Page 41 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

PID found an association between BV, AV, cervical postmenopausal women, with 50% presenting symptoms;
inflammation, and PID. The study included both PID however, only 32% seek medical help. These symptoms are
patients and a control group of women undergoing tubal often not recognized as being related to menopause. 43
sterilization. PID was diagnosed through laparoscopy, GSM can lead to complications such as labial atrophy,
culdocentesis, ultrasonography, and endometrial biopsy, vaginal prolapse, introital stenosis, and urethral issues.
and microbiological cultures of abdominal and cervical It also negatively affects quality of life, emotional well-
samples were conducted to identify the causative being, sexual function, and self-esteem. The VM plays
microorganisms. In the PID patients, the most frequently a fundamental role in defending against infections and
isolated abdominal microorganisms included Bacteroides, preserving gynecological health. A decline in Lactobacillus
Peptostreptococcus, E. coli, Ureaplasma urealyticum, and is linked to symptoms such as vulvovaginal atrophy and
Mycoplasma hominis. Sexually transmitted pathogens such vaginal dryness. Estrogen contributes to symptom relief
as N. gonorrhoeae and C. trachomatis were detected in 17% and helps restore Lactobacillus dominance in the vaginal
and 28% of patients, respectively. In the control group, environment, supporting genital tract protection and
no abdominal microorganisms were isolated. PID was overall vaginal well-being. 43
attributed to endogenous bacteria in 48% of cases, and to
sexually transmitted bacteria in 54%. 39 8.2. Microbiota in GSM
A retrospective cohort study reported a higher incidence Several investigations have explored the relationship
of PID among women diagnosed with BV. Among 2956 between the VM and GSM. A 2-year follow-up study
participants, the presence of BV, as determined by Nugent’s involving 750 women aged 35–60 revealed that
score (adjusted hazard ratio [aHR] 1.53) and Amsel’s postmenopausal women had a higher prevalence (49.7%)
criteria (aHR 2.15), and the use of vaginal douches (aHR of vaginal microbial communities with low Lactobacillus
1.47) were independently associated with an increased risk levels, in contrast to 21.2% in premenopausal and 22.9% in
of PID, regardless of sexual activity patterns or coexisting perimenopausal women. Vaginal environments dominated
STIs. Another study revealed an association between by species like L. crispatus, L. gasseri/jensenii, and L. iners
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prolonged use of Cu-IUDs and the development of tubo- were linked to a lower likelihood of developing vaginal
ovarian abscess (TOA) in postmenopausal women. Patients atrophy. In addition, L. gasseri/jensenii in postmenopausal
who had used an IUD for more than 10 years, without women was associated with fewer symptoms of vaginal
removal during menopause, showed a higher frequency of dryness and reduced libido, indicating the potential role
TOA and pelvic actinomycosis. 42 of VM in managing and preventing GSM, especially
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Collectively, PID involves infection of the upper genital after menopause. In a separate cross-sectional analysis
tract due to the ascending spread of pathogens linked to of 96 peri- and postmenopausal women, researchers
STIs, BV, and AV. Its development is influenced by factors examined the role of vaginal dysbiosis in GUSM. Among
such as genital tract inflammation, hormonal changes participants, 83.58% reported symptoms associated
during menopause, and prolonged use of Cu-IUDs. with the condition, and a greater microbial variety was
observed in postmenopausal individuals. A decline in
8. Vaginal and urinary microbiota in Lactobacillus levels correlated with both the onset and
menopause and genitourinary syndrome intensity of GUSM symptoms. Other microorganisms,
including E. coli, Shigella, Anaerococcus, Finegoldia,
8.1. Clinical presentation Enterococcus, Peptoniphilus harei, and Streptococcus, were
The GSM refers to a collection of symptoms associated with linked to genital and sexual complaints. Supplementation
reduced estrogen levels that impact the genital, urinary, with Lactobacillus was found to ease genital discomfort
and sexual health of women. While it can arise at various and enhance sexual function, suggesting it could offer a
stages of reproductive life, it is most frequently observed non-hormonal therapeutic option for addressing GSM
during menopause. Before 2014, terms like vulvovaginal symptoms. 45
atrophy, atrophic vaginitis, and urogenital atrophy 8.3. GSM treatment
were commonly used. That year, the North American
Menopause Society and the International Society for the Managing GSM poses challenges due to the broad
Study of Women’s Sexual Health introduced the term GSM spectrum of available therapies and the necessity to tailor
to provide a more accurate definition. VM, particularly treatment to each patient’s specific clinical profile. As
Lactobacillus spp., is crucial for genital health, but its levels noted by Cuccu et al., initial strategies typically involve
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decrease with menopause due to reduced estrogen. GSM is the use of vaginal lubricants and moisturizers, particularly
a progressive condition affecting between 67% and 98% of in cases of mild to moderate discomfort. In situations

Volume 11 Issue 5 (2025) 35 doi: 10.36922/JCTR025150016