Multi-strain Probiotics Alter Gut Microbiota and Estrobolome Pathways in Primary Dysmenorrhea
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Background
Exact cause of primary dysmenorrhoea is unknown but recent evidence uncovers a potential link between gut dysbiosis and benign gynaecological disorder via disruption of estrobolome.
Methods
A randomized controlled trial to investigate the effects of multi-strain oral probiotics MCP® BCMC® on primary dysmenorrhoea has been conducted. This is a secondary analysis comparing the stool microbiome in women with primary dysmenorrhoea and those without (control), and the effects of treatment with probiotics versus placebo.
Results
Although microbial richness and evenness were comparable between groups (alpha diversity, p > 0.05), gut microbial community composition differed significantly (Bray–Curtis PERMANOVA, p = 0.015), characterised by reduced Bifidobacterium adolescentis and Blautia and enrichment of Faecalibacterium in dysmenorrhoea, alongside condition-specific core taxa. Post-intervention analysis revealed significant shifts in microbial community structure between pre- and post-treatment groups (PERMANOVA, F = 2.11, R² = 0.134, p = 0.005), with probiotic supplementation inducing more consistent and directed microbiome changes than placebo, without altering alpha diversity (p > 0.05). Functional prediction showed no significant difference in overall β-glucuronidase pathway abundance (p > 0.05); however, dysmenorrhoea was associated with higher abundance of β-glucuronidase–producing taxa (MaAsLin2, q < 0.05) that were differentially modulated by probiotic treatment.
Conclusion
This discovery provides evidence on the microbial disruption in primary dysmenorrhoea as well as the benefit of probiotics to modulate the intestinal microbiota to improve the condition.
What is already known on this topic
PD is a common inflammatory gynaecological disorder that has historically been associated with hormonal imbalance and excessive prostaglandin production. Recent research indicates that the estrobolome, especially β-glucuronidase-producing bacteria may have a role in menstrual problems and inflammation. Although their impact in PD is still unclear, probiotics have also been shown to alleviate inflammatory-related disorders and modify gut flora.
What this study adds
Women with PD exhibited distinct gut microbial community profiles despite having comparable microbial richness and evenness to healthy controls. Dysmenorrhea was associated with reduced Bifidobacterium adolescentis and Blautia , enrichment of Faecalibacterium , and higher abundance of β-glucuronidase associated taxa. Multi-strains probiotic supplementation induced more consistent and directed microbiome shifts compared with placebo treatment, suggesting a modulatory effect on gut microbial composition and estrobolome-associated bacteria.
How this study might affect research, practice or policy
These results demonstrate the potential use of probiotics and other microbiome-targeted therapies as supplemental methods to treat primary dysmenorrhea in addition to traditional NSAID therapy. This study offers a foundation for incorporating gut microbiome and estrobolome profiling into gynaecological studies in clinical and translational research, potentially boosting the development of functional probiotics and precision therapies for illnesses related to hormones and inflammation.
