Microbiome and Uterine Fibroids: Unveiling the Hidden Connection


Uterine fibroids have puzzled healthcare professionals for years. Affecting millions of women during their reproductive years, fibroids can lead to a myriad of symptoms, including heavy menstrual bleeding, pelvic pain, and reproductive issues. 1 While the exact cause of fibroids remains a subject of ongoing research, recent studies2 have begun to shed light on a fascinating aspect of our biology that may play a crucial role in their development: the microbiome.

The human microbiome,3 a complex ecosystem of bacteria, viruses, fungi, and other microorganisms living in and on our bodies, has been recognized for its critical role in our overall health. It influences everything from digestion and immunity to mental health and, intriguingly, may have a significant impact on the development of uterine fibroids

The Gut Microbiome and Estrogen Metabolism

One of the pivotal discoveries4 linking the microbiome to uterine fibroids revolves around the gut microbiome’s role in estrogen metabolism. Estrogen, a hormone central to female reproductive health, has been implicated in the growth of fibroids5. The gut microbiome helps regulate the body’s estrogen levels through a process known as the “estrobolome,”6 a collection of gut bacteria genes that metabolize estrogens. 

An imbalance in these bacteria can lead to altered estrogen levels, potentially contributing to fibroid development.7 Research suggests8 that an unhealthy gut microbiome may impair the breakdown and elimination of estrogen from the body, leading to its accumulation and the stimulation of fibroid growth.

The Vaginal Microbiome and Pelvic Health

Similarly, the vaginal microbiome9 may also play a role in the health of the uterus. An imbalance in vaginal flora, characterized by a decrease in beneficial lactobacilli and an increase in harmful bacteria, can lead to inflammation and altered immune responses. This dysbiosis10 could create an environment conducive to fibroid growth. While direct evidence linking the vaginal microbiome to fibroids is still emerging, the known association11 between vaginal microbiome imbalances and other gynecological conditions suggests a potential connection worth exploring further.

Probiotics and Fibroid Management

Given the microbiome’s influence on fibroid development, targeting the microbiome presents a novel approach to managing fibroids. Probiotics12, beneficial bacteria that can help restore balance to the microbiome, have been proposed as a complementary treatment for fibroids. Although research in this area is in its infancy, preliminary studies suggest that probiotics may help modulate estrogen levels and reduce inflammation, potentially slowing fibroid growth.

Future Directions

The exploration of the microbiome’s role in uterine fibroids is still in its early stages, with much to learn about the complex interplay between our microbial inhabitants and fibroid development. Ongoing research13 is focused on identifying specific bacterial strains that may influence fibroid growth and understanding how dietary and lifestyle factors affect the microbiome’s composition and, by extension, fibroid risk.

As our knowledge expands, so too will the potential for innovative treatments targeting the microbiome. These could offer women with fibroids more personalized and less invasive treatment options, improving their quality of life.

Embracing a Microbial Perspective in Fibroid Care: A Path Forward

The connection between the microbiome and uterine fibroids unveils a hidden dimension of women’s health, emphasizing the profound impact of our microbial companions on our well-being. By continuing to unravel this complex relationship, we pave the way for groundbreaking approaches to prevent and manage fibroids, offering hope to millions of women worldwide.

The growing body of evidence linking the microbiome to fibroids underscores the importance of holistic health practices, including diet, exercise, and possibly probiotic supplementation, in maintaining hormonal balance and pelvic health. As we advance in our understanding, the microbiome could become a key focal point in fibroid research, diagnosis, and treatment, marking a significant leap forward in women’s healthcare.

  1. Uimari O, Subramaniam KS, Vollenhoven B, Tapmeier TT. Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding. Front Reprod Health. 2022 Mar 4;4:818243. doi: 10.3389/frph.2022.818243. PMID: 36303616; PMCID: PMC9580818.
  2. Korczynska, L., Zgliczynska, M., Zarychta, E., Zareba, K., Wojtyla, C., Dabrowska, M., & Ciebiera, M. (2023). The role of microbiota in the pathophysiology of uterine fibroids – a systematic review. Frontiers in Cellular and Infection Microbiology, 13, 1177366. https://doi.org/10.3389/fcimb.2023.1177366
  3. Moumita Sil, Sutanuka Mitra, Arunava Goswami,
    Chapter 65 - Probiotics and immunity: An overview,
    Editor(s): Debasis Bagchi, Amitava Das, Bernard William Downs,
    Viral, Parasitic, Bacterial, and Fungal Infections,
    Academic Press,
    Pages 847-861,
    ISBN 9780323857307
  4. Korczynska L, Zeber-Lubecka N, Zgliczynska M, Zarychta E, Zareba K, Wojtyla C, Dabrowska M, Ciebiera M. The role of microbiota in the pathophysiology of uterine fibroids - a systematic review. Front Cell Infect Microbiol. 2023 May 26;13:1177366. doi: 10.3389/fcimb.2023.1177366. PMID: 37305407; PMCID: PMC10250666.
  5. Borahay MA, Asoglu MR, Mas A, Adam S, Kilic GS, Al-Hendy A. Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. Reprod Sci. 2017 Sep;24(9):1235-1244. doi: 10.1177/1933719116678686. Epub 2016 Nov 20. PMID: 27872195; PMCID: PMC6344829.
  6. Mary E Salliss, Leslie V Farland, Nichole D Mahnert, Melissa M Herbst-Kralovetz, The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain, Human Reproduction Update, Volume 28, Issue 1, January-February 2022, Pages 92–131.
  7. Korczynska L, Zeber-Lubecka N, Zgliczynska M, Zarychta E, Zareba K, Wojtyla C, Dabrowska M, Ciebiera M. The role of microbiota in the pathophysiology of uterine fibroids - a systematic review. Front Cell Infect Microbiol. 2023 May 26;13:1177366. doi: 10.3389/fcimb.2023.1177366. PMID: 37305407; PMCID: PMC10250666.
  8. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45-53. doi: 10.1016/j.maturitas.2017.06.025. Epub 2017 Jun 23. PMID: 28778332.
  9. Wang J, Li Z, Ma X, Du L, Jia Z, Cui X, Yu L, Yang J, Xiao L, Zhang B, Fan H, Zhao F. Translocation of vaginal microbiota is involved in impairment and protection of uterine health. Nat Commun. 2021 Jul 7;12(1):4191. doi: 10.1038/s41467-021-24516-8. PMID: 34234149; PMCID: PMC8263591.
  10. Mao X, Chen H, Peng X, Zhao X, Yu Z and Xu D (2023) Dysbiosis of vaginal and cervical microbiome is associated with uterine fibroids. Front. Cell. Infect. Microbiol. 13:1196823. doi: 10.3389/fcimb.2023.1196823
  11. Zhao F, Hu X, Ying C. Advances in Research on the Relationship between Vaginal Microbiota and Adverse Pregnancy Outcomes and Gynecological Diseases. Microorganisms. 2023 Apr 11;11(4):991. doi: 10.3390/microorganisms11040991. PMID: 37110417; PMCID: PMC10146011.
  12. Mei Z, Li D. The role of probiotics in vaginal health. Front Cell Infect Microbiol. 2022 Jul 28;12:963868. doi: 10.3389/fcimb.2022.963868. PMID: 35967876; PMCID: PMC9366906.
  13. K VK, Bhat RG, Rao BK, R AP. The Gut Microbiota: a Novel Player in the Pathogenesis of Uterine Fibroids. Reprod Sci. 2023 Dec;30(12):3443-3455. doi: 10.1007/s43032-023-01289-7. Epub 2023 Jul 7. PMID: 37418220; PMCID: PMC10691976.