Postbiotic-Based Regenerative Therapy for Intrauterine Adhesions: Mechanisms, Microbiota Crosstalk, and Translational Perspectives.

Intrauterine adhesions (IUA) correlate with reproductive tract dysbiosis, including reduced Lactobacillus, overgrowth of Gardnerella, Prevotella, and Klebsiella, and fungal imbalance involving Candida albicans. These changes promote endometrial fibrosis through TGF-β/Smad activation, TLR4/NF-κB-driven inflammation, and ferroptosis. Postbiotics, probiotic-derived metabolites, suppress fibrotic signaling, modulate immunity, and restore microbial balance. This review synthesizes current evidence on microbiota-IUA interplay and promising postbiotic-based therapies, highlighting translational platforms such as hydrogel delivery systems and multi-omics integration.