Page 49 - JCTR-11-5

Journal of Clinical and
Translational Research Vaginal microbiota in menopause pathologies

Table 1. Pathologies associated with menopause and microbiota alteration
Pathology (references) Microbiota alteration
Recurrent urinary tract Decrease in Lactobacillus spp. in the vagina and reduction in SCFAs and intestinal bacteriocins, which normally inhibit
infection 28-30,32,33 uropathogen growth in the vagina and bladder
Bacterial vaginosis 37,38 Decrease in Lactobacillus spp. and increas e in anaerobes such as Gardnerella vaginalis, which expresses sialidase A—
enhancing bacterial adhesion, biofilm formation, and compromising vaginal defenses
Pelvic inflammatory Decrease in Lactobacillus spp.; increase in endogenous pathogens (Escherichia coli, Staphylococcus) and exogenous ones
disease 39-41 (Chlamydia trachomatis, Neisseria gonorrhoeae). BV promotes bacterial colonization and persistent inflammation, enabling
ascending infections
Genitourinary Significant decrease in Lactobacillus gasseri/jensenii and Lactobacillus crispatus, contributing to vaginal atrophy, dryness,
syndrome of and sexual dysfunction. Increased microbial diversity with the presence of E. coli, Shigella, and Streptococcus, causing
menopause 43-45 genital symptoms
Pelvic floor Decrease in Lactobacillus spp. and increase in vaginal microbial diversity are associated with OAB and UI. Inflammation
disorders—OAB, UI, weakens pelvic connective tissue, favoring POP. Associations exist, but more research is needed to establish causal links
POP 49-55
Gynecological Decrease in Lactobacillus spp. and increase in anaerobic vaginal bacteria promote dysbiosis, chronic inflammation, genetic
cáncer 56-58,64 instability, metabolic dysfunction, and cell proliferation. Disruption of the estrobolome reduces estrogen levels
Cervical cancer 56,68-74 Loss of Lactobacillus promotes HPV persistence and cancer progression. Dominance of Lactobacillus iners facilitates
inflammation, oncoprotein expression, and poor HPV clearance. BV with Gardnerella and Atopobium is linked to dysplasia
Endometrial BV and the genera Prevotella, Porphyromonas, and Atopobium drive chronic inflammation and cancer. Induction of IL-1β
cancer 56,76,77,79,83,84,86,87 and TNF-α promotes proliferation and angiogenesis. Estrobolome is disrupted
Ovarian cancer 88-96 BV and the genera Acinetobacter, Gardnerella, and Prevotella are associated with inflammation and cancer. Dysbiosis in
peritoneum and tumor tissue, with reduced microbial diversity, activates NF-κB. Intratumoral Proteobacteria and Firmicutes
produce DNA-damaging toxins. C. trachomatis infection, BRCA mutations, and microbiota contribute to progression/
metastasis
Periodontal Porphyromonas gingivalis and Fusobacterium nucleatum are found in both periodontal and vaginal microbiota.
disease 98-100,103,104 Vaginal dysbiosis may trigger systemic inflammation that exacerbates gum disease and periodontitis progression
Abbreviations: BV: Bacterial vaginosis; HPV: Human papillomavirus; IL-1β: Interleukin 1 beta; NF-κB: Nuclear factor kappa-light-chain-enhancer of
activated B cells; OAB: Overactive bladder; POP: Pelvic organ prolapse; SCFAs: Short-chain fatty acids; TNF-α: Tumor necrosis factor alpha;
UI: Urinary incontinence.

(ii) Shared bacterial composition: Although oral (iii) Probiotic supplements: Probiotics, especially those
and genital microbes originate from different containing Lactobacillus, may be beneficial for balancing
environments, they share certain common pathogens. both vaginal and oral microbiota, reducing menopause-
Bacteria such as P. gingivalis and F. nucleatum, associated symptoms, and preventing periodontal disease.
associated with periodontal disease, can also be found (iv) Regular monitoring: Postmenopausal women should
in the microbiota of the female genital tract, suggesting undergo regular gynecological and periodontal check-
an interaction between both microbiota. 99 ups to detect and treat any signs of vaginal infection or
(iii) Impact of estrogens: Estrogens not only regulate the periodontal disease early.
genital microbiota, but their decline also affects bone Menopause induces physiological changes that affect
formation capacity. 102 both the genital microbiota and periodontal health.
The decrease in estrogens and the resulting systemic
11.2. Clinical implications and management
inflammation contribute to conditions like BV and
The comprehensive management of postmenopausal periodontal disease, opening new possibilities for their
women’s health should consider both periodontal and preventive and therapeutic management. Table 1 provides
vaginal health. Key recommendations include: an overview of the principal pathologies associated with
(i) Hormonal treatment: HRT may help restore estrogen menopause and microbiota alteration. These conditions
levels, potentially improving both vaginal health and include rUTIs, BV, PID, GSM, pelvic floor disorders,
reducing the risk of periodontal disease. gynecological cancers (cervical, endometrial, and ovarian),
(ii) Proper oral hygiene: It is essential to maintain rigorous and periodontal disease. All of these have been linked to
oral hygiene, including regular brushing, flossing, and shifts in microbial composition and function, which may
periodic visits to the dentist. contribute to their onset and progression.

Volume 11 Issue 5 (2025) 43 doi: 10.36922/JCTR025150016