We have trillions of them in our bodies so it’s no surprise that we depend on them for overall health and wellness. Our relationship with our microbiome is defined as symbiotic - meaning they benefit from us and we benefit from them. 


How do we benefit from our gut microbiome?


They play an integral role in digesting the food we eat and transforming those foods into health molecules that feed our gut lining, protect our gut barrier, and communicate directly with our immune system. Imbalances in our gut microbiome can lead to digestive symptoms like bloating, irregular and uncomfortable bowel movements, acid reflux, etc. It can also lead to chronic health concerns like type 2 diabetes, obesity, and more.


Did you know that your gut microbiome can also impact many reproductive concerns? This includes PCOS, endometriosis, and fertility. 



PCOS and Gut microbiome.


PCOS, or polycystic ovarian syndrome is a genetic metabolic condition that impacts reproductive health. It’s estimated that 1.4 million Canadians are impacted by this endocrine disorder.


PCOS is associated with elevated testosterone, insulin levels, and inflammation. This triad can directly impact ovarian health and the ability to ovulate. Several studies have shown differences in the gut microbiota composition of those with PCOS. These differences are thought to play a role in insulin resistance, excess testosterone, and chronic inflammation. Targeting the gut microbiome as part of the treatment strategy has been a key method of supporting my PCOS patients. I often find this to be a missing link in treatment success.



Endometriosis and Gut microbiome


Endometriosis is an estrogen-responsive chronic inflammatory disorder that can lead to chronic pelvic pain and fertility concerns. It’s estimated to impact 1/10 menstruators. 


The bacteria in the gut microbiome can directly influence estrogen metabolism by producing a compound known as beta-glucuronidase. Beta-glucuronidase levels influence how much estrogen we excrete through our stool, and how much we re-absorb back into the body. Balance is key. Some research suggests that the composition of bacteria in endometriosis may result in more estrogen re-absorption, meaning more estrogen in the system. More research is needed but in an estrogen-responsive condition, like endometriosis, this is something to keep in mind.


Inflammation and managing said inflammation through key pro and anti-inflammatory markers are tightly regulated through the gut microbiota. Excessive intestinal permeability (i.e. the integrity of the gut barrier being compromised) can lead to more inflammatory molecules and bacterial toxins passing from the gut into the blood. The phenomenon has been demonstrated in endometriosis. Supporting the gut microbiome and the health of your gut lining may help reduce inflammation and be key in the management of endometriosis.


Fertility and the Microbiome


We know that the uterus has its very own microbiome (similar to the vagina, the skin, and other organ systems). We also know that imbalances in the uterine microbiome can directly impact fertility and pregnancy rates.



A 2020 systematic review showed that imbalances in the uterine microbiome (aka endometritis) could be highly prevalent among women suffering from unexplained infertility (from 40.7 to 55.7%), recurrent IVF failures (from 13.95 to 57.55%), and repeated early pregnancy loss (from 42.9 to 56%). Importantly, treatment of chronic endometritis can lead to a complete normalization and restoration of reproductive function in women with imbalances. In other words, this may be a modifiable factor – something that can be screened for and treated.


Many fertility clinics are now testing your uterine microbiome. This test is called the EMMA and ALICE. It is performed before a frozen embryo transfer. 


One of the major takeaways from this systematic review was that the predominant types of bugs found in chronic endometritis were coming from the intestinal flora – Enterococcus faecalis, Escherichia coli, and Streptococcus. Additionally, lipopolysaccharide, an endotoxin for gram-negative bacteria and a known indicator for leaky gut, maybe a trigger and mediator of chronic endometritis.


Treatment of endometriosis is done through targeted antibiotics and specific probiotics optimize the reproductive microbiome composition.



Summary and take-away.


The gut microbiome doesn’t only impact the gut! Many studies have demonstrated it’s role in chronic health conditions. Many new studies are now showing its impact on women’s health conditions. Research is continuing to mount in this area. Clinically, I have seen supporting gut health and the microbiome be a game-changer in supporting my patients.


If you’d like to learn more, book a discovery call, and let’s chat.


In Health,

Dr. Ashley Damm, BSc. ND



References: 

  1. Sun Y, Gao S, Ye C, Zhao W. Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol. 2023 Feb 24;13:1142041. doi: 10.3389/fcimb.2023.1142041. PMID: 36909735; PMCID: PMC9998696.
  2. Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022 Nov 24;12:1069557. doi: 10.3389/fcimb.2022.1069557. PMID: 36506023; PMCID: PMC9729346.
  3. Buzzaccarini, G., Vitagliano, A., Andrisani, A. et al. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J Assist Reprod Genet 37, 2897–2911 (2020). https://doi.org/10.1007/s10815-020-01955-8