Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation

Abstract

Objective To describe vaginal microbiota classified by community state types (CST) in a diverse cohort of postmenopausal women and evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms (vaginal dryness, vulvovaginal irritation, sexual pain, dysuria, urinary urgency), CSTs, estrogen, vaginal maturation index (VMI), and vaginal pH. Methods In the Study of Women's Health Across the Nation, 1,320 women aged 60.4 to 72.5 years self-collected (2015-2017) vaginal samples analyzed for microbiota composition and structure (CSTs) using 16S rRNA gene amplicon sequencing, VMI, and pH. GSM symptoms were collected with self-administered questionnaires; interviewers elicited estrogen use and measured body mass index. Serum E2 and E1 were measured using high-performance liquid chromatography. We analyzed data using Pearson χ 2 tests, analysis of variance, Kruskal-Wallis tests, and binomial logistic regression. Results The most frequently occurring CST was low Lactobacillus species IV-C (49.8%); 36.4% of women had CSTs dominated by Lactobacillus species. More than half of the women with vaginal atrophy biomarkers (VMI <50 and pH >5) had CST IV-C0, whereas women using estrogen or with higher E1 and E2 levels had a higher prevalence of Lactobacillus crispatus–dominated CST I (P values < 0.001). Sexual pain was associated with atrophy biomarkers and independently associated with Streptococcus species–dominated CST IV-C1 (odds ratio, 2.26; 95% confidence intervals, 1.20-4.23). For all other GSM symptoms, we found no consistent associations with E1 or E2 levels, atrophy biomarkers, or any CST. Conclusions Although close relationships exist among estrogen, CSTs, VMI, and pH, sexual pain was the only GSM symptom associated with the structure of vaginal microbiota and atrophy biomarkers.

Association between vaginal microbiota and vaginal inflammatory immune markers in postmenopausal women

“…Estrogen levels decrease during the menopausal transition, leading to decreased glycogen storage in vaginal epithelial cells and decreased prevalence of Lactobacillus. 12,13 There is clearly a relationship between estrogen and the vaginal microbiome after menopause. Previous studies have demonstrated that postmenopausal people using vaginal estradiol 14,15 and oral menopausal hormone therapy [16][17][18] are more likely to have vaginal microbiota dominated by Lactobacillus and lower vaginal microbial diversity.…”

Postmenopausal vaginal microbiota: more to discover

“…In this issue of Menopause , Waetjen et al 3 analyzed vaginal samples from a large cohort of postmenopausal women to evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms, microbiome composition and structure, estrogen use, vaginal maturation index, and vaginal pH. The microbiota composition and structure were obtained using established 16S rRNA gene amplification sequencing to identify the major groups and subgroups of vaginal microbiota, also termed CST.…”