Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy

Abstract

Objectives The vaginal microbiota help protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota between pre-, peri- and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA). Methods 87 women (age 35–60) were classified as premenopausal (n=30), perimenopausal (n=29) or postmenopausal (n=28) according to STRAW guidelines. Mid-vagina bacterial community composition was characterized by 16S rRNA gene analysis. Results Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, L. gasseri, L. iners, or L. jensenii; and two (CST-IV-A and IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B by Atopobium. There was a significant association between menopause stage and CST (p-value=0.004) and VVA and CST (p-value=0.002). Perimenopausal women were more likely to be classified as CST IV-A or the L. gasseri CST, whereas postmenopausal women were mostly CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared to women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A vs. L. crispatus CST (aOR: 25.89, 95% Credible Interval:2.98-406.79). Conclusions A distinct bacterial community state (CST IV-A) with low relative abundance of Lactobacillus was associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate and restore vaginal microbiota homeostasis which would provide stronger evidence for a causal relationship with VVA and ultimately improve treatment and prevention of atrophic vaginitis in menopause.

Vaginal microbiota and genitourinary menopausal symptoms: a cross-sectional analysis

“…The classic description of the postmenopausal vagina is of an environment devoid of lactobacilli, with an elevated pH, although numerous studies show that a significant proportion of women maintain vaginal colonization with lactobacilli after menopause. 4–6 Between 40–80% of women develop vulvovaginal symptoms in menopause, 1,2,22 which can be a source of significant distress. 23 The etiology of these common symptoms is not well understood, which limits treatment options.…”

“…While all postmenopausal women experience a drop in serum estradiol, not all lose vaginal lactobacilli. 3,4,6 Recent data have shown that free glycogen in vaginal fluid, which is liberated from epithelial cells by enzymes like α-amylase, is associated with Lactobacillus colonization in both pre- and postmenopausal women, suggesting glycogen may be a mediating factor for Lactobacillus presence. 7,8 In premenopausal women, serum estrogen levels were not correlated with free vaginal glycogen levels, but this relationship has not been examined in postmenopausal women.…”

Cervical and Vaginal Flora Specimens Are Highly Concordant with Respect to Bacterial Vaginosis-Associated Organisms and Commensal Lactobacillus Species in Women of Reproductive Age

“…Subject information was collected by having subjects complete a questionnaire. Exclusion criteria included pregnancy and menopausal or postmenopausal status, as these conditions are known to influence the composition of the vaginal flora (10,11). In addition, patients were excluded if they were positive for Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis, as these infections can provoke cervical and/or vaginal inflammation, which could confound immunological analysis of BV.…”

A Community Based Study on Pelvic Inflammatory Disease in Postmenopausal Females: Microbiological Spectrum and Socio- Demographic Correlates

“…All postmenopausal women who had completed at least one year of menstruation free period were included. Women who did not give consent, those who had not attained menopause, those who were receiving hormone replacement therapy and those who were suffering from severe, debilitating illness were excluded [16,17].…”