Endometriosis (EM) is a chronic condition characterized by the presence of ectopic endometrial tissue outside the uterus, affecting approximately 10% of reproductive-age women. It significantly impacts fertility and quality of life due to severe chronic pelvic pain (CPP) and associated psychological symptoms such as depression and anxiety. The pathogenesis of EM involves complex interactions among endocrine, inflammatory, immune, oxidative, and proangiogenic mechanisms. Microbial dysbiosis in the gut and reproductive tract plays a crucial role in immune system dysregulation, elevated proinflammatory cytokines, and disrupted estrogen metabolism, contributing to the inflammatory and oxidative stress that underlie EM and its associated CPP. Dietary interventions and nutritional supplements can help manage EM symptoms by targeting these mechanisms. This review explores the interplay among the microbiome, inflammation, and oxidative stress as common threads in EM and its psychological comorbidities, highlighting how dietary and nutritional interventions can influence the microbiome, reduce inflammation and oxidative stress, and alleviate pain and psychological symptoms. The review also discusses the impact of the gut, vaginal, and peritoneal bacterial flora on EM, the estrogen-gut microbiome axis, and the estrobolome, providing insights into potential biomarkers and therapeutic targets for EM.Endometriosis (EM) is a chronic condition characterized by the presence of ectopic endometrial tissue outside the uterus, affecting approximately 10% of reproductive-age women. It significantly impacts fertility and quality of life due to severe chronic pelvic pain (CPP) and associated psychological symptoms such as depression and anxiety. The pathogenesis of EM involves complex interactions among endocrine, inflammatory, immune, oxidative, and proangiogenic mechanisms. Microbial dysbiosis in the gut and reproductive tract plays a crucial role in immune system dysregulation, elevated proinflammatory cytokines, and disrupted estrogen metabolism, contributing to the inflammatory and oxidative stress that underlie EM and its associated CPP. Dietary interventions and nutritional supplements can help manage EM symptoms by targeting these mechanisms. This review explores the interplay among the microbiome, inflammation, and oxidative stress as common threads in EM and its psychological comorbidities, highlighting how dietary and nutritional interventions can influence the microbiome, reduce inflammation and oxidative stress, and alleviate pain and psychological symptoms. The review also discusses the impact of the gut, vaginal, and peritoneal bacterial flora on EM, the estrogen-gut microbiome axis, and the estrobolome, providing insights into potential biomarkers and therapeutic targets for EM.