Research advances in traditional Chinese medicine and emerging therapies for endometritis: a review

Endometritis is a common reproductive disorder in humans and animals characterized by infection, inflammation, immune dysregulation, and impaired endometrial function. Limitations of current antibiotic-based management, including antimicrobial resistance, recurrence, and persistent inflammation, have stimulated interest in complementary and emerging therapies. This review aimed to compare traditional Chinese medicine-related interventions, microRNA-based approaches, probiotics, and other emerging treatments for endometritis, with emphasis on their mechanisms, therapeutic targets, supporting evidence, and translational limitations. PubMed, ScienceDirect, and the China National Knowledge Infrastructure were searched for English-language original studies published up to 31 August 2025. Eligible studies investigated endometritis interventions or underlying mechanisms in endometrial cells, experimentally induced animal models, or naturally affected animals; selected studies of related conditions were included as clearly identified indirect evidence. After duplicate removal and eligibility assessment, included publications were grouped by intervention and mechanism and evaluated qualitatively for study design, experimental model, controls, target manipulation, treatment timing, outcomes, and limitations. A total of 148 publications were included. Herbal interventions comprised isolated phenylpropanoids, terpenoids, alkaloids, and flavonoids, as well as extracts and multi-herb formulas, and were associated with reduced inflammation, oxidative stress, ferroptosis, and cell injury, together with modulation of microbial composition. MicroRNA studies identified regulators of inflammatory signaling, while probiotic studies indicated potential effects on pathogen interactions, immune responses, and endometrial barrier integrity. However, most evidence was derived from cell and experimentally induced animal models, and studies in naturally affected animals were limited. These interventions target multiple processes involved in endometrial injury and repair, but their clinical and veterinary application requires rigorous studies demonstrating sustained disease resolution, improved reproductive outcomes, standardized dosing and composition, and safety in the intended host. Graphical Abstract