Page 43 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

between healthy individuals and those with certain abundance of Lactobacillus, indicating that such microbial
conditions may offer diagnostic value. Specific bacterial imbalances may play a significant role in the development
profiles could act as indicators for disorders such as of OAB manifestations, particularly urgency in the absence
53
endometriosis and urinary incontinence. Adjusting the of infection. This pattern is also seen in urgency urinary
microbiota using probiotics or comparable methods is incontinence, where urinary dysbiosis may influence
proposed as a possible therapeutic approach. Moreover, bladder storage symptoms. Research has shown 80%
the relationship between microbial diversity and symptom bacterial growth in women with OAB, undetected by
severity is highlighted, as greater bacterial diversity might standard cultures, highlighting the need to improve
increase the severity of conditions. The included studies diagnostic methods. 53
49
utilized sophisticated methods, including 16S rRNA gene Emerging evidence suggests that urinary microbiota
analysis and focused metabolic profiling, which have may be pivotal in tailoring individualized therapies for
contributed to a deeper understanding of the microbiome. women affected by urgency urinary incontinence, allowing
It underscores the importance of a personalized treatment more precise classification of subtypes and optimizing
approach based on individual microbial differences. treatment strategies. This underscores the growing
However, an important gap is identified—the lack of causal recognition of the microbiome’s role in the development
evidence between changes in the microbiome and pelvic and management of urinary tract conditions. In contrast,
54
floor dysfunctions. Longitudinal studies manipulating the the systematic review conducted by Sze et al. examined
25
microbiome to assess its direct effects on these dysfunctions the relationship between dysbiosis in the gut, vagina, and
are suggested. 49 urinary tract in women diagnosed with OAB. While a
One study explored how the urinary and VM are consistent bacterial profile was not observed among healthy
linked to the intensity of mixed urinary incontinence participants, OAB patients displayed reduced microbial
(MUI) symptoms in women. The study included 210 diversity. Although the overall bacterial composition
51
participants, with 126 diagnosed with MUI and 84 serving between cases and controls did not differ significantly,
as controls. Researchers identified six distinct urinary the urinary microbiome of those with OAB appeared
microbiome profiles; one group, characterized by low more susceptible to changes influenced by the intestinal
Lactobacillus levels and increased microbial diversity, was or vaginal environment. These findings point to a possible
correlated with more frequent and intense episodes of total interconnection between the three microbial ecosystems,
and urgency incontinence. The reference group, dominated but further studies are needed to clarify this association. 25
by Lactobacillus, showed less severe symptoms. Although In addition, Yu et al. carried out a meta-analysis
55
vaginal community types were not related to the severity of including 7298 Chinese women across eight studies,
incontinence, alpha diversity in urine showed that greater exploring the relationship between pelvic floor disorders
bacterial richness was associated with more incontinence and vaginal microbial alterations. The results indicated
episodes. The results suggest that lower Lactobacillus that a reduced presence of Lactobacillus, increased vaginal
dominance and higher bacterial diversity may be linked to discharge, and a history of vaginitis were linked to higher
greater severity of urinary incontinence, but more research pelvic floor disorder risk. The review highlights that
is needed to determine whether other bacterial genera also imbalances in the VM may lead to inflammation and
play a role. 51 damage to pelvic support tissues, potentially contributing
Before 2012, it was commonly assumed that the to the onset of pelvic organ prolapse. This condition results
urinary tract of healthy individuals was sterile. However, from weakening of the pelvic structures—ligaments,
metagenomic analysis has uncovered the presence of a muscles, and connective tissue—often influenced by
distinct urinary microbiota, reshaping the understanding changes in extracellular matrix components such as
of lower urinary tract disorders (LUTD). Alterations in collagen, elastin, and proteoglycans, all synthesized by
this microbial community, termed urinary dysbiosis, have fibroblasts and crucial for pelvic stability.
emerged as a possible contributing factor to functional In summary, the urinary and VM play a significant role
LUTD. A review encompassing 36 studies found that in women’s urogenital and reproductive well-being during
viable bacteria present in urine, but undetectable through menopause. Variations in microbial diversity within these
traditional cultures, may play a central role in dysbiosis. ecosystems have been associated with conditions such
52
An important observation is that women experiencing as urinary incontinence and OAB. Although notable
OAB present distinct urinary microbial profiles when associations have been reported, further studies are
compared to asymptomatic women. Notably, there is a required to confirm causality. Modulating the microbiome,
higher presence of genera like Gardnerella and a reduced including through probiotic interventions, holds promise

Volume 11 Issue 5 (2025) 37 doi: 10.36922/JCTR025150016