Probiotics in the Management of Endometriosis: A Meta-Analysis and Systematic Review
Location
Center for Advanced Learning & Simulation (CALS)
Publication Date
May 2026
Start Date
8-5-2026 10:45 AM
End Date
8-5-2026 11:00 AM
Description
Background: Endometriosis affects 6-10% of women and is associated with pelvic pain and decreased quality of life. Frequently, outcomes from first-line medical therapy are limited and may warrant second-line agents or surgery which may introduce adverse effects, impact quality of life, and impose notable financial burden for patients and the healthcare system. As with other chronic inflammatory conditions, studies demonstrate a correlation between gut dysbiosis and endometriosis. Specifically, decreased lactobacilli concentration and increased firmicute to bacteriodetes ratio may impact inflammation and enteric estrogen metabolism, resulting in disease exacerbation.
Objectives: The goal was to examine whether probiotic supplementation to target gut dysbiosis may improve pelvic pain and quality of life among patients with endometriosis.
Methods: A systematic review and meta-analysis was performed to identify trials that evaluated pelvic pain with visual analog score (VAS), among patients with endometriosis, as an outcome of probiotic supplementation. Two randomized controlled trials were identified (n = 2 of 99) evaluating 8 and 12 week (respectively) daily probiotic (lactobacillus supplementation) compared to placebo. Quality of evidence and risk of bias was assessed using the Cochrane Risk of Bias in Randomized Trials (RoB 2.0) tool. No detectable between-study heterogeneity was identified. A fixed-effect model was utilized to analyze mean difference (MD) in pelvic pain (VAS) between probiotic intervention and placebo.
Main results: The Risk of Bias (RoB 2.0) tool was used to establish low publication bias for the two randomized control trials. A pooled MD of –1.28 (95% CI –1.44 to –1.12) was identified demonstrating significant reduction of pelvic pain in favor of probiotic supplementation intervention in relation to placebo after 8 weeks of intervention. One of the trials evaluated pelvic pain (VAS) after 8 weeks of intervention followed by 4 weeks without supplementation or placebo and identified a non-significant MD of –1.28 (95% CI –1.61 to –0.95). No adverse outcomes were identified.
Conclusions: Probiotic supplementation may be a promising low-risk intervention to reduce pelvic pain among patients with endometriosis, but future research is encouraged in the setting of limited data.
PROSPERO registration: ID#: CRD420251108243; Date of registration: 19 July 2025
Recommended Citation
Backer-Meurke, Sean L. DO; Guthrie-Beckstrom, Estefania MD; Malone, Kristin MD/MPH; Chen, Siyi PhD; and Sutton, Elizabeth F. PhD, "Probiotics in the Management of Endometriosis: A Meta-Analysis and Systematic Review" (2026). Dept. of Obstetrics & Gynecology Resident Research Day. 8.
https://digitalscholar.lsuhsc.edu/obgyn_rd/2026/presentations/8
Probiotics in the Management of Endometriosis: A Meta-Analysis and Systematic Review
Center for Advanced Learning & Simulation (CALS)
Background: Endometriosis affects 6-10% of women and is associated with pelvic pain and decreased quality of life. Frequently, outcomes from first-line medical therapy are limited and may warrant second-line agents or surgery which may introduce adverse effects, impact quality of life, and impose notable financial burden for patients and the healthcare system. As with other chronic inflammatory conditions, studies demonstrate a correlation between gut dysbiosis and endometriosis. Specifically, decreased lactobacilli concentration and increased firmicute to bacteriodetes ratio may impact inflammation and enteric estrogen metabolism, resulting in disease exacerbation.
Objectives: The goal was to examine whether probiotic supplementation to target gut dysbiosis may improve pelvic pain and quality of life among patients with endometriosis.
Methods: A systematic review and meta-analysis was performed to identify trials that evaluated pelvic pain with visual analog score (VAS), among patients with endometriosis, as an outcome of probiotic supplementation. Two randomized controlled trials were identified (n = 2 of 99) evaluating 8 and 12 week (respectively) daily probiotic (lactobacillus supplementation) compared to placebo. Quality of evidence and risk of bias was assessed using the Cochrane Risk of Bias in Randomized Trials (RoB 2.0) tool. No detectable between-study heterogeneity was identified. A fixed-effect model was utilized to analyze mean difference (MD) in pelvic pain (VAS) between probiotic intervention and placebo.
Main results: The Risk of Bias (RoB 2.0) tool was used to establish low publication bias for the two randomized control trials. A pooled MD of –1.28 (95% CI –1.44 to –1.12) was identified demonstrating significant reduction of pelvic pain in favor of probiotic supplementation intervention in relation to placebo after 8 weeks of intervention. One of the trials evaluated pelvic pain (VAS) after 8 weeks of intervention followed by 4 weeks without supplementation or placebo and identified a non-significant MD of –1.28 (95% CI –1.61 to –0.95). No adverse outcomes were identified.
Conclusions: Probiotic supplementation may be a promising low-risk intervention to reduce pelvic pain among patients with endometriosis, but future research is encouraged in the setting of limited data.
PROSPERO registration: ID#: CRD420251108243; Date of registration: 19 July 2025
Comments
Advisor: Antonia Traina MD