The dietary axis of endometriosis prevention: a gut microbiota-estrobolome framework situated within a multidimensional model of risk modification, early recognition, and disease management
- 1Department of Obstetrics and Gynecology, Faculty of Health and Sport Sciences, Széchenyi István University, Győr, Hungary
- 2Department of Obstetrics and Gynecology, Faculty of Medicine, University of Szeged, Szeged, Hungary
- 3Department of Molecular Biology, Faculty of Science, University of Szeged, Szeged, Hungary
Abstract
Endometriosis affects approximately 5%–10% of reproductive-aged women and imposes a substantial yet underexplored preventive research gap relative to treatment-focused literature. Diet is the central axis of this review: we organize the dietary evidence around an explicit mechanistic sequence—food-group-level epidemiological risk, hypothesised to be mediated by gut-microbiota dysbiosis and the estrogen-metabolizing “estrobolome”, and thence to candidate dietary and probiotic interventions—and then situate this dietary axis within a broader multidimensional prevention framework spanning additional primary prevention (other modifiable lifestyle factors, environmental endocrine-disruptor exposure), secondary prevention (non-invasive early screening, adolescent menstrual-health education, and, as a conceptual proposal, targeted early hormonal intervention following the neo-evolutionary model of Vercellini and colleagues), and tertiary-level management of established disease. While, to our knowledge, six recent reviews and meta-analyses (2024–2026) have quantitatively synthesized randomized-trial evidence on dietary and nutraceutical interventions for endometriosis-associated pain, none situates this evidence within an explicit gut microbiota-estrobolome mechanistic framework or a broader multidimensional prevention model—the distinguishing contribution of this review. We advance this framework as a hypothesis-generating prevention research agenda rather than a set of clinically established preventive measures. Cost-effectiveness is treated as a cross-cutting dimension: endometriosis-specific economic evaluations of prevention and screening remain scarce—with a digital symptom-checker Markov model as a notable exception—so analogous frameworks from chronic-disease lifestyle-intervention economics are proposed as methodological templates. We synthesize current evidence, controversies, and priority directions, with particular emphasis on the dietary axis and its mechanistic underpinnings.
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BibTeX
@article{nagy2026dietary,
title = {{The dietary axis of endometriosis prevention: a gut microbiota-estrobolome framework situated within a multidimensional model of risk modification, early recognition, and disease management}},
author = {Sándor Nagy and Csaba Busznyák and Csilla Dézsi and Csilla Dézsi and Viktor Gulyás-Oldal and Ekaterina Paschali and Dániel Sallai and Imre Gálóczi and Imre Gálóczi and Károly Szili},
journal = {Frontiers in Reproductive Health},
year = {2026},
month = oct,
doi = {10.3389/frph.2026.1943184},
url = {https://doi.org/10.3389/frph.2026.1943184},
note = {CC BY},
}
RIS
TY - JOUR
TI - The dietary axis of endometriosis prevention: a gut microbiota-estrobolome framework situated within a multidimensional model of risk modification, early recognition, and disease management
AU - Sándor Nagy
AU - Csaba Busznyák
AU - Csilla Dézsi
AU - Csilla Dézsi
AU - Viktor Gulyás-Oldal
AU - Ekaterina Paschali
AU - Dániel Sallai
AU - Imre Gálóczi
AU - Imre Gálóczi
AU - Károly Szili
PY - 2026
DA - 2026/10/23
JO - Frontiers in Reproductive Health
DO - 10.3389/frph.2026.1943184
UR - https://doi.org/10.3389/frph.2026.1943184
AB - Endometriosis affects approximately 5%–10% of reproductive-aged women and imposes a substantial yet underexplored preventive research gap relative to treatment-focused literature. Diet is the central axis of this review: we organize the dietary evidence around an explicit mechanistic sequence—food-group-level epidemiological risk, hypothesised to be mediated by gut-microbiota dysbiosis and the estrogen-metabolizing “estrobolome”, and thence to candidate dietary and probiotic interventions—and then situate this dietary axis within a broader multidimensional prevention framework spanning additional primary prevention (other modifiable lifestyle factors, environmental endocrine-disruptor exposure), secondary prevention (non-invasive early screening, adolescent menstrual-health education, and, as a conceptual proposal, targeted early hormonal intervention following the neo-evolutionary model of Vercellini and colleagues), and tertiary-level management of established disease. While, to our knowledge, six recent reviews and meta-analyses (2024–2026) have quantitatively synthesized randomized-trial evidence on dietary and nutraceutical interventions for endometriosis-associated pain, none situates this evidence within an explicit gut microbiota-estrobolome mechanistic framework or a broader multidimensional prevention model—the distinguishing contribution of this review. We advance this framework as a hypothesis-generating prevention research agenda rather than a set of clinically established preventive measures. Cost-effectiveness is treated as a cross-cutting dimension: endometriosis-specific economic evaluations of prevention and screening remain scarce—with a digital symptom-checker Markov model as a notable exception—so analogous frameworks from chronic-disease lifestyle-intervention economics are proposed as methodological templates. We synthesize current evidence, controversies, and priority directions, with particular emphasis on the dietary axis and its mechanistic underpinnings.
SN - 2673-3153
ER -