Consolidated peer-reviewed literature spanning four topics that all bear on the citizen-science study studies/001-evvy-surgery-recovery/:
Citation confidence convention. Where the PMID is provided, the citation has been verified or is from a paper the author has strong confidence about. Where the citation is marked
⚠️ verify before publication, the authors / journal / year are correct but the exact PMID or volume/page details should be confirmed against PubMed before formal publication. Open a GitHub issue for any errors.
The vaginal microbiome of reproductive-age women organizes into a small number of distinct Community State Types (CSTs), most dominated by a single Lactobacillus species. CST-IV — the diverse, low-Lactobacillus, Gardnerella/anaerobe-associated state — is the one linked to bacterial vaginosis, elevated genital inflammation, and increased adverse reproductive outcomes.
1.1 Ravel J, Gajer P, Abdo Z, et al. “Vaginal microbiome of reproductive-age women.” Proc Natl Acad Sci USA. 2011;108 Suppl 1:4680-4687. PMID: 20534435
The landmark paper defining CST-I through CST-V from 16S rRNA sequencing of 396 North American women. Every paper since builds on this CST framework.
1.2 Anahtar MN, Byrne EH, Doherty KE, et al. “Cervicovaginal bacteria are a major modulator of host inflammatory responses in the female genital tract.” Immunity. 2015;42(5):965-976. PMID: 25992865
Demonstrates that CST-IV communities produce substantially higher levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) than L. crispatus-dominated communities — the mechanistic basis for downstream reproductive and surgical effects.
1.3 France MT, Ma B, Gajer P, et al. “VALENCIA: a nearest centroid classification method for vaginal microbial communities based on composition.” Microbiome. 2020;8(1):166. PMID: 33228810
The modern algorithm for CST assignment used in current microbiome research. If you want to systematically classify a participant’s Evvy result into a CST, this is the reference method.
1.4 Fettweis JM, Brooks JP, Serrano MG, et al. “Differences in vaginal microbiome in African American women versus women of European ancestry.” Microbiology. 2014;160(Pt 10):2272-2282. PMID: 25073854
The Vaginal Human Microbiome Project. Documents ancestry-related differences in CST prevalence — important context for citizen-science cohort interpretation.
The clinical assays in routine US primary care (Affirm VPIII DNA probe, Amsel criteria with wet-mount microscopy, Nugent Gram-stain score) were designed in the 1980s–1990s for one specific clinical question: “Should I prescribe antibiotics for symptomatic bacterial vaginosis right now?” They were calibrated to detect high-abundance, symptomatic infections — not the subclinical, low-absolute-load, high-relative-abundance dysbiosis patterns that more recent research links to chronic reproductive outcomes including endometriosis severity, preterm birth, and post-surgical complications.
2.1 Brown HL, Fuller DD, Jasper LT, et al. “Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis.” Infect Dis Obstet Gynecol. 2004;12(1):17-21. PMID: 15117088
Original sensitivity/specificity characterization of Affirm VPIII against clinical/microscopic standards. Documents the detection threshold (~2 × 10⁵ organisms/mL for G. vaginalis probe).
2.2 Cartwright CP, Pherson AJ, Harris AB, et al. “Multicenter study establishing the clinical validity of a nucleic-acid amplification-based assay for the diagnosis of bacterial vaginosis.” Diagn Microbiol Infect Dis. 2018;92(3):173-178. (⚠️ verify exact PMID and year before publication.)
Compares newer NAAT-based BV diagnostics to Amsel/Nugent and Affirm-class assays. Documents that NAAT assays detect a meaningful fraction of cases the older assays miss.
2.3 Hardick J, Giles J, Hardick A, et al. “Performance of the Cepheid CT/NG Xpert rapid PCR test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae and Affirm VPIII for vaginitis.” J Clin Microbiol. — (⚠️ multiple papers in this series; verify specific volume/PMID for the Affirm VPIII comparison.)
Methodological comparison literature documenting the assay-specific sensitivity tradeoffs.
2.4 Muzny CA, Schwebke JR. “Pathogenesis of Bacterial Vaginosis: Discussion of Current Hypotheses.” J Infect Dis. 2016;214 Suppl 1:S1-S5. PMID: 27449868
Reviews current understanding of how dysbiotic communities establish, including the recognition that “BV” is not a single state but a spectrum — many of which standard clinical assays cannot resolve.
2.5 Schwebke JR, Muzny CA, Josey WE. “Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual update.” J Infect Dis. 2014;210(3):338-343. PMID: 24511102
Establishes the Gardnerella biofilm pathophysiology. Helps explain why low-absolute-load Gardnerella communities (Affirm-negative) can still be clinically meaningful — biofilm communities at lower planktonic loads can still drive persistent inflammation.
2.6 Onderdonk AB, Delaney ML, Fichorova RN. “The Human Microbiome during Bacterial Vaginosis.” Clin Microbiol Rev. 2016;29(2):223-238. PMID: 26864580
Comprehensive review of the molecular characterization era of BV research — including the case for why traditional clinical diagnostics undercount the BV-spectrum disease burden.
Until 2019, “Gardnerella” was treated as a single species — Gardnerella vaginalis. Genomic analysis revealed that what was clinically called “G. vaginalis” is actually four distinct species plus an additional 9 genomic species. Clinical DNA-probe assays (including Affirm VPIII) were designed against the pre-2019 single-species target. Modern metagenomic sequencing detects all four species individually.
3.1 Vaneechoutte M, Guschin A, Van Simaey L, et al. “Emended description of Gardnerella vaginalis and description of Gardnerella leopoldii sp. nov., Gardnerella piotii sp. nov. and Gardnerella swidsinskii sp. nov., with delineation of 13 genomic species within the genus Gardnerella.” Int J Syst Evol Microbiol. 2019;69(3):679-687. PMID: 30648938
The taxonomy paper that split the genus. Critical for interpreting any clinical microbiome result — a CST-IV community driven primarily by G. swidsinskii, G. piotii, or G. leopoldii (with low G. vaginalis) is likely invisible to pre-2019 clinical assays.
3.2 Hill JE, Albert AYK; VOGUE Research Group. “Resolution and Cooccurrence Patterns of Gardnerella leopoldii, G. swidsinskii, G. piotii, and G. vaginalis within the Vaginal Microbiome.” Infect Immun. 2019;87(12):e00532-19. PMID: 31527124
Documents species-level co-occurrence patterns, demonstrating that the 4 Gardnerella species cluster differently across CST-IV variants and that they may have distinct clinical implications.
3.3 Khan S, Voordouw MJ, Hill JE. “Competition among Gardnerella subgroups from the human vaginal microbiome.” Front Cell Infect Microbiol. 2019;9:374. PMID: 31737576
In vitro competition dynamics showing the four species are not interchangeable. Different Gardnerella species may produce different inflammatory and biofilm phenotypes.
4.1 Ata B, Yildiz S, Turkgeldi E, et al. “The Endobiota Study: A Comparison of Vaginal, Cervical, and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls.” Sci Rep. 2019;9(1):2204. PMID: 30778155
The most-cited single study on microbiome differences in endometriosis. Found significantly altered vaginal and cervical microbiota in women with stage 3/4 endometriosis. Anchor reference for the field.
4.2 Hernandes C, Silveira P, Rodrigues Sereia AF, et al. “Microbiome Profile of Deep Endometriosis Patients: Comparison of Vaginal Fluid, Endometrium and Lesion.” Diagnostics (Basel). 2020;10(3):163. PMID: 32188065
Compares microbiome composition across vaginal fluid, eutopic endometrium, and endometriotic lesion tissue in deep-infiltrating endo patients. Documents that lesion-level microbiome differs from vaginal — relevant for the ascending colonization mechanism.
4.3 Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. “The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain.” Hum Reprod Update. 2021;28(1):92-131. PMID: 34718567
Comprehensive systematic review in the highest-impact reproductive-medicine journal. Synthesizes evidence across gut, vaginal, cervical, endometrial, and peritoneal microbiomes in endometriosis. Essential reading for anyone entering this literature.
4.4 Leonardi M, Hicks C, El-Assaad F, El-Omar E, Condous G. “Endometriosis and the microbiome: a systematic review.” BJOG. 2020;127(2):239-249. PMID: 31621155
Independent systematic review from an Australian group. Covers vaginal, gut, peritoneal, and lesion microbiomes in endometriosis with explicit quality-of-evidence caveats.
4.5 Molina NM, Sola-Leyva A, Saez-Lara MJ, et al. “New Opportunities for Endometrial Health by Modifying Uterine Microbial Composition: Present or Future? A Review.” Biomolecules. 2020;10(4):593. PMID: 32290428
Forward-looking review on whether modifying the uterine microbiome (anatomically adjacent to vaginal) can improve endometrial-health outcomes.
4.6 Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. “Estrogen-gut microbiome axis: Physiological and clinical implications.” Maturitas. 2017;103:45-53. PMID: 28778332
The “estrobolome” review. Bacteria producing β-glucuronidase deconjugate hepatically cleared estrogens in the gut, allowing reabsorption and effectively recycling estrogens back into circulation. Directly relevant to the endometriosis estrogen-clearance story this whole repo investigates.
4.7 Plottel CS, Blaser MJ. “Microbiome and malignancy.” Cell Host Microbe. 2011;10(4):324-335. PMID: 21925106
The earlier conceptual framing for how microbiome composition modulates estrogen-driven disease risk via deconjugation pathways. Foundational citation for the estrobolome field.
4.8 Kwa M, Plottel CS, Blaser MJ, Adams S. “The intestinal microbiome and estrogen receptor-positive female breast cancer.” J Natl Cancer Inst. 2016;108(8):djw029. PMID: 27107051
Extends the estrobolome framework specifically to estrogen-receptor-positive disease. The mechanism (β-glucuronidase deconjugation → reabsorption → elevated estrogen exposure) generalizes from breast cancer to endometriosis.
This is the section that explicitly synthesizes liver-side and microbiome-side estrogen clearance into a single mechanistic framework. It is novel in synthesis but not in components. Each leg has substantial published support; the integrative cohort research is sparse.
Estrogen-driven inflammatory disease in endometriosis is, per published mechanism, potentially the product of two parallel mechanisms operating simultaneously:
A clinical intervention that addresses only Mechanism 1 (typical functional medicine “liver detox”) could in principle produce an effect that is attenuated by the patient’s microbial deconjugation pressure. Whether this attenuation occurs at clinically meaningful magnitude in any given patient — and how variable it is across patients — has not been directly demonstrated in cohort research.
This is the integrative hypothesis: that the dual-axis framing matters clinically. It is plausible, mechanistically grounded, and consistent with the broader endometriosis-microbiome systematic reviews (Salliss 2021). It is not yet confirmed.
No prospective cohort study has measured all of the following simultaneously in the same endometriosis patients:
The integrative framework — that Phase 2 hepatic support produces dose-attenuated effects in patients with high microbial β-glucuronidase load — is implicit in Salliss 2021 and Baker 2017 but has not been the subject of a dedicated empirical cohort study.
Four structural reasons:
The case-study + protocol + Study 001 architecture in this repository is designed to begin generating pilot-level evidence for the integrative framework. It is not the cohort study that the field ultimately needs, but it provides the methodological infrastructure (data collection, anonymization, analysis scripts) and proof-of-concept that a citizen-science version of the integrative cohort study is feasible.
For the dedicated case-study walkthrough of this integrative framework, see case-studies/001-core-restore-no-bc/microbiome-estrogen-axis.md.
Among the many mechanistic hypotheses for endometriosis, the bacterial contamination hypothesis (Khan and colleagues) is the most directly relevant to why a vaginal microbiome intervention should affect endo outcomes. The short version: dysbiotic vaginal communities produce more lipopolysaccharide (LPS) from gram-negative organisms. LPS ascends into the uterus and peritoneum. LPS activates Toll-like receptor 4 (TLR4) on endometrial and endometriotic cells, driving proliferation, angiogenesis, and inflammation.
5.1 Khan KN, Kitajima M, Hiraki K, et al. “Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis.” Fertil Steril. 2010;94(7):2860-2863. PMID: 20627244
The founding paper. Demonstrates E. coli contamination of menstrual effluent in women with endometriosis and direct effects of bacterial endotoxin on endometriotic tissue.
5.2 Khan KN, Kitajima M, Hiraki K, et al. “Toll-like receptors in innate immunity: role of bacterial endotoxin and toll-like receptor 4 in endometrium and endometriosis.” Gynecol Obstet Invest. 2009;68(1):40-52. PMID: 19349727
Establishes TLR4 expression on endometrial and endometriotic tissue and demonstrates responsiveness to LPS at physiologic concentrations.
5.3 Khan KN, Fujishita A, Hiraki K, et al. “Bacterial contamination hypothesis: a new concept in endometriosis.” Reprod Med Biol. 2018;17(2):125-133. PMID: 29692669
Consolidating review of the hypothesis nearly a decade after the founding paper. Important to cite this when framing the microbiome-endo link as mechanistic, not merely correlational.
The central hypothesis of Study 001 is that pre-operative vaginal microbiome state predicts post-surgical recovery trajectory. The supporting literature is strongest for transvaginal procedures (hysterectomy, cervical procedures) but increasingly applies to abdominal-approach pelvic procedures including laparoscopic endometriosis excision.
6.1 Haggerty CL, Hillier SL, Bass DC, Ness RB; PID Evaluation and Clinical Health Study Investigators. “Bacterial vaginosis and anaerobic bacteria are associated with endometritis.” Clin Infect Dis. 2004;39(7):990-995. PMID: 15472851
Links BV-associated anaerobes to endometritis — directly relevant to post-procedure complications and recovery trajectories.
6.2 Persson E, Bergström M, Larsson PG, et al. “Infections after hysterectomy. A prospective nation-wide Swedish study.” Acta Obstet Gynecol Scand. 1996;75(8):757-761. (⚠️ verify exact PMID before publication.)
Population-level data linking pre-operative vaginal microbiology to post-hysterectomy infection.
6.3 Lewis FM, Bernstein KT, Aral SO. “Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases.” Obstet Gynecol. 2017;129(4):643-654. PMID: 28277350
Covers the link between CST-IV communities and multiple adverse reproductive outcomes including surgical complications and preterm birth.
6.4 Guo SW. “Recurrence of endometriosis and its control.” Hum Reprod Update. 2009;15(4):441-461. PMID: 19279046
Anchor reference for recurrence rates and the rationale for ongoing post-surgical management. Relevant context for why pre/post-op microbiome work matters — surgery removes lesions but not the inflammatory environment that grew them.
The user originally asked for Netherlands-specific microbiome research because the Isala Project (the methodological precedent for Study 001) was incorrectly assumed to be Dutch. The actual project is Belgian-led, but there IS substantial Netherlands-based vaginal microbiome research. Both are documented here for context.
7.1 Borgdorff H, van der Veer C, van Houdt R, et al. “The association between ethnicity and vaginal microbiota composition in Amsterdam, the Netherlands.” PLoS One. 2017;12(7):e0181135. PMID: 28700710
Amsterdam UMC cohort study documenting ethnic variation in vaginal microbiome composition within a Dutch urban population. Important for cohort-design planning because it shows population heterogeneity that any citizen-science cohort will need to account for.
7.2 Dols JA, Molenaar D, van der Helm JJ, et al. “Molecular assessment of bacterial vaginosis by Lactobacillus abundance and species diversity (LBD-score).” BMC Infect Dis. 2016;16:180. PMID: 27098488
Amsterdam-led development of a quantitative molecular BV-scoring approach. Useful for participants who want a research-grade score on their Evvy data.
7.3 van de Wijgert JHHM, Borgdorff H, Verhelst R, et al. “The vaginal microbiota: what have we learned after a decade of molecular characterization?” PLoS One. 2014;9(8):e105998. PMID: 25148517
Dutch-led comprehensive review summarizing a decade of vaginal microbiome molecular characterization. Landmark synthesis piece.
7.4 van de Wijgert JHHM. “The vaginal microbiome and sexually transmitted infections are interlinked: Consequences for treatment and prevention.” PLoS Med. 2017;14(12):e1002478. PMID: 29281632
Dutch-led perspective on why CST-IV microbial state amplifies STI and adverse-outcome risk through shared inflammatory mechanisms.
7.5 Kort R, Westerik N, Serrano LM, et al. “A novel consortium of Lactobacillus rhamnosus and Streptococcus thermophilus for increased access to functional fermented foods.” Microb Cell Fact. 2015;14:195. PMID: 26635079
From Remco Kort’s group at VU Amsterdam. Kort’s broader lab work on lactic acid bacteria and probiotic / vaginal microbiome transplant (VMT) approaches is a Netherlands-based line of research with potential intervention relevance.
7.6 Lebeer S, Ahannach S, Gehrmann T, et al. “A citizen-science-enabled catalogue of the vaginal microbiome and associated factors.” Nat Microbiol. 2023;8(11):2183-2195. PMID: 37884815
The Isala Project. Belgium-led (University of Antwerp), ~3,345 women, self-collected swabs under citizen-science consent. The direct methodological precedent for Study 001.
7.7 Falony G, Joossens M, Vieira-Silva S, et al. “Population-level analysis of gut microbiome variation.” Science. 2016;352(6285):560-564. PMID: 27126039
The Flemish Gut Flora Project (Belgium) — another European citizen-science microbiome project demonstrating that large-scale community involvement produces publishable, high-impact findings.
Running a citizen-science study responsibly means borrowing from groups who have done it well before. The projects below established the standard for consent, data handling, participant experience, and publication transparency.
8.1 McDonald D, Hyde E, Debelius JW, et al. “American Gut: an Open Platform for Citizen Science Microbiome Research.” mSystems. 2018;3(3):e00031-18. PMID: 29795809
The flagship US citizen-science microbiome project. ~10,000+ participants. Methodology for consent, sample collection, data aggregation, and publication that has been adopted widely.
8.2 Lebeer S, Ahannach S, Gehrmann T, et al. 2023 (see 7.6 above)
The most recent and most directly relevant citizen-science vaginal microbiome study.
8.3 Ahannach S, Spacova I, Decorte R, Jehaes E, Lebeer S. “At the intersection of science, citizens and stakeholders: Reflections on the Isala citizen-science project on the vaginal microbiome.” Cell Rep Med. 2023;4(11):101253. (⚠️ verify exact PMID before publication.)
Reflective piece by the Isala team on how to run a citizen-science microbiome project, including consent, data handling, participant experience, and stakeholder engagement. Essential reading for any replication.
8.4 Topol E. “Individualized medicine from prewomb to tomb.” Cell. 2014;157(1):241-253. PMID: 24679539
Conceptual framing for why patient-generated, wearable-integrated data has become scientifically credible in the last decade. Useful for legitimizing citizen-science microbiome + wearable work to skeptical reviewers or clinicians.
Study 001 uses WHOOP-measured HRV as the primary endpoint for post-surgical recovery trajectory. The validity of this endpoint rests on two evidence bases: HRV as an inflammation proxy generally, and HRV deficits in endometriosis specifically.
9.1 Thayer JF, Sternberg E. “Beyond heart rate variability: vagal regulation of allostatic systems.” Ann N Y Acad Sci. 2006;1088:361-372. PMID: 17192580
The paper establishing HRV (specifically high-frequency power / rmssd) as a valid non-invasive proxy for inflammation and allostatic load. Used in every serious wearable-research study for this reason.
9.2 Kulshrestha R, Pandey A, Jain A, et al. “Heart rate variability as a non-invasive marker of autonomic dysfunction in women with endometriosis.” Indian J Physiol Pharmacol. 2022;66(4):263-270. (⚠️ verify exact PMID before publication.)
Documents reduced baseline HRV in women with endometriosis vs. healthy controls — the population-level background against which this study’s cohort will be measured.
9.3 Laborde S, Mosley E, Thayer JF. “Heart rate variability and cardiac vagal tone in psychophysiological research — Recommendations for experiment planning, data analysis, and data reporting.” Front Psychol. 2017;8:213. PMID: 28265249
Methodology paper on how to report HRV analyses transparently. Study 001’s analysis plan conforms to these recommendations.
The “older insurance-covered test misses what the newer out-of-pocket test detects” pattern is well-documented across multiple diagnostic categories — not just vaginal microbiome. It reflects the structure of how Laboratory Developed Tests (LDTs) are regulated in the US, how insurance coverage decisions are made, and how clinical guidelines lag the research base.
10.1 FDA. “Discussion Paper: Laboratory Developed Tests (LDTs).” 2017 Discussion Paper + 2024 Final Rule. Available at FDA.gov
Documents the historical regulatory framework where LDTs (including Evvy and similar mNGS-based tests) operated under CLIA certification rather than FDA clearance. The 2024 Final Rule began bringing LDTs under FDA oversight on a phase-in schedule. Relevant context for why insurance coverage of LDT-based vaginal microbiome panels has been limited.
10.2 Genentech / Hexagon Biosciences / FDA Public Workshop Materials. ⚠️ These are working-document sources rather than peer-reviewed papers. They document the regulatory rationale around LDT oversight and the implications for coverage decisions.
Background reading for understanding why a CLIA-certified-but-not-FDA-cleared assay (mNGS for vaginal microbiome) is unlikely to get insurance coverage without additional regulatory or evidence developments.
10.3 Centers for Medicare and Medicaid Services (CMS). Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for Molecular Pathology (87XXX series CPT codes) and Next-Generation Sequencing (NCD 90.2 for advanced cancer).
Documents how Medicare specifically determines coverage. Insurance carriers typically mirror these patterns. Microbiome-based mNGS for non-cancer indications generally falls outside current coverage pathways.
10.4 Centers for Disease Control and Prevention. “Sexually Transmitted Infections Treatment Guidelines, 2021 — Bacterial Vaginosis.” MMWR Recomm Rep. 2021;70(4):1-187.
The current CDC guideline for BV. Centers on Amsel criteria + Nugent score + clinical management of symptomatic BV. Does not address subclinical CST-IV characterization. This is the standard-of-care anchor that current insurance coverage policy is built around.
10.5 American College of Obstetricians and Gynecologists (ACOG). “Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin, Number 215.” Obstet Gynecol. 2020;135(1):e1-e17. PMID: 31856123
Current ACOG guideline. Centered on symptomatic management, with Affirm VPIII and similar molecular assays accepted as diagnostic alternatives to Amsel/Nugent. Subclinical CST-IV is not part of the diagnostic framework.
10.6 Wynia MK, Schwab AP. “Ethical considerations in coverage decisions for genetic testing.” Genet Med. 2006;8(4):202-210. (⚠️ representative citation for the broader literature on coverage decisions, equity, and access to advanced diagnostics — verify exact citation depending on the angle you want to develop.)
Documents the structural equity concerns when newer, more sensitive diagnostics are out-of-pocket while older, less sensitive ones are covered. Direct framing for why the Affirm-vs-Evvy coverage gap is an equity issue, not just a science issue.
10.7 Health Affairs / JAMA / NEJM commentary on direct-to-consumer molecular diagnostics. ⚠️ Multiple op-eds and analyses over the past 5 years. Worth a targeted PubMed search before publication if you want to anchor the policy argument with peer-reviewed support.
10.8 Lev-Sagie A, Goldman-Wohl D, Cohen Y, et al. “Vaginal microbiome transplantation in women with intractable bacterial vaginosis.” Nat Med. 2019;25(10):1500-1504. PMID: 31591599
Documents that even when subclinical CST-IV is identified, the treatment landscape is limited. Vaginal microbiome transplant (VMT) and live biotherapeutic products are still emerging. From the insurance perspective: “no FDA-approved treatment → unlikely to cover the diagnostic that identifies the problem.”
10.9 Cohen CR, Wierzbicki MR, French AL, et al. “Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis.” N Engl J Med. 2020;382(20):1906-1915. PMID: 32402161
The Lactin-V (live L. crispatus CTV-05) Phase 2b trial — the most advanced live biotherapeutic for vaginal microbiome restoration in development. If FDA-approved, it would change the treatment landscape and likely change coverage decisions for microbiome diagnostics.
If you’re starting cold and want the shortest path to evaluating Study 001 on its own terms:
Those nine sources are enough to evaluate Study 001 on its merits and to challenge any assumption it rests on.
For deeper or more recent literature:
"endometriosis"[MeSH] AND ("microbiome" OR "microbiota") AND ("vaginal" OR "cervical")"community state type" AND ("pregnancy" OR "surgical" OR "infection")"Gardnerella" AND ("swidsinskii" OR "leopoldii" OR "piotii")"citizen science" AND ("microbiome" OR "microbiota")"LPS" AND "endometriosis" AND ("TLR4" OR "Toll-like receptor")"heart rate variability" AND ("surgical recovery" OR "post-operative")"laboratory developed test" AND ("FDA" OR "reimbursement" OR "coverage")"bacterial vaginosis" AND ("metagenomic" OR "next-generation sequencing") AND ("sensitivity" OR "comparison")"vaginal microbiome transplant" OR "LACTIN-V" OR "CTV-05""Affirm VPIII" AND ("sensitivity" OR "comparison" OR "performance")../studies/001-evvy-surgery-recovery/README.md — the citizen-science study this bibliography supports../studies/001-evvy-surgery-recovery/research.md — study-specific narrower bibliographybirth-control-context.md — related research on hormonal contraception × liver function (some of the same Phase 2 pathway research)../protocols/01-estrogen-clearance/why-this-works.md — the mechanistic walkthrough for the case-study and protocol; references some of the same microbiome research from the estrobolome angleLast updated: 2026-05-27. Please open a GitHub issue for any errors in citation details.