Gut Dysbiosis in Selected Gynecological Diseases Associated with Female Infertility: A Scoping Review

Łukasz Nowakowski; Katarzyna Warchoł; Agnieszka Kuźniar; Barbara Zimoń; Michał M Skoczylas; Paweł Marzec; Grzegorz Krawczyk; Dorota Jegorow; Robert Pankiewicz; Andrew Z Warchoł; Maciej Banach; Kinga Kuranty; Piotr Olcha

doi:10.3390/jcm15176705

Uterine and Pelvic Conditions · Fibroids

Gut Dysbiosis in Selected Gynecological Diseases Associated with Female Infertility: A Scoping Review

Nowakowski Ł, Warchoł K, Kuźniar A, Zimoń B, Skoczylas MM, Marzec P, Krawczyk G, Jegorow D, Pankiewicz R, Warchoł AZ, Banach M, Kuranty K, Olcha P

Published August 29, 2026 Journal of clinical medicine

DOI 10.3390/jcm15176705 PMID 42739710 PMC PMC13565995

RRM Academy Synopsis

Gut microbiome changes may be linked to PCOS and endometriosis

A scoping review of 106 sources reported gut microbiome changes in women with polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS). Changes were also reported in endometriosis and uterine fibroids. Gut microbiome findings were more consistent in PMOS / PCOS and endometriosis than in fibroids. The authors say microbiome tests are not yet ready for clinical use.

Key Findings

The authors identified 876 records, removed 192 duplicates, screened 684 unique records, and included all 106 full-text articles they assessed.
Of the 106 sources, 29 reported standardized microbiome-derived indicators, which were summarized descriptively. No meta-analysis was performed because of heterogeneity in study design, assessment methods, and outcome measures.
Findings were more consistent for PMOS / PCOS and endometriosis than for uterine fibroids, where the authors call the evidence limited, with mild and inconsistent reductions in diversity.
The authors list common signatures reported across the three conditions: less microbial diversity, a higher Firmicutes/Bacteroidota ratio, more Proteobacteria and Candida fungi, and fewer bacteria that produce short-chain fatty acids.
The authors state that no uniform, verified, and validated criteria exist for an unfavorable gut microbiota profile, and that tests based on the microbiome are not yet ready for clinical use.

Interpretation

A scoping review maps the available studies. This one ran no meta-analysis, made no formal appraisal of study quality, and was not registered. Searches covered three databases and English-language papers from 2015 to 2025. The authors note that most studies were cross-sectional, a design that does not allow conclusions about direction or cause. Sample collection and sequencing methods varied. The review summarizes microbiome measures in women with these conditions and reports no pregnancy outcomes. The authors state that well-designed randomized trials of microbiome-based treatments are scarce.

RRM Context

Restorative reproductive medicine looks for the underlying condition behind infertility. PMOS / PCOS and endometriosis are two of those conditions. This review adds the gut microbiome as a possible inflammatory and metabolic angle on them. The authors write that PMOS / PCOS evidence supports the relevance of diversity measures as assessment tools. They call the endometriosis findings preliminary.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background and Objectives

Female infertility represents a significant public health issue. Available evidence supports the hypothesis that the gut microbiota may play an essential role in women's reproductive health and may serve as a diagnostic or prognostic biomarker in specific gynecological disorders. A substantial part of current research concerns disturbed communication between the hypothalamic-pituitary-ovarian axis and the gut microbiota, providing the basis for analyzing this phenomenon as the gut-ovary axis or the gut-vagina-ovary axis. The primary aim of this scoping review was to map the available evidence on the relationship between gut microbiota composition and female infertility, with particular emphasis on polycystic ovary syndrome (PCOS, currently polyendocrine metabolic ovarian syndrome, PMOS) endometriosis, and uterine fibroids.

Methods

The review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, and Google Scholar were searched using terms related to gut microbiota, female infertility, PCOS, endometriosis, and uterine leiomyomas. Peer-reviewed publications in English published between 2015 and 2025 were considered. The included studies were descriptively synthesized to identify recurring microbiota patterns and research gaps.

Results

The reviewed evidence indicates that gut dysbiosis may be associated with selected gynecological disorders affecting fertility, including PCOS, endometriosis, and uterine fibroids. The gut microbiome may have potential value as a biomarker supporting diagnosis, treatment selection, and prognosis.

Conclusions

The gut microbiome represents a promising but still insufficiently validated area in the management of gynecological diseases associated with female infertility. Further high-quality clinical studies are needed to verify the effectiveness of microbiome-based therapies and to develop evidence-based guidelines for managing infertility associated with gut dysbiosis.

Topics

Uterine and Pelvic Conditions › Fibroids › Fibroids and Fertility · Endometriosis › Fertility and Outcomes › Ovarian Reserve · PMOS / PCOS › Pathophysiology › Hyperandrogenism

Łukasz Nowakowski, Katarzyna Warchoł, Agnieszka Kuźniar, Barbara Zimoń, Michał M Skoczylas, Paweł Marzec, Grzegorz Krawczyk, Dorota Jegorow, Robert Pankiewicz, Andrew Z Warchoł, Maciej Banach, Kinga Kuranty, Piotr Olcha

Ł Nowakowski, K Warchoł, A Kuźniar, Barb Zimoń, B Zimoń, M Skoczylas, P Marzec, G Krawczyk, D Jegorow, Bob Pankiewicz, Rob Pankiewicz, Bobby Pankiewicz, R Pankiewicz, Andy Warchoł, Drew Warchoł, A Warchoł, M Banach, K Kuranty, P Olcha

PMID 42739710 42739710 DOI 10.3390/jcm15176705 10.3390/jcm15176705 Nowakowski et al. 2026, Nowakowski 2026

Gut Dysbiosis in Selected Gynecological Diseases Associated with Female Infertility: A Scoping Review

Gut microbiome changes may be linked to PCOS and endometriosis

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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