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Zhang, X., Ma, Y., Lv, G., and Wang, H. (2023). Ferroptosis as a Therapeutic Target for Inflammation-Related Intestinal Diseases. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1095366"},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Gao, W., Zhang, T., and Wu, H. (2021). Emerging Pathological Engagement of Ferroptosis in Gut Diseases. Oxid. Med. Cell. Longev., 2021.","DOI":"10.1155\/2021\/4246255"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11739-023-03374-w","article-title":"Gut Microbiota, Intestinal Permeability, and Systemic Inflammation: A Narrative Review","volume":"19","author":"Petito","year":"2024","journal-title":"Intern. Emerg. Med."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Xie, H., Yu, S., Tang, M., Xun, Y., Shen, Q., and Wu, G. (2025). Gut Microbiota Dysbiosis in Inflammatory Bowel Disease: Interaction with Intestinal Barriers and Microbiota-Targeted Treatment Options. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1608025"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S2468-1253(24)00390-X","article-title":"The Intestinal Barrier: A Pivotal Role in Health, Inflammation, and Cancer","volume":"10","author":"Neurath","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1016\/j.ajpath.2017.08.005","article-title":"Lipopolysaccharide-Induced Increase in Intestinal Epithelial Tight Permeability Is Mediated by Toll-Like Receptor 4\/Myeloid Differentiation Primary Response 88 (MyD88) Activation of Myosin Light Chain Kinase Expression","volume":"187","author":"Nighot","year":"2017","journal-title":"Am. J. Pathol."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Soranno, D.E., Coopersmith, C.M., Brinkworth, J.F., Factora, F.N.F., Muntean, J.H., Mythen, M.G., Raphael, J., Shaw, A.D., Vachharajani, V., and Messer, J.S. (2025). A Review of Gut Failure as a Cause and Consequence of Critical Illness. Crit. Care, 29.","DOI":"10.1186\/s13054-025-05309-7"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Kalopedis, E.A., Zorgani, A., Zinovkin, D.A., Barri, M., Wood, C.D., and Pranjol, M.Z.I. (2025). Leveraging the Role of the Microbiome in Endometriosis: Novel Non-Invasive and Therapeutic Approaches. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1631522"},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Alghetaa, H., Mohammed, A., Singh, N.P., Bloomquist, R.F., Chatzistamou, I., Nagarkatti, M., and Nagarkatti, P. (2023). Estrobolome Dysregulation Is Associated with Altered Immunometabolism in a Mouse Model of Endometriosis. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1261781"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Arag\u00f3n, A., Jurado, R., Jara, J., Rodr\u00edguez, J.M., and Orgaz, B. (2024). Investigating the Metabolism of Estrogens in Ligilactobacillus Salivarius Strains Isolated from Human Milk and Vaginal Microbiota. Nutrients, 16.","DOI":"10.3390\/nu16060861"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"18586","DOI":"10.1074\/jbc.RA119.010950","article-title":"Gut Microbial \u03b2-Glucuronidases Reactivate Estrogens as Components of the Estrobolome That Reactivate Estrogens","volume":"294","author":"Ervin","year":"2019","journal-title":"J. Biol. Chem."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Sui, Y., Wu, J., and Chen, J. (2021). The Role of Gut Microbial \u03b2-Glucuronidase in Estrogen Reactivation and Breast Cancer. Front. Cell Dev. Biol., 9.","DOI":"10.3389\/fcell.2021.631552"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Murga, M.L., Gil-Ortiz, F., Serrano-Garc\u00eda, L., and Llombart-Cussac, A. (2023). A New Paradigm in the Relationship between Gut Microbiota and Breast Cancer: \u03b2-Glucuronidase Enzyme Identified as Potential Therapeutic Target. Pathogens, 12.","DOI":"10.20944\/preprints202307.0979.v1"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/humupd\/dmab035","article-title":"The Role of Gut and Genital Microbiota and the Estrobolome in Endometriosis, Infertility and Chronic Pelvic Pain","volume":"28","author":"Salliss","year":"2021","journal-title":"Hum. Reprod. Update"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Pai, A.H.Y., Wang, Y.W., Lu, P.C., Wu, H.M., Xu, J.L., and Huang, H.Y. (2023). Gut Microbiome-Estrobolome Profile in Reproductive-Age Women with Endometriosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242216301"},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Bau\u0219ic, A.I.G., Scurtu, F., Manu, A., Matasariu, D.R., and Br\u0103til\u0103, E. (2025). Gut Microbiota Dysbiosis in Endometriosis: A Potential Link to Inflammation and Disease Progression. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26115144"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00394-017-1445-8","article-title":"Gut Microbiota Functions: Metabolism of Nutrients and Other Food Components","volume":"57","author":"Rowland","year":"2018","journal-title":"Eur. J. Nutr."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1355S","DOI":"10.3945\/jn.109.119776","article-title":"Equol: History, Chemistry, and Formation","volume":"140","author":"Setchell","year":"2010","journal-title":"J. Nutr."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3390\/metabo5010056","article-title":"The Role of Colonic Bacteria in the Metabolism of the Natural Isoflavone Daidzin to Equol","volume":"5","author":"Rafii","year":"2015","journal-title":"Metabolites"},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Baldi, S., Trist\u00e1n Asensi, M., Pallecchi, M., Sofi, F., Bartolucci, G., and Amedei, A. (2023). Interplay between Lignans and Gut Microbiota: Nutritional, Functional and Methodological Aspects. Molecules, 28.","DOI":"10.3390\/molecules28010343"},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Wada, K., Suda, W., Ueno, T., Masuoka, H., Yamakawa, M., Nakashima, Y., Sugino, M., Mori, T., Uchiyama, S., and Sumoto, Y. (2025). Gut Microbiota Associated with Equol Production in School-Age Children. Eur. J. Nutr., 64.","DOI":"10.1007\/s00394-025-03625-w"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1093\/humrep\/dex372","article-title":"Endometriosis Induces Gut Microbiota Alterations in Mice","volume":"33","author":"Yuan","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1093\/humrep\/dez041","article-title":"Antibiotic Therapy with Metronidazole Reduces Endometriosis Disease Progression in Mice: A Potential Role for Gut Microbiota","volume":"34","author":"Chadchan","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Hantschel, J., Weis, S., Sch\u00e4fer, K.H., Menger, M.D., Kohl, M., Egert, M., and Laschke, M.W. (2019). Effect of Endometriosis on the Fecal Bacteriota Composition of Mice during the Acute Phase of Lesion Formation. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226835"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1136\/gutjnl-2025-336185","article-title":"Intraperitoneal Translocation of Gut Microbiota Induces NETosis and Promotes Endometriosis","volume":"75","author":"Wu","year":"2025","journal-title":"Gut"},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Sobstyl, A., Cha\u0142upnik, A., Mertowska, P., and Grywalska, E. (2023). How Do Microorganisms Influence the Development of Endometriosis? Participation of Genital, Intestinal and Oral Microbiota in Metabolic Regulation and Immunopathogenesis of Endometriosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241310920"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.molmed.2018.07.004","article-title":"The Immunopathophysiology of Endometriosis","volume":"24","author":"Symons","year":"2018","journal-title":"Trends Mol. Med."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Guo, C., and Zhang, C. (2024). Role of the Gut Microbiota in the Pathogenesis of Endometriosis: A Review. Front. Microbiol., 15.","DOI":"10.3389\/fmicb.2024.1363455"},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Shifon, S., Tyrinova, T., Veretelnikova, T., Pasman, N., and Chernykh, E. (2025). Endometriosis as an Immune-Mediated Disease: Pathogenetic Mechanisms and Therapeutic Strategies. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1727183"},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Garmendia, J.V., De Sanctis, C.V., Hajd\u00fach, M., and De Sanctis, J.B. (2025). Endometriosis: An Immunologist\u2019s Perspective. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202504.1726.v1"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"e202101224","DOI":"10.26508\/lsa.202101224","article-title":"Gut Microbiota\u2013Derived Short-Chain Fatty Acids Protect against the Progression of Endometriosis","volume":"4","author":"Chadchan","year":"2021","journal-title":"Life Sci. Alliance"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s40168-025-02243-2","article-title":"Microbiota Insights in Endometriosis","volume":"13","author":"Parpex","year":"2025","journal-title":"Microbiome"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1186\/s40001-025-03334-4","article-title":"Evaluation of Microecological Therapy in Endometriosis through Modulation of the Gut Microbiota","volume":"30","author":"Qiao","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00404-021-06075-x","article-title":"A Systematic Review of Toll-like Receptors in Endometriosis","volume":"304","author":"Mansur","year":"2021","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Escorcia Mora, P., Valbuena, D., and Diez-Juan, A. (2025). The Role of the Gut Microbiota in Female Reproductive and Gynecological Health: Insights into Endometrial Signaling Pathways. Life, 15.","DOI":"10.3390\/life15050762"},{"key":"ref_140","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Prieto, I., Vargas, E., Salas-Espejo, E., L\u00fcll, K., Canha-Gouveia, A., P\u00e9rez, L.A., Fontes, J., Salumets, A., Andreson, R., and Aasmets, O. (2024). Gut Microbiome in Endometriosis: A Cohort Study on 1000 Individuals. BMC Med., 22, Erratum in BMC Med. 2024, 22, 448. https:\/\/doi.org\/10.1186\/s12916-024-03692-6.","DOI":"10.1186\/s12916-024-03692-6"},{"key":"ref_141","doi-asserted-by":"crossref","unstructured":"Li, Z., Yin, Z., Chen, W., and Wang, Z. (2025). Impact of Gut and Reproductive Tract Microbiota on Estrogen Metabolism in Endometriosis. Am. J. Reprod. Immunol., 93.","DOI":"10.1111\/aji.70109"},{"key":"ref_142","first-page":"CD004753","article-title":"Nonsteroidal Anti-Inflammatory Drugs for Pain in Women with Endometriosis","volume":"2017","author":"Brown","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12958-025-01508-7","article-title":"The \u201cDouble-Edged Sword\u201d Effect of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Treatment of Endometriosis (EMS)","volume":"24","author":"Shi","year":"2025","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s40265-018-0928-0","article-title":"Current and Emerging Therapeutics for the Management of Endometriosis","volume":"78","author":"Ferrero","year":"2018","journal-title":"Drugs"},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Miku\u0161, M., \u0160prem Gold\u0161tajn, M., Lagan\u00e0, A.S., Vukorepa, F., and \u0106ori\u0107, M. (2023). Clinical Efficacy, Pharmacokinetics, and Safety of the Available Medical Options in the Treatment of Endometriosis-Related Pelvic Pain: A Scoping Review. Pharmaceuticals, 16.","DOI":"10.3390\/ph16091315"},{"key":"ref_146","doi-asserted-by":"crossref","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":"ref_147","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1016\/j.fertnstert.2007.08.051","article-title":"Low-Dose Oral Contraceptive Pill for Dysmenorrhea Associated with Endometriosis: A Placebo-Controlled, Double-Blind, Randomized Trial","volume":"90","author":"Harada","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.fertnstert.2017.07.1165","article-title":"Ethinylestradiol 20 \u039cg\/Drospirenone 3 Mg in a Flexible Extended Regimen for the Management of Endometriosis-Associated Pelvic Pain: A Randomized Controlled Trial","volume":"108","author":"Harada","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_149","doi-asserted-by":"crossref","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":"2023","journal-title":"F&S Rep."},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Rzewuska, A.M., \u017bybowska, M., Sajkiewicz, I., Spiechowicz, I., \u017bak, K., Abramiuk, M., Ku\u0142ak, K., and Tarkowski, R. (2023). Gonadotropin-Releasing Hormone Antagonists\u2014A New Hope in Endometriosis Treatment?. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031008"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1080\/17425255.2025.2499550","article-title":"Pharmacokinetic Considerations for Gonadotropin-Releasing Hormone Agonists and Antagonists to Treat Endometriosis","volume":"21","author":"Paoletti","year":"2025","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2147\/IJWH.S442357","article-title":"Oral GnRH Antagonists in Combination with Estradiol and Norethindrone Acetate for Pain Relief Associated with Endometriosis: A Review of Evidence of a Novel Class of Hormonal Agents","volume":"16","author":"Othman","year":"2024","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1016\/S0140-6736(22)00622-5","article-title":"Once Daily Oral Relugolix Combination Therapy versus Placebo in Patients with Endometriosis-Associated Pain: Two Replicate Phase 3, Randomised, Double-Blind, Studies (SPIRIT 1 and 2)","volume":"399","author":"Giudice","year":"2022","journal-title":"Lancet"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.fertnstert.2022.08.856","article-title":"Oral Gonadotropin-Releasing Hormone Antagonists for Treating Endometriosis-Associated Pain: A Systematic Review and Network Meta-Analysis","volume":"118","author":"Yan","year":"2022","journal-title":"Fertil. Steril."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"630.e1","DOI":"10.1016\/j.ajog.2024.06.040","article-title":"Efficacy, Tolerability, and Bone Density Outcomes of Elagolix with Add-Back Therapy for Endometriosis-Associated Pain: Twelve Months of an Ongoing Randomized Phase 3 Trial","volume":"231","author":"Miller","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/14740338.2025.2547017","article-title":"Safety of Current Strategies to Manage Moderate to Severe Pain in Patients with Endometriosis","volume":"25","author":"Ferrero","year":"2026","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/S0015-0282(99)00393-3","article-title":"Aromatase: A Key Molecule in the Pathophysiology of Endometriosis and a Therapeutic Target","volume":"72","author":"Zeitoun","year":"1999","journal-title":"Fertil. Steril."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"43","DOI":"10.5114\/pm.2016.58773","article-title":"Aromatase Inhibitors in the Treatment of Endometriosis","volume":"1","year":"2016","journal-title":"Menopausal Rev."},{"key":"ref_159","doi-asserted-by":"crossref","unstructured":"Oral, E. (2022). Hormonal Therapy in Endometriosis and Adenomyosis: Danazol, Aromatase Inhibitors. Endometriosis and Adenomyosis, Springer International Publishing. Correction in Endometriosis and Adenomyosis; Oral, E., Ed.; Springer International Publishing: Cham, Switzerland, 2022; pp. C1\u2013C3.","DOI":"10.1007\/978-3-030-97236-3_45"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1210\/en.2008-1088","article-title":"Up-Regulation of Cyclooxygenase-2 Expression and Prostaglandin E2 Production in Human Endometriotic Cells by Macrophage Migration Inhibitory Factor: Involvement of Novel Kinase Signaling Pathways","volume":"150","author":"Carli","year":"2009","journal-title":"Endocrinology"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1080\/14656566.2023.2209315","article-title":"Aromatase Inhibitors in the Pharmacotherapy of Endometriosis","volume":"24","author":"Gardella","year":"2023","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1080\/13543784.2020.1842356","article-title":"Aromatase Inhibitors for the Treatment of Endometriosis: A Systematic Review about Efficacy, Safety and Early Clinical Development","volume":"29","author":"Garzon","year":"2020","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.2147\/DDDT.S315726","article-title":"A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date","volume":"17","author":"Peitsidis","year":"2023","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_164","first-page":"397","article-title":"Endometriosis: Evaluation and Treatment","volume":"106","author":"Edi","year":"2022","journal-title":"Am. Fam. Physician"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1097\/AOG.0000000000005923","article-title":"Pharmacologic Interventions for Endometriosis-Related Pain","volume":"146","author":"Kou","year":"2025","journal-title":"Obstet. Gynecol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"102311","DOI":"10.1016\/j.coph.2022.102311","article-title":"Hormonal Drugs for the Treatment of Endometriosis","volume":"67","author":"Capezzuoli","year":"2022","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_167","doi-asserted-by":"crossref","unstructured":"Mitchell, J.-B., Chetty, S., and Kathrada, F. (2022). Progestins in the Symptomatic Management of Endometriosis: A Meta-Analysis on Their Effectiveness and Safety. BMC Women\u2019s Health, 22.","DOI":"10.1186\/s12905-022-02122-0"},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Dick, A., Matok, I., Gutman-Ido, E., Lessans, N., and Dior, U.P. (2025). GnRH Analogues and Dienogest for Second Line Treatment of Endometriosis-Associated Pain: A Systematic Review, Meta-Analysis, and Network Meta-Analysis. Eur. J. Obstet. Gynecol. Reprod. Biol., 312.","DOI":"10.1016\/j.ejogrb.2025.114093"},{"key":"ref_169","doi-asserted-by":"crossref","unstructured":"New, E.P., and Mikhail, E. (2021). A Narrative Review of Using GnRH Analogues to Reduce Endometriosis Recurrence after Surgery: A Double-Edged Sword. Gynecol. Pelvic Med., 4.","DOI":"10.21037\/gpm-2020-mtet-03"},{"key":"ref_170","doi-asserted-by":"crossref","unstructured":"Shi, J., Tan, X., Feng, G., Zhuo, Y., Jiang, Z., Banda, S., Wang, L., Zheng, W., Chen, L., and Yu, D. (2023). Research Advances in Drug Therapy of Endometriosis. Front. Pharmacol., 14, Erratum in Front. Pharmacol. 2023, 14, 1274946. https:\/\/doi.org\/10.3389\/fphar.2023.1274946.","DOI":"10.3389\/fphar.2023.1199010"},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s11154-011-9182-4","article-title":"Metabolic Effects of Contraceptive Steroids","volume":"12","author":"Nath","year":"2011","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Lopez, L.M., Grimes, D.A., and Schulz, K.F. (2019). Steroidal Contraceptives: Effect on Carbohydrate Metabolism in Women without Diabetes Mellitus. Cochrane Database Syst. Rev., 2019.","DOI":"10.1002\/14651858.CD006133.pub5"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2147\/OAJC.S501434","article-title":"PCOS and Obesity: Contraception Challenges","volume":"16","author":"Meczekalski","year":"2025","journal-title":"Open Access J. Contracept."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1515\/cclm-2023-0384","article-title":"The Effect of Hormonal Contraceptive Therapy on Clinical Laboratory Parameters: A Literature Review","volume":"62","author":"Hillebrand","year":"2024","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_175","doi-asserted-by":"crossref","unstructured":"Cree, J.M.E., Brennan, N.M., Poppitt, S.D., and Miles-Chan, J.L. (2024). The Effect of the Oral Contraceptive Pill on Acute Glycaemic Response to an Oral Glucose Bolus in Healthy Young Women: A Randomised Crossover Study. Nutrients, 16.","DOI":"10.3390\/nu16203490"},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1530\/EC-20-0423","article-title":"Effects of Oral Contraceptives on Metabolic Parameters in Adult Premenopausal Women: A Meta-Analysis","volume":"9","author":"Toloza","year":"2020","journal-title":"Endocr. Connect."},{"key":"ref_177","first-page":"1","article-title":"The Hormonal Contraceptive Choice in Women with Polycystic Ovary Syndrome and Metabolic Syndrome","volume":"6","author":"Battipaglia","year":"2025","journal-title":"GREM Gynecol. Reprod. Endocrinol. Metab."},{"key":"ref_178","doi-asserted-by":"crossref","unstructured":"Meriggiola, M.C., and Gemzell-Danielsson, K. (2021). The Effect of Hormonal Contraceptives on Metabolism. Female and Male Contraception, Springer International Publishing.","DOI":"10.1007\/978-3-030-70932-7"},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1530\/EJE-20-0406","article-title":"Current Use of Combined Hormonal Contraception Is Associated with Glucose Metabolism Disorders in Perimenopausal Women","volume":"183","author":"Mosorin","year":"2020","journal-title":"Eur. J. Endocrinol."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/j.fertnstert.2016.10.022","article-title":"Estrogen-Progestins and Progestins for the Management of Endometriosis","volume":"106","author":"Vercellini","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"e2143730","DOI":"10.1001\/jamanetworkopen.2021.43730","article-title":"Association of Hormonal Contraceptive Use with Adverse Health Outcomes","volume":"5","author":"Brabaharan","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_182","unstructured":"Edwards, M., and Can, A.S. (2025). Progestins. StatPearls, StatPearls Publishing."},{"key":"ref_183","doi-asserted-by":"crossref","unstructured":"Regidor, P.-A., Mueller, A., and Mayr, M. (2023). Pharmacological and Metabolic Effects of Drospirenone as a Progestin-Only Pill Compared to Combined Formulations with Estrogen. Women\u2019s Health, 19.","DOI":"10.1177\/17455057221147388"},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1080\/13625187.2021.1957094","article-title":"Metabolic and Laboratory Effects of a Progestin-Only Pill Containing Drospirenone 4 Mg in Comparison to Desogestrel 75 \u039cg: A Double-Blind, Double-Dummy, Prospective, Randomised Study","volume":"26","author":"Palacios","year":"2021","journal-title":"Eur. J. Contracept. Reprod. Health Care"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1161\/HYPERTENSIONAHA.122.20018","article-title":"Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations","volume":"80","author":"Cameron","year":"2023","journal-title":"Hypertension"},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1001\/jama.2021.21392","article-title":"Contraception Selection, Effectiveness, and Adverse Effects","volume":"326","author":"Teal","year":"2021","journal-title":"JAMA"},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/AOG.0b013e3181662d17","article-title":"Effect of Depot Medroxyprogesterone Acetate on Glucose Tolerance in Generalized Lipodystrophy","volume":"112","author":"Yauger","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"e1134","DOI":"10.1210\/clinem\/dgae318","article-title":"Moderate Associations Between the Use of Levonorgestrel-Releasing Intrauterine Device and Metabolomics Profile","volume":"110","author":"Toffol","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1093\/humrep\/deh053","article-title":"Lipid, Glucose and Homocysteine Metabolism in Women Treated with a {GnRH} Agonist with or without Raloxifene","volume":"19","author":"Palomba","year":"2004","journal-title":"Hum. Reprod."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1002\/cncr.23440","article-title":"Metabolic Changes during Gonadotropin-releasing Hormone Agonist Therapy for Prostate Cancer","volume":"112","author":"Smith","year":"2008","journal-title":"Cancer"},{"key":"ref_191","doi-asserted-by":"crossref","unstructured":"Okwuosa, T.M., Morgans, A., Rhee, J.-W., Reding, K.W., Maliski, S., Plana, J.-C., Volgman, A.S., Moseley, K.F., Porter, C.B., and Ismail-Khan, R. (2021). Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association. Circ. Genom. Precis. Med., 14.","DOI":"10.1161\/HCG.0000000000000082"},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1111\/bju.14609","article-title":"Metabolic Consequences of Gonadotropin-releasing Hormone Agonists vs Orchiectomy: A Randomized Clinical Study","volume":"123","author":"Kistorp","year":"2019","journal-title":"BJU Int."},{"key":"ref_193","first-page":"E1035","article-title":"Effect of Ovarian Suppression with Gonadotropin-Releasing Hormone Agonist on Glucose Disposal and Insulin Secretion","volume":"294","author":"Toth","year":"2008","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.fertnstert.2006.11.045","article-title":"Ovarian Suppression with a Gonadotropin-Releasing Hormone Agonist Does Not Alter Insulin-Stimulated Glucose Disposal","volume":"87","author":"Cooper","year":"2007","journal-title":"Fertil. Steril."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1210\/jc.2015-4065","article-title":"Acute Female Hypogonadism Alters Adipose Tissue Fatty Acid Storage Factors and Chylomicronemia","volume":"101","author":"Santosa","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_196","doi-asserted-by":"crossref","unstructured":"Etezadi, A., Marashi, S.M., Nazari, L., Sina, M., Samadi Nasab, F., Amirlatifi, S., Zamanifard, S., Zahiri, Z., and Khodaparast, F. (2025). Effects of GnRH Agonists and Antagonists on Cardiovascular and Metabolic Systems in Adults: Mechanistic Pathways and Risk Management. Biomed. Pharmacother., 193.","DOI":"10.1016\/j.biopha.2025.118860"},{"key":"ref_197","doi-asserted-by":"crossref","unstructured":"Lin, E., Garmo, H., Van Hemelrijck, M., Zethelius, B., Stattin, P., Hagstr\u00f6m, E., Adolfsson, J., and Crawley, D. (2022). Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer with Cardiovascular Disease Risk and Hypertension in Men with Diabetes. JAMA Netw. Open, 5.","DOI":"10.1001\/jamanetworkopen.2022.25600"},{"key":"ref_198","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1210\/jc.2018-02339","article-title":"Higher Insulin Resistance and Adiposity in Postmenopausal Women with Breast Cancer Treated with Aromatase Inhibitors","volume":"104","author":"Gibb","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_199","doi-asserted-by":"crossref","unstructured":"Boszkiewicz, K., Piwowar, A., and Petryszyn, P. (2022). Aromatase Inhibitors and Risk of Metabolic and Cardiovascular Adverse Effects in Breast Cancer Patients\u2014A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11113133"},{"key":"ref_200","doi-asserted-by":"crossref","unstructured":"Li, W., Lin, A., Qi, L., Lv, X., Yan, S., Xue, J., and Mu, N. (2023). Immunotherapy: A Promising Novel Endometriosis Therapy. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1128301"},{"key":"ref_201","doi-asserted-by":"crossref","unstructured":"Dai, Y., Ye, Z., Lin, X., and Zhang, S. (2025). Immunopathological Insights into Endometriosis: From Research Advances to Future Treatments. Semin. Immunopathol., 47.","DOI":"10.1007\/s00281-025-01058-5"},{"key":"ref_202","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1080\/13543784.2025.2609734","article-title":"Targeting Inflammation in Endometriosis: Emerging Therapeutic Options","volume":"34","author":"Perrone","year":"2025","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_203","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1093\/humupd\/dmr023","article-title":"Vasculogenesis: A New Piece of the Endometriosis Puzzle","volume":"17","author":"Laschke","year":"2011","journal-title":"Hum. Reprod. Update"},{"key":"ref_204","doi-asserted-by":"crossref","unstructured":"Liu, S., Xin, X., Hua, T., Shi, R., Chi, S., Jin, Z., and Wang, H. (2016). Efficacy of Anti-VEGF\/VEGFR Agents on Animal Models of Endometriosis: A Systematic Review and Meta-Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166658"},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1007\/s43032-020-00213-7","article-title":"Impact of Bevacizumab on Experimentally Induced Endometriotic Lesions: Angiogenesis, Invasion, Apoptosis, and Cell Proliferation","volume":"27","author":"Zani","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1177\/1933719115584448","article-title":"Effects of Pazopanib, Sunitinib, and Sorafenib, Anti-VEGF Agents, on the Growth of Experimental Endometriosis in Rats","volume":"22","author":"Yildiz","year":"2015","journal-title":"Reprod. Sci."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1093\/humrep\/deaa337","article-title":"Use of Dopamine Agonists to Target Angiogenesis in Women with Endometriosis","volume":"36","author":"Pellicer","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1093\/humrep\/den499","article-title":"Dopamine Agonist Administration Causes a Reduction in Endometrial Implants through Modulation of Angiogenesis in Experimentally Induced Endometriosis","volume":"24","author":"Carda","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_209","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000546198","article-title":"Cabergoline\u2019s Promise in Endometriosis: Restoring Molecular Balance to Improve Reproductive Potential","volume":"91","author":"Shahgholi","year":"2025","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_210","doi-asserted-by":"crossref","unstructured":"Iampietro, C., Brossa, A., Canosa, S., Tritta, S., Croston, G.E., Reinheimer, T.M., Bonelli, F., Carosso, A.R., Gennarelli, G., and Cosma, S. (2022). Quinagolide Treatment Reduces Invasive and Angiogenic Properties of Endometrial Mesenchymal Stromal Cells. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23031775"},{"key":"ref_211","doi-asserted-by":"crossref","unstructured":"Qin, R., Tian, G., Liu, J., and Cao, L. (2022). The Gut Microbiota and Endometriosis: From Pathogenesis to Diagnosis and Treatment. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.1069557"},{"key":"ref_212","doi-asserted-by":"crossref","unstructured":"Xholli, A., Cremonini, F., Perugi, I., Londero, A.P., and Cagnacci, A. (2023). Gut Microbiota and Endometriosis: Exploring the Relationship and Therapeutic Implications. Pharmaceuticals, 16.","DOI":"10.3390\/ph16121696"},{"key":"ref_213","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/j.chom.2024.09.014","article-title":"Vaginal Lactobacilli Produce Anti-Inflammatory \u03b2-Carboline Compounds","volume":"32","author":"Glick","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_214","doi-asserted-by":"crossref","unstructured":"Waehama, E., Fukuda, K., Mansouri, A., Hulugalla, M., Akthar, I., Yousef, M.S., and Miyamoto, A. (2025). Peptidoglycan Derived from Lacticaseibacillus rhamnosus and Lactobacillus acidophilus Suppress TLR2\/1-Mediated Inflammation in Bovine Endometrial Epithelial Cells. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1622307"},{"key":"ref_215","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/1028415X.2025.2567415","article-title":"Tolerogenic Probiotics and Gut-Brain Axis: Targeting Pain Receptors in Neuroimmune Disorders","volume":"29","author":"Hatami","year":"2026","journal-title":"Nutr. Neurosci."},{"key":"ref_216","doi-asserted-by":"crossref","first-page":"15490","DOI":"10.1038\/s41598-022-19839-5","article-title":"Lactobacillus plantarum S9 Alleviates Lipid Profile, Insulin Resistance, and Inflammation in High-Fat Diet-Induced Metabolic Syndrome Rats","volume":"12","author":"Zhao","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_217","doi-asserted-by":"crossref","first-page":"4921","DOI":"10.1096\/fj.201801672R","article-title":"In Vivo Screening of Multiple Bacterial Strains Identifies Lactobacillus rhamnosus Lb102 and Bifidobacterium animalis ssp. lactis Bf141 as Probiotics That Improve Metabolic Disorders in a Mouse Model of Obesity","volume":"33","author":"Daniel","year":"2019","journal-title":"FASEB J."},{"key":"ref_218","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1080\/10408398.2022.2117783","article-title":"Role of Probiotics\/Synbiotic Supplementation in Glycemic Control: A Critical Umbrella Review of Meta-Analyses of Randomized Controlled Trials","volume":"64","author":"Xu","year":"2024","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_219","doi-asserted-by":"crossref","unstructured":"Luangphiphat, W., Prombutara, P., Jamjuree, P., Chantarangkul, C., Vitheejongjaroen, P., Muennarong, C., Fukfon, K., Onwan, M., and Taweechotipatr, M. (2025). The Efficacy of Lacticaseibacillus Paracasei MSMC39-1 and Bifidobacterium Animalis TA-1 Probiotics in Modulating Gut Microbiota and Reducing the Risk of the Characteristics of Metabolic Syndrome: A Randomized, Double-Blinded, Placebo-Controlled Study. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0317202"},{"key":"ref_220","doi-asserted-by":"crossref","unstructured":"Vinderola, G., Sanders, M.E., Cunningham, M., and Hill, C. (2024). Frequently Asked Questions about the ISAPP Postbiotic Definition. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1324565"},{"key":"ref_221","doi-asserted-by":"crossref","unstructured":"Ma, L., Tu, H., and Chen, T. (2023). Postbiotics in Human Health: A Narrative Review. Nutrients, 15.","DOI":"10.3390\/nu15020291"},{"key":"ref_222","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1210\/endrev\/bnae025","article-title":"Postbiotic Impact on Host Metabolism and Immunity Provides Therapeutic Potential in Metabolic Disease","volume":"46","author":"Fang","year":"2025","journal-title":"Endocr. Rev."},{"key":"ref_223","doi-asserted-by":"crossref","unstructured":"Mishra, N., Garg, A., Ashique, S., and Bhatt, S. (2024). Potential of Postbiotics for the Treatment of Metabolic Disorders. Drug Discov. Today, 29.","DOI":"10.1016\/j.drudis.2024.103921"},{"key":"ref_224","doi-asserted-by":"crossref","first-page":"5768","DOI":"10.1080\/10408398.2022.2158174","article-title":"Recent Advances and Potentiality of Postbiotics in the Food Industry: Composition, Inactivation Methods, Current Applications in Metabolic Syndrome, and Future Trends","volume":"64","author":"Zhong","year":"2024","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_225","doi-asserted-by":"crossref","unstructured":"Wang, W., Miao, C., Chen, Q., Wang, L., Chang, X., Zhao, L., Ma, W., Lei, S., Ma, M., and Zhang, Y. (2025). Postbiotic Supplementation Promotes Gut Barrier Integrity and Immune Balance in Cats via Microbiota Modulation. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1692845"},{"key":"ref_226","doi-asserted-by":"crossref","unstructured":"Algieri, F., Tanaskovic, N., Rincon, C.C., Notario, E., Braga, D., Pesole, G., Rusconi, R., Penna, G., and Rescigno, M. (2023). Lactobacillus paracasei CNCM I-5220-Derived Postbiotic Protects from the Leaky-Gut. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1157164"},{"key":"ref_227","doi-asserted-by":"crossref","first-page":"2400754","DOI":"10.1002\/mnfr.202400754","article-title":"Postbiotics as Antiinflammatory and Immune-Modulating Bioactive Compounds in Metabolic Dysfunction-Associated Steatotic Liver Disease","volume":"68","author":"Yilmaz","year":"2024","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_228","doi-asserted-by":"crossref","unstructured":"Thakur, R., and Kaur, S. (2025). Use of Postbiotics and Parabiotics from Lactobacilli in the Treatment of Infectious Diarrhea. Microb. Pathog., 204.","DOI":"10.1016\/j.micpath.2025.107580"},{"key":"ref_229","doi-asserted-by":"crossref","unstructured":"Asefa, Z., Belay, A., Welelaw, E., and Haile, M. (2025). Postbiotics and Their Biotherapeutic Potential for Chronic Disease and Their Feature Perspective: A Review. Front. Microbiomes, 4.","DOI":"10.3389\/frmbi.2025.1489339"},{"key":"ref_230","doi-asserted-by":"crossref","first-page":"25078","DOI":"10.1021\/acs.jafc.4c06303","article-title":"Lactobacillus rhamnosus 1.0320 Postbiotics Ameliorate Dextran Sodium Sulfate-Induced Colonic Inflammation and Oxidative Stress by Regulating the Intestinal Barrier and Gut Microbiota","volume":"72","author":"Zhang","year":"2024","journal-title":"J. Agric. Food Chem."},{"key":"ref_231","doi-asserted-by":"crossref","unstructured":"Kim, N., and Yang, C. (2024). Butyrate as a Potential Modulator in Gynecological Disease Progression. Nutrients, 16.","DOI":"10.3390\/nu16234196"},{"key":"ref_232","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.freeradbiomed.2025.07.019","article-title":"Gut Microbiota Derived Butyrate Enhances Ferroptosis Sensitivity in Endometriosis through FFAR2\/PPAR-\u03b3\/PINK1\/Parkin Mediated Mitophagy","volume":"238","author":"Gou","year":"2025","journal-title":"Free Radic. Biol. Med."},{"key":"ref_233","doi-asserted-by":"crossref","unstructured":"Liu, M., Peng, R., Tian, C., Shi, J., Ma, J., Shi, R., Qi, X., Zhao, R., and Guan, H. (2024). Effects of the Gut Microbiota and Its Metabolite Short-Chain Fatty Acids on Endometriosis. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1373004"},{"key":"ref_234","doi-asserted-by":"crossref","unstructured":"Xu, Y., Zhu, Y., Wu, X., Peng, W., Zhong, Y., Cai, Y., Chen, W., Liu, L., Tan, B., and Chen, T. (2025). Gut Microbiota-Derived Acetate Ameliorates Endometriosis via JAK1\/STAT3-Mediated M1 Macrophage Polarisation. Microb. Biotechnol., 18.","DOI":"10.1111\/1751-7915.70202"},{"key":"ref_235","doi-asserted-by":"crossref","unstructured":"Martire, F.G., Costantini, E., D\u2019Abate, C., Capria, G., Piccione, E., and Andreoli, A. (2025). Endometriosis and Nutrition: Therapeutic Perspectives. J. Clin. Med., 14.","DOI":"10.3390\/jcm14113987"},{"key":"ref_236","doi-asserted-by":"crossref","unstructured":"Neri, L.C.L., Quintiero, F., Fiorini, S., Guglielmetti, M., Ferraro, O.E., Tagliabue, A., Gardella, B., and Ferraris, C. (2025). Diet and Endometriosis: An Umbrella Review. Foods, 14.","DOI":"10.3390\/foods14122087"},{"key":"ref_237","doi-asserted-by":"crossref","unstructured":"Cirillo, M., Argento, F.R., Becatti, M., Fiorillo, C., Coccia, M.E., and Fatini, C. (2023). Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241914601"},{"key":"ref_238","doi-asserted-by":"crossref","unstructured":"Abulughod, N., Valakas, S., and El-Assaad, F. (2024). Dietary and Nutritional Interventions for the Management of Endometriosis. Nutrients, 16.","DOI":"10.3390\/nu16233988"},{"key":"ref_239","doi-asserted-by":"crossref","unstructured":"Zhou, L., Liu, B., Jian, X., Jiang, L., and Liu, K. (2025). Effect of Dietary Patterns and Nutritional Supplementation in the Management of Endometriosis: A Review. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1539665"},{"key":"ref_240","doi-asserted-by":"crossref","unstructured":"Tomio, K., Kawana, K., Taguchi, A., Isobe, Y., Iwamoto, R., Yamashita, A., Kojima, S., Mori, M., Nagamatsu, T., and Arimoto, T. (2013). Omega-3 Polyunsaturated Fatty Acids Suppress the Cystic Lesion Formation of Peritoneal Endometriosis in Transgenic Mouse Models. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073085"},{"key":"ref_241","doi-asserted-by":"crossref","unstructured":"Liu, E., Wang, Q., Bai, Y., Zhang, X., and Wang, J. (2025). Effect of Omega-3 Polyunsaturated Fatty Acid on Endometriosis. Clinics, 80.","DOI":"10.1016\/j.clinsp.2025.100654"},{"key":"ref_242","doi-asserted-by":"crossref","unstructured":"Piecuch, M., Garbicz, J., Waliczek, M., Malinowska-Borowska, J., and Rozentryt, P. (2022). I Am the 1 in 10\u2014What Should I Eat? A Research Review of Nutrition in Endometriosis. Nutrients, 14.","DOI":"10.3390\/nu14245283"},{"key":"ref_243","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1111\/apt.70161","article-title":"Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated with Endometriosis (EndoFOD)\u2014A Randomised, Controlled Crossover Feeding Study","volume":"61","author":"Varney","year":"2025","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_244","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/ajo.12594","article-title":"Endometriosis in Patients with Irritable Bowel Syndrome: Specific Symptomatic and Demographic Profile, and Response to the Low FODMAP Diet","volume":"57","author":"Moore","year":"2017","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/11\/4883\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:48:23Z","timestamp":1780404503000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/11\/4883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":244,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijms27114883"],"URL":"https:\/\/doi.org\/10.3390\/ijms27114883","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}