Page 37 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

and vaginal pH is lower, in White women. In contrast, related to atrophic vaginitis. Although molecular methods
21
the predominance of lactobacilli decreases and vaginal to study the microbiome have advanced, most clinical
pH gradually increases in women of Asian, Hispanic, and settings worldwide still rely on traditional approaches such
Black descent, respectively. In addition, CST III (L. iners) as Gram staining and Nugent scoring to evaluate VM.
1
is associated with microbial states of high diversity. Exogenous sex steroids used in hormone replacement
15
A bidirectional interaction exists between the female therapy (HRT) for menopause are commonly employed to
reproductive system and the VM. Physiological changes manage menopausal symptoms. There is growing evidence
occurring from birth and extending beyond menopause that estrogen-containing compounds may promote a
can impact the VM; while conversely, the VM itself can healthier VM. In the previously mentioned Australian
affect reproductive functions. 9 review, it was found that among postmenopausal women
using HRT, topically applied exogenous estrogen was
4. Vaginal and urinary microbiota in associated with an increased prevalence of Lactobacillus. 16
menopause
Compared to the VM, information on the urinary
The decline in estrogen levels during menopause leads microbiota remains limited. Some findings suggest that
to a reduced presence of Lactobacillus species, decreased hormonal imbalances after menopause may lead to
glycogen in vaginal epithelial cells, and lower lactic acid dysbiosis, potentially contributing to both anatomical and
production. Consequently, vaginal pH rises, making functional changes that impact women’s general health.
the environment more prone to infections. This shift in These alterations can compromise vaginal integrity and
VM increases the risk of conditions such as BV, aerobic contribute to the onset of genitourinary syndrome of
vaginitis (AV), and vaginal candidiasis in postmenopausal menopause (GSM). In addition, an imbalanced urinary
women. In addition, estrogen deficiency and low glycogen microbiota has been linked to symptoms like urinary
contribute to vaginal atrophy, characterized by thinning urgency and incontinence, as well as conditions such as
of the squamous epithelium (mainly basal and parabasal interstitial cystitis, bladder pain syndrome, and neurogenic
layers), decreased vaginal secretions, dryness, and painful bladder. As these issues frequently occur in postmenopausal
intercourse. Several studies confirm that both the women, the influence of hormonal shifts on microbial
1,4
diversity and abundance of lactobacilli diminish after composition may be significant. Menopause is associated
menopause. A study from Sweden comparing fertile and with increased alpha diversity in the urinary microbiome
postmenopausal women found a higher frequency of and a reduced abundance of Lactobacillus in urine—
17
L. crispatus colonization in fertile women (p=0.0036). variations that may precede rUTIs like cystitis. Further
Similarly, Zhang et al. reported a reduced diversity investigation is essential to clarify how menopause-related
18
of Lactobacillus spp. in postmenopausal compared to changes in urinary microbiota affect the development of
premenopausal women (p<0.05). Another investigation urinary tract disorders. 22
demonstrated that premenopausal women had
significantly greater free glycogen levels, which correlated 5. Gut microbiome
with higher Lactobacillus counts, while postmenopausal The importance of the gut microbiota in overall health
women showed lower glycogen and Lactobacillus levels and disease is now widely recognized. A recent editorial
23
(p=0.03). Using 16S rRNA gene sequencing, it was shown discusses how the balance or imbalance of the intestinal
19
that during menopause, CST IV becomes predominant, microbiota affects immunity and general health. Factors
marked by diverse bacterial populations and a lack of such as genetics, diet, age, stress, medications, and mode
Lactobacillus. CST IV-A contains a few lactobacilli and of delivery determine the microbial composition of the
various anaerobes such as Anaerococcus, Peptoniphilus, gut and, consequently, its influence on immune responses.
and Prevotella. Conversely, CST IV-B is characterized by A microbiota in eubiosis, or in a balanced state, promotes
a large proportion of Atopobium along with Prevotella, the production of metabolites with immunoregulatory and
Parvimonas, Sneathia, Gardnerella, Mobiluncus, and
Peptoniphilus. The emergence of CST IV is linked to protective effects, maintaining the organism’s homeostasis
20
BV, a microbiota imbalance that causes symptoms like and health. In contrast, dysbiosis or microbial imbalance
unpleasant odor, discharge, and discomfort. BV is more can trigger inflammation and epithelial dysfunction.
1,4
prevalent after menopause and is associated with increased The editorial brings together research linking the gut
risks of UTIs, STIs, and gynecological problems such as microbiota to a range of conditions, from viral infections
pelvic inflammatory disease (PID). Women who exhibit and respiratory diseases to cancer and neuropsychiatric
CST III vaginal profiles during perimenopause tend to shift disorders. It also highlights the therapeutic potential
toward CST IV-A after menopause, which is more closely of dietary bioactive compounds and beneficial

Volume 11 Issue 5 (2025) 31 doi: 10.36922/JCTR025150016