How the Gut Microbiome Links to Menopause and Obesity, with Possible Implications for Endometrial Cancer Development

Malou P. H. Schreurs*, Peggy J. de Vos van Steenwijk, Andrea Romano, Sabine Dieleman, Henrica M. J. Werner

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Background: Interest is growing in the dynamic role of gut microbiome disturbances in human health and disease. No direct evidence is yet available to link gut microbiome dysbiosis to endometrial cancer. This review aims to understand any association between microbiome dysbiosis and important risk factors of endometrial cancer, high estrogen levels, postmenopause and obesity. Methods: A systematic search was performed with PubMed as primary database. Three separate searches were performed to identify all relevant studies. Results: Fifteen studies were identified as highly relevant and included in the review. Eight articles focused on the relationship with obesity and eight studies focused on the menopausal change or estrogen levels. Due to the heterogeneity in patient populations and outcome measures, no meta-analysis could be performed. Both the menopausal change and obesity were noted to enhance dysbiosis by reducing microbiome diversity and increasing the Firmicutes to Bacteroidetes ratio. Both also incurred estrobolome changes, leading to increased systemic estrogen levels, especially after menopause. Furthermore, microbiome dysbiosis was reported to be related to systemic inflammation through toll-like receptor signaling deficiencies and overexpression of pro-inflammatory cytokines. Conclusions: This review highlights that the female gut microbiome is intrinsically linked to estrogen levels, menopausal state and systemic inflammation, which indicates gut microbiome dysbiosis as a potential hallmark for risk stratification for endometrial cancer. Studies are needed to further define the role the gut microbiome plays in women at risk for endometrial cancer.

Original languageEnglish
Article number2916
Number of pages32
JournalJournal of Clinical Medicine
Issue number13
Publication statusPublished - Jul 2021


  • AXIS
  • DIET
  • PTEN
  • RISK
  • endometrial cancer
  • estrogen
  • gut microbiome
  • menopause
  • obesity

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