Page 48 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

11. Vaginal and urinary microbiota in other tissues such as the gums, promoting the progression
menopause and periodontal disease of periodontitis. 97,101

Periodontal disease, encompassing both gingivitis and In addition, certain bacteria frequently found in
periodontitis, is a chronic infection resulting from the both the oral cavity and VM, including P. gingivalis
build-up of bacterial plaque on the tooth surface. This and F. nucleatum, are linked to periodontal disease
97
98-100,103
condition involves a persistent inflammatory response and may also colonize the vaginal environment.
that affects the tissues supporting the teeth, including the This suggests that infections originating in the
gums, periodontal ligament, and alveolar bone. It has a mouth might affect the VM, potentially impacting
97
complex origin, but key pathogens such as Porphyromonas women’s reproductive and gynecological health. BV
gingivalis and Aggregatibacter actinomycetemcomitans are and periodontal disease both involve an imbalance
recognized as major contributors. 98-100 The interaction in microbial communities, known as dysbiosis.
between these microorganisms and the host immune These conditions have been linked to a higher risk of
defense can trigger tissue breakdown and ultimately pregnancy complications, although a clear causal link
result in tooth loss. In addition, the disease can remains unproven. Research involving South African
introduce anaerobic Gram-negative bacteria, toxins, adolescent girls found that bacteria commonly linked to
lipopolysaccharides, and proinflammatory substances periodontal disease, including Prevotella intermedia and
into the circulation, potentially influencing the onset Porphyromonas endodontalis, were present in greater
or progression of systemic conditions. Menopause, amounts in the oral microbiota of those with disrupted
associated with a decrease in hormone levels, particularly VM. This points to a potential connection between oral
estrogen, has been identified as a risk factor for periodontal and vaginal microbial imbalances, highlighting the need
104
deterioration. Studies have shown that postmenopausal for further studies to clarify any causal relationship.
women have a higher prevalence of periodontal disease, In a study conducted at the Hospital Clínico San
which could be linked to increased systemic inflammation Borja Arriarán, which included pregnant women with
and hormonal changes that affect both vaginal and oral preterm labor before 34 weeks of gestation, a prevalence
microbiota. 97,101 of periodontal disease of 93.2% was found. Furthermore,
27.1% of patients showed microbial invasion of the
A study from India found a link between menopause,
periodontal tissue damage, and osteoporosis. When amniotic fluid, with 18.6% associated with periodontal
pathogenic bacteria. Cervicovaginal infection was observed
comparing premenopausal and postmenopausal women, in 83.1% of patients, with BV present in 23.7%. Among
measurements such as dental plaque, gingival inflammation, the women with cervicovaginal infection, 72.9% also had
probing depth, and clinical attachment loss were periodontal disease. Preterm birth (<37 weeks) occurred
significantly higher in postmenopausal women (p=0.01). in 64.4% of the patients and was significantly associated
These findings suggest that women after menopause have with generalized periodontal disease and the concurrent
an increased risk of periodontitis, highlighting the need for presence of ascending bacterial infection and periodontal
preventive care and timely treatment of oral conditions. disease. In addition, patients with preterm birth and
97
In addition, another study concluded that steroid sex generalized periodontal disease showed a higher frequency
hormones, particularly estrogen, play a crucial role in of chorioamnionitis and funisitis, suggesting that infection
modulating periodontal tissue responses to bacterial contributed to preterm labor. This study highlights the
99
plaque. The decline in estrogen during menopause could interaction and importance of the periodontal and VM
alter these responses and contribute to the development of in pregnant women. This relationship is likely to be no
periodontal disease. Although it is known that estrogen different in postmenopausal women.
101
deficiency is associated with bone loss in the periodontium,
the exact mechanism by which this deficiency leads to 11.1. Biological mechanisms linking periodontal
bone loss remains an area of research. 102 disease with genital microbiota

The relationship between the VM and periodontal Several biological mechanisms have been proposed to
health has been increasingly recognized. Although they explain the link between genital microbiota dysbiosis
belong to different biological systems, it has been suggested and periodontal disease, particularly in postmenopausal
that both microbiota could influence each other due to the women:
interconnectedness of inflammatory processes. Several (i) Systemic inflammation: Dysbiosis in the VM during
103
studies indicate that dysbiosis in the VM, especially menopause can induce a systemic inflammatory
during menopause, can induce a systemic inflammatory response that affects other tissues, including the gums,
response that affects not only the genital tract but also promoting the progression of periodontitis. 103

Volume 11 Issue 5 (2025) 42 doi: 10.36922/JCTR025150016