Endometriosis: Understanding Symptoms and the Emerging Microbiome Link

Endometriosis is a chronic, oestrogen-driven condition affecting around 1 in 10 women, where tissue similar to the womb lining grows elsewhere in the body. It can severely impact daily life, yet diagnosis and treatment remain far from ideal. On average, women wait seven years for a diagnosis, and there’s still no cure — only symptom-management options such as pain relief, hormonal treatments, or surgery, each with their own drawbacks.

Relevance of the microbiome environment 

The causes of endometriosis are still not fully understood, but emerging research shows a bidirectional relationship between the condition and the host’s microbiome. This discovery opens the door to potentially modulating the microbiome to reduce the risk of onset, slow disease progression, and ease symptoms.

The microbiome refers to the community of bacteria, viruses, and yeasts that live in and on the body. While the gut microbiome is the largest and best known, women also have distinct vaginal, cervical, and endometrial microbiomes that can strongly influence genitourinary and reproductive health.

Using vaginal microbiome sampling, researchers have specifically found a lower abundance of Lactobacillus bacteria in the endometriosis group compared to the control.  Other initial studies have found a greater abundance of opportunistic, inflammatory microbes in higher levels in those patients suffering from endometriosis.  More research is needed, but these initial findings are significant, and underpin the importance of maintaining a healthy vaginal microbiome with high abundance of health promoting lactobacilli bacteria.

Symptom overview 

Endometriosis symptoms often include severe period pain and heavy bleeding, which can be so debilitating they disrupt day-to-day life. Women may also experience lower tummy or back pain, pain during or after sex, discomfort when going to the toilet, fatigue, shortness of breath, low mood, and anxiety. These symptoms can stem from heavy blood loss and low iron, as well as the ongoing mental and physical strain of chronic pain.

Symptoms typically affect women throughout their menstruating years and often improve after menopause when periods stop.

If you’re experiencing any of these symptoms, it’s important to speak with a healthcare professional for proper assessment and diagnosis.

Management of endometriosis symptoms 

Symptom management often involves a mix of diet, lifestyle changes, and medication, with most women finding a personalised approach that works for them. GPs may recommend pain relief or hormonal treatments, and if these aren’t effective, surgery can be used to remove areas of endometriosis tissue.

Lifestyle strategies such as following an anti-inflammatory diet, maintaining a healthy weight, and avoiding constipation can also help. Some women benefit from supplements like magnesium glycinate or omega-3 fish oil to reduce inflammation and support muscle and nervous-system relaxation. (Always seek guidance from a qualified practitioner and check for interactions with medications.)

Probiotics to support the vaginal and bladder microbiome environments 

Research consistently shows that lactobacilli are key to maintaining a healthy vaginal, endometrial, and bladder microbiome.

Our probiotics contain the four strains naturally found in a healthy vagina and can be taken orally to help restore and support optimal lactobacilli levels. These bacteria create a protective acidic environment that keeps inflammatory, opportunistic microbes in check — inflammation that may contribute to endometriosis symptoms.

We recommend these probiotics for women experiencing vaginal or bladder discomfort. Ultimate V supports a healthy vaginal microbiome, while Ultimate UT includes added D-mannose for those prone to UTIs.

Vaginal microbiome testing 

Vaginal microbiome testing is a powerful way to understand whether your intimate microbiome is supporting your health or contributing to genitourinary or reproductive issues. A healthy vaginal environment is typically dominated by protective lactobacilli, with few or no opportunistic microbes.

Our qPCR test identifies exactly which bacteria and yeast are present and in what amounts. It also detects inflammatory aerobic and anaerobic microbes, allowing for targeted interventions to rebalance the microbiome and support overall health.

This testing can be used as a preventative health check or to help uncover whether inflammatory microbes may be driving existing symptoms.

Final words on endometriosis 

There has been increasing coverage about the poor healthcare provision for women with endometriosis. A seven-year wait for answers is unacceptable and leads to significant physical, mental, family, and socioeconomic impacts.

We hope to see meaningful progress in this area, particularly as the role of the microbiome in endometriosis becomes better understood. At Pelvic Relief, our focus is to support women in optimising their genitourinary health through microbiome testing, probiotics, and guidance toward appropriate medical or holistic care.

References 

Ser, H.-L., Au Yong, S.-J., Shafiee, M. N., Mokhtar, N. M., & Ali, R. A. R. (2023). Current updates on the role of microbiome in endometriosis: A narrative review. Microorganisms, 11(2), 360. https://doi.org/10.3390/microorganisms11020360

Da Silva, A. S., Anwar, S., Park, S., Park, S., Goodfellow, L., & Sergaki, C. (2025). The untapped potential of vaginal microbiome diagnostics for improving women’s health. Frontiers in Cellular and Infection Microbiology, 15, Article 1595182. https://doi.org/10.3389/fcimb.2025.1595182 

Xholli, A., Cremonini, F., Perugi, I., Londero, A. P., & Cagnacci, A. (2023). Gut microbiota and endometriosis: Exploring the relationship and therapeutic implications. Pharmaceuticals (Basel), 16(12), 1696. https://doi.org/10.3390/ph16121696