Review of plant metabolites versus conventional antibiotics for endometritis in women of reproductive age

Endometritis is a common gynecological disorder predominantly affecting women of reproductive age. This condition is clinically characterized by symptoms including abdominal pain and irregular bleeding, often leads to impaired fertility, and is primarily driven by infection, injury, or endocrine disturbances. Conventional antibiotic therapy faces considerable challenges, including side effects and the rising threat of antimicrobial resistance, necessitating the exploration of safer and more effective treatment alternatives. Notably, plant metabolites have emerged as promising candidates for endometritis treatment, offering broad natural sources, low toxicity, and multi-target actions on the endometrium. These metabolites exert therapeutic effects by modulating key mechanistic pathways, including the suppression of pro-inflammatory signaling (e.g., NF-κB and MAPK pathways), inhibition of the NLRP3 inflammasome, activation of the antioxidant Nrf2 pathway, and regulation of various cell death modalities such as apoptosis, pyroptosis, and ferroptosis. Additionally, they contribute to endometrial restoration by strengthening the epithelial barrier, modulating hormonal balance, and inhibiting fibrosis. This review systematically categorizes plant metabolites with demonstrated efficacy against endometritis, elucidates their underlying mechanisms, and summarizes their current applications. Finally, we critically discuss the existing limitations of the field and outline future research priorities. Our findings may provide a theoretical and experimental foundation to facilitate the clinical translation and application of these promising plant metabolites.