Page 38 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

microorganisms in immune modulation. Taken together, of the urogenital tract. The interaction between the gut,
the editorial underscores the importance of maintaining vaginal, and urinary microbiomes has gained relevance in
a balanced microbiota as a comprehensive strategy to understanding conditions such as UTIs, overactive bladder
preserve health, including the health of the urogenital (OAB) syndrome, and disorders related to the climacteric
ecosystem. period. 22
Although the primary focus is the gut, the authors There is a functional connection between these three
suggest broader implications. The immunological microbial ecosystems, and their disruption may predispose
effects of the microbiota may extend to other mucosal individuals to recurrent or chronic urinary diseases. After
environments, such as the vagina, by influencing epithelial menopause, VM shows reduced Lactobacillus dominance
integrity, pH regulation, and susceptibility to infections. and an increased presence of anaerobes and Gardnerella
Thus, the state of the gut microbiome may indirectly affect vaginalis, facilitating colonization of the lower urinary
the composition and stability of the VM. tract. In turn, the gut microbiome serves as a reservoir for
uropathogenic bacteria, such as Escherichia coli, which can
5.1. Gut microbiome metabolites and the diversity translocate and disturb the balance of the urobiome. 7
of the vaginal and urinary microbiota
This gut-vagina-bladder axis is regulated through
The gut microbiome produces a variety of metabolites shared immunological and metabolic networks. Factors
with systemic effects, including on the vaginal and urinary such as diet, antibiotic use, age, and hormone levels exert
ecosystems. These compounds include short-chain fatty a joint influence. A gut microbiota rich in Lactobacillus
acids (SCFAs), β-glucuronidases, urolithins, and other and Bifidobacterium species is associated with a lower
bioactive metabolites, which can modify the composition risk of vaginal dysbiosis and recurrent cystitis, whereas its
and stability of microbiota in other body sites, thereby alteration may promote low-grade systemic inflammation,
influencing urogenital health. 23 a condition commonly observed among postmenopausal
β-glucuronidases, enzymes produced by the intestinal women. 8
estrobolome, enable the reactivation of estrogens in the In functional disorders such as OAB, the urinary
gut, promoting their recirculation and exerting beneficial microbiome is characterized by reduced Lactobacillus
local effects on the vaginal epithelium, pH, and microbial abundance and greater microbial diversity —patterns that
25
composition. 24 are often mirrored in the vaginal and gut microbiomes.
SCFAs such as butyrate, propionate, and acetate— These parallels support the existence of a shared microbial
produced through the fermentation of dietary fibers—act axis that modulates urogenital function.
as immunomodulators and enhance epithelial integrity, The gut also plays a role in hormonal regulation through
exerting anti-inflammatory effects. These fatty acids play the estrobolome, a collection of bacterial genes capable of
a protective role by helping to preserve microbial balance metabolizing estrogens. 24
in the vaginal and urinary tracts.²² This improvement in
mucosal function may reduce the migration of intestinal This microbiome-hormone axis is also implicated in the
microorganisms toward the urogenital tract. 7,25 development of gynecological cancers. Alterations in the
gut and VM can affect local immunity, promote chronic
Urolithins are metabolites produced by the gut
microbiota from ellagitannins, compounds found in inflammation, and modify estrogen availability—factors
that are all key to carcinogenesis.
26,27
foods such as pomegranates and walnuts. Among them,
urolithin A is excreted in the urine and may act directly Overall, the gut, vaginal, and urinary microbiomes are
on the bladder, possibly promoting a urinary ecosystem closely interconnected. An integrated analysis of these
dominated by Lactobacillus. 22 ecosystems provides a more comprehensive understanding
of urogenital diseases and opens new avenues for
A deficiency of these metabolites—related to inadequate
diet, gut dysbiosis, or menopause—is associated with a developing innovative, personalized therapeutic strategies
in women’s health.
more diverse microbiota, loss of Lactobacillus, and an
increased risk of infections. 7,25 6. Vaginal and urinary microbiome and

5.2. Gut microbiome and vaginal and urinary interaction with the immune system in
microbiota in menopause menopause
The human microbiome plays a fundamental role in During menopause, hormonal changes induce profound
women’s health, particularly in the regulation and defense remodeling of the urogenital tract, including alterations in

Volume 11 Issue 5 (2025) 32 doi: 10.36922/JCTR025150016