Unraveling the Microbiome Connection: Exploring the Nexus of Endometriosis, Anxiety, and Dysbiosis

Abstract

Endometriosis is a complex gynecological disease affecting approximately 10-15% of individuals assigned female at birth, and often presents with co-occurring symptoms of anxiety. Available evidence from preclinical and clinical research suggests that alterations of the microbiome may play a key role in both endometriosis and anxiety. We hypothesized that individuals with endometriosis and co-occurring anxiety will exhibit differences in self-reported mental health symptoms, endometriosis/pelvic pain symptoms, and gastrointestinal symptoms, in addition to altered microbial diversity/abundance in comparison to surgical patients without endometriosis. To address this hypothesis, a convenience sampling of 80 individuals undergoing surgical procedures by minimally invasive gynecological surgeons at Banner University Medical Center Phoenix was utilized. Among the 80 individuals, 42 were diagnosed with endometriosis and 38 were not diagnosed with endometriosis. Statistically significant differences were observed between the groups in terms of age, education, BMI, diagnosis of CPP, self-reported diagnosis and/or treatment for anxiety, and vaginal pH. Drawing from self-reported mental health, endometriosis/pelvic pain, and gastrointestinal symptoms individuals with endometriosis display a unique symptom experience in comparison to their counterparts without endometriosis. In addition to varying symptomologies, the vaginal and gastrointestinal microbiomes in individuals with endometriosis exhibit a distinct microbial signature. This signature includes an increased abundance of Lactobacillus in the vaginal microbiome and elevations of specific taxa in the gastrointestinal microbiome. Elevations in Bifidobacterium and Clostridium, gastrointestinal taxa are capable of encoding for ß-glucuronidase and ß-galactosidase, and Slackia and Bifidobacterium longum gastrointestinal taxa capable of equol production, may be contributing to elevated levels of deconjugated estrogens, Lactobacillus abundance in the vaginal microbiome, and elevated anxiety levels in the endometriosis group of this cohort.