Page 42 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

where symptoms are more intense, hormonal treatment United States for managing GSM. Despite lacking FDA
options are generally indicated. Topical hormonal options, approval, its application as a vaginal gel has demonstrated
such as vaginal creams, are preferred due to their lower risk positive effects on the vaginal maturation index and pH
of side effects compared to systemic treatments. Notable levels in postmenopausal women. The combination of
options include ospemifene and dehydroepiandrosterone estriol with Lactobacillus acidophilus has been reported
(DHEA), which improve vaginal and urinary symptoms to improve GSM symptoms and support the recovery of
without significantly altering systemic estrogen levels. VM. In women with a personal history of breast cancer,
Although hormone therapy is beneficial, it carries hormonal therapies should generally be avoided. In these
potential risks, particularly for women with a personal cases, non-hormonal alternatives such as lubricants,
history of cancer or who are considered at elevated risk. hyaluronic acid, pelvic floor therapy, and laser-based
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The safety of these treatments remains a controversial treatments offer reasonable and safe options. Emerging
topic, requiring further research, particularly in women research indicates that probiotics, either alone or used
with a history of breast cancer. It is crucial for physicians alongside ET, can help relieve symptoms of vulvovaginal
to consider the benefit-risk profile of each patient before atrophy. In postmenopausal women, oral probiotics like
prescribing hormonal treatments and to promote informed Lactobacillus rhamnosus Gr-1 and Lactobacillus reuteri
decisions based on available evidence. 46 RC-14 were associated with significant reductions in
Nugent scores and notable improvements in GSM
A multicenter study carried out across 28 sites in symptoms (p=0.0001). Another study found that the use of
Spain involving 108 postmenopausal women found that estrogen together with probiotics was especially beneficial
using 0.005% vaginal estriol gel was effective in lowering for symptoms like vaginal dryness and painful intercourse.
the recurrence of UTIs. Participants treated with estriol In ovariectomized rat models, supplementation with
experienced a notable decline in infection rates and an Lactobacillus decreased menopausal symptoms and
improvement in vaginal pH, supporting its potential as enhanced intestinal barrier function. Altogether, VM is
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a safe and beneficial therapy for postmenopausal women crucial for genital health and is related to GSM. Estrogen
affected by GSM. Over the years, multiple clinical deficiency in menopause reduces Lactobacillus, leading
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guidelines have addressed the treatment of this condition. to symptoms such as vaginal dryness and urinary issues.
The United States Food and Drug Administration Vaginal dysbiosis, characterized by fewer Lactobacillus
(FDA) has authorized various therapies for managing and more pathogenic bacteria, exacerbates symptoms.
vulvovaginal atrophy and vasomotor symptoms linked Management strategies encompass vaginal estrogen
to menopause. Nonetheless, the FDA has also issued formulations, ospemifene, DHEA, and estriol, along with
warnings about the potential risks of hormone therapy, non-hormonal therapies suitable for women diagnosed
including increased risks of cardiovascular events, with breast cancer. Among the non-hormonal alternatives,
breast cancer, and thromboembolism. These concerns laser-based treatments and Lactobacillus supplementation
led many women to discontinue systemic hormone have demonstrated encouraging outcomes.
treatment following the findings from the Women’s Health
Initiative. For pharmacological treatments, systemic ET 9. Vaginal and urinary microbiota in
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is the main option for vasomotor symptoms, while local menopause and pelvic floor disorders
ET is used for vaginal symptoms. Vaginal ET is considered
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the first-line treatment for GSM, as it involves lower doses A systematic review explored the influence of the
and has fewer side effects. In women who have undergone microbiome on female reproductive and urological health,
hysterectomy, only estrogen is used, whereas in those with addressing conditions such as urinary incontinence, OAB,
an intact uterus, it is combined with progestogens. 43 pelvic pain, fecal incontinence, and hypoactive sexual
desire disorder. It underscores the relevance of microbial
DHEA, also known as prasterone, is effective for species like Lactobacillus, which are key to preserving
treating dyspareunia (pain during sexual intercourse) and microbial homeostasis. A significant association was
other GSM symptoms. DHEA improves vaginal lubrication observed between symptom severity in OAB and increased
and epithelial function without affecting systemic microbial richness and diversity. Genera including
estrogen levels. Ospemifene, a selective estrogen receptor Lactobacillus, Streptococcus, Gardnerella, Prevotella,
modulator, is also effective in treating dyspareunia and Methylobacterium, Acinetobacter, and Sphingomonas
vaginal dryness, offering beneficial effects on bones and were linked to the intensity of OAB-related symptoms,
anti-estrogenic effects on breast tissue. 43 suggesting a connection between bladder microbiota
Estriol, a naturally occurring estrogen with mild composition and clinical manifestations. The work
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potency, is commonly employed in countries outside the highlights how variations in microbial composition

Volume 11 Issue 5 (2025) 36 doi: 10.36922/JCTR025150016