Could Endometriosis Be Caused by Bacteria?

Story at-a-glance

• A 2023 study found Fusobacterium could be linked to the development of endometriosis, which is a proliferation of uterine endometrial tissue in areas of the abdomen outside the uterus
• The condition causes pain, heavy and irregular periods, fatigue and gastrointestinal symptoms during a menstrual period, such as diarrhea, constipation and pain with urination or bowel movements
• Certain species of Fusobacterium are commonly found in the human gut and oral flora, but infections with other invasive species have been linked to a wide range of clinical presentations from non-severe pharyngitis to life-threatening abscesses and sepsis
• Endometriosis places women at an increased risk of other health problems, including infertility, cancer, cutaneous melanoma, Non-Hodgkin’s lymphoma, autoimmune diseases, cardiovascular disease, asthma, obesity, migraine headaches and irritable bowel syndrome
• Women can take several steps to reduce the risk of developing endometriosis or help reduce the symptoms, including avoiding endocrine-disrupting chemicals as the condition is hormone dependent, avoiding sugar to reduce inflammation and pain, and considering several nutraceuticals that may help reduce symptoms

There is a good and a bad side to bacteria. One 2023 study¹ published in Science Translational Medicine revealed data suggesting one genus of an anaerobic, gram-negative bacteria,² Fusobacterium, plays an influential role in the development of endometriosis. This genus of bacteria has species that live symbiotically with humans and others that develop invasive infections.

The inappropriate use of antibiotics and bacterial infections has culminated in the “greatest public health challenge of our time”³ — antimicrobial resistance. One important focus of attaining and maintaining optimal health is supporting a balanced gut microbiome. When bacteria develop the ability to avoid the drugs designed to kill them, resistant infections can proliferate and become difficult or impossible to treat.

Your gut microbiome is a major contributor to a wide range of physical, mental and emotional health conditions. Research links gut microbial dysbiosis to obesity, Type 2 diabetes, cardiovascular disease,⁴ athletic performance,⁵ cognitive impairment,⁶ depression and anxiety.⁷ It should then come as no surprise that bacteria may play a role, regardless of how significant, in many of the prevalent chronic health conditions that plague society.

The film, “The Invisible Extinction,”⁸ highlights the work of microbiologists Dr. Martin Blaser and Gloria Dominguez-Bello — a husband-wife team — who warn that the human microbiome is endangered, putting human health at risk.

As data indicating the significance of a healthy microbiome to overall health continues to mount, researchers are also identifying ways in which harmful bacteria play a role in noninfectious disease development. And, one particular bacterial infection associated with endometriosis, Fusobacterium, may suggest a potential treatment pathway for this painful disorder.⁹

Could This Bacteria Trigger Endometriosis?

The 2023 study¹⁰ found that Fusobacterium, a bacterial type that’s commonly found in the human gut and oral flora, may be linked to endometriosis. The study included 155 women in Japan¹¹ and found 64% of women presenting with endometriosis had Fusobacterium within ovarian endometriotic lesions. However, less than 10% of women without endometriosis had the Fusobacterium in their endometrium.¹²

The researchers used an animal model and inoculated Fusobacterium into mice which then increased myofibroblasts and the weight and number of endometriotic lesions. The mice were treated with antibiotics and researchers found this could, in large part, not only prevent endometriosis from developing, but help reduce the endometriotic lesions that were already established.

The researchers believe the data support a potential mechanism for the development of endometriosis and suggest it could be an approach to treating the disease.¹³

In addition to evaluating for the presence of Fusobacterium within human endometrial tissue and testing an animal model, the researchers also used cell culture experiments to find that the bacteria initiated a substance called TGF-beta, which appeared to activate normally dormant cells.

Although certain species of Fusobacterium live symbiotically within the oral and gut microflora, this species of Fusobacterium is invasive and has been linked to other infections and diseases.¹⁴ Although the infections with Fusobacterium are uncommon,¹⁵ they tend to infect younger and older individuals and cause a wide range of clinical symptoms from non-severe pharyngitis to life-threatening abscesses and sepsis.

What Is Endometriosis?

The word “endometriosis” is derived from the name of the tissue that lines the uterus, which is the endometrium. This lining is what the body releases with each menstrual cycle. Each month, the body grows a new endometrium in preparation for a potential pregnancy. Endometriosis occurs when this tissue grows in areas of the abdomen outside of the uterus.

According to Johns Hopkins Medicine, the condition affects up to 10% of women.¹⁶ The endometrial tissue most often grows on or around the reproductive organs, such as the ovaries, fallopian tubes, space between the uterus and the rectum, or the lining of the pelvic cavity. Less frequently, it can also grow around the bladder, intestines, rectum and stomach.

The condition increases pain associated with menstrual cramps and can cause pain during or after sex. Women may also experience heavy or irregular periods, fatigue and gastrointestinal symptoms during a menstrual period such as diarrhea, constipation and pain with urination or bowel movements.

Although the condition has no known cause, data does show certain factors increase the risk, including starting menstruation before age 11, a family history of endometriosis and periods that last more than 7 days. Although in many cases, a diagnosis of endometriosis begins with severe symptoms, some women can have endometriotic lesions outside the uterus but have no symptoms.¹⁷

While data from the featured study is encouraging, as it helps to at least point to a potential trigger, it’s important to note that endometriosis is likely multifactorial and may have cultural or environmental differences. A 2021 study¹⁸ published in Reproductive Sciences evaluated a group of 371 fertile women with endometriosis, 175 from China and 196 from Italy. Symptoms and quality of life were compared, which revealed significant differences between the two groups.

Italian women presented with symptoms at a younger age, more frequently with severe pain, were more often diagnosed with deep infiltrating endometriosis and had more systemic comorbidities at the time of diagnosis than women from China. Scores on tests also showed the Italian group of women had worse health-related quality of life.

In the group of Chinese women, there was less pain, diagnosis at an older age, ovarian and superficial endometriosis and better quality of life scores. The researchers suggested that the differences may be related to ethnicity, healthcare system or social and cultural background.¹⁹

Endometriosis and Comorbidities

Endometriosis is debilitating. According to Science Alert,²⁰ women in the U.K. often wait an average of 7.5 years before seeing their physician for a diagnosis and Yale Medicine²¹ estimates that women in the U.S. may experience symptoms for 10 years before getting a proper diagnosis.

Unfortunately, this places these women at risk of more health problems, including infertility. In some cases, endometriosis causes complete infertility, but in other cases, fertility may not be affected. Research²² also suggests that women with endometriosis have a higher risk of pregnancy-related complications, including preterm delivery, miscarriage, preeclampsia, bowel perforation and uterine rupture.

When left untreated, endometriosis not only leads to infertility, but other organ damage. A 2015 systematic review²³ of the literature identified studies that looked at the association between endometriosis and specific diseases.

They found increasing evidence that women with endometriosis have a higher risk of several chronic diseases, suggesting that the condition is not harmless with respect to long-term health. According to this review, women with endometriosis had a “higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer.”²⁴

In a separate article,²⁵ one of the scientists postulated potential explanations for the associations, including that studies may have had a methodological bias. Other explanations included the potential that endometriosis induces physiological changes that increase the risk of chronic disease, that women with endometriosis share specific risk factors for chronic disease, or that the treatment for endometriosis could increase the risk of some chronic diseases.

Analysis of data from Taiwan²⁶ identified similar associations between endometriosis and chronic diseases. In this population, the researchers also found an association with irritable bowel syndrome, migraine headaches, pelvic inflammatory disease, obesity, chronic liver disease, cardiovascular disease, diabetes, rheumatoid arthritis and chronic renal disease.

A 2023 study²⁷ published in the journal Nature Genetics may help explain the comorbidity with other inflammatory and pain-related conditions. In a genome-wide association meta-analysis of European and East Asian participants, the researchers:

“… observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis.”

The severity of the symptoms can affect mental health²⁸ and may compromise social relationships, which in turn influences support systems. Depression and anxiety can also amplify the perception of pain. In one study,²⁹ researchers estimated that at least one-third of women with endometriosis suffer from depression and anxiety.

Reducing Symptoms of Endometriosis

Insulin sensitivity may also play a role in endometriosis. A 2019 review³⁰ looked at the likelihood of the coexistence of Type 1 diabetes and endometriosis, including the prospect that therapeutic strategies could help reduce complications. While Type 1 diabetes is an autoimmune disease, endometriosis is not.

However, according to the paper, they share similar pathophysiological pathways, including an association with chronic inflammation and an overactive immune response. A 2002 study³¹ also showed women with endometriosis more frequently had mechanical dysfunction in the gastrointestinal system and reactive hypoglycemia with normal insulin levels.

According to the researchers, the nerve dysfunction found in women with endometriosis was identical to that found in individuals with insulin resistance and resulted in debilitating gastrointestinal symptoms. In addition to strategies that improve insulin sensitivity and reduce resistance, women with endometriosis may consider addressing other factors that contribute to symptoms of endometriosis, such as:

Source: Original Article

Publish Date: 2024-02-23 08:33:09