Page 40 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

However, genomic analysis revealed differences in that G. vaginalis comprises virulent subtypes with distinct
specific bacterial populations, such as Bacteroidales, genetic and phenotypic characteristics. Recent research
Prevotellaceae, and Actinobacteria. These findings has identified 10 different strains, some of which produce
underscore the need for further research to clarify the role of β-galactosidase. Notably, strains that express the sialidase a
the urinary microbiome in rUTIs among postmenopausal gene are associated with BV and exhibit the ability to form
women. The rise in antimicrobial resistance has intensified biofilms. This enzyme cleaves sialic acid residues from
6
efforts to develop strategies aimed at modifying the glycoproteins in the vaginal mucus, exposing binding sites
urogenital microbiota as a therapeutic approach for rUTIs. that facilitate G. vaginalis adhesion, support its nutrition
The interconnection between the vaginal and urinary acquisition, and protect it from host immune defenses. As
microbiota is key, as both contain Lactobacillus, which a result, the bacteria can proliferate and compromise the
offers protection against pathogens. Hormonal therapy with protective mucosal barrier. 9
estrogens, both systemic and vaginal, has been associated A review by Daniel et al. explored the association
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with an increase in Lactobacillus abundance and a reduced between intrauterine device (IUD) use and BV. Out of 1140
incidence of rUTIs. However, in women with a history of identified articles, 15 studies were included, comprising
rUTIs, a higher presence of pathogens and antimicrobial cross-sectional, case-control, cohort, quasi-experimental,
resistance genes has been observed, suggesting that and randomized trials. These studies examined BV
microbiota alterations may contribute to infection prevalence in women using copper IUDs (Cu-IUDs) and
persistence. In this regard, it has been shown that ET can levonorgestrel-releasing IUDs (LNG-IUDs), organizing
modify the urogenital microbiota, promoting a healthier the data into three categories: (i) point prevalence of BV
microbiota environment and protecting against rUTIs among IUD users, (ii) incidence and prevalence of BV in
in postmenopausal women. In summary, the intestinal, Cu-IUD users, and (iii) incidence and prevalence in LNG-
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urinary, and vaginal microbiomes play an interconnected IUD users. The findings suggest that Cu-IUDs may increase
role in the pathogenesis of rUTIs in postmenopausal the incidence of BV. However, there was insufficient
women. Therapies aimed at restoring microbiota balance, evidence to establish a definitive relationship between
such as ET and probiotics, show promising potential for LNG-IUD use and BV onset, largely due to variability in
preventing and managing these infections. study designs and diagnostic criteria.

7.2. VM and recurrent vaginal candidiasis Vaginal dysbiosis, particularly BV, is associated with
Vulvovaginal candidiasis (VVC) is one of the most common increased risk of acquiring urogenital infections, including
vaginal infections; however, there is limited data on its STIs such as HIV. Studies have shown that women with
impact in postmenopausal women. The decline in estrogen a normal VM are less likely to contract HIV-1 than those
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levels during menopause alters the vaginal environment, with BV.
increasing susceptibility to VVC. Nevertheless, the 7.4. Microbiota of the reproductive tract and PID
likelihood of developing VVC decreases by approximately
7% for each year after age 57, likely due to lower glycogen PID is an infection of the upper genital tract caused by
levels in these women. Factors such as medications pathogens ascending from the vagina and cervix, affecting
(e.g., tamoxifen, antibiotics, HRT) and comorbidities the uterus, fallopian tubes, and ovaries. These pathogens
like diabetes or immunosuppression can increase the may be endogenous, such as Staphylococcus aureus, E. coli,
prevalence of infection. Despite these associations, little coagulase-negative Staphylococcus, Klebsiella pneumoniae,
research exists on the prevalence, risk factors, treatment, Klebsiella oxytoca, and Proteus mirabilis, which are common
and recurrence of VVC in postmenopausal women. in AV, or exogenous, mainly Neisseria gonorrhoeae and
Given the changes in both the vaginal environment and Chlamydia trachomatis. BV is also associated with an
the characteristics of Candida species, the disease is not increased risk of PID. Furthermore, dysbiosis in the VM,
accurately diagnosed, emphasizing the need for further especially the decline in Lactobacillus species, facilitates
studies and patient education to support appropriate the growth of pathogens and increases the likelihood of
treatment in this population. 36 inflammation in the upper reproductive tract. Women with
vaginal dysbiosis are at higher risk of bacterial colonization,
7.3. VM and BV - pathogenic mechanisms of which can lead to pelvic infections. It has been proposed
G. vaginalis that Lactobacillus protects the host by reducing the ability
G. vaginalis is included in CST IV of the VM, even among of C. trachomatis to infect epithelial cells. 39,40
healthy women, complicating the interpretation of its role A prospective study investigating the microbiota of
in the pathogenesis of BV. However, evidence suggests the upper and lower genital tracts in patients with acute

Volume 11 Issue 5 (2025) 34 doi: 10.36922/JCTR025150016