Estrobolome, gut microbiota and estrogen dependent diseases: endocrine immunometabolic integration and new translational frontiers

The interaction between the gut microbiota and estrogen metabolism has consolidated, over the last decade, as a relevant pathophysiological axis in estrogen dependent diseases. The concept of the estrobolome, introduced by Plottel and Blaser in 2011, describes the functional set of microbial genes capable of metabolizing estrogens and modulating their enterohepatic recirculation. Accumulated evidence demonstrates that alterations in the composition and function of the microbiota influence not only β glucuronidase activity, but also systemic inflammatory processes, production of short chain fatty acids, epigenetic modulation and peripheral hormonal signaling.This review integrates mechanistic and clinical data involving polycystic ovary syndrome, endometriosis and lipedema, proposing a systemic model in which intestinal dysbiosis, metabolic endotoxemia and hormonal modulation converge toward inflammatory amplification and estrogen dysregulation. The article also discusses synergistic therapeutic strategies, advances in postbiotics, precision microbiome approaches and perspectives for functional biomarkers of the estrobolome.The consolidation of this field represents a transition from the observational phase to structured intervention, requiring multidisciplinary integration between endocrinology, immunology, microbiology and precision medicine.