Effects of intrauterine contraception on the vaginal microbiota

Abstract

Objectives There have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. Study Design DNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. Results The vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. Conclusions Although the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. Implications We found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered.

Effects of the copper IUD on composition of the vaginal microbiota in the olive baboon

“…The lack of change between the pre-IUD phase and IUD phase is consistent with recently published work in humans, although the human study did not extend to after IUD removal [9]. The mechanism behind the change in vaginal microbiota after IUD removal is unclear, as is the biological significance.…”

“…temperature, weight, menstrual cycle, discharge) and no changes in the vaginal microbiota attributable to Cu-IUD insertion and long-term use; however, we did find a slight but statistically significant alteration of the vaginal microbiota after Cu-IUD removal. The baboon recapitulates data and reports from human patients receiving a Cu-IUD: transcervical insertion is successful, no physiologic changes are observed while using the Cu-IUD, and insertion and use do not significantly affect the vaginal microbiota [9]. As we have demonstrated with the LNG-IUS in the baboon, we conclude that the olive baboon is a feasible model system for Cu-IUD studies.…”

Vaginal progesterone is associated with decreased group B streptococcus colonisation at term: a retrospective cohort study

“…Daily intravaginal progesterone suppository is considered an alternative option if access to 17‐OHP‐C is limited . The literature on whether progestogens have an effect on the vaginal microbiome is conflicting . Progesterone has known antibacterial, immunomodulatory, and anti‐inflammatory properties, with demonstrated effects on dendritic cells, macrophages, T‐cells, B‐cells, and cytokine release .…”

“…15,16 The literature on whether progestogens have an effect on the vaginal microbiome is conflicting. [17][18][19][20][21] Progesterone has known antibacterial, immunomodulatory, and anti-inflammatory properties, [22][23][24] with demonstrated effects on dendritic cells, macrophages, T-cells, B-cells, and cytokine release. [25][26][27][28][29][30][31] Animal models have demonstrated that intravaginal progesterone has local anti-inflammatory effects at the maternalfetal interface and the cervix.…”

Vaginal microbiota of adolescents and their mothers: A preliminary study of vertical transmission and persistence

“…The composition of the vaginal microbiota is distinct from other body sites and contains types of bacteria that seem specific to the vagina [5]. For example, the vaginal microbiota is often dominated by specific types of Lactobacillus , most commonly L. crispatus and L. iners [6, 7]. Vaginal Lactobacillus sp.…”